Tag Archives: Preventative Care

Post # 56 – What is Optimal Blood Pressure and How to Achieve it?

14 Sunday Aug 2016

Posted by in Aging, Causes of Death, Living to 120, Nutrition, Optimal Health, Optimal Nutrition, Reversing Chronic Diseases, Uncategorized

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First, a quick story and my own experience over the last six months.

For a number of years, I have had my blood pressure in tens (between 110 and 119) for Systolic and in the seventy’s for the Diastolic.  So, my typical BP measurement might be 112/74.

For the last couple of years, however, every time I visited a doctor or clinic, I noticed that it was in the high twenty’s or low thirty’s for Systolic (125 to 135 range) and low eighty’s for the Diastolic pressure. For example, I might see my as BP 128/82. Doctors always called it out as “normal” and I ignored it assuming that those were spurious readings.

About six months ago, I decided to get a BP monitor and started measuring my blood pressure frequently – like every day and even multiple times during a day.  I noticed that the higher readings I had seen during the last couple of years were actually true. I wanted to know if it was inevitable that my BP would be creeping up as I get older.  Or, could I do something about it?

And, so I decided to take a deeper dive into this topic of BP.

First, I asked my wellness doc if he had any ideas. He told me that it was nothing to worry about. When I insisted on understanding why my BP not stay in the tens for Systolic and seventy’s for diastolic, he told me that I was already eating a pretty clean vegetarian diet.  He suggested I could experiment with vegan diet and also suggested a couple of books to read.

Well after about six months of eating vegan (only plant based whole food, no eggs, no dairy, no meat) and daily monitoring my BP, it looks like my BP is nicely settling in the tens range for systolic and in the seventy’s range for diastolic and times even lower.

And, here is a quick synopsis of what I learned along the way about what is optimal BP and how to achieve it. You might find surprising some of  what I learned and am sharing here.

What is Optimal BP?

We have all heard that BP is the “silent killer”. That uncontrolled high BP can injure or kill you. According to American Heart Association website, possible health consequence can happen over time, if left untreated include:

  • Coronoary Heart Disease or CHD, i.e., damage to the heart and coronary arteries, including heart attack, heart disease, congestive heart failure, aortic dissection and atherosclerosis (fatty buildups in the arteries that cause them to harden)
  • Stroke
  • Kidney damage
  • Vision loss
  • Erectile dysfunction
  • Memory loss
  • Fluid in the lungs
  • Angina
  • Peripheral artery disease

I am sure you have also heard that BP less than 120/80 is considered “normal”.  120 – 139 for systolic or 80 to 89 for diastolic is considered pre-hypertension.  And, anything above those numbers is considered hypertension and your doc will say that you must do something to bring it in the lower ranges. NIH National, Heart, Lung, and Blood Institute website publishes this guidance:

Stages of High Blood Pressure in Adults

Stages Systolic
(top number)		 Diastolic
(bottom number)
Prehypertension 120–139 OR 80–89
High blood pressure Stage 1 140–159 OR 90–99
High blood pressure Stage 2 160 or higher OR 100 or higher

Well, where do these numbers come from?

As you may already know, if you have been reading these blog posts, that I am always suspect of the word “normal”.  I prefer talking about “optimal”.

 Updated Research on BP

In BMJ 2009, M R Law et al, published a very extensive meta-analysis study of 143 previously completed clinical trials on the use of BP lowering drugs. A meta-analysis study is a study of already published studies to assemble an overall conclusion. A key conclusion of this meta-analysis study was:

“The relative risk estimates of CHD events and stroke in the blood pressure difference trials were similar across all levels of blood pressure before treatment down to 110 mm Hg systolic and 70 mm Hg diastolic, below which there were too few data.”

Basically, from all previous studies they analyzed that the risk of all coronary heart disease and stoke continued to decrease as the BP were lowered to 110/70.  They could not tell if the trend would continue below 110/70, since there was not enough data available for cases below 110/70.

So, 110/70 is definitely better than 120/80 in reducing the risk of CHD and strokes.  Is 105/65 or other lower numbers better than 110/70, they could not prove it due to insufficient data.

Here is another conclusion:

“This, the largest meta-analysis of randomised trials of blood pressure reduction to date, shows that lowering systolic blood pressure by 10 mm Hg or diastolic blood pressure by 5 mm Hg using any of the main classes of blood pressure lowering drugs, reduces CHD events (fatal and non-fatal) by about a quarter and stroke by about a third, regardless of the presence or absence of vascular disease and of blood pressure before treatment, with no increase in non-vascular mortality. Heart failure is also reduced by about a quarter. Proportional disease reduction for a given blood pressure reduction independent of pretreatment blood pressure.”

Translated it means the risk of CHD and strokes decreases at the same rate no matter what the starting point is. So, when you lower your systolic BP from 140 to 130, or 130 to 120 or from 120 to 110, you decrease you risk by the same amount, of CHD by 25% and strokes by 33%.

The following example from the research paper illustrate this calculations.

“At age 60-69, the relative risk of stroke is 0.43 (57% decrease) for a 20 mm Hg decrease in systolic blood pressure. For a blood pressure decrease twice as great (40 mm Hg), the relative risk of 0.43 effectively applies twice (0.43×0.43, or 0.432), which is 0.18 (an 82% decrease).”

That is quite amazing, isn’t it?

Do you have to take meds to lower your blood pressure?

Short answer is: of course, not.

Michael Gregor, M.D. in his book, “How not to Die”, Chapter 7: How Not to Die from High Blood Pressure, very succinctly lays out who the villains and heroes are in the epic story of BP.

Gregor book

Villains are Sodium and all the foods that sneak sodium in the form of salt into our diet. Mechanism seems simple enough. Sodium causes water retention and body raises blood pressure to try to expel the excess retained water from the body.

There is a plethora of research that shows that if you lower your sodium intake to less than 500 mg a day, you can achieve a 110/70 BP.

Heroes are anti-oxidant, potassium and nitrate rich foods that provide antidote to sodium and the damage it does to the cardiovascular system. Adding the following foods to your diet will further lower or make it easier to bring it in the right range:

  • Rhubarb
  • Leafy green vegetables;, arugula, cilantro, butter leaf lettuce, Mesclun greens, beet greens, basil, oak leaf lettuce Swiss chard
  • Beets
  • Ground flaxseed
  • Whole Grains
  • Hibiscus Tea

Does the BP have to go up as we age?

Short answer is: NO.

Yes, the phenomenon of BP going up with age is what has been observed in “normal” situations. However, citing lots of existing research, Dr. Gregor demonstrates that the idea that BP has to go up as we age is a myth. With proper food intakes we can have a healthy BP for life.

Bottom line

There is extensive research available to establish that high Blood Pressure is indeed the silent killer it is made out to be. Consequences of high BP if left unchecked for extended period of time can cause many health issues beyond coronary heart disease and strokes.

120/80 may be considered “normal”, but is not actually optimal. Clear evidence exists that by lowering BP to 110/70, you can further reduce risks of CHD and stroke.  Further, benefits of lowering BP to less than 120/80 are significant.  There is not enough evidence at this time that numbers lower numbers than 110/70  further reduce the risks.

Meds are not the only means to lower BP. You can use lifestyle changes to lower BP to 110/70 or lower.

 Reducing sodium intake dramatically, lower than 500 mg per day, can lower the BP to 110/70.

Anti-oxidant, potassium and nitrate rich foods provide antidote to sodium and the damage it does to the cardiovascular system. Adding the following foods to your diet will further lower or make it easier to bring it in the right range:

  1. Rhubarb
  2. Leafy green vegetables;, arugula, cilantro, butter leaf lettuce, Mesclun greens, beet greens, basil, oak leaf lettuce Swiss chard
  3. Beets
  4. Ground flaxseed
  5. Whole Grains
  6. Hibiscus Tea

AHA’s website offers a neat little tool for you to see how much BP you can expect to lower with different recommended lifestyle changes.

 

So there you have it, results of my experience and deep dive into this topic so far!

What are your thoughts on this subject?

Would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input.

 

Post #55 – Gravity-Based Life Style for Optimal Health

30 Saturday Jul 2016

Posted by in Lean Mass, Living to 120, Optimal Exercise, Optimal Health, Uncategorized, Vigor, Vitality, Yoga

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On Father’s Day this year, my wife gave me an Apple Watch as a gift. And, as you can probably guess, I went straight to the fitness apps.

Apple watch allows you to continuously measure heart rate, daily steps walked, and the distance walked.  You can also set it to remind you to stand up, as I often as you tell it to and it keeps track of how many times you actually did stand up. And, it gives you at-a-boys for hitting and moving toward your goals. So, I starting using all these features right away.

But soon after I was wondering: What does the research say about the benefits of daily activities such as standing, walking etc.? Is their science behind this or is it just a gimmick?

Sitting Kills, Moving Heals

My first step was to carefully read the book we had already in the house: Sitting Kills, Moving Heals by Joan Vernikos, Ph.D., former Director of NASA’s Life Sciences Division.  She spent her whole life working at NASA studying the ill effects on astronauts of space travel and living in space in zero gravity. More importantly, she studied how to minimize these ill effects and how to rehabilitate astronauts when they return to earth’s gravity.

Sitting Kills

And, even more importantly, Vernikos and other scientists also made the key connection that sitting on earth is the same as living in zero gravity. Having made that connection, they found that much of the research for space living becomes relevant to those of us who are earth bound.

According to Vernikos, when astronauts spend time in space, here are the kinds of health issues they develop:

  • Blood volume reduced
  • Body weight and mass decreases
  • Increased calcium excretion
  • Increased risk of kidney stones
  • Heart shrinks – cardiac output decreased
  • Heart muscle wall becomes thinner
  • Red blood cells reduced.
  • Stamina/aerobic capacity reduced
  • Lowered growth hormone response to exercise
  • Muscle atrophy; loss of muscle mass
  • Muscle strength reduced; size of fiber decreased
  • Fat moves in to replace muscle mass
  • Muscle sensitivity to insulin reduced
  • Muscle less able to take up sugar
  • Sense of taste and hearing dulled
  • Biological rhythm disturbed
  • Calcium lost from bone
  • Bone mass and density decreased
  • Increased risk of bladder infection
  • Delayed wound healing
  • Testosterone reduced

The list sounds pretty awful, doesn’t it?  After reading this list, you wonder why would anyone want to go live in space.

But these are the same effects that you see as people age on earth.

And, here is the kicker: Space research shows that these conditions induced through Gravity Deprivation Syndrome (GDS) are reversible once you get astronauts re-introduced to gravity.  It often takes almost one day of re-conditioning with gravity for each day spent in space to fully recover.

What about earth-bound people like you and I? We experience GDS is through sedentary life style. Through sitting and bed rest, we experience zero gravity like condition.

GDS starts as early as age 20.   Using bone density loss as a measure of GDS, earth-bound people experience a bone loss at the rate of about 10% per decade. No wonder, by 70’s and 80’s most people have serious osteoporosis conditions with frail bones.

These sedantary lifestyle induced GDS is the reason we are now hearing catch phrases like: Sitting Kills; Sitting is the new Smoking, etc.

How to Overcome Gravity Deprivation Syndrome (GDS)

Through studies and experimentation, researchers have found that to counter the effects of GDS, standing up often is what matters, not how long you remain standing.

Every time you stand up, the body initiates a shift in fluids, volume, hormones and causes muscle contraction to occur, and almost every nerve in the body is stimulated. If you stand up 16 times a day for two minutes, the body would read that as 16 stimuli, whereas if you stood once and remained standing for 32 minutes, it would see that as one stimulus.

Gym Workouts are No Substitute

Another surprising result: Gym workouts of 30 to 60 minute even daily may not be total replacement for activities required to counter GDS. To counter GDS, one needs to exercise stabilizer muscles that include tendons, ligaments, and other connective tissues. Most folks focus on mobilizer muscles that include thighs, biceps, hamstrings, triceps, chest muscles, abs etc.

James Levine an exercise physiologist at the Mayo Clinic in Rochester, MN, coined the term Non-Exercise Activity Thermogenesis (NEAT). NEAT is defined as the small, brief, yet frequent muscular movements one makes throughout the day, of which changing position is the most effective. Here are some examples of NEAT movements, other than standing up:

  • Bending over to pick up something
  • Squatting
  • Stretching upward to take something off a shelf
  • Getting dressed and undressed
  • Playing a musical instrument
  • Stirring a pot
  • Crossing and uncrossing your legs
  • Waving one’s hands while talking
  • Fidgeting

So, more such activities we do, the more effects of GDS we overcome, even though we do not break a sweat.

Bottom Line

 Extrapolating extensive research conducted for space travels, shows that Gravity Deprivation Syndrome (GDS) has serious consequences to our health.  These symptoms of detrimental health due to GDS are often associated with aging, but actually are due to decreased activity as people grow old. Achieving and maintaining optimal health requires strategies to maximize activities to counter the effects of GDS.

The following is a list of some very effective actions to counter GDS:

  • Stand up sit Down
  • Stand tall
  • Stretch at your desk
  • Walk tall
  • Take the stairs instead of elevator
  • Practice balancing when you put on and take off your pants, shoes and socks
  • Use a broom
  • Play on swings; use rocking chairs
  • Dance
  • Play catch; throw Frisbee
  • Do yoga

Remember that exercise is not for gym any more.  So, as often as possible, inconvenience yourself by:

  • Parking far away from the destination,
  • Taking stairs instead of elevators,
  • Stepping up on escalators,
  • Walking instead of taking people movers,
  • Getting up frequently to reach for things, and
  • Carrying your brief case instead of rolling.

All these action help in keeping your stabilizer muscles in top shape for optimal health.

What are your thoughts on this subject?

Would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input.

Post #53 – How to Optimize Your Immune System? –  Part III  – with Exercise

30 Monday May 2016

Posted by in Aging, Living to 120, Optimal Exercise, Optimal Health, Puposely Living, Vigor, Vitality, wellness, Yoga

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In Post #51, I discussed some basic terminology of the immune systems, how immune system works, and what kinds of issues happen when it does not work.

Things that are in our control to enhance our immunity and also so the immune system does not go haywire are the ones that you have heard about gazillions of time by now and are probably tired of hearing about: Nutrition, Exercise and Lifestyle.

In Post #52, we discussed how to boost your immune system with nutrition.   In this post, let’s focus on how and what type of Exercise can boost the immune system.

Impact of exercise on Immune systems

Quite a bit of research is available on how exercise impacts the immune system, although most of it is about impact of exercise on colds and flu. Based on the available research, here are some theories why exercise helps improve the immunity:

  • Physical activity may help flush bacteria out of the lungs and airways. This may reduce your chance of getting a cold, flu, or other airborne illness.
  • Exercise causes changes in antibodies and white blood cells (the body’s immune system cells that fight disease). These antibodies or white blood cells circulate more rapidly, so they could detect illnesses earlier than they might have before.
  • The brief rise in body temperature during and right after exercise may prevent bacteria from growing. This temperature rise may help the body fight infection more effectively. (This is similar to what happens when you have a fever.)
  • Exercise slows down the release of stress-related hormones. Some stress increases the chance of illness. Lower stress hormones may protect against illness.

Getting a little deeper into the subject, here are some findings from some specific studies:

  1. Exercise can provoke moderate acute elevations in IL-6 exerting anti-inflammatory effects
  2. Exercise increases numbers of Neutrophils, T and B lymphocytes, and NK cells – all key components of the immune system
  3. Exercise improves antigen specific T cell function for better protection from infectious agents and greater immunosurveillance
  4. Exercise enhances a variety of macrophage biology and capacities
  5. Exercise improves gut microbiota,  i.e., the bacteria collection in the gut

But how much exercise should you do?

We have all heard that exercise is good for you.  And, as this blog post is emphasizing, among other things, exercise also enhances the immune system. But how much exercise?

In this study, the researchers examined three groups of people: elite athletes, recreational athletes, and sedentary controls. Their results were kind of interesting:

  • The elite athletes had the most upper respiratory issues (66% got sick).
  • The couch potatoes were next (45% got sick).
  • The recreational athletes were the healthiest (22% got sick).

All kinds of other research has found the same thing, so exercise scientists tend to use a J-shaped curve to model the immune effects of exercise. It looks like this:

immunity vs exercise

So one thing is clear, moderate exercise is significantly better for you than no exercise at all. If you are sedentary, it does not seem to take much to get the benefits of improved immune system. For example, daily walking for one hour at a 60 to 65% maximum heart rate (computed as 220-your age) gets you near the optimal range in the above chart.

From the chart, it is clear that there is a point where the benefit of training stops and the negative effect of over-training on the immune system sets in. This literature review article, goes into much more specifics on the kind of exercise that produces the immune-suppressant, i.e., harmful, response:

  • Relatively long workouts (1.5 hours or more), especially without refueling during the workout.
  • A reasonably high intensity, but not excessively difficult (since you have to be able to keep it up for a while).
  • An inadequate recovery period between workouts.

Basically, the kind of grueling training elite athletes often go through preparing for a competition, such as running a marathon.

This article puts it slightly differently:

“No activity is worse than some, while too much may be worse than none at all. The ideal lies somewhere in between – though not necessarily in the middle, but rather smack dab in the “just enough” section. Can “just enough” be quantified? Perhaps it could be quantified using a battery of round-the-clock tests and measurements of anabolic and catabolic hormones, various serum concentrations, lactate build-up, cortisol, testosterone ratios, etc., but that would be expensive, unwieldy, and completely individualized. … If you want to avoid over-training, there are some grand, overarching principles to follow, but you’ll also want to pay attention to certain personal, entirely subjective cues.

That’s what my trainer and yoga teachers call “listening to your body”. There are days, when I am feeling physically ragged since I may not have slept well, or I may be catching a virus, or am feeling physically exhausted or whatever.   In such situations, I need to carefully “listen to my body” and either take it easier than usual or just totally skip the session.

Bottom Line

To optimize immune systems, exercise plays a critical role. It only takes a moderate amount of exercise to get the optimal benefit of exercise for improving immune system. For example any of these activities or some combination of these done daily would optimize the immune systems:

  1. walking for 1 hour at a pace of 60-65% of maximum heart rate of approximately 220 minus your age,
  2. An hour long yoga routine,
  3. A strength training session with body weight or light weights could do the trick

On the other hand, extended periods of over-training can compromise and may lead to sub-optimal immune system. It is more difficult to define over-training with objective measures and may depend upon many individual factors.  It is best to listen to your body and develop a subjective feel for what level of exercise may be “just right” for you for optimal immune system.

 

What are your thoughts on this subject?

Would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input.

 

Post #52 – How to Optimize Your Immune System? –  Part II  – With Nutrition

24 Sunday Apr 2016

Posted by in Living to 120, Nutrition, Optimal Health, Optimal Nutrition, Supplements, Uncategorized, wellness

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In Post #51, I discussed some basic terminology of the immune systems, how immune system works, and what kinds of issues happen when it does not work. In this post the focus is what we can do to keep our immune system healthy and working as designed.

So, what can we do to optimize our immune system?

Things that are in our control to enhance our immunity and make sure that the immune system does not go haywire are the ones that you have heard about gazillions of time by now and are probably tired of hearing about: Nutrition, Exercise and Lifestyle.

Each one is a topic in itself.  In this post, let’s tackle nutrition.

Immune systems and nutrition

As Prof. Chris D’Adamo, Director of Research at Center of Integrative Medicine at University of Maryland School of Medicine, recently gave a talk summarizing research on different foods are known to have immunity enhancing properties. Lot of the content that follows is from his talk.

Mushrooms –  Over 5,000 different types of mushrooms exist in nature many of which are used in traditional medical systems.

In Shitake mushrooms Polysaccharides alpha-Glucans enhance immune system by enhancing the macrophage activity. Shitake mushrooms have been shown in research to have antibacterial, anti-fungal, anti-viral effects. They have also been shown to offer defense against influenza virus and useful in cancer therapy.

Maitake mushrooms enhance immune activity.  While White Button mushrooms have been shown to regulate immune activity, both up and down as needed and useful against breast and prostate cancers. So, eating a variety of mushrooms can enhance and regulate the immune system. 

Cooking mushrooms is better since many contain hyrozines, a carcinogen that is deactivated by heat.

As a practical tip, just wipe mushrooms clean and not  wash in water  since mushrooms are porous and soaking may make them soggy.

If you are not the mushroom eating type, mushroom extracts are as also available that blend different varieties of mushrooms. Here are some:

Mushroom extract

Allium Vegetables –  Garlic, Onions, scallions, shallots, chives, leeks,etc.

The Allium genus includes approximately 500 species that include garlic, onion, leeks, chives, scallions which are used all over the world in different delicacies. Some allium vegetables have been employed for millenia in the traditional medical practice to treat cardiovascular diseases.  These vegetables have been shown to have applications as antimicrobial, antithrombotic, antitumor, hypolipidaemic, antiarthritic and hypoglycemic agents.

In recent years, extensive research has focused on the anticarcinogenic potential of allium vegetables and their constituents, viz., allylsulfides and flavonoids (particularly quercetin which is present abundantly in onion). Epidemiological studies have shown that higher intake of allium products is associated with reduced risk of several types of cancers. These epidemiological findings are well correlated with laboratory investigations. Organosulfur compounds present in Allium vegetables, are considered to be responsible for the beneficial effects of these herbs.

To maximize health benefits of garlic crushing or chopping garlic bulb is important since it converts sulfur compound alliin to more bioactive allicin. It is also important to leave crushed/chopped garlic for serveral minutes before cooking for enhanced activity of allinase enzymes.

And, to maximize health benefits of onions, don’t overpeel.  Flavonoid content is highest in the outermost layers.

Probiotics or Fermented Foods

Bacteria in the gut, aka Gut Biota, continues to be one of the most exciting topic in health and wellness research. Gut biota and therefore probiotics play a huge role in immunity. Some believe as much as 50% of the immunity is in the gut.  Probiotics are defined as any live microorganisms that confer health benefits.

Foods fermented with “probiotic” bacteria or yeast are therefore very important to any diet to enhance immunity.  In traditional diets, common fermented foods are:

  • Miso and natto – fermented beans/grains usually soy
  • Kimchi – fermetend cabbage, radhishes, etc.
  • Kambuch – fermented tea
  • Yogurt, lassi, kefir – fermented dairy
  • Sauerkraut – fermented cabbage
  • Ogi – fermented grains

If not chosen carefully, any of these foods can be used in a way that turns them into junk food.  For example, in the US, we have taken healthful yogurt and turned it into a junk food by adding sugar and other additives.  To figure out what yogurt to buy, check out website  http://cornucopia.org/yogurt-scorecard/.   Out of 130 yogurts, the site lists Activa, Yoplait and Dannon as numbers 124, 126, and 129.

 Sugar in yoplait

If you choose to add a probiotic as a supplement, you may also need to do some research.  You will need to look into what genus, species and strains of bacteria a product contains. It is important that the supplement is shipped on ice, since probiotics diet if exposed to high temperatures. Following brands do ship their products on ice:

Probiotics

Other Supplements for Enhancing Immunity

Zinc is essential to immune function.  There is over 30 years of research that shows that Zinc reduces duration, severity and incidence of common cold.  You do need to take zinc within 24 hours of symptom onset for best effect.

Vitamin C is also essential for immune function.  Research has shown that vitamin c prevents common cold and reduces duration of cold symptoms among people who exercise regularly.

Elderberry is a dark-colored berry high in anthcyannis. It is shown to relieve flu symptoms and inhibit bronchitis virus replication.

Oregano oil has very strong antimicrobial properties.  It has very strong taste and can burn in contact with skin. So, it is taken in capsules or a few drops in water. Also, being antimicrobial it is not useful to take it at the same time you are taking probiotic or eating fermented foods.

An acute prevention/treatment plan for a cold or flu

With all this knowledge, Prof D’Adamo shared how he attacks with nutrition cold or flu if he sees it coming. As soon as possible after exposure or symptoms begin…

  • 1 gram of vitamin C every 1-2 hours
  • 1 full dropper oregano oil in water in morning (with food)
  • 2 Sambucol/Sambucus tablets morning & night (with food)
  • 50 mg zinc tablet morning & night (with food)
  • 2 mushroom extract capsules (New Chapter/Stamets morning & night
  • 100 billion CFU probiotics (Natren) with yogurt before bed
  • Drink water throughout day!!!

He is a pretty big guy.  So smaller people might need less, bigger people may need more or bigger doses.

Bottom Line

To optimize immune systems, the following should be part of diet or as supplements:

  • Variety of mushrooms
  • Allium vegetables – used properly
  • Fermented foods or probiotics

It is useful to have a personal plan and kit ready for attacking common colds and flu by boosting your immune system, as soon as you see it coming.  Research shows that you can prevent and reduce severity and/or duration. Zinc, Vitamin C, elderberry extract, probiotics, mushroom extract, oregano oil and plenty of water are past folklore and are now part of evidence-based medicine.

 

What are your thoughts on this subject?

Would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input.

 

Post #51 – How to optimize your immune system? – Part I

10 Sunday Apr 2016

Posted by in Nutrition, Optimal Exercise, Optimal Health, Optimal Nutrition, Uncategorized, Vitality, wellness

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The term immune system is talked about a lot these days in various contexts. On one end of the spectrum people talk about “building” one’s immune system to ward off or overcome diseases. On the other hand, you may have heard conversation about where the disease itself is the result of some “immune disorder”.

Many years ago, when I used to visit my primary physician to deal with my seasonal allergies (which I was able to successfully cure, as I described in another blog post), I would often ask him, what was underlying cause of my allergies and he would say, “It is something to do with immune system.  We don’t understand much about immune system yet.”

Later after doing my own research, I figured out that actually we do know a lot about the immune system and there is a lot we can do about it too. And, that knowledge gave me the impetus to take actions to cure my seasonal allergies. See my post So, did I tell you the story about my allergies?

In this post, I would like to delve into what exactly is immune system and what we can do so it is really a friend and not our foe.

What is Immune System?

Here is a quick summary of some key terms from National Institute of Allergy and Infectious Diseases (NIAID) at NIH website.

The immune system is a network of cells, tissues, and organs that work together to protect the body from infection. The overall function of the immune system is to prevent or limit infection.

Immune system is comprised of multiple organs, cells and response types that include:

Immune System

Skin: The skin is usually the first line of defense against microbes. Skin cells produce and secrete important antimicrobial proteins, and immune cells can be found in specific layers of skin.

Bone marrow: The bone marrow contains stems cells that can develop into a variety of cell types. The stem cells in the bone marrow create two types of immune cells: innate immune cells and adaptive immune cells.

Innate immune cells —neutrophils, eosinophils, basophils, mast cells, monocytes, dendritic cells, and macrophages— are important first-line responders to infection.

Adaptive immune cells—B cells and T cells—that are responsible for mounting responses to specific microbes based on previous encounters since they retain immunological memory.

Natural killer (NK) cells share features of both innate and adaptive immune cells, as they provide immediate defenses like innate cells but also may be retained as memory cells like adaptive cells.

Lymphocytes – B, T, and NK cells also are called lymphocytes.

Bloodstream: Immune cells constantly circulate throughout the bloodstream, patrolling for problems. When blood tests are used to monitor white blood cells, another term for immune cells, a snapshot of the immune system is taken. If a cell type is either scarce or overabundant in the bloodstream, this may reflect a problem.

Thymus: T cells mature in the thymus, a small organ located in the upper chest.

Lymphatic system: The lymphatic system is a network of vessels and tissues composed of lymph, an extracellular fluid, and lymphoid organs, such as lymph nodes. The lymphatic system is a conduit for travel and communication between tissues and the bloodstream. Immune cells are carried through the lymphatic system and converge in lymph nodes, which are found throughout the body.

Lymph nodes are a communication hub where immune cells sample information brought in from the body. For instance, if adaptive immune cells in the lymph node recognize pieces of a microbe brought in from a distant area, they will activate, replicate, and leave the lymph node to circulate and address the pathogen. Thus, doctors may check patients for swollen lymph nodes, which may indicate an active immune response.

Spleen: The spleen is an organ located behind the stomach. Spleen is important for processing information from the bloodstream. Immune cells are enriched in specific areas of the spleen, and upon recognizing blood-borne pathogens, they will activate and respond accordingly.

Mucosal tissue: Mucosal surfaces are prime entry points for pathogens, and specialized immune hubs are strategically located in mucosal tissues like the respiratory tract and gut.

How does immune systems defenses work?

An immune response is generally divided into innate and adaptive immunity.

Immune Types of Response

Innate immunity occurs immediately, when circulating innate cells recognize a problem by expressing genetically coded receptors. Collectively, these receptors can broadly recognize viruses, bacteria, fungi, and even non-infectious problems. However, they cannot distinguish between specific strains of bacteria or viruses. Their key feature is quick and broad.

Adaptive immunity occurs later, as it relies on the coordination and expansion of specific adaptive immune cells. If a B or T cell has a receptor that recognizes an antigen from a pathogen and also receives cues from innate cells that something is wrong, the B or T cell will activate, divide, and disperse to address the problem. B cells make antibodies, which neutralize pathogens, rendering them harmless. T cells carry out multiple functions, including killing infected cells and activating or recruiting other immune cells.

Vaccination, or immunization, is a way to train your immune system against a specific pathogen. Vaccination achieves immune memory without an actual infection, so the body is prepared when the virus or bacterium enters. Saving time is important to prevent a pathogen from establishing itself and infecting more cells in the body.

When immune system is not working as intended?

When the immune system is working well through all the parts and pieces we discussed above, it is a thing of beauty. As a pathogen enters the body, body’s defenses are activated through the appropriate part of the immune system.  The pathogen is recognized and immediately zapped.

When immune system is not working properly there could be different types of issues.

Immune Deficiencies

Temporary Immune Deficiencies: Temporary immune deficiency can be caused by a variety of sources that weaken the immune system. Common infections, including influenza and mononucleosis, can suppress the immune system.

When immune cells are the target of infection, severe immune suppression can occur. For example, HIV specifically infects T cells, and their elimination allows for secondary infections by other pathogens.

Patients receiving chemotherapy, bone marrow transplants, or immunosuppressive drugs experience weakened immune systems until immune cell levels are restored. Pregnancy also suppresses the maternal immune system, increasing susceptibility to infections by common microbes.

Allergy

Allergies are a form of hypersensitivity reaction, typically in response to harmless environmental allergens like pollen or food. Hypersensitivity reactions can be caused by antibodies, IgE or IgG, which are produced by B cells in response to an allergen. Overproduction of these antibodies activates immune cells like basophils and mast cells, which respond by releasing inflammatory chemicals like histamine. And that is why people take antihistamine to stop allergic reactions such as sneezing.

Allergic reactions can also be caused by T cells, which may either directly cause damage themselves or activate macrophages and eosinophils that damage host cells.

Autoimmune Diseases

Autoimmune diseases occur when adaptive immune cells that recognize host cells persist unchecked. Autoimmunity is either organ-specific or systemic, meaning it affects the whole body. Autoimmune diseases have a strong genetic component, and with advances in gene sequencing tools, researchers have a better understanding of what may contribute to specific diseases.

Cancer

Some forms of cancer are directly caused by the uncontrolled growth of immune cells. Leukemia is cancer caused by white blood cells. Lymphoma is cancer caused by lymphocytes, i.e., adaptive B or T cells. Myeloma is cancer caused by plasma cells, i.e.,  mature B cells. Unrestricted growth of any of these cell types causes cancer.

In addition, an emerging concept is that cancer progression may partially result from the ability of cancer cells to avoid immune detection.

So, what can we do optimize our immune system?

Things that are in our controls to enhance our immunity and make sure that the immune system does not go haywire are the ones that you have heard about gazillions of time by now and are probably tired of hearing about: Nutrition, Exercise and Lifestyle.

In the next post, we will talk of specifics of nutrition, exercise and lifestyle that can enhance immune system and also prevent it from attacking itself or the body.

In the meantime, what are your thoughts on this subject?

Would love to hear from you and learn from you.

Please click on Comment to leave your comments or question so others can benefit from your input.

 

 

Post #49 – What is the role of massage therapy in Optimal Health?

14 Sunday Feb 2016

Posted by in Aging, Optimal Health, Puposely Living, Quality of Life, Reversing Chronic Diseases, Stress, Uncategorized, wellness

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After so many years, my wife and I finally surrendered to the suggestions of our trainer and started getting massages at least once a month. He had been telling us how massage can be great for recovering from the stresses left over from hard workouts.  And, about six months ago, we decided to give it a shot and get massages on a regular basis.

So, I thought I will take some time to do some research into the role of massage therapy and share the research and our own experience in this blog post.

man_massage_table

What Is Massage Therapy?

Massage therapy dates back thousands of years. References to massage appear in ancient writings from China, Japan, India, and Egypt.

According to National Center of Complementary and Integrative Health (NCCIH) of the National Institute of Health (NIH) the term “massage therapy” includes many techniques and the type of massage given usually depends on specific need, physical condition and the expertise of the massage therapist.

In general, massage therapists work on muscle and other soft tissue to help you feel better.  The following massages you hear most about in the US:

In Swedish massage, the therapist uses long strokes, kneading, deep circular movements, vibration, and tapping.

Deep (tissue)massage technique uses slower, more-forceful strokes to target the deeper layers of muscle and connective tissue, commonly to help with muscle damage from injuries.

Sports massage combines techniques of Swedish massage and deep tissue massage to release chronic muscle tension. It is adapted to the needs of athletes.

Myofascial trigger point therapy focuses on trigger points—areas that are painful when pressed and are associated with pain elsewhere in the body. Examples of these are:

  • Accupressure – where therapist applies strong physical pressure on specific point on the body.
  • Reflexology – Similar to acupressure where pressure is applied to certain points on hands and feet.

But there are other massages that are not quite as common and are based on Indian medicine, Ayuerveda:

Marma-point Massage – where a therapist applies very gentle touch to some or all of the 107 different marma-points in the body to correct any imbalances in the body

Shirodhara – where warm oil is poured to the forehead

Abhyanga – oil massage is done by two people with synchronized movements

Massage therapy is sometimes done using essential oils as a form of aromatherapy.

Benefits of Massage

A lot of the scientific research on massage therapy is preliminary or conflicting, but much of the evidence points toward beneficial effects on pain and other symptoms associated with a number of different conditions. Much of the evidence suggests that these effects are short term and that people need to keep getting massages for the benefits to continue.

While more research is needed to confirm the benefits of massage, some studies have found massage may also be helpful for:

  • Anxiety
  • Digestive disorders
  • Fibromyalgia
  • Headaches
  • Insomnia related to stress
  • Myofascial pain syndrome
  • Soft tissue strains or injuries
  • Sports injuries
  • Temporomandibular joint pain

According to Arthritis Foundation  regular massage of muscles and joints, whether by a licensed therapist at a spa or by self-massage at home, can lead to a significant reduction in pain for people with arthritis, according to Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, who’s conducted a number of studies on the benefits of massage, including on people with arthritis. In Field’s research and other recent studies on the effects of massage for arthritis symptoms, regular use of the simple therapy led to improvements in pain, stiffness, range of motion, hand grip strength and overall function of the joints.

In a study published in Science Translational Medicine by Dr. Mark A. Tarnoplsky et al found that a short, 10-minute Swedish-style massage session can reduce inflammation, which can help your muscles recover after a hard workout.

And, then of course, there are studies that attribute the benefits of massage just to receiving a dose of human touch that offers all sorts of healthy responses from lowering blood pressures, depression, improving immunity to oxytocin release for increased bonding response.

 What are the risks of Massage Therapy?

Massage therapy appears to have few risks when performed by a trained practitioner. However, massage therapists should take some precautions in people with certain health conditions. NCCIH recommend that:

  • In some cases, pregnant women should avoid massage therapy. Talk with your health care provider before getting a massage if you are pregnant.
  • People with some conditions such as bleeding disorders or low blood platelet counts should avoid having forceful and deep tissue massage. People who take anticoagulants (also known as blood thinners) also should avoid them. Massage should not be done in any potentially weak area of the skin, such as wounds.
  • Deep or intense pressure should not be used over an area where the patient has a tumor or cancer, unless approved by the patient’s health care provider.

Our Experience

Over the years, my wife and I have received massages during vacations etc.  We received several different Ayurvedic massages at the Ayurrvedic Institute in Albuquerque NM every day for a week of an intense detox and cleanse program called Panchakarma.  I have also received locally in Maryland Marma-Point massages.  And, now for the last six month, we are receiving massages once a month.

I described my experience of relieving migraine using acupressure in another blog post.

Massages that we receive from the same person every month are very therapeutic in that the therapist is getting to know our body. She is able to adjust her technique based on what our body needs. I am able to tell her any specific issue I may have. Usually these tend to be some stiff muscles that she could pay attention to.  During and after the massage, she is the one who tells me where the stiff muscles are.

Areas around my shoulders and neck are where I seem to burry my stresses and are getting more and more limber as a result of the massages.  I can definitely feel the result of my relaxed muscles in my yoga practice.

I have found Ayuervedic massages to be totally blissful. It blows me away how such gentle touches at the Marma-points or pouring of oil on third-eye can totally transport my body into a meditative state.

Bottom Line

Regular massage therapy definitely is valuable in creating and maintaining Optimal Health.  Repeating from the NCCIH website:

  • A lot of research on the effects of massage therapy has been carried out.
  • While often preliminary or conflicting, there is scientific evidence that massage may help with back pain and may improve quality of life for people with depression, cancer, and HIV/AIDS.
  • Massage therapy appears to have few risks if it is used appropriately and provided by a trained massage professional.

What do you think?

What are your experiences and knowledge of massages therapy?  

Please share your thought by clicking on “Leave A Comment” link.

I would love to learn and share with others what I learn from you?

 

 

Post #48 – Is cancer preventable through optimal healthy living?

10 Sunday Jan 2016

Posted by in Causes of Death, Ideal Body Weight, Living to 120, Nutrition, Optimal Exercise, Optimal Health, Optimal Nutrition, Supplements, Uncategorized, Vitality, wellness

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My wife Kimberly was telling me the other day that 2015 has been quite a remarkable year in that we had several cancer episodes among our friends and families.  Even a couple of them died.

So, that got me thinking… is cancer preventable through optimal healthy living?

What is cancer anyways?

According National Institute of Health (NIH), National Cancer Institute (NCI) website www.cancer.gov, cancer is the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues.

Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.

When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors.

Many cancers form solid tumors, which are masses of tissue. Cancers of the blood, such as leukemias, generally do not form solid tumors.

Cancerous tumors are malignant, which means they can spread into, or invade, nearby tissues. In addition, as these tumors grow, some cancer cells can break off and travel to distant places in the body through the blood or the lymph system and form new tumors far from the original tumor.

A cancer that has spread from the place where it first started to another place in the body is called metastatic cancer. Under a microscope, metastatic cancer cells generally look the same as cells of the original cancer.

How does cancer arise?

Cancer is a genetic disease—that is, it is caused by changes to genes that control the way our cells function, especially how they grow and divide. Three main types of genes may be involved—proto-oncogenes or genes involved in normal cell growth, tumor suppressor genes, and DNA repair genes. These changes are sometimes called “drivers” of cancer.

Genetic changes that cause cancer can be inherited from our parents. They can also arise during a person’s lifetime as a result of errors that occur as cells divide or because of damage to DNA caused by certain environmental exposures. Cancer-causing environmental exposures include substances, such as the chemicals in tobacco smoke, and radiation, such as ultraviolet rays from the sun. (Our Cancer Causes and Risk Factors page has more information.)

Inherited genetic mutations play a major role in about 5 to 10 percent of all cancers. Researchers have associated mutations in specific genes with more than 50 hereditary cancer syndromes, which are disorders that may predispose individuals to developing certain cancers.

How to prevent cancer?

So, now finally getting to the topic we started with – how to prevent cancer. Here are the four major ways to help prevent cancer:

  1. Avoid or control things known to cause cancer.
  2. Changes in diet and lifestyle.
  3. Finding precancerous conditions early. Precancerous conditions are conditions that may become cancer.
  4. Chemoprevention (medicines to treat a precancerous condition or to keep cancer from starting).

Let us take these items one at a time.

  1. Avoid or control things known to cause cancer.

Factors that are known to increase the risk of cancer:

  • Cigarette Smoking and Tobacco Use
  • Infections: HPV, Hepatitis B and C, Espstein-Barr virus, Helcobater pylori
  • Radiation: Ultraviolet sunlight, medical radiation, radon gas in homes
  • Immunosuppressive Medicines
  1. Changes in diet and lifestyle

Factors that may affect the risk of cancer:

  • Diet
  • Alcohol
  • Physical Activity
  • Obesity
  • Environmental Risk Factors: second hand smoke, asbestos, air pollution, pesticides, arsenic in drinking ware

Diet is anything we put in our mouths on a regular basis.

Diet is always a controversial subject. Media loves to talk about any new tidbit that comes out through research regarding diet.

Some studies show that fruits and non-starchy vegetables may protect against cancers of the mouth, esophagus, and stomach. Fruits may also protect against lung cancer.

Some studies have shown that a diet high in fat, proteins, calories, and red meat increases the risk of colorectal cancer, but other studies have not shown this.

It is not known if a diet low in fat and high in fiber, fruits, and vegetables lowers the risk of colorectal cancer.

According to American Cancer Society website www.cancer.org, here are the dietary guidelines to prevent cancer:

  • Be as lean as possible throughout life without being underweight.
  • Avoid excess weight gain at all ages. For those who are overweight or obese, losing even a small amount of weight has health benefits and is a good place to start.
  • Choose foods and drinks in amounts that help you get to and maintain a healthy weight.
  • Limit how much processed meat and red meat you eat.
  • Eat at least 2½ cups of vegetables and fruits each day.
  • Choose whole grains instead of refined grain products.
  • Avoid alcohol or drink no more than 1 drink per day for women or 2 per day for men.

T. Colin Campbell, PhD distills his 30 years of research on cancer and diet in “The China Study”. He concludes that a vegan diet minimizes the risk of all types of cancers as well as many other types of health risks.

For Physical Activity, American Cancer Society recommendation is for cancer prevention:

  • Exercise:
    • Adults: Get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week.
    • Children and teens: Get at least 1 hour of moderate or vigorous intensity activity each day, with vigorous activity on at least 3 days each week.
  • Limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment.

Doing some physical activity above usual activities, no matter what one’s level of activity, can have many health benefits.

  1. Finding cancer or precancerous conditions early. Precancerous conditions are conditions that may become cancer.

Then there is the matter of “early detection and early cure.”

Cancer is a group of diseases that can cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects the organs or tissues. If a cancer has spread (metastasized), signs or symptoms may appear in different parts of the body.

 Treatments work best when cancer is found early – while it’s still small and is less likely to have spread to other parts of the body. This often means a better chance for a cure, especially if the cancer can be removed with surgery.

A good example of the importance of finding cancer early is melanoma skin cancer. It can be easy to remove if it has not grown deep into the skin. The 5-year survival rate (percentage of people who live at least 5 years after diagnosis) at this early stage is around 98%. Once melanoma has spread to other parts of the body, the 5-year survival rate drops to about 16%.

Some symptoms, such as tiredness or coughing, are more likely caused by something other than cancer. Symptoms can seem unimportant, especially if there’s a clear cause or the problem only lasts a short time. In the same way, a person may reason that a symptom like a breast lump is probably a cyst that will go away by itself. But no symptom should be ignored or overlooked, especially if it has lasted a long time or is getting worse.

Most likely, symptoms are not caused by cancer, but it’s important to have them checked out, just in case. If cancer is not the cause, a doctor can help figure out what the cause is and treat it, if needed.

These days it is not that difficult to get one’s genome mapped and find out any cancer syndromes that might be present and actively take the necessary preventative actions.

The American Cancer Society recommends these cancer screening guidelines for early detection of cancer  for most adults. Screening tests are used to find cancer before a person has any symptoms.

  1. Chemoprevention (medicines to treat a precancerous condition or to keep cancer from starting).

Chemoprevention is the use of substances to lower the risk of cancer, or keep it from recurring. The substances may be natural or made in the laboratory. Some chemopreventive agents are tested in people who are at high risk for a certain type of cancer. The risk may be because of a precancerous condition, family history, or lifestyle factors.

Some chemoprevention studies have shown good results. For example, selective estrogen receptor modulators (SERMS) such as tamoxifen or raloxifene have been shown to reduce the risk of breast cancer in women at high risk. Finasteride and dutasteride have been shown to reduce the risk of prostate cancer.

Bottomline

Cancer is a genetic disease that may be the result of either mutated inherited genes or the ones occur later due to health, lifestyle and environment issues.  Only about 5 to 10% of the risk of cancer is due to mutated inherited genes.

Yes, healthy lifestyle choices we have been discussing in other blog posts do lead to decreasing the chances of cancer.  To minimize the risk of cancer:

  1. Be of Lean weight
  2. Eat clean with lots of fruits and vegetables and only sparing amount of white meats
  3. Avoid the use of alcohol or tobacco
  4. Avoid second-hand smoke, pesticides and other environmental carcinogens
  5. Stay active and exercise
  6. Get regular checkups and screening tests
  7. In case of any signs or symptoms, get a quick check up to rule out any cancerous or precancerous condition.

 

Your thoughts on this subject?

Would love to hear, learn and share information.

If possible, please do leave comment in the blog itself, so others can share and learn.

#47 – What does optimal dental health look like and how to achieve it?

06 Sunday Dec 2015

Posted by in Living to 120, Optimal Health, Uncategorized, Vitality, wellness

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A couple of years ago, during one of my regular visits to my dentist, I told him that my goal is to live to 120 and wanted to make sure that my teeth will last and stay healthy until then.

He immediately turned to me hygienist and said, “Dr. Thareja here has just given us permission to challenge him to do everything he needs to do for optimal dental health.”

Now I was 35 years old when I visited a dentist for the first time. You see, I grew up in India. My parents taught me that all I needed to do was brush my teeth every day and my teeth will be just fine. But something bothered me all the time.  Both my parents had lost most of their teeth when they were in their forties. They had gotten the last few pulled out so that they could get fitted with dentures.

Turning 35, even though nothing was hurting, I realized that I did not cherish the thought of having dentures in my forties.  Hence the first visit to the dentist.

The dentist was surprised to learn that I had never seen a dentist until that day.  He did a thorough cleaning. Although there was bleeding and pain during the cleaning, there were really no issues – no cavities, no gum disease etc. He told me to regularly brush and floss.

I bought floss and tried it for a few times. I did not really know how to do the flossing or what good it was doing. I did a little bit of reading, but gingivitis, tartar, gum disease, plaque these words did not seem to make any sense to me. So, I stopped flossing and went back to just brushing my teeth. And, continued with my once a year visit with the dentist.

Few years later, a dentist moved into our office building it. I decided to try him out.  My very first visit with Dr. Doug Drewyer’s office was quite different. He asked me that they would like to measure my gum separation before doing the cleaning. After the hygienist had done the measurements, Dr. Doug explained the significance of the measurements. He showed me that for certain teeth gums had separated much more. And, that was not good.

My next question was obvious: What could I do to prevent this gums separating from the teeth?  He told me the key was flossing. Since with flossing, you scrape off any plaque that might cause gums to inflame, lose vitality in the tissue and start separating from the teeth and eventually result in teeth falling out – even when the teeth themselves are healthy.

So then it finally made sense to me: So that’s how my parents lost their healthy teeth even when they were brushing every day!! 

Initially, Dr. Doug told me to floss just twice a week and then three times a week and then every day.  I later learned that he was taking this incremental approach to not overwhelm me.  His experience is that if he tells patients to floss every day on the first visit, very few are able to do that.

You may have heard the dentist joke.  Someone asks his dentist, “Which teeth should I floss?”  Dentist’s snap answer, “Only the ones you want to keep!”

Researching for this blog, I found a website called Mouth Healthy, sponsored by American Dental Association. It has a lot of very user-friendly information that explains all those things that I was trying to learn 15 to 20 years ago. And, if you are not familiar with these basis terms, here is a quick overview:

Your teeth are covered with a sticky film called plaque that can contribute to tooth decay and gum disease. Plaque contains bacteria, which following a meal or snack containing sugar can release acids that attack tooth enamel. Repeated attacks can cause the enamel to break down, eventually resulting in cavities. Check out these fascinating (or disgusting?) pictures of plaque attack close up.

Cavities, or tooth decay, is the destruction of your tooth enamel, the hard, outer layer of your teeth. It can be a problem for children, teens and adults. Plaque, a sticky film of bacteria, constantly forms on your teeth. When you eat or drink foods containing sugars, the bacteria in plaque produce acids that attack tooth enamel. The stickiness of the plaque keeps these acids in contact with your teeth and over time the enamel can break down. This is when cavities can form. A cavity is a little hole in your tooth.

Cavities are more common among children, but changes that occur with aging make cavities an adult problem, too. Recession of the gums away from the teeth, combined with an increased incidence of gum disease, can expose tooth roots to plaque. Tooth roots are covered with cementum, a softer tissue than enamel. They are susceptible to decay and are more sensitive to touch and to hot and cold. It’s common for people over age 50 to have tooth-root decay.

Decay around the edges, or a margin, of fillings is also common for older adults. Because many older adults lacked benefits of fluoride and modern preventive dental care when they were growing up, they often have a number of dental fillings. Over the years, these fillings may weaken and tend to fracture and leak around the edges. Bacteria accumulate in these tiny crevices causing acid to build up which leads to decay.

Decay can also be the result of dry mouth, which can be caused by certain medication or other health issues.

Plaque that is not removed with thorough daily brushing and cleaning between teeth can eventually harden into calculus or tartar. This makes it more difficult to keep your teeth clean. When tartar collects above the gum line, the gum tissue can become swollen and may bleed easily. This is called gingivitis.

Gingivitis is the early stage of gum disease. Gum disease, also known as periodontal disease, is an infection of the tissues that surround your teeth, and is caused by a buildup of plaque. In its early stages, symptoms may include:

  • gums that bleed easily
  • red, swollen, tender gums
  • bad breath

Some factors that can put you at higher risk of developing gingivitis include:

  • poor dental care
  • smoking or chewing tobacco
  • genetics
  • crooked teeth that are hard to keep clean
  • pregnancy
  • diabetes
  • medications, including steroids, certain types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives

Take care of your gums…help your heart?

The American Heart Association published a Statement in April 2012 supporting an association between gum disease and heart disease. The article noted that current scientific data do not indicate if regular brushing and flossing or treatment of gum disease will decrease the incidence, rate or severity of the narrowing of the arteries (called atherosclerosis) that can lead to heart attacks and strokes. However, many studies show an as-yet-unexplained association between gum disease and several serious health conditions, including heart disease, even after adjusting for common risk factors.

You may have seen health and lifestyle surveys used for estimating life-expectancy that want to know if you floss daily. If you do the models give you credit for an extra 2 to 4 years of life.

You may have seen commercial or ads for chewing gum claiming better dental health from chewing gum.  What is that about? Saliva, or spit, plays a significant role in maintaining oral health. It is derived from blood and acts as the bloodstream of the mouth. What this means is, like blood, saliva helps build and maintain the health of soft and hard tissues. When saliva flow is reduced oral health problems such as tooth decay and other oral infections can occur. Chewing is the most efficient way to stimulate salivary flow. It causes muscles to compress the salivary glands and release saliva. Saliva

  • Washes away food and debris from teeth and gums
  • Helps moisten and break down food to ease swallowing and enhances ability to taste
  • Provides disease-fighting substances throughout your mouth to help prevent cavities and other infections
  • Helps keep the surface of your teeth strong by providing high levels of calcium, fluoride and phosphate ions at the tooth surface.

Bottom Line

So, when I asked Dr. Doug to tell me everything I need to do to have my teeth until 120, he incrementally added a suggestion of using tiny gum brush to catch plaque that floss might not catch. But other than that he reinforced the same things that he has told me before – which is very consistent with everything I have learned through my research.

You can help prevent tooth decay, cavities, gum disease etc. and keep healthy teeth for life by following these tips:

  1. Brush twice a day with fluoride toothpaste.
  2. Clean between your teeth daily with floss or interdental cleaner.
  3. Eat nutritious and balanced meals and limit snacking.
  4. Check with your dentist about the use of supplemental fluoride, which strengthens your teeth, and about use of dental sealants (a plastic protective coating) applied to the chewing surfaces of the back teeth (where decay often starts) to protect them from decay.
  5. Visit your dentist regularly for professional cleanings and oral examination.

And, if you are not sure how exactly to floss, here are instructions from National Institute of Dental and Craniofacial Research: PLAQUE: What it is and how to get rid of it.  You will notice that NIH also recommends brushing (or scraping) tongue in addition to the teeth.

I can tell you from my experience that the above list of five steps works. These days my twice annual dentist cleaning visits are basically cleaning stains and some scarping and very little, if any, pain, bleeding or discomfort. And, it has been getting better over time.

What are your thoughts and experience on maintaining optimal dental health?

I would love to learn from you.

Post #31 – What supplements to take for Optimal Health?

04 Sunday Jan 2015

Posted by in Functional Medicine, Nutrition, Optimal Health, Optimal Nutrition, Supplements

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On June 8, 2014, I wrote a blog post #15, “Is taking multivitamin and supplements helpful, harmless or harmful?” There I described my thinking on this subject and what I was taking at that time as supplements. Back then I was taking supplement in 29 pills. These days, it is up to 42 pills! So, to anyone watching, it must feel a little more than crazy.

Over the holidays, when family and friends saw me take all those supplement pills, I kept getting these questions:

“What are all these pills you are taking?”

Do you need all these supplements?

Is it even safe to take all these on a daily basis?

Finally, I pulled out my bag of supplements and gave them the full tour. I particularly wanted to hear my niece’s opinion, who is a cardiologist, to understand if I was doing anything wrong.

So, I thought this was a good topic to revisit.

Here is what I am taking these days and why, and a little background how I got there. The following chart summarizes the supplements, their brand names and generally what there are for.

No. Vendor Name Description # Pills per Day
1.

 

 Xtendlife Total Balance Men’s Premium Daily multivitamins, minerals. It also have many other items generally considered beneficial 7
2. Xtendlife Omega 3/ QH Ultra Fish Oil, Omega 6, Omega 9, Ubiqunol 4
3. Nature’s Bounty Flaxseed Oil 1200 mg each Flaxseed Oil 2
4. Nature’s Bounty D3-2000 2000 mg each Vitamin D3 2
5. LifeExtension Glucosamine / Chondroitin Glucosamine Sulfate and Chondroitin Sulfate – for joint health 2
6. NOW Calcium Citrate

250 mg calcium each

 Along with Vitamin D, Manganese, Zinc, Copper and Magnesium required for absorption – for bone health 2
7. Nature’s Plus Red Rice Yeast

600 mg each

 To manage cholesterol 2
8. Xtendlife Male Rejuvinator For prostate health 6
9. Life Extension Super Miaforte For Low T 4
10. RAW Probiotics Ultimate Care-100 Billion Garden of Life 34 different strains of bacteria 1
11. VitaminShoppe B-Complex 50 All B Vitamins – recommended by Genova Diagnostics 1
12. Life Extension Optimized Folate

L-Methylfolate 1000 mg

 Metabolically active form of folic acid -– recommended by Genova Diagnostics 1
13. MethylCobamin Vitamin B-12 1mg Recommended by Genova Diagnostics 1
14. SOLGRID Chelated Molybdenum Recommended by Genova Diagnostics 1
15. VitaminShoppe Alpha Lipoic Acid 100 mg Recommended by Genova Diagnostics 1
16. KAL Magnesium 400mg each Recommended by Genova Diagnostics 1
17. VitaminShoppe CoQ-10

200 mg

 Additional amount for allergies and liver support 1
18. VitaminShoppe NAC N-Acetyl-L-Cysteine 600mg For hay fever/ rag weed allergies and liver support 2
19. VitaminShoppe Milk Thistle extract 300mg For hay fever/ rag weed allergies and liver support 1

Here is the story of how I got to my current 42 pills a day regime.

I started with the daily multivitamin.

That is the most basic. I know that many people, including some of the physicians I have had, believe that it is best to get the basic vitamins and minerals “in a natural way”. I guess that means from what we eat or drink. But doing the research on this topic I have decided that there isn’t much “natural” about our lifestyle.

Eating foods that include pizzas, fried ice creams, drinking caramel macchiatos, going through eating and dieting binges, living in temperature controlled houses and offices, using gadgets and gizmos for everything, rushing to doctors for prescription for every symptom, I am not sure what it really means to get nutrients that body needs in a “natural way”. And, with all the technology that we use to grow our food these days, even fruits and vegetable can hardly be called “natural”.

Any doctor will tell you, yes if you are deficit in any of the basic vitamins and minerals, you can develop health issues. The way I look at it, why would I want to chance having deficit of any of these essential items? So, as far as I am concerned, daily dose of all essential vitamins and minerals is a must.

My search for the best multivitamin in the marketplace led me to Xtendlife. And, as you can see in this table below, their super-duper multivitamin product is Total Balance Men’s Premium – which includes lots of other well-known herbs and molecules in additional to the essential vitamins and minerals. So, that is what I have been taking. In the table, each underscored item is a hyperlink to the detail about that item on Xtendlife’s website. In many cases, hyperlink shows the literature they have used to determine the daily optimal dose, which in some cases you will notice is much more than 100% for USDA recommended daily allowance (RDA).

Supplement Facts (Total Balance Men’s Premium multivitamin) Serving size: 7 Tablets Servings per container: 15
Amount Per Serving % Daily Value*
Calories 25
     Calories from fat 5
Vitamin A 5000 IU 100%
(from Natural mixed carotenoids)
Vitamin C 285 mg 480%
(from 180 mg of Calcium ascorbate, 200 mg of Potassium ascorbate and 40 mg of  Ascorbyl palmitate)
Vitamin D3 500 IU 130%
(as Cholecalciferol)
Vitamin E 100 IU 330%
(as D-Alpha tocopheryl succinate from vegetable and soy bean oils 1 mg = 1.21 IU)
Vitamin K2 180 mcg 230%
(as Menaquinone)
Thiamin 10 mg 670%
(from 14 mg of Thiamin hydrochloride)
Riboflavin 10 mg 590%
(from 21 mg of Riboflavin-5-phosphate)
Niacin 27 mg 140%
(from 15 mg of Nicotinic acid, 15 mg of Niacinamide and 0.97 mg Chromium nicotinate)
Vitamin B6  8mg 400%
(from 12 mg of Pyridoxal-5-phosphate)
Folic Acid 300 mcg 80%
Vitamin B12  25 mcg 420%
(as Cobamamide)
Biotin 400 mcg 130%
Pantothenic acid 41 mg 410%
(from 48 mg Calcium pantothenate)
Calcium 50 mg 6%
(from 90 mg of Dicalcium phosphate, 180 mg of Calcium ascorbate, 60 mg of Calcium magnesium inositol hexaphosphate and 48 mg of Calcium pantothenate)
Phosphorus 28 mg 4%
(from 90 mg of Dicalcium phosphate, 60 mg of Calcium magnesium inositol hexaphosphate, 21 mg of  Riboflavin- 5-phosphate and 12 mg of Pyridoxal- 5-phosphate)
Iodine 150 mcg 100%
(from 197 mcg Potassium iodide)
Magnesium 67 mg 20%
(from 200 mg of Magnesium citrate, 102 mg of Magnesium stearate and 60 mg of Calcium magnesium inositol hexaphosphate)
Zinc 19 mg 130%
(from 33 mg of Zinc acetate dihydrate and 31 mg of Zinc citrate)
Selenium 100 mcg 140%
(from 250 mcg of L-selenomethionine)
Copper 0.2 mg 10%
(from 1.43 mg of Copper gluconate)
Manganese 2 mg 100%
(from 8 mg of Manganese citrate)
Chromium 106 mcg 90%
(from 970 mcg of Chromium nicotinate)
Molybdenum 64 mcg 90%
(from 163 mcg of Sodium molybdate)
Potassium 74 mg 2%
(from 200 mg of Potassium ascorbate, 100 mg of Tripotassium citrate and 0.197 mg of Potassium iodide)
RNA 150 mg **
(Ribonucleic acid, from yeast)
Green tea extract 100 mg **
(from Camellia sinensis, leaf)
(providing 80 mg of catechins)
Milk thistle extract  100 mg **
(from Silybum marianum, seed)
(providing 80 mg of silymarins)
Soy lecithin 100 mg **
(a source of Phosphatidyl choline)
Betain HCL 99 mg **
MSM 99 mg **
(Methylsulfonyl methane)
Choline bitartrate 93 mg **
DMG HCL 90 mg **
N-acetyl glucosamine  79 mg **
(from Crustacean shells)
Hesperidin 78 mg **
(from Citrus aurantium (Bitter orange) fruit)
N-acetyl L-cysteine 74 mg **
Horsetail extract 60 mg **
(from Equisetum arvense, stem & leaf)
Inositol 59 mg **
(from 50 mg of Inositol and 60 mg of Calcium magnesium inositol hexaphosphate)
SAMe 51 mg **
(from 98 mg S-adenosylmethionine tosylate)
Alpha lipoic acid 50 mg **
Bacopa extract 50 mg **
(from Bacopa monnieri, leaf)
(providing 15 mg of bacosides)
Black cumin extract  50 mg **
(from Nigella sativa, seed)
(equivalent to 190 mg of Black cumin seeds)
Ginger extract 50 mg **
(from Zingiber officinale, root)
(providing 2.5mg of gingerols)
Ginkgo extract 50 mg **
(from Ginkgo Biloba,leaf)
(providing 12.5 mg of ginkgo flavonoglycosides and 3 mg of terpene lactones)
Guggul gum extract 50 mg **
(from Commiphora mukul, gum exudate)
(providing 1.25 mg of guggulsterones)
PABA 50 mg **
(p-Aminobenzoic acid)
Pine bark extract  50 mg **
(from Pinus massoniana, bark)
Turmeric extract 50 mg **
(from Curcuma longa, root)
(providing 47.5 mg of curcuminoids)
5-Hydroxytryptophan  49 mg **
(from Griffonia simplicifolia, seed)
Myricetin 49 mg **
(from 70 mg of Myrica cerifera (Bayberry), leaf)
Grape seed extract  30 mg **
(from Vitis vinifera, species)
(providing at least 450 mg/g phenolics)
Mineral sea salts 30 mg **
(providing trace elements including strontium, tungsten and rubidium)
Piperine 28 mg **
(from 30 mg of Piper nigrum extract (Black pepper), fruit extract)
Trans-resveratrol 25 mg **
(from 50 mg of Japanese knotweed (Polygonum cuspidatum), root)
Isoflavones 20 mg **
(from 50 mg of Soybean extract)
Coenzyme Q-10  19 mg **
Luteolin 18 mg **
(from Arachis hypogaea (Peanut), shell)
Alfalfa extract  10 mg **
(from Medicago sativa, aerial parts)
(equivalent to 110 mg of fresh alfalfa)
Phosphatidyl L-serine  9 mg **
(from 50 mg of Soybean lecithin)
Policosanol 8 mg **
(from 17 mg of Sugar cane extract)
Red clover extract  7 mg **
(from Trifolium pratense, aerial parts)
(providing 2.5 mg of isoflavones)
ATP 5 mg **
(Adenosine triphosphate, from Yeast)
Tocotrienol/tocopherol complex 2 mg **
(from 10 mg of Tocomin® (from Palm tree oil))
Vinpocetine 2 mg **
(from Criocerus longiflorus, whole plant)
Boron 720 mcg **
(from 12 mg of Boron citrate)
Amino Acid Blend
L-lysine HCL 164.00 mg **
L-carnosine 148.50 mg **
L-tyrosine 100.00 mg **
L-arginine HCL 90.00 mg **
L-methionine 89.55 mg **
L-ornithine HCL 50.00 mg **
L-proline 50.00 mg **
L-cysteine 49.75 mg **
L-glutamine 49.75 mg **
L-pyroglutamic acid 49.75 mg **
Taurine 49.25 mg **
(Reduced) L-glutathione 49.00 mg **
Male Health Support Blend
Phytosterols 190 mg **
(from 200 mg Soybean extract)
Saw palmetto extract  160 mg **
(from Serenoa repens fruit)
(providing 40 mg of fatty acids)
Nettle extract 100 mg **
(from Urticae dioica root)
Chrysin 99 mg **
(from Oroxylum indicum bark)
Zinc acetate dihydrate 33 mg **
Lycopene 99 mcg **
(from 15 mg of Tomato extract)
Enzyme Blend
Bromelain 50 mg **
(from Pineapple stem)
Nattozimes® 50 mg **
(Protease from fermentation of Aspergillus oryzae & Aspergillus melleus)
Amylase 30 mg **
(from fermentation of Aspergillus oryzae)
Lipase 20 mg **
(from fermentation of Aspergillus niger)
Immunity Stimulating Blend
Aloe vera  50 mg **
(from Aloe barbadensis leaf juice powder)
(equivalent to 10,000 mg of Aloe leaf juice)
Olive leaf extract  50 mg **
(from Olea europaea, leaf)
(providing 7.5 mg of oleuropein)
Beta glucan 35 mg **
(from yeast)
Tea polysaccharides 12 mg **
(from 50 mg of Camellia sinensis leaf)
Eye Health Blend
Bilberry extract 40 mg **
(from Vaccinum myrtillus fruit)
(providing 10 mg of proanthocyanins and anthocyanins)
Rutin  9 mg **
(from Saphorae japonica bud)
Lutein  2.4 mg **
(from 50 mg of Aztec marigold flower)
Astaxanthin 800 mcg **
(from 40 mg of Haematococcus pluvialis)
Zeaxanthin 475 mcg **
(from 10 mg of Aztec marigold flower)

I had started taking Vitamin D-3, several years ago, when my routine blood work showed deficiency. Statistics show that over 70% of people living in Northern hemisphere are deficient in Vitamin D-3. There are over 500 different genes that Vitamin D can switch on and off. And, every single cell in our body has a receptor for Vitamin D. Looks like a must supplement to me! Two pills a day of Nature’s bounty 2000mg per day is the dose I have chosen.

Next must for me after the multivitamins and Vitamin D is Omega 3. I have been taking both based on Fish Oil and Flax Seed Oil. Again, I found Xtendlife Omega 3 as the best product in the market. I have chosen to take to their super-duper product, Ultra QH, which in additional to Omega 3, contains Omega 6, Omega 9 and Ubiqunol. For flax seed oil, I selected Nature’s Bounty product. There are different recommendations on minimum vs. optimal. I have settled on four pills of Ultra QH and 2 pills of flax seed oil.

To these I added Glucosamine Sulfate and Chondroitin Sulfate for joint health. Most primary physicians are recommending these for over-50 patients for joint health. Add to that Calcium Citrate for bone health (again physicians recommend these routinely for over-50 patients, especially women).

When I told my physician that I wanted to get off Lipitor and demonstrated to him that with exercise and nutrition I had gotten to within striking range of the target of 100 for LDL, he recommended Red Rice Yeast as “natural statin”. In the last two tests, my LDL has been 90 and 88. So, I am keeping on with Red Rice yeast.

My primary physician had recommended Saw Palmetto for prostate health. I found a good formulation, at VitaminShoppe of Saw Palmetto & Pygeum Complex. That worked well for me. Then I found even a better formulation, Male Rejuvinator at Xtendlife.

Early last year, I did a full hormone panel of tests and found that my Testosterone was quite low. In my search for supplements to rebuild Testosterone, I came across a formulation called Super Miaforte from Life Extension. I have been taking Super Miaforte for about nine months now. Follow up test results for Testosterone have been very encouraging so far.

So, in the middle of last year, I made an appointment with University of Maryland Medical Center, School of Integrative Medicine clinic. There I met with Dr. Lauren Richter, a functional medicine specialist. I told her my objective of purposely living to 120, discussed my lifestyle, showed her all the supplements I was taking and posed to her this question: So, what supplement should I take for an optimal health?

Instead of looking at me cross-eyed, she said that she (and functional medicine specialists) has a very specific approach to figuring out the optimal nutrition in-take. She recommended that I go through blood/urine test called NutrEval FMV by Genova Diagnostics. The tests involve looking at a large number of metabolic biomarkers, and then as a result, deducing very specific recommendations about supplements for optimal health.

Test results pointed out high need for me for the entire B-complex (Thimain -B1, Riboflavin -B2, Niacin-B3, Pyridxine-B6, Biotin-B7, Folic Acid -B9, and Cobalamin-B12), Magnesium and need for me to add Vitamin C, alpha-Lipoic Acid, Molybdenum and Zinc and Probiotics to what I was already taking. Results contained very specific quantities for these. Dr. Richter reviewed what I was already taking and told to me to continue taking those.

Finally, when I discussed with Dr. Richter, my past history of hay fever/allergies, which had re-emerged for a couple of weeks at the beginning of this past fall, she recommended I take Milk Thistle, up the quantity of CoQ10 and add N-Acetyl-L-Cysteine (NAC) 600mg –all in support of the liver.

So, at that point, I added these recommended supplements to my regime.

I have been doing this full regime faithfully now for about five months. I definitely have had more energy than before. I have not really experienced any side effects so far.

So, there you have it – full story of my supplement regime.

What do you think?

What is your practice/experience/research on supplements?

I would love to hear.

Post #13 – Ever heard of Functional Medicine?

27 Tuesday May 2014

Posted by in Aging, Functional Medicine, Living to 120, Reversing Chronic Diseases, Vigor, Vitality

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In my previous blog posts, I have talked about curing my allergies, fixing migraines, and curing a whole host of other issues without pharmacological medicines. Yes, actually curing these issues and not just managing or controlling the symptoms.

For the longest amount of time, I found it difficult to talk about to these things with my physicians or even lay people. I must admit it all sounded so much like woo doo even to me as I would talk about it. A common refrain from doctors was, “We only practice evidence based medicine.” I did not know what to believe or not believe, except that from my personal experience (evidence of n=1), I could prove that these things work.

All that changed, when last year Kimberly and I attended the Health and Wellness Conference 2013 at the University of Maryland, School of Medicine at the Center of Integrative Medicine in Baltimore, Maryland. There we heard talks about yoga, Qi Gong, nutrition, meditation, detoxing, and many other so called “alternative” therapies in the setting of Evidence Based Medicine.

Key note speaker was Mark Hyman, MD. He has a private practice Ultra Wellness Center in Massachusetts. He wrote a book, The Blood Sugar Solution, which received endorsement from President Bill Clinton. He talked about the diagnosis and cure of Diabesity, a term he has coined as combination of diabetes and obesity. And, he talked about diabesity in the context of what he called Functional Medicine.

Since then I have studied up quite a bit on Functional Medicine and I do believe that many of my conversations in my blog posts fit in that framework. More I dig into this topic the more entranced I am getting with this topic. I feel that functional medicine is the key to the kingdom, when it comes to wellness, vitality and living the optimal health span and life span.

Jeffrey Bland, Ph.D. is considered “father” of this field. Mark Hyman calls him his mentor. Among Bland’s other accomplishments, he has founded Personalized Lifestyle Medicine Institute and The Institute for Functional Medicine. Recently, he has written a book, “The Disease Delusion, Conquering the Causes of Chronic Illness for a Healthier, Longer, and Happier Life.”

Institute for functional medicine describes functional medicine as follows:

“Functional medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms. Functional medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, functional medicine supports the unique expression of health and vitality for each individual.”

So, the basic idea of functional medicine is to take a systems approach to disease and wellness rather than either chasing symptoms or taking germ theory approach that generally focuses on single point of correction. In his book, Jeffrey Bland talks of seven different systems for our bodies:

  1. Assimilation and Elimination
  2. Detoxification
  3. Defense
  4. Cellular Communication
  5. Cellular Transport
  6. Energy
  7. Structure

So the objective in functional medicine is to investigate symptoms to pinpoint one or more of these seven systems that are not working properly and then to change diet, exercise and lifestyle to fix the system imbalance and thereby the diseases and the symptoms.

The end result is often pretty low tech, and may seem underwhelming. That is, implement changes in diet, exercise and lifestyle to redirect expression of certain genes to cure a disease.

However, approach to getting there can be fairly high-tech in identifying the true root cause, identifying the systems that are out of balance and gene expressions that may be responsible for the underlying imbalance. And, as you see from the stories, results can be very profound and almost magical.

If you know someone, who is being treated for certain symptoms of chronic diseases by meds. e.g., high blood pressure, obesity, brain fog, constant fatigue, high cholesterol, inflammation, muscle aches, etc..  The meds being used often lead to side effects that need to be treated by other meds, which in turn are causing other side effects etc.. Such a person is the perfect candidates for functional medicine.

Have you heard of functional medicine?

Do you have any experience with functional medicine?

I have been looking for good certified functional medicine practitioners in our area that we could consult and also recommend to our friends and family. We have access to some lists, but no personal experience yet. Do you know of such a practitioner?

I would love to learn if you know someone.