Tuesday, January 31, 2012

Integrative Recommendations for Rheumatoid Arthritis

An integrative approach to autoimmune illness, including rheumatoid arthritis, includes general measures to reduce inflammation in the body.  Simultaneously reducing stress and improving stress management maximizes your healing response and can help reduce flares, because stress is expressed as inflammation in the body.

Mind- Body Techniques
Meditation is highly recommended for all patients with severe generalized inflammation. Consider enrolling in a Mindfulness Based Stress Reduction program, or learning vipassana meditation. Mindfulness has been shown to measurably reduce salivary cortisol and plasma DHEAS (“Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS)….Carlson et al, Psychoneuroimmunology 2004.
Relaxation exercises and the development of improved methods to cope with stress are also believed to be helpful, through the use of Tai Chi, Yoga, or a similar body based meditative practice. 
Reflective or disclosure journaling is helpful, particularly writing regarding emotionally charged events in your life. 

Removing toxins
Eliminate coffee and tobacco.  Make alcohol are rare treat, if at all. Consider elimination of commonly offending foods, with or without IgG food sensitivity testing.  Dairy, wheat, citrus, and nuts are common culprits.  Total elimination of suspected foods from your diet for three weeks followed by reintroduction of each food separately may be revealing.
Shift to an organic based diet, including dairy, eggs, and meat products.  At least avoid the more pesticide laden foods – see foodnews.org to learn which foods are more important to get organic. Limited research suggests a substantial improvement for some people with rheumatoid arthritis with a change to a vegan diet.  Improvement is seen only after several months.

Increase omega-3 fatty acid intake by eating more cold water fish, adding ground flaxseeds, or fish oil.  See www.ewg.org/node/15436 for information to help you avoid excessive mercury exposure. Consider the recommendations of the anti-inflammatory diet and gradually incorporate as many of these as make sense to you. 

Helpful for many people with Rheumatoid Arthritis; less likely to be beneficial for those taking corticosteroids such as prednisone.

Fish oil supplements are recommended.  Look for high quality brands like Nordic Naturals or Carlsons.  Determine your dose not by the total amount shown on the front of the bottle, but with the sum content of DHA plus EPA.  Start with a daily dose of 1000 mg  of DHA + EPA, and increase every five days or so until you take a total of 25 mg DHA and 15 mg EPA / lb of body weight, or 3-5 g/day, ideally split between morning and evening doses, with food.
GLA (Gamma Linolenic Acid), as GLA 1.4-2.8 gm/day) or Evening Primrose Oil (12-22 gm/day). Start two weeks after beginning fish oil, and use ONLY IF TAKING MODERATE DOSE OF FISH OIL AS WELL!
Vitamin D, 2000 IU/day or as indicated by testing.
Calcium 1000 mg daily, ideally as Ca Citrate
Magnesium 400 – 750 mg daily, as tolerated.
Selenium 100 mg  (not to exceed 400 microgram/day) and less if you eat many nuts (one brazil nut provides an average of 100 micrograms of selenium.)
AND PERHAPS: Vitamin C, 250 mg twice daily.

Botanicals:  (each are included in the supplement Zyflamend)
Ginger, starting with 1 gm twice daily, increasing weekly up to total of 2 gm twice daily. Turmeric, ½ gm twice daily, increasing to 1 gm twice daily.  To absorb it, cook it must be cooked in oil.

A personalized well balanced exercise program has numerous and significant benefits.

Avoid herbal supplements that stimulate the immune system, such as Echinacea, Astragalus, Alfalfa Sprouts, Iron, St. Johns Wort. Alfalfa sprouts contain the amino acid L-canavanine, which can stimulate the immune system in people with lupus and increase inflammation. Other legumes are safe to eat as they have a much lower concentration of L-canavanine.  It’s probably best to also avoid iron unless you are anemic and iron deficient.  (Keep in mind some menstruating women will need appropriate doses of iron to prevent anemia.)  St. John’s Wort can cause many other medicines to be less effective.

As recommended by your rheumatologist.

Post Authored by : 
Georgia Tetlow, MD
Clinical Assistant Professor of Rehabilitation Medicine, Thomas Jefferson Medical College
Phone: (888) 702-7974
Email: info@beingmybestself.com
Website: www.beingmybestself.com

Sunday, January 29, 2012

What to do if you suspect your teen is using drugs or alcohol - by Wendy Sunderlin

Despite all of your efforts to keep your kids drug-free, one day you might suspect that your son or daughter is using drugs or alcohol. By the end of eighth grade, approximately 50% of adolescents have had at least one drink and more than 20% report having been “drunk” (American Academy of Pediatrics). Drug and alcohol use increases chances of addiction and it can change the developing brain.

One thing remains true, parents are the most influential people on a teen’s decision about drug use. So what are the facts? Substance use (including alcohol) can change the direction of a young person’s life physically, emotionally, and behaviorally. It can weaken the ability to concentrate and retain information, impair judgment, lead to risky behaviors, and cause poor decision making.

Parents are sometimes afraid that they will push their teen away when talking to them about substance use. You may be worried that your child will get in trouble with the law and it will ruin his ability to qualify for scholarships or hold a job. The ultimate goals is to protect your child from harm and irreparable damages.

When you have your first suspicion that your teen may be using, what should you do?

Sit down in a place without distractions (yes, your teen should put down his/her cell phone) and  
talk with your child. Be sure to choose a time when you are calm and when there is plenty of time.
Tell your child what you see and/ or feel. Be specific about the things you have observed that have caused concern. Make it known if you have found any alcohol cans/bottles, drug paraphernalia, etc.
Explain exactly how their appearance or behavior has changed and why it concerns you.
Directly state your family rules on substance use. “In this family, we don’t smoke marijuana.” Then be clear on your house rules. Most importantly, FOLLOW THROUGH WITH OUTLINED CONSEQUENCES.
Be prepared for your teen to deny using any substances. Your child may get angry and try to change the subject. If you child asks you about your substance
use history, be honest and share the consequences you experienced.
Ask your child why he/she is using drugs or alcohol. Once you get a better idea of the situation, pressures, or motivation then you have a clearer direction of what to do next.
Do not deny any substance use is taking place with your teen.
Provide a safe, nonjudgmental person for your child to talk to. This could be a counselor, coach, grandparent, church leader, or another mentor.

For more information on talking to your teen about substances visit:

www.mayoclinic.com/health/teen- drinking
http://www.parentactionondrugs.org/ parentquestions.php

Your pediatrician or family doctor can be a great resource as well.

For more information and to read additional articles on teen trends and talking with teens, visit Wendy Sunderlin's TeenLifeTalks website at http://www.teenlifetalks.com/Resources_Newsletters.php

The Importance of Vitamin D - by Georgia Tetlow, MD

Vitamin D is inversely associated with risk of colorectal cancer. The higher your vitamin D level, the less likely you are to get cancer of the colon or rectum. Big news!!

A few years back, Dr. Freedman and colleagues studied 16,818 participants in the Third National Health and Nutrition Examination Survey (Freedman et al. 2007). Colorectal cancer mortality was found to be inversely related to vitamin D blood levels, with levels of 80 nmol/L or higher associated with a 72% risk reduction (95% confidence interval = 32% to 89%). Levels lower than 50 nmol/L supported the inverse relationship between 25(OH)D levels and colorectal cancer mortality—again—the higher the levels, the lower the cancer risk. Overall, a meta-analysis showed that in all five studies, a significant protective effect against developing colorectal cancer was conferred by vitamin D sufficiency. (Gorham et al. 2007)
Additional research is forthcoming regarding vitamin D’s important role in the prevention of breast, prostate and pancreatic cancer.

It’s important to get your vitamin D level tested, and essential to get repleted to the right level! Unlike integrative physicians, so many conventional physicians still underdose. Make sure your levels are appropriate for the upcoming winter months, when a higher dose of vitamin D is often needed.

Vitamin D Prevents Colorectal Cancer: Dose-Response Relationship. Gorham et.al. American Journal of Preventive Medicine Volume 32, Issue 3, March 2007, Pages 210-216.

Dr. Georgia Tetlow practices integrative medicine at The Resiliency Center. Visit www.beingmybestself.com, call 888-702-7974 or email info@beingmybestself.com.

Read other articles by Dr. Tetlow here:  [Insert link to: http://drgt-integrativemedicine.com/]

Nutritional Guidelines to Enhance Mood and Emotional Well-being by Joel Edman

While some of us recognize that when we eat better and take nutritional supplements our mood is better, for others this relationship may be difficult to evaluate. It also may be surprising to learn that there are actually several significant areas of research linking nutrition and mood.  As described below, nutritional factors influencing depression, for example, range from folate and vitamin D, to omega 3 fatty acids and hypoglycemia.  There are also a number of nutritional supplements that can be important and they will be described later as well.  As is always presented in this column, these approaches are most beneficial when they are applied within the context of an overall integrative medicine program that includes dietary guidelines, nutritional supplements, physical fitness, relaxation techniques and other modalities, and then a uniquely developed overall program is designed for each individual.
When describing nutritional influences on mood and other symptoms or problems, it is important to keep a couple of key points in mind.  The first is that a healthy diet should always be the foundation of a good nutritional plan.  Another way to say this is that you can’t make up for a poor diet by taking a lot of supplements.  Targeted nutritional supplements can then be included to add to the benefits of a good diet, producing an even better effect than each one would have had by itself.
Dietary Influences
There are several ways in which an imbalanced or poor diet can influence mood.    This can be particularly important when our diet is not as good as we would like it to be, but it can often be compounded by other problems such as significant stress (which may increase the requirement of specific nutrients), stomach or intestinal symptoms (which may weaken digestion and absorption of important nutrients and phytonutrients), aging effects, exposure to environmental insults, and/or other influences.
            One primary characteristic of diet is that it provides essential vitamins and minerals that serve as cofactors or facilitators for the production of specific neurotransmitters or brain signal molecules.  For example, the B complex vitamins (thiamine, riboflavin, pyridoxine, cobalamin and folate) help to make the neurotransmitters dopamine, serotonin, GABA and acetylcholine.  This understanding has led to the term “stress B-complex”, and a B-complex nutritional supplement is often recommended for people who have high levels of stress, or symptoms of depression and/or anxiety.
            The most well-documented influence for B complex vitamins has been found for folate and depression, although low levels of vitamin B12 can also be very important for  mood and other nervous system symptoms, and B12 deficiency or insufficiency is more common as we get older.  Some research suggests that the relationship between folate and depression may be more significant in men than women, and for recurrent depression more than a single depressive episode, yet it would be important to look at for everyone that has depression.  Since folate is found in healthy foods such as vegetables, whole grains, beans, and fruit which are suggestive of healthier dietary patterns, it may be difficult to separate out the influence of folate specifically vs. the diet in general.  However, there are other studies that have found that lower folate levels were associated with poorer response to anti-depressant medications (such as selective serotonin reuptake inhibitors -SSRIs) and that folate supplementation may produce more benefit than SSRI therapy alone in people with major depression. 
Another important dietary factor to discuss is that of healthy fats, specifically omega 3 fatty acids.  A recent major study suggested that omega 3 fatty acids had significant anti-depressive effects.  Although much of this research has looked at effects of supplemental fish oil, containing EPA and DHA, there is other research that has shown that lower dietary fish and omega 3 fatty acid intake and lower blood levels of omega 3 fatty acids are associated with different types of depression. 
The inclusion of healthy fat in the diet is likely beneficial in several ways including: (a) nervous system function; (b) anti-inflammatory effects – which occur with specific conditions and aging; (c) following a healthy dietary pattern which would be similar to a Mediterranean-type diet or vegetarian-based diet; and (d) helps to balance macronutrients (protein, healthy fat and complex carbohydrates) and therefore stabilize blood sugar.  These healthy omega 3 fatty acids or fats are primarily from specific types of fish (salmon, sardines, tuna, etc), flax seeds, soy products, nuts/seeds and dark green leafy vegetables).  While monounsaturated fats (primarily from olive oil, olives, nuts/seeds and avocado) are likely helpful too, there is little research at this time to support a relationship to mood.
The last dietary factor to discuss, yet perhaps one of the most important, is hypoglycemia or abnormal glucose tolerance/insulin resistance.  Although there has been little recent research, studies have suggested a significant relationship between depression, and abnormal glucose metabolism and/or insulin resistance.  One study found significantly higher blood sugar levels, greater glucose responses during an oral glucose tolerance test (OGTT), larger insulin responses during the OGTT, and insulin resistance in people with depression.  Symptoms of hypoglycemia include fatigue, headaches, depression, anxiety, heart palpitations, irritability before meals and possibly other symptoms.  Causes of hypoglycemia include excessive sugar and refined carbohydrate intake, missing meals, excessive coffee or caffeine intake, inadequate dietary protein or fat (preferably healthy fat), significant stress and/or inadequate magnesium or chromium intake.
Nutritional Supplement Effects
            The use of nutritional supplements is an essential part of a nutritional program that can boost mood.  As already discussed, a B-complex supplement with good amounts of vitamin B12 and folate is important to take, although some good multivitamin and mineral supplements may work just as well since they would have the range of vitamins and minerals that are important, as well as about 25 to 50 mg of most B-complex vitamins.  A fish oil supplement is another important product to take to provide extra amounts of omega 3 fatty acids and insure therapeutic benefit.
            A third part of a foundation supplement program would be calcium, magnesium and vitamin D.  As we know calcium is helpful for bone density and bone strength, but it can also be beneficial for the nervous system.  Magnesium, which may be the nutrient that is most commonly deficient in the US, has a calming effect on the nervous system, helps with blood sugar regulation, and has other benefits for allergies, hormonal balance and heart functioning.  Finally, vitamin D has been found to be helpful for some people with seasonal mood fluctuations or season affective disorder (SAD) and vitamin D is also  frequently found to be deficient when a blood test is done.
            With regard to other supplements that could be helpful, there are many.  Probably the best researched products are S-adenosyl-methionine or SAMe, and the herb, St. John’s Wort.
SAMe is an amino acid that is a major factor needed in the production of several neurotransmitters and for nerve cell membranes.   There is actually extensive research spanning three decades to support its use.  Although the exact mechanism of action is unknown, there is enough clinical research and experience to suggest that SAMe is effective for many people.
While St. John’s Wort has been found very helpful for mild to moderate depression, its use in major depression is less clear.  It is also worth noting that there is significant potential for an interaction between St. John’s Wort and other medications since they are metabolized by the same liver enzymes.  It is therefore important to discuss these issues with your doctors and other healthcare practitioners.
As for other potentially useful supplements, it is not possible to describe them in detail, but they would include products such as 5-HTP, DHEA, inositol, supplements for sleep (for example, melatonin, valerian, etc.),  and some others.  To explore the use of these supplements it would be best to work with an experienced and effective group of integrative medicine practitioners.
Practical Approach
An overall integrative medicine approach is essential.  Since dietary changes and programs can be challenging, careful consideration should be given to what is possible for each individual.  Therefore, a reasonable diet or therapeutic diet should be combined with targeted supplements, stretching and exercise, relaxation techniques and other modalities. 
It is always helpful to get some blood testing done which can assess whether there are some imbalances or clinical/subclinical deficiencies or insufficiencies.  Validated common testing would include blood levels of vitamin B12, folate, and homocysteine, as well as other nutrient measures such as, 25 hydroxy vitamin D, and  red blood cell (RBC) magnesium and zinc.  Some tests commonly used by integrative medicine practitioners, but not well validated, are urinary panels for neurotransmitter metabolites, metabolic profiles, fatty acid profiles, detoxification profiles and others. 
             With regard to nutritional supplementation, one approach is to recommend a foundational program.  Such a program might include a comprehensive multivitamin and mineral complex, omega 3 fatty acids/fish oil and a calcium/magnesium/vitamin D supplement.  Additional targeted supplements could be focused on anti-depressive effects, anxiety, sleep, and/or other aspects of an individuals’ circumstances.  Through the combination of dietary guidelines and nutritional supplementation as well as other integrative modalities, good mood and emotional well-being will surely follow.

Monday, January 23, 2012

A Wave by Dean Solon

you sitting by the ocean, the waves rolling in, washing ashore, a few feet from your outstretching toes...
you swimming in the ocean, the waves rolling over you, washing you down...
you sitting, here, now, waves circulating and coursing through your body...
and you a wave, you the wave, splashing into the sand, and you the water receding back into the sea...

allowing an unfolding of intention, lightly...
allowing an unfolding of practice, lightly...
because this is not really about attaining anything,
because this is not really about achieving anything.

sitting...with the unexplainable, with the inexplicable, with the surprise, of breathing in and breathing out, of being with a body, with a mind, in a life, here and now.

sitting...with a pulsing, with a pervading, of awareness, of alertness, of your heart beating, of being here now.

here is the place
here is the place
now is the time

sit with this.  sit with this.
sitting with awareness of THIS, without attachment to THIS.
sitting with this...with this body, with this mind, with this life, with this breath.

here is the place
now is the time


Friday, January 13, 2012

2012 by Dean Solon

sitting with quiet...mindfulness, and mindlessness...with an openness to whatever is present, and presenting.

the guru-devotee, master-disciple, relationship still can be effective, and still has a place in our world;  yet this may be an age when it is becoming less necessary.  because, in this quickening and accelerating age we are living in, when anything and everything is changing at a breathtaking (and breath-giving) speed, and where information may be transmitted, exchanged, shared, in almost no time at all, the possibility of awakening is right here, right now.
       enlightenment is never more than a moment away.
each of us is mystery.  each of us is mastery.
each of us lives with a golden Buddha heart.
each of us has light streaming through us,
and each of us may see the light streaming in and through any and all others' eyes...hearts...minds.
       "blessings to the spiritual Master within"
yes, in this time---our time---the means of great destruction are readily available, and only a button-pushing-moment away.
AND yes, in this time, our time, the means of connection, of awareness and awakening, are only a heartbeat away.

perhaps, here now, in a passage of time referred to as 2012, we may understand an essence of the Buddha's teaching is not about becoming a buddha (an "awakened one");  it is about being a buddha...an awakened one.
       may this be the best year yet.

Thursday, January 5, 2012

Let’s Resolve to Have a Great Year – by DeliaTrapuzzano, MFT

Happy 2012! I am looking forward to experiencing loads of positive changes in this coming year.  My name is Delia Trapuzzano and I am thrilled to be a part of the healing professionals with their practices at the Resiliency Center.  I am a Marriage and Family Therapist.  I thoroughly enjoy working with children of all ages and their families.  Nothing gives me more joy than being a part of the process of enabling families to enjoy a harmonious family life.  Family Therapy is special because problems are never the fault of one person.  A family is a system and whenever the system goes haywire, everyone needs to pull together to be part of the solution.  Think about it.  If any one of us was stranded alone on a desert island, we wouldn’t have any problems (except for survival, of course).  No matter how bizarre a person’s behavior might be, it only comes to light because of the way other people are affected by it.  We are all intensely impacted by the people we live with.  This is why I find family therapy so fascinating.  A person might grow and make significant changes in his or her life but once they are back in their family system, they seem to revert to their old self.  Many people probably noticed that phenomenon when visiting family over the holidays.  It’s possible to ignore relational issues or hope things will get better, but if the patterns don’t change, chances are, the problems won’t go away by themselves.  Sometimes families need outside help to shine a light on the issues and show each person their role in creating or perpetuating the problem.  A family therapist can provide a safe environment to allow each family member to express him or her self and be heard.  No matter how “right” a person might be he will not be able to invoke changes in others unless he is prepared to make some changes in himself.

A great first step in making changes is to start with acceptance.  Whether you want to inspire a change in someone else or in yourself, it is best to start by accepting what is.  This may seem contradictory but it’s not.  If a person is too attached to the outcome or the goal, a certain amount of resistance will exist.  This is a spiritual law.  When you are determined to have something different, it implies that you don’t want what you have.  It is analogous to focusing on what you don’t want instead of focusing on what you do desire.  This is why so many New Years Resolutions do not pan out.  It is better to “accept what is” on a deep level than to focus on change.  That is, don’t just say “I’m okay with being over-weight.” Feel and experience the love and gratitude for everything that you are and know that unwanted pounds are just a small, unimportant part of the whole package.  The more you experience that genuine peace, acceptance and gratitude for all that you are, the more you will want to take better care of the body that holds your heart and soul.  You will love all of you.

Another factor that comes into play when people make resolutions or commitments to themselves is the concept of “all or nothing.”  You set yourself up for failure when you say “from now on, I’m going to this, that, and the other thing.” As soon as you don’t, you beat yourself up and decide that since you already failed at the commitment, you might as well call the whole thing off or punish yourself by make things worse somehow.  If you genuinely accept yourself, you will celebrate your successes and excuse some digressions.

Treating yourself with love and acceptance enables you to be more creative and open to knowing what is best for you.  Who knows, you may not be happier as a skinny person.  Just start small by maybe eating more vegetables.  You may find that you really like the taste.  Now you realize that eating healthier meals improves you energy and digestive system.  You will gradually and naturally continue to eat well and you will find recipes that appeal to your changing taste buds.  Now your added energy might motivate you pursue some activities that you always used to love.  You might take up tennis or walk in the park with a friend, or go out dancing.  Moving around, doing things you enjoy makes you feel even better so you continue to do more of it.  Pretty soon, your lifestyle has changed for the better because you are listening to your body and treating yourself with love.  Extra weight may or may not come off, but you will certainly feel better in every way. 

In addition to family therapy, I am also a certified hypnotist.  Hypnosis can help people reach their goals by understanding how the subconscious mind is “trying to keep you safe and happy” but sometimes doing so in ways that are in conflict with conscious desires.  I have special New Years rates for the month of January and February to help people make some changes with much less effort.  I have a strong aversion to cigarette smoking.  As much as I love plants, I welcome the day the tobacco plant becomes extinct.  If I didn’t have bills to pay, I would invite everyone to come in for free smoking cessation hypnosis and counseling.  If it is your desire to be a non-smoker in 2012, I salute and support you.

In closing, I would like to quote Ellen Degeneres in saying, “Be kind to one another.”  And I would add, “Be kind to yourself.”  Have a wonderful year.

Delia Trapuzzano is a Marriage and Family Therapist who joined the community of practitioners with practices at The Resiliency Center this year. To learn more about her work or to schedule an initial consultation, contact her at delia.trap@verizon.net or 610-416-7535.