Blog Archives - Page 3 of 3 - Lake Country Medical Concierge

A Greener, Healthier Mediterranean Diet

January 27, 2021/in Blog /by lakecountry

New research indicates a “green” version of the Mediterranean diet may provide increased health benefits compared to the standard version of the diet.^[1]

The traditional Mediterranean diet, long promoted for its healthfulness, stresses eating vegetables, fruits, fish and whole grains while avoiding highly-processed and sugary foods. It includes a small amount of poultry and red meat as well. The green Mediterranean diet allows even less poultry and red meat — instead opting for plant-based protein sources such as nuts, shakes and green tea.^[1]

Greener Diet, Greater Benefits

In a six-month study of 294 participants with obesity, international researchers compared the health benefits the standard Mediterranean diet against the green version — both diets were paired with physical activity.^[1] The researchers’ data showed the green version provided superior benefits, especially for cardiovascular health.

Compared to the standard Mediterranean diet, the green variant enabled a healthier ratio of “bad” LDL cholesterol to “good” HDL cholesterol.^[1] The green diet also facilitated lower resting blood pressure and decreased risk of insulin resistance. Overall, participants on the green Mediterranean diet had a lower 10-year risk of cardiovascular disease than those on the standard version.

Though both Mediterranean diet types provided similar amounts of weight loss, the green diet allowed male participants to reduce their waist size more than those following the standard diet.^[1] Interestingly, female participants didn’t experience the same difference in waist size reduction between the two diets.

Both Mediterranean diet types produced healthier results than a basic, non-Mediterranean diet, the study found.^[1]

Trying the Green Mediterranean Diet

The green Mediterranean diet is an attractive path to a healthier lifestyle. So, how can you try this new version a classic diet?

First, familiarize yourself with the basic outline of a Mediterranean diet — the American Heart Association provides an excellent list of common guidelines.^[2] To make your diet “green,” further limit your consumption of poultry and red meat and substitute them with plant-based protein sources.^[1][3]

It’s very helpful to plan your day-to-day meals to ensure each of them matches your diet well. You can plan your meals in a notebook, write them on a calendar, or try digital solutions such as apps.

Finally, diet alone isn’t enough to maintain good health. It’s important to stay physically active. Your physical activity needs depend on your age and other factors. The Centers for Disease Control (CDC) offers a handy guide to staying active at any age.^[4]

As always, it’s very important to talk with your doctor before trying a new diet and exercise plan; you should make sure any changes are safe for you.

Sources:

More Exercise Equals More Cardiovascular Benefits

January 20, 2021/in Blog /by lakecountry

More Exercise Equals More Cardiovascular Benefits

A new study suggests increased exercise consistently leads to better heart health. The study, conducted by the University of Oxford, found that even people who already exercise regularly can enjoy greater cardiovascular benefits by exercising more.^[1]

The study analyzed data collected from accelerometers worn by 90,211 participants; one week of data was analyzed from each participant.^[1] Researchers used the data to determine each participant’s physical activity level and, from there, correlated their physical activity with their cardiovascular health.

According to the study, people with high amounts of physical activity have roughly half the risk of cardiovascular disease compared with those with low amounts of physical activity.^[1] While participants with the most exercise enjoyed the greatest benefits, any amount of regular exercise resulted in better cardiovascular health. Vigorous exercise corresponded with the best cardiovascular benefits, though moderate exercise also provided considerable benefits.

Regular exercise has long been promoted for its positive cardiovascular effects, and the Oxford University study further confirms those effects. Yet, just one in three American adults receives the recommended amount of physical activity each week, according to the U.S. Department of Health and Human Services.^[2] So, how can we get more cardiovascular exercise?

Exercise Made Easy

The National Institutes of Health (NIH) recommends some excellent exercises that will specifically target your heart health.^[3] Rigorous movements such as jogging, dancing, bicycling and swimming can help you reap the rewards of exercise. Everyday activities such as walking and gardening can be beneficial, too.

Muscle-strengthening exercises, such as weight lifting and pushups, also can improve your cardio health despite not being as specifically targeted to your cardiovascular system.^[3]

Choose the level of exercise intensity that works for you. Light exercise requires almost no effort, whereas moderate-intensity exercise will push your body to work noticeably harder than usual. Vigorous exercise will force your body closer to its limits.

In order to exercise safely, it’s important to know your target heart rate — which varies by age — for each level of intensity. You can visit the Centers of Disease Control Website (CDC) for a handy guide to determining your target heart rate.^[4] And, as always, consult with your doctor about how you can best maintain a safe, healthy exercise routine.

Stay Active, Stay Healthy

No matter what exercise you choose, it’s important to avoid a sedentary lifestyle as much as possible. Indeed, regular inactivity increases your risk of obesity, diabetes, cardiovascular disease, deep-vein thrombosis, and metabolic syndrome, according to Harvard Medical School.^[5] So, stay active and give your cardiovascular system — and your body in general — the care it deserves!

Sources:

COVID-19: The Sleep Connection

January 13, 2021/in Blog /by lakecountry

COVID-19 could have important links to sleep. A new article from The Atlantic details how COVID-19 affects sleep patterns — and how better sleep could lessen the severity of the virus and potentially prevent it.^[1]

Long-Term Insomnia

COVID-19 survivors have reported, among other persistent symptoms, long-term insomnia.^[2]While researchers are still investigating how infection could cause ongoing insomnia, a leading hypothesis blames inflammation.^[1]Researchers speculate inflammation from COVID-19 may disrupt the nervous system’s communications pathways and, thus, interfere with the body’s ability to fall asleep. Sleep deprivation prevents the body from “cleaning out” the pathways of the nervous system, which would reduce inflammation. This prompts a vicious cycle: inflammation causes insomnia, which worsens inflammation — which causes further insomnia. The result is a protracted affliction with sleeplessness.

Infection Prevention

As COVID-19’s connection to long-term insomnia undergoes further study, research suggests good sleep patterns may be key to lessening the severity of COVID-19 — or preventing infection altogether.

Melatonin, the hormone that controls our sleep cycle, may help prevent COVID-19. Research shows people taking melatonin have a much lower risk of COVID-19 infection.^[3]In addition, intubated COVID-19 patients have higher survival rates when receiving melatonin.^[4]Already, research has demonstrated that melatonin helps calibrate the immune system.^[5]

Although melatonin supplements can help us achieve optimal levels of the hormone, a simpler solution is to embrace a regular sleep schedule. By going to sleep and waking up at regular times each day, we help our bodies naturally produce a steady supply of melatonin.^[1]Adequate sleep allows the body to refresh the nervous system and, working in concert with melatonin, strengthen the immune system.^[1]Good sleep patterns forge a strong immune system and, perhaps, the ability to better resist COVID-19.

However, good sleep can be fleeting. The nonstop distractions of modern life have been compounded by an anxious social climate beset with health concerns, lockdowns, job loss and more. In 2020, the British Sleep Society reported less than half of people in the United Kingdom have refreshing sleep.^[6]In these trying times, good sleep may require a truly concentrated effort.

Keys to Better Sleep

So, how can build better sleep patterns?

First and foremost, it’s essential to set a regular routine. Maintain a regular time to wake up and go to sleep — and follow it regardless of whether it’s a weekday or weekend. Research shows a regular sleep cycle can help you fall asleep easier and enjoy more restful sleep.^[7]Small habits like listening to music before bed can enhance your routine with valuable relaxation time.

It’s also important to stay away from screens for at least 30 minutes before bedtime. Blue light can suppress melatonin secretion and disrupt your sleep cycle.^[8]Consider reading a good book rather than your smartphone as you drift off.

As growing research suggests COVID-19 heavily influences sleep — and that sleep may be a key tool in fighting the disease — it’s more essential than ever to develop better sleep patterns.

Sources:

Happy, Healthy 2021: Time to Get Your Move On!

January 6, 2021/in Blog /by lakecountry

For many of us, the new year marks the perfect time to set goals and make resolutions. Losing weight, eating right and regular exercise often top the list of annual self-improvement strategies. But surveys show those efforts seem to fizzle within months. By June, just 1 in 5 Americans say they’ve kept up with their new year’s resolution on a consistent basis.

This year, maintaining good health is even more critical than ever, which is why we’re designating 2021 as the year to get your move on! Staying active is the key to boosting your energy, improving your mood and keeping your body fit. Regular physical activity may help lower your risk of high blood pressure, heart disease, stroke, diabetes and certain cancers.¹

Developing a daily exercise routine that you can stick with is the best approach, but movements of all kinds can keep your heart pumping and your vascular system strong, especially during these winter months. The cold weather, along with the pandemic, is keeping us inside more than we’d like, so here are some tips to keep you off the couch and on your feet.

Subscription online exercise classes

In the Age of Apple TV, Amazon Prime and Hulu, you can take just about any fitness class you can think of in your own living room or basement. For a flat monthly subscription fee, you can stream unlimited classes, from cycle spinning to treadmill running, weight and strength training to stretching, Pilates, barre, yoga and meditation. Some services such as Peloton and Daily Burn offer live sessions. You don’t need to invest in a Peloton bike, either; the Peloton app can be downloaded onto your tablet, phone, TV or computer. Apple Fitness Plus launched a new service in December that’s available for Apple watch users with a variety of workout class types, including core, HIIT, strength, and rowing. CNET online has a rundown of the best apps and what workouts they offer.²

You might want to try a few different apps before settling on the subscription you like best. The good news is that most of them offer a free, limited trial period. Remember, if you’re new to exercising, start out slowly and build up over time to avoid any strain or injuries.

Buy a fitness tracker

Prices have dropped, battery life has increased, and the quality has gone up, so there’s really no excuse not to purchase a fitness tracker, especially if you need to shed that ‘quarantine 15’. Fitness trackers can help you keep track of steps taken and calories burned, while monitoring your heart rate, sleep patterns, stress levels and water consumption. Best of all, the trackers are a constant reminder (and motivator!) to keep you on your toes. There are so many brands and models to choose from, the key is to do your research before buying to suit your needs. We recommend reading PGMag and Consumer Reports online to get started.³,⁴

Make Your Smart Phone Smarter

If a fitness tracker isn’t your thing, there’s a simple way to keep your activity level up throughout the day. Use your smart phone to set alarms every 30 minutes, as a reminder to get up out of your chair – and move! Researchers have long warned that inactivity and prolonged sitting leads to increased sickness based on studies of bus drivers and office postal workers back in the 1950s. After 30 minutes of sitting, your metabolism slows down by 90%, limiting the power of enzymes within your body to move the bad fat from your arteries to your muscles.⁵ By getting up, stretching and moving around, you recharge your body and help reboot your brain. Take calls standing up or drink a cup of tea or coffee while standing by the window.

If you live in a home or building with stairs, take advantage of those steps as much as possible for quick sprints that will elevate your heart rate. And finally, if you’re working from home or find yourself sitting for much of the day, you might want to consider a height-adjustable standing desk. Experts recommend shifting from sitting to standing throughout the day as the best way of keeping joints flexible and lessen back strain. Be sure to wear shoes with good arch supports and use a comfortable floor mat to ease any pressure.

Let’s all make 2021 the year we commit to getting our move on!

Citations:

1-https://www.heart.org/en/healthy-living/fitness/getting-active/get-real-about-getting-active

2- https://www.cnet.com/health/best-streaming-workout-subscriptions-for-2021/

3- https://www.pcmag.com/picks/the-best-fitness-trackers

4- https://www.consumerreports.org/fitness-trackers/which-fitbit-fitness-tracker-or-smartwatch-is-the-right-fit-for-you/

5- https://www.washingtonpost.com/news/wonk/wp/2015/06/02/medical-researchers-have-figured-out-how-much-time-is-okay-to-spend-sitting-each-day/

Your Mom was Right – Eat your Beets, They’re Good for Your Heart

December 18, 2020/in Blog /by lakecountry

By Bianca Garilli, ND

From Metagenics Institute

I have a patient who doesn’t like vegetables. In fact, this person is also not a fan of water (sans flavoring), exercise, nor high fiber foods such as legumes. This scenario is, in many ways, a perfect setup for a number of lifestyle-related chronic diseases, including hypertension. This patient has been on a cocktail of medications for many years but expressed to me that they’d like reduce the list. So, it was with great excitement that I recently shared emerging research on a natural, food-based approach for reducing blood pressure with this individual.

But, first, a little science background. Nitric oxide or NO, is an important signaling molecule in humans and is required for a large number of reactions and biochemical pathways in the body. NO can be made by the body (endogenously) through various, intricate enzymatic pathways and also through non-enzymatic pathways which require precursor nitrates and nitrites.¹ One of the best sources of nitrates is the diet; beetroot and leafy greens such as arugula and spinach being some of the highest sources of dietary nitrates.¹ After consumption, the dietary nitrate molecules are metabolized by oral bacteria into nitrites which are then endogenously transformed into the cardioprotective NO molecule.^2-3

As noted above, NO plays a critical role in cardiovascular health. For example, low levels of NO in the body can lead to various pathologies, most notably endothelial dysfunction which contributes to hypertension and atherosclerosis; low NO has also been found to play a role in diabetes and hypercholesterolemia.¹

In contrast, healthy levels of NO in the body support vascular tone, healthy blood flow, leukocyte adhesion, and platelet aggregation.¹Consuming food-based nitrates on a routine basis, then, would seem to be a logical next step for those desiring to prevent or treat NO deficiency-related disease processes. And, in fact, that logic is backed by science, which is the exciting new research I was hoping to share with the unnamed individual mentioned earlier.

A recent study published in Nutrition Reviews presents a systematic review and meta-analysis including 23 studies that measured blood pressure, endothelial function, arterial stiffness, platelet aggregation, and/or blood lipid outcomes in response to oral inorganic nitrate/nitrite intake.⁴ The analyses demonstrated that inorganic nitrate intake significantly reduced resting blood pressure, improved endothelial function (measured as flow-mediated dilatation), arterial stiffness, and platelet aggregation.⁴

Many of the studies in this review, utilized beets and beetroot juice as their sources for nitrates in their research. I don’t know about you, but my mother always made sure I ate my beets. These colorful root vegetables have leaves that are also edible and are classified in the Amaranthaceae family, the same family as quinoa, spinach, and lamb’s quarters (AKA wild spinach).⁵

One of the beetroot studies was a double-blind, placebo-controlled clinical trial that randomized 68 hypertensive individuals 18-85 years of age to one of two groups: 250 mL/day of beetroot juice or the “placebo”250 mL/day of nitrate-free beetroot juice for 4 weeks.⁶ Participants consumed their respective drinks daily for 4 weeks; this was preceded by a 2-week run-in period followed by a 2-week wash-out period. The trial found that daily supplementation with dietary nitrate from beetroot juice was associated with a reduction in blood pressure: systolic ↓7.7-8.1mmHg; diastolic ↓2.4-5.2mmHg.⁶ Additionally, endothelial function improved by approximately 20% and there was a reduction in arterial stiffness by 0.59m/s.⁶

These clinical trial findings are in agreement with a review and meta-analysis⁷ that analyzed results from multiple studies investigating the therapeutic benefits of beetroot juice supplementation on blood pressure. This review found an overall reduction in systolic and diastolic blood pressure of 3.55 mmHg and 1.32 mmHg, respectively, and these reductions were significantly greater in the beetroot juice supplemented groups vs. control groups.⁷ This same publication also noted greater improvements in blood pressure with higher (500 mL/day) vs. lower (70-140 mL/day) beetroot juice doses or with longer periods of consumption (≥2 weeks vs. <2 weeks).⁷

So, as in every good story, there is a moral. First and foremost – listen to your parents. Next, make your plate colorful and eat your vegetables, every day and lots of them. Finally, incorporate beets and other high-nitrate foods such as spinach and arugula into your healthful diet.

Citations

Luiking YC et al. Regulation of nitric oxide production in health and disease. Curr Opin Clin Nutr Metab Care. 2010; 13(1): 97–104.
Hobbs DA et al. Blood pressure-lowering effects of beetroot juice and novel beetroot-enriched bread products in normotensive male subjects. Br J Nutr. 2012;108(11):2066-74.
Khatri J et al. It is rocket science – why dietary nitrate is hard to “beet”! Part I: twists and turns in the realization of the nitrate-nitrite-NO pathway. Br J Clin Pharmacol. 2017;83(1):129–139.
Jackson JK et al. The role of inorganic nitrate and nitrite in cardiovascular disease risk factors: a systematic review and meta-analysis of human evidence. Nutr Rev. 2018;76(5):348-371.
Encyclopedia Brittanica. Amaranthaceae. https://www.britannica.com/plant/Amaranthaceae. Accessed July 26, 2018.
Vikas K et al. Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study. Hypertension. 2015;65(2):320–327.
Bahadoran Z et al. The nitrate-independent blood pressure-lowering effect of beetroot juice: a systematic review and meta-analysis. Adv Nutr. 2017;8(6):830-838.

Vitamin D: More Important than Ever

December 16, 2020/in Blog /by lakecountry

Vitamin D has always been integral to a healthy diet, but recent evidence suggests it may have a critical role in fighting COVID-19. According to new research, people with low vitamin D levels upon hospital admission for COVID-19 have an almost quadrupled chance of dying.^[1]

Vitamin D’s role in fighting COVID-19 is only beginning to be explored, but this vitamin already boasts a host of health benefits. It promotes healthy bone growth and can, according to medical research cited by Harvard University, even reduce cancer cell growth, help fight infections and reduce inflammation.^[2]

Do You Get Enough Vitamin D?

So, how can you get enough vitamin D in your diet? Let’s explore options that provide good amounts of this important nutrient.

Fish contain more vitamin D than any other food type, according to the U.S. Food and Drug Administration (FDA).^[3] That’s not all, though — fish also are a stellar source of protein, omega-3 fats and multiple minerals. Be careful, however, to follow FDA advisories about fish with high amounts of mercury.

Eggs are another source of vitamin D, according to the Centers for Disease Control and Prevention (CDC).^[4] Although they contain less vitamin D than fish, egg yolks nonetheless have a small amount of vitamin D, according to the National Institutes of Health (NIH).^[5] Eggs also are a good source of phosphorous, calcium and potassium.^[5]

Although fish are among the few foods with a naturally high vitamin D content, other foods and drinks can be enhanced — or, fortified — to contain more vitamin D. Milk, for example, can be fortified with vitamin D.^[4] For those avoiding animal products, fortified cereals and juices can provide a good alternative.

While food can provide varying amounts of vitamin D, it’s ultimately difficult to get enough from food alone. In fact, most people should take vitamin D supplements to get enough in their diet, according to Harvard University.^[2] Supplements come in many shapes and sizes, so choose wisely!

So, do you get enough vitamin D in your diet? With the rise of COVID-19, it might be more important than ever. Consult with your doctor, maintain a healthy diet and experience the wonders of vitamin D for yourself!

You can order vitamin D through Metagenics, our trusted supplier of nutraceuticals and supplements.

Sources:

Inflammation: The Good, the Bad, & the Ugly

December 10, 2020/in Blog /by lakecountry

By Bianca Garilli, ND, IFMCP

Sourced from Metagenics Institute

Too much inflammation can be a bad thing

When the topic of chronic disease comes up, the term inflammation is sure to be close behind. In fact, inflammation has received a fairly bad rap in the past years as research has underscored its prominent role in the promotion and perpetuation of many aspects of physiological dysfunction. Although not the root cause per se, inflammation has been shown to “add fuel to the fire” of a host of disease processes, playing a role in nearly all chronic illnesses.^1-4Here are a few examples where inflammation “feeds the flames” of prevalent diseases:^1-4

Certain types of cancers
Cardiometabolic disease
Asthma
Autoimmune disorders
Certain types of arthritis and pain
Cognitive and mental health dysfunction

Timely and balanced inflammation can be a good thing

Interestingly, inflammation is not always a “bad thing” and, when expressed in a timely and correct manner, is an integral part of human health. In fact, appropriate, acute inflammation serves as a first line response to potential pathogens, it limits excessive tissue damage after trauma, and stimulates the body’s inherent repair processes.⁵

Dolor (pain), calor (heat), rubor (redness), and tumor (swelling) were initially identified in the first century AD by the Roman scholar Celsus as the four classic signs of the inflammatory process.⁶ A fifth cardinal sign, functio laesa (loss of function), was eventually added and thought to be attributed to Galen, although controversy remains over the original contributor.⁷

The body is naturally primed to respond to damage or infection through the acute inflammatory reactions of locally occurring cells that produce cytokines and other acute inflammatory mediators. These strategically placed immune cells respond to looming “danger” (infectious agents and trauma) by sending out a series of chemical messages to communicate the problem to various cell types located elsewhere throughout the body. At the same time, other cells are stimulated to release specific substances such as histamine, bradykinin, serotonin, and prostaglandins—each playing a unique role in inflammatory processes, such as the extremely important vasodilation of local blood vessels.⁸ When “reinforcements” (mainly neutrophils, sometimes eosinophils and others) from various locations answer the chemical signal and arrive to the scene, they are able to migrate directly through the vasodilated capillary walls (diapedesis), making it easier and more expedient for an acute response to occur.⁹

Healthy, acute inflammation stimulates healing

The benefits of this complex, orchestrated sequence of events is protection and repair to the damaged or infected tissues and can be characterized by the processes of “hemostasis and chemotaxis.”¹⁰ These processes reduce the risk of excessive bleeding, further damage, or spread of infection beyond the localized site.¹⁰ The acute inflammation stage typically lasts a matter of hours to days.¹⁰

In a synchronized dance and while initial steps of acute inflammation are still occurring, additional chemical signals are also being sent out to initiate critical phases of the healing process. The healing process can be characterized by two major phases—the proliferative phase and the maturation-remodeling phase:¹⁰

The proliferative phase, which can last several weeks, is when granulation tissue is formed, and re-epithelialization and neovascularization occur within the damaged tissues.
The maturation-remodeling phase is when strengthening of the scar tissue occurs for maximum impact.

Bacterial infection, an open tissue wound, and blunt trauma are just a few examples where these acute inflammation processes are both critical and beneficial. Acute inflammation plays a major role in human health, essentially discouraging further damage and supporting the healing process. Without an appropriate inflammatory response to infectious agents or trauma, healing is difficult and incomplete.

Resolving prolonged inflammation is critical

Unfortunately, when the inflammatory process goes awry or simply continues too long, this leads to the well-known term, “chronic inflammation,” along with its subsequent downstream chronic illness influences. In some cases, the cells associated with an appropriate inflammatory response fail to return, or resolve, to their pre-inflammation states; in other cases the inflammatory process is heightened and prolonged.¹¹ In both situations there is typically an external stimuli perpetuating the inflammation; this could be a persistent infectious agent, or in other cases, it may involve dietary interactions or toxic exposures. In many cases, the chemical milieu associated with obesity perpetuates the inflammatory molecules, leading to further downstream damage.^11-13

Maintaining a healthy and effective inflammatory response

There are two approaches to maintaining a healthy and effective inflammatory response: First, an appropriately timed and placed acute inflammatory process is required in response to infection and trauma and for initiating the healing process. Second, it’s critical that once the benefit of the acute inflammatory response has passed, that the molecular basis of the response returns to its pre-inflammatory state, rather than smoldering into a low-grade chronic inflammation state. This inflammation resolution is an active process facilitated by lipid mediators—specialized pro-resolving mediators (SPMs); this physiological process and the key players were discovered only a couple decades ago by Charles Serhan, PhD, DSc and colleagues.^14-16

Here are some specific steps related to lifestyle and personalized nutrition that can be implemented to support a healthy and effective inflammatory response and combat the chronicity of inflammation:^16-20

Follow an anti-inflammatory dietary approach—variety of whole, minimally processed foods rich in fiber, brightly colored fruits and vegetables high in antioxidants and phytonutrients, and adequate intake of high-quality proteins and healthy fats, especially long-chain omega-3 fatty acids; some food plans avoid or limit gluten, soy, nightshades, dairy products, and sugars.
Maintain a healthy weight and support lean and bone mass by participating in routine exercise and
Limit exposure to endocrine-disrupting chemicals (EDCs) like obesogens whenever possible
Make adequate and high-quality sleep a priority
Avoid or limit chronic sources of stress and support healthy stress responses to avoid inflammatory stress molecule production
Promote healthy gut barrier function through intake of prebiotics and probiotics
Reduce oxidative damage to cells through sufficient or increased intake of antioxidants such as vitamins C, E, and A (beta-carotene) and phytonutrients
Consider a personalized supplementation plan with anti-inflammatory actions in the body, such as omega-3s EPA and DHA, curcumin, xanthohumol, Boswellia serrata, ginger, and tetrahydro-iso-alpha acids (THIAA), and CoQ₁₀
Consider a personalized supplementation plan that includes targeted nutraceuticals that support the resolution of inflammation, like SPMs, to target unresolved inflammation and turn off the damaging effects of long-term, low-grade chronic inflammatory pathways

Citations

Hunter P. The inflammation theory of disease. The growing realization that chronic inflammation is crucial in many diseases opens new avenues for treatment. EMBO Rep. 2012;13(11):968–970.
Forrester JS et al. Persistence of inflammatory cytokines cause a spectrum of chronic progressive diseases: implications for therapy. Med Hypotheses. 2005;65(2):227-231.
Tsoupras A et al. Inflammation, not cholesterol, is a cause of chronic disease. Nutrients. 2018;10(5):E604.
Felger JC et al. Imaging the role of inflammation in mood and anxiety-related disorders. Curr Neuropharmacol. 2018;16(5):533–558.
Munn LL. Cancer and inflammation. Wiley Interdiscip Rev Syst Biol Med. 2017;9(2).
Ciaccia L et al. Fundamentals of inflammation. Yale J Biol Med. 2011;84(1):64–65.
Rather LJ. Disturbance of function (function laesa): the legendary fifth cardinal sign of inflammation, added by Galen to the four cardinal signs of Celsus. Bull N Y Acad Med. 1971;47(3):303–322.
Medline. Immune response. https://medlineplus.gov/ency/article/000821.htm. Accessed March 29, 2019.
Muller WA. Getting leukocytes to the site of inflammation. Vet Pathol. 2013;50(1):7–22.
Wallace HA et al. Wound Healing Phases. Treasure Island, FL. StatPearls Publishing. 2019. https://www.ncbi.nlm.nih.gov/books/NBK470443/. Accessed March 29, 2019.
Minihane AM et al. Low-grade inflammation, diet composition and health: current research evidence and its translation. Br J Nutr. 2015;114(7):999–1012.
Bischoff SC et al. Intestinal permeability – a new target for disease prevention and therapy. BMC Gastroenterol. 2014;14:189.
Pahwa R et al. Chronic Inflammation. Treasure Island, FL. StatPearls Publishing. 2019. https://www.ncbi.nlm.nih.gov/books/NBK493173/. Accessed April 3, 2019.
Serhan CN et al. Novel functional sets of lipid-derived mediators with antiinflammatory actions generated from omega-3 fatty acids vi cyclooxygenase 2-nonsteroidal antiinflammatory drugs and transcellular processing. J Exp Med. 2000;192(8):1197-1204.
Serhan CN et al. Lipid mediators in the resolution of inflammation. Cold Spring Harb Perspect Biol. 2015;7(2):a016311.
Serhan CN. Pro-resolving lipid mediators in inflammation are leads for resolution physiology. Nature. 2014;510(7503):92–101.
Beavers KM et al. Effect of exercise training on chronic inflammation. Clin Chim Acta. 2010;411(11-12):785–793.
Nappi F et al. Endocrine aspects of environmental “obesogen” pollutants. Int J Environ Res Public Health. 2016;13(8):E765.
Calder PC et al. Inflammatory disease processes and interactions with nutrition. Br J Nutr. 2009;101 Suppl 1:S1-45.
Liu YZ et al. Inflammation: the common pathway of stress-related diseases. Front Hum Neurosci. 2017;11:316.

COVID-19 and Pregnancy: What Do We Know?

December 2, 2020/in Blog /by lakecountry

By Michael Stanclift, ND

Sourced from Metagenics Institute

Introduction
Expectant mothers may find some reassurance in recent evidence suggesting COVID-19 infection during pregnancy doesn’t appear to pose the same dangers as related viral infections (e.g. SARS, MERS).¹ Pregnant women contracting COVID-19 must still be cautious about their and their developing babies’ health, especially since treatment options are more limited during pregnancy; however, documented cases give us some insight into the short-term effects. As with all things related to COVID-19, the data is still emerging, and we must keep in mind that new information could further support or undermine what we know now. Data on pregnancy is limited by the number of cases and the time frame of the pandemic—meaning we will not know longer range effects or the validity of these findings for some time.

COVID-19-positive pregnant women mostly without symptoms
Doctors in a London hospital during its COVID-19 peak detected coronavirus (SARS-CoV-2) in 7% of pregnant women admitted for delivery; nearly all of them (89%) had no symptoms.² During the pandemic peak in New York, the positive rate for SARS-CoV-2 in pregnant women was over twice as high as London (15%), with a similar number of them asymptomatic as well.^2,3 The authors expressed concern that their findings support a trend of asymptomatic infection in healthcare facilities, suggesting poor infection control.²

What happens when a pregnant woman gets COVID-19
Unlike with infections such as influenza, pregnant women do not appear to be at increased susceptibility for COVID-19 infection, nor do they have more severe disease when they contract it.⁴ COVID-19 infection in pregnant women presents in much the same way as in nonpregnant patients—usually with a cough, fever, labored breathing, and low lymphocytes.¹Compared to infections caused by similar coronaviruses (SARS/MERS), the death rate in pregnant women with COVID-19 has yet to be determined; initial reports are very low, while SARS/MERS respectively have an 18% and 25% mortality rate in this population.^1,5,6

1^st trimester: In other infections, developing a fever in the first trimester doesn’t contribute to birth defects, though it does increase the likelihood of inattention disorders in childhood.¹ Because of the timeline of the pandemic, we don’t have data on COVID-19-related effects from young children born to mothers who had the infection, but experts hypothesize the same may hold true.¹ Based on small numbers of COVID-19 cases, it doesn’t appear to increase the risk for miscarriage (spontaneous abortion) above the risk of the general population.^1,7
2^nd/3^rd trimester: Data from small numbers of cases show COVID-19 infection poses fetal risks, such as intrauterine growth restriction (9-10%) and preterm birth (39-43%), though the preterm birth information is somewhat conflicting.^1,7,8
Early childhood: COVID-19 presents mostly as a mild respiratory illness in most children.¹
Predicting severity of COVID-19 in pregnancy: Assessing and predicting mortality of COVID-19 in pregnant patients is more difficult than in nonpregnant patients, as the normal course of pregnancy skews measures used to predict the course of disease, such as D-dimer and sequential organ failure assessment (SOFA).¹ This can make it a bit more difficult to predict when the severity of a case may increase and require higher levels of interventions.
Treatment of COVID-19 in pregnancy: Pregnant women who develop severe disease and require a ventilator need higher levels of oxygen to adequately provide for their growing fetus.¹ Remdesivir, the most promising drug for the treatment of COVID-19, appears to be safe for use during pregnancy, as does chloroquine, though it may require higher doses in pregnant patients.¹ An HIV antiviral being used, lopinavir-ritonavir, is safe in pregnancy, as demonstrated through public health data.¹ Unfortunately, ribivarin, an antiviral drug, and baricitinib, a Janus kinase inhibitor being used for COVID-19, aren’t safe to use during pregnancy.¹ Pregnant and breastfeeding women are excluded from current vaccine phase 1 and 2 clinical trials, though some OB/GYNs argue this is “both misguided and not justifiable and may have excluded them from potentially beneficial interventions.”^9-11
Special considerations for pregnant healthcare workers: N95 masks can reduce oxygen uptake and are recommended against (as is frontline work) for pregnant women working in healthcare with growth-restricted fetuses.¹
Vertical transmission (mother spreading the virus to baby): In theory, passing the infection from mother to baby while in utero is possible due to ACE2 (the receptor the virus uses to enter cells) expression on the placenta; however, no confirmed cases proving this have been recorded to date.¹ A study published in JAMA found IgG and IgM antibodies against SARS-CoV-2 in newborn infants born to COVID-19-positive mothers.¹²Since IgM does not cross the placenta, it suggests the infants were possibly exposed to the virus in utero; however, throat swabs and blood samples from the babies were negative for the virus.¹² Measuring IgM antibodies has limitations with the possibility of false positives, so more evidence is needed to confirm the infection could be passed this way.¹³In cases where a baby tested positive after being delivered by a COVID-19-infected mother, other causes of transmission could not be completely ruled out.¹Additionally, in COVID-19-positive mothers the virus does not seem to appear in amniotic fluid, umbilical cord blood, breast milk, or throat swabs from the infants.¹
Delivery, breastfeeding, and skin-to-skin contact: Numerous reputable professional obstetrics societies declare vaginal delivery is safe for women with COVID-19, without risk of spreading the infection to the infant.^1,8 Women with the infection may need to wear a facemask and avoid skin-to-skin contact with their new babies after delivery; however, all evidence suggests it is safe for the baby to drink breastmilk—which should bring some comfort to both.¹

Conclusion
Pregnant women are not more likely to get COVID-19, nor are they more likely to have a severe case based on the findings so far. While COVID-19 infection during pregnancy certainly presents possible risks to them and their babies, the emerging evidence is reassuring. In the absence of other modifying factors that increase risk and course of disease, pregnant women can reasonably expect that contracting COVID-19 while pregnant has the same risks as nonpregnant patients of similar makeup. Treatment options for pregnant women are mostly similar, with some limitations. There is no compelling evidence that pregnant women can spread the infection to their babies, other than normal transmission routes, namely respiratory droplets. Should their babies develop the infection, the course is generally mild in children.

The American College of Obstetricians and Gynecologists (ACOG) along with the Centers for Disease Control (CDC) has created guidelines based on the available research to date; however, there are still several unanswered questions, and additional information is needed to make better informed decisions. Therefore, those clinicians with pregnant women under their care should routinely monitor any changes and updates to these recommendations.

Citations

Dashraath P et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020. pii: S0002-9378(20)30343-4.
Khalil A et al. SARS-CoV-2 in pregnancy: symptomatic pregnant women are only the tip of the iceberg. Am J Obstet Gynecol. pii: S0002-9378(20)30529-9.
Coronavirus Resource Center. Johns Hopkins University and Medicine. https://coronavirus.jhu.edu/map.html. Accessed May 14, 2020.
Blitz MJ et al. Intensive care unit admissions for pregnant and non-pregnant women with COVID-19. Am J Obstet Gynecol. 2020. pii: S0002-9378(20)30528-7.5.
Karami P et al. Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings. Travel Med Infect Dis. 2020;101665.
Hantoushzadeh S et al. Maternal death due to COVID-19 disease. Am J Obstet Gynecol. 2020;S0002-9378(20)30516-0.
Yan J et al. Coronavirus disease 2019 (COVID-19) in pregnant women: A report based on 116 cases. Am J Obstet Gynecol. 2020;S0002-9378(20)30462-2.
Della Gatta AN et al. COVID19 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol. 2020;S0002-9378(20)30438-5.
Safety and immunogenicity study of 2019-nCoV vaccine (Mrna-1273) for prophylaxis of SARS-CoV-2 iInfection (COVID-19). ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT04283461?term=mrna-1273&draw=2&rank=1. Accessed May 13, 2020.
Safety, tolerability and immunogenicity of INO-4800 for COVID-19 in healthy volunteers. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT04336410?term=ino-4800&draw=2&rank=1. Accessed May 13, 2020.
Costantine MM et al. Protection by exclusion: Another missed opportunity to include pregnant women in research during the coronavirus disease 2019 (COVID-19) pandemic. Obstet Gynecol. 2020. [Epub ahead of print].
Zeng H et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA. 2020;323(18):1848‐1849.
Kimberlin DW et al. Can SARS-CoV-2 infection be acquired in utero?: Moredefinitive evidence is needed. JAMA. 2020. [Epub ahead of print].

The CDC’s New COVID-19 Guidelines: What You Should Know

November 13, 2020/in Blog /by webmaster

COVID-19 is still a new disease, and we learn more every day about preventing it. The Centers for Disease Control and Prevention (CDC) released updated guidelines to help you avoid catching COVID-19.^[1]Let’s explore some important takeaways.

How COVID Spreads

To better understand COVID-19 prevention, let’s first review how the disease spreads. According to the new CDC guidelines, COVID-19 spreads mostly through close contact — defined as being within 6 feet of an infected person.^[2]At this close range, COVID-19 can spread from person to person through respiratory droplets — small bits of liquid expelled when we breathe, talk, sing, cough or sneeze. These droplets become known as particles if they dry quickly in the air.

Although respiratory droplets and particles usually spread through close contact, they also sometimes can stay airborne and infectious for minutes to hours after an infected person leaves a space.^[2]

In addition to transmission through the air, COVID-19 occasionally spreads via contaminated surfaces and, rarely, from animals to humans.^[2]

Staying Safe

In light of COVID-19’s transmission methods, let’s talk about preventing it.

Keeping a distance of at least six feet from other people is heavily emphasized by the CDC’s prevention guidelines.^[1]Social distancing demonstrably lessens the spread of COVID-19, according to research published by the CDC.^[3]

Next up is wearing a mask. A growing body of evidence confirms mask-wearing slows the spread of COVID-19.^[4]It’s important to choose the right kind of mask, though. The CDC recommends well-fitted masks with two or more layers of washable, breathable fabric.^[5]

Washing your hands is crucial, too. Soap and water are preferred here, but hand sanitizer with at least 60 percent alcohol content can suffice.^[1]You especially should wash your hands after leaving a public place and after blowing your nose, coughing or sneezing. These, however, are just a few of the instances where the CDC recommends washing your hands.

Speaking of disinfecting, it’s important to sanitize frequently-touched surfaces, such as tables, doorknobs, phones and keyboards every day.^[1]After cleaning these surfaces of any dirt, apply a household disinfectant to finish the job.

It’s also important to avoid crowded or poorly-ventilated indoor spaces. COVID-19 droplets and particles more easily travel through the air — and even beyond six feet from infected people — in poorly ventilated spaces.^[2]

What If I Get Sick?

It’s key to stay home and isolate from others — except to get medical care — if you are sick with COVID-19 or suspect you might be.^[6]You should stay in contact with your doctor and monitor your symptoms, including checking your temperature regularly. Symptoms of COVID-19 include fever, cough and more. Of course, you also should wear a mask when needed, cover your coughs and sneezes, and avoid sharing personal household items with others. You might also consider getting tested for COVID-19. The CDC offers more detailed guidance for what to do if you get sick.

A Developing Story

As doctors and scientists continue discovering more about COVID-19, it’s likely recommendations for preventing the disease will change further. Be sure to check the CDC website for the latest updates. You can also visit our COVID-19 page for useful information and resources.

Sources:

3 Reasons You Need Sleep (and 3 Ways to Get Enough)

October 23, 2020/in Blog /by webmaster

Sleep can become an afterthought in today’s busy world. Whether it’s working late, watching your favorite shows, or staying current on world events, there are tons of distractions to keep us awake. However, lack of sleep can have worse consequences than simply feeling sleepy. Here are three major reasons you need sleep… and three ways to get enough.

Sleep Helps You Think
Have you ever stayed up late watching sports or preparing for a busy day? Sleep deprivation hurts our ability to reason and remember. Studies show sleeplessness can hurt both short-term and long-term memory. [1] Even decision making and reasoning are hampered by sleep deprivation. [1] So, getting quality sleep can help you be sharper and more productive.
Sleeplessness is Linked to Mental Disorders
Insomnia, a medical condition where people have difficulty sleeping, was found to precede 69 percent of depression cases in one study. [2] Even for children, data suggests poor sleep can signal the onset of depression. [3] What’s more, other research shows 24 to 36 percent of people with insomnia also suffer from anxiety disorders. [4]
Drowsiness is Dangerous
Did you know drowsy driving can be similar to drunk driving? One study found that sleep-deprived drivers drove as poorly as drunk drivers. [5] Sleep deprivation can be dangerous in the workplace, too. Research shows sleep-deprived workers are much likelier to have workplace accidents. [5] In fact, a study conducted in the Netherlands showed highly-fatigued workers were 70 percent likelier to have accidents than workers with low fatigue levels. Sleep loss can be dangerous for elderly people, too. For example, data indicates sleep-deprived older women are likelier to suffer falls than those with adequate sleep. [5]

It’s obvious we all need sleep. But what’s a healthy amount? The answer varies by age according to National Sleep Foundation recommendations. [6] Newborns require 14 to 17 hours of sleep, more than any other age group. Young adults need 7 to 9 hours, and older adults require 7 to 8 hours.

With that established, let’s talk about how to get enough sleep.

Set a Schedule
A regular sleep schedule is great for sleep at any age — it ensures you get enough sleep to power through life. A good sleep cycle not only means getting enough sleep, but also enables better sleep. One study found a regular sleep cycle resulted in better sleep and less trouble going to sleep. [7] Plus, the same study found people with a regular sleep cycle were less sleepy during the day. Other research even found irregular sleep patterns nearly doubled the risk of cardiovascular disease in older adults. [8]
Put the Screens Away
The National Sleep Foundation recommends avoiding screens on electronic devices like phones, tablets and laptops for at least 30 minutes before bedtime. [9] These devices can emit blue light, which research shows suppresses our secretion of melatonin, a key hormone for falling asleep. [10] So, rather than racking up screen time just before bed, consider picking up a good book to let your melatonin get to work.
Just Relax
Speaking of reading a good book, it’s critical to wind down before bedtime. While reading is one option, studies show music can profoundly impact sleep. One study found music made people feel better rested and prolonged their REM sleep. [11] Another study of young adults found music can facilitate longer deep sleep. [12] If music isn’t your thing, then consider taking a warm bath or shower. A review of 13 different studies found a warm bath or shower one to two hours before bed helped people fall asleep significantly faster. [13]

So, make sleep a top priority, and enjoy the benefits to your health and wellness in waking life.

Sources:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656292/
2. https://www.sciencedirect.com/science/article/abs/pii/S0022395606001440
3. https://www.sciencedirect.com/science/article/abs/pii/S1087079214000392
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181635/
5. https://www.ncbi.nlm.nih.gov/books/NBK19958/
6. https://www.sciencedirect.com/science/article/abs/pii/S2352721815000157
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143130/
8. https://www.nih.gov/news-events/news-releases/study-finds-irregular-sleep-patterns-double-risk-cardiovascular-disease-older-adults
9. https://www.sleepfoundation.org/articles/healthy-sleep-tips
10. https://pubmed.ncbi.nlm.nih.gov/30311830/
11. https://pubmed.ncbi.nlm.nih.gov/22494532/
12. https://pubmed.ncbi.nlm.nih.gov/23663079/
13. https://www.sciencedirect.com/science/article/abs/pii/S1087079218301552