Back Clinic Functional Medicine Team. Functional medicine 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.
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.
By changing the disease-centered focus of medical practice to this patient-centered approach, our physicians are able to support the healing process by viewing health and illness as part of a cycle in which all components of the human biological system interact dynamically with the environment. This process helps to seek and identify genetic, lifestyle, and environmental factors that may shift a person’s health from illness to well-being.
Nowadays, many individuals are incorporating various fruits, vegetables, lean portions of meat, and healthy fats and oils into their diet to get all the vitamins and minerals that their bodies need. The body needs these nutrients biotransformed into energy for the muscles, joints, and vital organs. When normal factors like eating unhealthy foods, not getting enough exercise, and underlying conditions affect the body, it can cause somato-visceral issues that correlate with disorders that push many individuals to feel unwell and miserable. Luckily, some supplements and vitamins like magnesium help with overall health and can reduce the effects of these environmental factors that are causing pain-like symptoms in the body. In this 3-part series, we will look at the impact of magnesium helping the body and what foods contain magnesium. Part 1 looks at how magnesium correlates with heart health. Part 2 looks at how magnesium helps with blood pressure. We refer our patients to certified medical providers that provide many available therapy treatments for individuals suffering from underlying conditions associated with low magnesium levels affecting the body and correlated to many underlying conditions affecting a person’s health and wellness. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis. We accept that education is a marvelous way when asking our providers’ hard-hitting questions at the patient’s request and acknowledgment. Dr. Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
An Overview Of Magnesium
Have you been experiencing muscle numbness in different locations in your body? What about muscle cramps or fatigue? Or have you been experiencing issues with your heart? Suppose you have been dealing with these overlapping issues that are affecting not only your body but your overall health. In that case, it could correlate with your body’s low magnesium levels. Studies reveal that this essential supplement is the body’s fourth most abundant cation when it comes to magnesium since it is a co-factor for multiple enzymic reactions. Magnesium helps with cellular energy metabolism, so the muscles and vital organs can function properly and helps replenish intracellular and extracellular water intake. Magnesium helps with the body’s metabolism, but it can also help reduce the effects of chronic conditions affecting the body.
How Magnesium Helps The Body
Additional studies reveal that magnesium is important in lowering chronic conditions’ effects on the body. Magnesium could help many individuals dealing with cardiovascular issues or chronic diseases associated with the heart or the muscles surrounding the upper and lower extremities of the body. How can magnesium help with overlapping health disorders that can affect the body? Studies show that taking magnesium can help prevent and treat many common health conditions:
Metabolic syndrome
Diabetes
Headaches
Cardiac arrhythmias
Many of these conditions are associated with everyday factors that can affect the body and lead to chronic disorders that can cause pain to the muscles, joints, and vital organs. So, taking magnesium can reduce pre-existing conditions from elevating the body and causing more harm.
Magnesium In Food
Biomedical physiologist Alex Jimenez mentions that magnesium supplementation usually causes diarrhea and explains what foods are high in magnesium. Surprisingly, avocados and nuts have a chaulk full of magnesium. One medium avocado has about 60 milligrams of magnesium, while nuts, especially cashews, have approximately 83 milligrams of magnesium. One cup of almonds has about 383 milligrams of magnesium. It also has 1000 milligrams of potassium, which we covered in an earlier video, and around 30 grams of protein. So this is a good snack to break up the cup into about half-cup serving throughout the day and snack on as you’re going. The second one is beans or legumes; for example, one cup of black beans cooked has around 120 milligrams of magnesium. And then wild rice is also a good source of magnesium. So what are the signs of low magnesium? The symptoms of low magnesium are muscle spasms, lethargy, irregular heartbeat, pins and needles in the hands or legs, high blood pressure, and depression. This video was informative for you regarding magnesium, where to find it, and the best supplemental forms to take it in. Thank you again, and tune in next time.
Foods Containing Magnesium
When it comes to taking magnesium, there are many ways to incorporate magnesium into the body’s system. Some people take it in supplemental form, while others eat healthy, nutritious foods with a chaulk full of magnesium to get the recommended amount. Some of the foods that are riched in magnesium include:
Dark Chocolate=65 mg of magnesium
Avocados=58 mg of magnesium
Legumes=120 mg of magnesium
Tofu= 35 mg of magnesium
What is great about getting these magnesium riched foods is that they can be in any dishes we consume for breakfast, lunch, and dinner. Incorporating magnesium in a healthy diet can help boost the body’s energy levels and help support the major organs, joints, and muscles from various disorders.
Conclusion
Magnesium is an essential supplement that the body needs to boost energy levels and help reduce the effects of pain-like symptoms that can cause dysfunction in the body. Whether it is in supplemental form or eating it in healthy dishes, magnesium is an important supplement that the body needs to function properly.
References
Fiorentini, Diana, et al. “Magnesium: Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency.” Nutrients, U.S. National Library of Medicine, 30 Mar. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8065437/.
Schwalfenberg, Gerry K, and Stephen J Genuis. “The Importance of Magnesium in Clinical Healthcare.” Scientifica, U.S. National Library of Medicine, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5637834/.
Having and maintaining flexibility in the joints depends on the connective tissues surrounding the muscles. Proper lubrication in the connective tissues enables the fibers to slide over one another easily. Naturally occurring proteins collagen and elastin are key components of connective tissue that provide strength and elasticity. The more elastic the connective tissue, the more flexibility around the joint. If it is becoming difficult to stretch out or there is chronic stiffness and tightness, there are foods that help maintain flexibility and enhance overall health.
Foods That Help Maintain Flexibility
Joint flexibility means functioning connective tissues that join the skeleton and muscles and the ability of different body parts to extend and complete motions. Connecting tissues assists with movement and stabilization. These issues include:
Ligaments
Ligamentscan be band-shaped or string-shaped collagen fibers that connect bones.
Tendons
Tendonsare similar to ligaments and are band or string shaped but connect muscles to the bones.
Fascia
Fascia is a densely woven mesh that wraps around the blood vessels, bones, muscles, organs, and nerves.
Flexibility keeps the muscles active and mobile as they are necessary for daily physical activities. When these tissues become stiff from inactivity or an unhealthy diet, it limits the body’s range of movement and increases the risk of injury. Stretching improves flexibility, and adding foods to a nutrition plan will help maintain limberness.
Nutrition
A nutrition plan full of vitamins, minerals, and antioxidants will nourish connecting tissues and cells and increase collagen production. Foods rich in essential fatty acids/EFAs, vitamin C, sulfur, and water will promote healthy connective tissue for enhanced flexibility.
Fatty Acids
Essential fatty acids include omega-3 and omega-6, primarily found in fish, flax seeds, and liquid oils.
These fatty acids are essential because they cannot be made in the body.
Foods likefatty fish, flax seeds, walnuts, or supplements, can help achieve the proper ratio.
For individuals not too keen on fish, consider omega-3 supplements.
Collagen
Collagen is the main protein from connective tissue, and vitamin C is essential for collagen production.
Vitamin C-rich foods – oranges, bell peppers, broccoli, strawberries, tomatoes, leafy green vegetables, raspberries, pineapple, cruciferous vegetables, parsley, and watermelon.
Make various smoothie recipes for breakfast or an afternoon snack.
Sulfur helps maintain the flexible bonds in connective tissues.
Animal proteins that provide sulfur include fish, poultry, beef, and eggs.
Vegetable sources include Brussels sprouts, cabbage, broccoli, cauliflower, onions, and garlic.
Hydration
Water is not considered food as it contains no calories, but it is vital as it makes up 76 percent of the muscles. A high percentage of water content is the key to muscle elasticity. When the body is dehydrated, it holds onto water, causing fluid retention and stiffness. The more the muscles stay dehydrated, the more they have trouble recovering from physical activities, fatigue levels increase, the range of motion decreases, and the risk of injury increases. Don’t wait until you are thirsty. Stay hydrated throughout the day to keep the joints lubricated and energy levels high.
Fruits high in water include:
Strawberries
Watermelon
Cantaloupe
Peaches
Grapefruit
Pineapple
Apples
Pears
Vegetables high in water include:
Cucumber
Lettuce
Zucchini
Celery
Eggplant
Limit Salt and Sugar Intake
Processed foods tend to have a high salt content.
Too much salt causes the joints to swell as the body retains fluid.
Keeping sugar intake low is important in enhancing flexibility.
This is because sugar breaks down the collagen in the skin and connective tissues.
This means avoiding processed foods, ready meals, and junk food.
Flexibility can be improved by eliminating foods that destroy collagen, focusing on foods that reduce insulin spikes, and maintaining hydration in the connective tissues. A nutritionist can develop a personalized nutrition plan for optimal neuromusculoskeletal health.
Foods That Help Maintain Flexibility
References
Beba, Mohammad et al. “The effect of curcumin supplementation on delayed-onset muscle soreness, inflammation, muscle strength, and joint flexibility: A systematic review and dose-response meta-analysis of randomized controlled trials.” Phytotherapy research: PTR vol. 36,7 (2022): 2767-2778. doi:10.1002/ptr.7477
Kviatkovsky, Shiloah A et al. “Collagen peptide supplementation for pain and function: is it effective?.” Current opinion in clinical nutrition and metabolic care vol. 25,6 (2022): 401-406. doi:10.1097/MCO.0000000000000870
MacKay, Douglas, and Alan L Miller. “Nutritional support for wound healing.” Alternative medicine review: a journal of clinical therapeutic vol. 8,4 (2003): 359-77.
Shaw, Gregory, et al. “Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis.” The American journal of clinical nutrition vol. 105,1 (2017): 136-143. doi:10.3945/ajcn.116.138594
Zdzieblik, Denise, et al. “Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides.” Applied physiology, nutrition, and metabolism = Physiologie applique, nutrition et metabolism vol. 42,6 (2017): 588-595. doi:10.1139/apnm-2016-0390
The cardiovascular system allows oxygen-rich blood and other enzymes to travel throughout the body and allow the various muscle groups and vital organs to function and do their jobs. When multiple factors like chronic stress or disorders begin to affect the heart, it can lead to cardiovascular issues that mimic chest pains or heart disorders that can affect a person’s daily lifestyle. Fortunately, there are many ways to ensure the heart stays healthy and prevent other chronic issues that can disrupt the body’s function. Today’s article looks at one of the essential supplements known as magnesium, its benefits, and how it corresponds with heart health in this 3-part series. Part 2 looks at how magnesium lowers blood pressure. Part 3 looks at the different foods containing magnesium and improves health. We refer our patients to certified providers that consolidate many available treatments for many individuals suffering from low magnesium levels affecting the cardiovascular system and correlating to chronic conditions that can cause overlapping risk profiles in the body. We encourage each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is a fantastic way when asking our providers intricated questions at the patient’s request and understanding. Dr. Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
What Is Magnesium?
Have you noticed that your blood glucose levels are elevated? What about feeling low on energy? Or have you been dealing with constant headaches? When many individuals are dealing with these issues that affect their health, it could be due to low magnesium levels affecting their bodies. Studies reveal that magnesium is the fourth most abundant cation that is a cofactor for 300+ enzymes in the body. Magnesium is an essential supplement that is an important electrolyte that hydrates the intracellular water intake in the body. Additional studies have revealed that magnesium plays a huge role in the body’s metabolism and involves hormone receptor bindings to allow muscle contraction, cardiac excitability, neurotransmitter release, and vasomotor tone. Magnesium is also necessary for the body as it is an active transport for potassium and calcium to go across the cellular membrane for proper functioning.
The Benefits Of Magnesium
When it comes to magnesium, there are many beneficial properties that it can provide to the body. Some of the benefits of taking magnesium include:
Boost exercise performance
Regulating neurotransmitters
Reduce depression and anxiety
Regulate blood glucose levels
Prevent migraines
When many individuals have low magnesium levels, studies reveal that common health conditions like migraines, metabolic syndrome, diabetes, and cardiac arrhythmias. These various health conditions can affect not only the vital organs in the body, but when a person has low magnesium levels, their energy levels are low, and they begin to feel sluggish. Additionally, a person with low energy levels from magnesium deficiency can affect their health and wellness. Studies reveal that magnesium deficiencies could cause overlapping risk profiles in the body, which can develop into chronic disorders like cardiovascular issues, hypotension, and osteoporosis.
An Overview Of Magnesium
Biomedical physiologist Alex Jimenez will be going over magnesium with you. But before we get started, it’s important to define some things. The first one is glycolysis. So if we break that down, glyco means carbohydrates or sugar. Lysis implies the breakdown of such glycolysis, the breakdown of carbohydrates. The next one is the co-factor. A co-factor is defined as a non-protein chemical compound that is required for enzymatic activity. You can think of this as the enzyme being the car, and the co-factor is the key. With the key, the vehicle can get started. So what is magnesium? Magnesium is a positively charged cat ion and an electrolyte we need for our bodies. So why is magnesium important? Because it supports proper muscle and nerve function? It regulates glucose metabolism or the breakdown of carbs in glycolysis. And five out of the ten steps in glycolysis require magnesium as a co-factor. So that is over 50% of the breakdown of carbs requires magnesium as a co-factor. It helps regulate our bone density.
Magnesium & Heart Health
As stated earlier, magnesium is an essential supplement that helps with intracellular water intake and helps with the body’s energy levels. So how does magnesium help the heart? Studies reveal that the many diverse roles that magnesium offers to the body allow it to regulate blood pressure and glycaemic control associated with the heart. Many cardiac patients take magnesium to ensure the intracellular membranes travel through the heart. Additionally, additional studies reveal that foods rich in magnesium can help lower the risk of major cardiovascular risks like ischemic heart disease and coronary heart disease. Magnesium also helps reduce pain-like symptoms associated with metabolic syndrome and hypertension that can affect the various muscle groups and joints. When the intracellular membrane is supported by magnesium and travels from the heart to the rest of the entire body, fewer pain-like symptoms can affect joints, muscles, and vital organs.
Conclusion
Magnesium is the fourth most abundant essential supplement that provides intracellular water intake in the body and can provide support to the cardiovascular system. This supplement plays a huge role in the body as it supports its metabolism and makes sure that it reduces cardiovascular issues. When many individuals have low magnesium levels, chronic problems like cardiovascular disorders, metabolic syndrome, and musculoskeletal disorders will develop and affect the body’s function to work properly. Incorporating magnesium-rich foods or supplements can lower the risk of these issues from progressing further and help regulate the elevated hormone levels affecting the body. Part 2 will look at how blood pressure is reduced when taking magnesium.
References
Al Alawi, Abdullah M, et al. “Magnesium and Human Health: Perspectives and Research Directions.” International Journal of Endocrinology, U.S. National Library of Medicine, 16 Apr. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5926493/.
Allen, Mary J, and Sandeep Sharma. “Magnesium – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishin, 3 Mar. 2022, www.ncbi.nlm.nih.gov/books/NBK519036/.
DiNicolantonio, James J, et al. “Magnesium for the Prevention and Treatment of Cardiovascular Disease.” Open Heart, U.S. National Library of Medicine, 1 July 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6045762/.
Rosique-Esteban, Nuria, et al. “Dietary Magnesium and Cardiovascular Disease: A Review with Emphasis in Epidemiological Studies.” Nutrients, U.S. National Library of Medicine, 1 Feb. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5852744/.
Schwalfenberg, Gerry K, and Stephen J Genuis. “The Importance of Magnesium in Clinical Healthcare.” Scientifica, U.S. National Library of Medicine, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5637834/.
Swaminathan, R. “Magnesium Metabolism and Its Disorders.” The Clinical Biochemist. Reviews, U.S. National Library of Medicine, May 2003, www.ncbi.nlm.nih.gov/pmc/articles/PMC1855626/.
Dr. Alex Jimenez, D.C., presents how chronic stress can impact the body and how it is correlated with inflammation in this 2-part series. Part 1 examined how stress correlates with various symptoms affecting the body’s gene levels. Part 2 looks at how inflammation and chronic stress correlate with the various factors that can lead to physical development. We refer our patients to certified medical providers who provide available treatments for many individuals suffering from chronic stress associated with the cardiovascular, endocrine, and immune systems affecting the body and developing inflammation. We encourage each of our patients by mentioning them to associated medical providers based on their analysis appropriately. We understand that education is a delightful way when asking our providers questions at the patient’s request and understanding. Dr. Jimenez, D.C., only uses this information as an educational service. Disclaimer
How Stress Can Impact Us?
Dr. Alex Jimenez, D.C., presents: Stress can create many emotions that can hugely impact many of us. Whether it is anger, frustration, or sadness, stress can make anyone reach a breaking point and cause underlying conditions that can develop into cardiovascular issues. So those people with the highest level of anger, when you look at the cardiovascular literature, have the least probability of survival. Anger is a bad player. Anger causes arrhythmia. This study looked at, now that we have people with ICDs and defibrillators, we can monitor these things. And we see that anger can trigger ventricular arrhythmias in patients. And it’s easy now to follow, with some of our technology.
Anger has been linked to episodes of atrial fibrillation. When you think about it, it’s adrenaline outpouring into the body and causing coronary constriction. It’s increasing the heart rate. All of these things can lead to arrhythmia. And it doesn’t have to be AFib. It can be APCs and VPCs. Now, some very interesting research has come out about telomerase and telomeres. Telomeres are little caps on the chromosomes, and telomerase is the enzyme linked to telomere formation. And now, we can understand through the language of science, and we’re starting to use technology and use science in a way that we could never do before to understand the impact of stress on telomeres and telomerase enzymes.
The Factors That Lead Up To Chronic Stress
Dr. Alex Jimenez, D.C., presents: So one of the key people to study this is the Nobel Prize-winning, Dr. Elizabeth Blackburn. And what she said is that this is a conclusion, and we’ll come back to some of her other studies. She tells us that the telomeres of babies from women in utero had a lot of stress or were even shorter in young adulthood compared to mothers who did not have the same stressful situations. Maternal psychological stress during pregnancy may exert a programming effect on the developing telomere biology system that is already apparent at birth as reflected by the setting of newborn leukocyte telemetry length. So children can come in imprinted, and even if they do, this can be transformed.
What about racial discrimination these boxes here show high racial discrimination leading to low telomere length, which most of us have ever thought about. So, shorter telomere length leads to an increased risk of cancer and overall mortality. Cancer incidence rates are 22.5 per 1000 person-years in the shortest telomere group, verse 14.2 in the middle group, and 5.1 in the longest telomere group. Shorter telomeres can lead to instability of the chromosome and result in cancer formation. So, now we understand, through the language of science, the impact of stress on the telomerase enzyme and the telomere length. According to Dr. Elizabeth Blackburn, 58 premenopausal women were caregivers of their chronically ill children verse women who had healthy children. The women were asked how they perceive stress in their lives and whether it impacts their health by affecting their cellular aging.
That was the question of the study as they looked at telomere length and telomerase enzyme, and this is what they found. Now, the keyword here is perceived. We are not to judge each other’s stress. Stress is personal, and some of our responses may be genetic. For example, someone who has homozygous comps with a sluggish gene may have much more anxiety than someone who doesn’t have this genetic polymorphism. Someone who has an MAOA in an MAOB may have more anxiety than someone who doesn’t have that genetic polymorphism. So there is a genetic component to our response, but what she found was perceived psychological stress. And the number of years caring for chronically ill children was associated with shorter telomere length and less telomerase activity, providing the first indication that stress can impact telomere maintenance and longevity.
How To Transform Our Stress Response?
Dr. Alex Jimenez, D.C., presents: That’s powerful, and many healthcare providers are under some form of stress. And the question is, what can we do to transform our response? Framingham also looked at depression and identified clinical depression as a bigger risk for cardiovascular events and poor outcomes than smoking, diabetes, high LDL, and low HDL, which is crazy because we spend all of our time on these things. Yet, we don’t spend much time dealing with the emotional aspects of vascular disease. This is affected depression, inventory, a simple screening test for depression, looking at people with high levels of depression versus low levels of depression. And you can see that as you go from the low to the highest level, as you work your way through, the chance of survival becomes less.
And many of us have our theories as to why this occurs. And is it because if we are depressed, we don’t say, “Oh, I’m going to eat some brussels sprouts, and I’m going to take those B vitamins, and I’m going to go out and exercise, and I’m going to do some meditation.” So post-MI independent risk factor for an event is depression. Our mindset regarding depression makes us incapable of functioning normally and can make our bodies develop issues that affect our vital organs, muscles, and joints. So, depression is a big player, as 75% of post-MI deaths are related to depression, right? So looking at patients, now, you have to ask the question: Is it the depression causing the problem, or is it the cytokine sickness that’s already led to the heart disease causing the depression? We have to factor all of this in.
And yet another study looked at over 4,000 people with no coronary disease at baseline. For every increase of five points on the depression scale, that increased risk by 15%. And those with the highest depression scores had a 40% higher coronary artery disease rate and a 60% higher death rate. So mostly everyone thinks it’s a cytokine sickness that leads to MI, vascular disease, and depression. And then, of course, when you have an event, and you come out with a whole host of issues around it, we know that people who are depressed have a twofold increase in mortality, a fivefold increase in death after a heart attack, and poor outcomes with surgery. It’s like this, what came first, the chicken or the egg?
How Depression Is Linked With Chronic Stress?
Dr. Alex Jimenez, D.C., presents: Every surgeon knows this. They don’t want to do surgery on depressed people. They know the outcome is not good, and of course, they are less likely to follow through on all of our great functional medicine recommendations. So what are some of the mechanisms of autonomic dysfunction have been evaluated heart rate variability and low levels of omega-3s, which have a profound effect on the brain, and low levels of vitamin D. There are those inflammatory cytokines we talked about not getting restorative sleep, and many of our heart patients do have apnea. And remember, don’t just think it’s the heavyset heart patients with thick short necks; it can be quite deceiving. And it’s really important to look at the structure of the face and, of course, social connection, which is the secret sauce. So is autonomic dysfunction a mechanism? One study looked at heart rate variability in people with a recent MI, and they looked at over 300 people with depression and those without depression. They found that four heart rate variability indices will lower in people with depression.
Gut Inflammation & Chronic Stress
Dr. Alex Jimenez, D.C., presents: So here are two groups of people having a heart attack and heart rate variability, rising to the top as a possible etiology. One of the many things that can also affect chronic stress in the body is how the gut microbiome plays its part in oxidative stress. The gut is everything, and many heart patients laugh because they would ask their cardiologists, “Why do you care about my gut microbiome? Why would this affect my heart?” Well, all that gut inflammation is causing cytokine sickness. And what a lot of us have forgotten since medical school is that many of our neurotransmitters come from the gut. So chronic inflammation and exposure to inflammatory cytokines appear to lead to alterations in dopamine function and the basal ganglia, reflected by depression, fatigue, and psychomotor slowing. So we can’t emphasize the role of inflammation and depression enough if we take a look at acute coronary syndrome and depression, which was associated with higher markers for inflammation, more elevated CRP, lower HS, lower heart rate variability, and something that never gets checked in the hospital, which is nutrition deficiencies.
And in this case, they looked at omega-3s and vitamin D levels, so at a minimum, an omega-3 check and a vitamin D level are warranted in all of our patients. And certainly, if you can get a full diagnosis for stress-induced inflammation. Another condition you must look at when it comes to stress-induced inflammation is osteoporosis in the joints. Many people with osteoporosis will have muscle loss, immune dysfunction, fat around the midline, and high blood sugar are associated with aging, and it can come from elevated cortisol levels in the body.
High cortisol heart disease risks are two times higher in people taking high doses of steroids. Small amounts of steroids don’t have the same risk, so it is not as big a deal. Of course, we try to get our patients off of steroids. But the point here is that cortisol is a stress hormone and is a stress hormone that raises blood pressure and puts weight on the midline, makes us diabetic, causes insulin resistance, and the list is endless. So, cortisol’s a big player, and when it comes to functional medicine, we have to look at the various tests that pertain to elevated levels of cortisol like food sensitivity, a 3-day stool valve, a nutra-valve, and an adrenal stress index test to look at what is going on with the patients. When there is a heightened sympathetic nervous system and high cortisol, we discussed everything from coagulopathy to decreased heart rate variability, central obesity, diabetes, and hypertension.
Parental Relationships & Chronic Stress
Dr. Alex Jimenez, D.C., presents: And turning on the renin-angiotensin system it’s all linked to stress. Let’s look at this study that looked at 126 Harvard Medical students, and they were followed for 35 years, a long research. And they said, what’s the incidence of significant illness, heart disease, cancer, hypertension? And they asked these students very simple questions, what was your relationship with your mom and your dad? Was it very close? Was it warm and friendly? Was it tolerant? Was it strained and cold? This is what they found. They found that if the students identified their relationship with their parents as strained 100% incidence of significant health risk. Thirty-five years later, if they said it was warm and close, the results cut that percentage in half. And it would help if you thought about what it is and what can explain this, and you’ll see how adverse childhood experiences make us sick in a few minutes and how we learn our coping skills from our parents.
Conclusion
Dr. Alex Jimenez, D.C., presents: Our spiritual tradition comes from our parents often. Our parents are the ones who frequently teach us how to get angry or how to resolve conflict. So our parents have had a profound effect on us. And when you think about that, our connection is also not very surprising. This is a 35-year follow-up study.
Chronic stress can lead to multiple issues that can correlate to illness and dysfunction in the muscles and joints. It can affect the gut system and lead to inflammation if it is not taken care of immediately. So when it comes to the impact of stress affecting our daily lives, it can be numerous factors, from chronic conditions to family history. Eating nutritious foods high in antioxidants, exercising, practicing mindfulness, and going to daily treatments can lower the effects of chronic stress and reduce the associated symptoms that overlap and cause pain to the body. We can continue with our health and wellness journey pain-free by utilizing various ways to lower chronic stress in our bodies.
Dr. Alex Jimenez, D.C., presents how stress can impact many individuals and correlate with many conditions in the body in this 2-part series. We refer our patients to certified medical providers who provide multiple available treatments for many people suffering from hypertension associated with the cardiovascular, endocrine, and immune systems affecting the body. We encourage each of our patients by mentioning them to associated medical providers based on their analysis appropriately. We understand that education is a delightful way when asking our providers questions at the patient’s request and understanding. Dr. Jimenez, D.C., only uses this information as an educational service. Disclaimer
How Stress Impacts the Body
Dr. Alex Jimenez, D.C., presents: Now everyone responds to changes in the environment differently. When it comes to many individuals doing everyday activities from working at their job, opening on the weekends, traffic jams, taking exams, or preparing for a big speech, the body goes through a constant state of hyperreactive to a stage of emotional, mental exhaustion that leaves the individual to be exhausted and stressed out. And the key is to recognize this before it happens, as we see this impact of stress on our patients and ourselves. And the first thing to realize is what the initiating event is causing this impact.
Whatever the initiating event, the most important part is our perception of the event. What does it mean to us? Is it our perception? When the body goes through this initiating event, it can cause the perception to lead to the response and the effect on our body. So perception is everything as we talk about stress and the stress response. Now, we have over 1400 chemical reactions that occur in the body. So for this talk’s purpose, we’ll discuss the three key ones: adrenaline and neuro-adrenaline, aldosterone, and of course, cortisol.
And why are these important? Because every one of these has a huge impact on cardiovascular disease. Now, in the 1990s, many doctors were starting to understand the effect of stress on the physical body. And what happens to people when their HPA-axis signals that they are under threat and start flooding their bodies with stress hormones? Well, we see enhanced coagulation. We see a shift in the renin and angiotensin system. It revs up. We see weight gain in people and insulin resistance. What a lot of people don’t realize is that lipids become abnormal with stress. Almost every one of our patients knows that tachycardia and arrhythmia occur when our adrenaline is flowing, and our blood pressure increases. Now, think about this through the language of medicine.
Around the 1990s, doctors were giving aspirin and Plavix at the time for coagulation. We continue to provide ACEs and ARBs to our patients. The impact of cortisol causes weight gain and insulin resistance. We give statins; we give metformin. We provide beta blockers for that, tachycardia, and calcium blockers for that high blood pressure. So every single hormone that gets turned on with stress, we have a drug that we’re using to balance that. And quite frankly, for years, we talked about how good beta blockers were for the heart. Well, when you think about that, beta blockers do block adrenaline. So when doctors look at this, they begin to think, “Well, maybe we need to medicate and meditate, right? We’re using all these drugs, but we may need to look at other ways to transform the stress response.”
What is Vasoconstriction?
Dr. Alex Jimenez, D.C., presents: We won’t read every one of these symptoms because there are so many, but it all comes down to the same thing. Stress. We have to think of someone who’s in an auto accident, for example, and that person is bleeding. So the body is beautiful in that it puts together a way to stop the individual from bleeding or vasoconstriction. Vasoconstriction is constructing these blood vessels and making the platelets sticky so they form a clot, and the blood can stop. This increases the cardiac output by raising the heart rate and increases aldosterone, which causes salt and water retention to raise the blood pressure. So for someone in a medical emergency, like an accident, bleeding, or losing volume, this is the beauty of the human body. But unfortunately, we see people living this way, literally 24/7. So we know the vasoconstriction and the platelet stickiness, and we see increases in markers for inflammation, homocysteine, CRP, and fibrinogen, all of which increase cardiovascular risk.
We see the impact of cortisol, not only raising blood pressure, not only causing diabetes and insulin resistance, but also depositing abdominal fat around the midline. And then, as you’ll see in a few minutes, there are links between stressful events and arrhythmias like atrial fibrillation and even ventricular fibrillation. For the first time in medicine, in cardiology, we have a syndrome called takosubo cardiomyopathy, which is affectionately called broken heart syndrome. And this is a syndrome in which the myocardium becomes acutely stunned to the point of causing severe left ventricular function or dysfunction. And usually, this is triggered by bad news and an emotionally stressful event. It looks like someone needs a heart transplant. So when we think about the old Framingham risk factors, we say, which of these are impacted by stress?
Symptoms of Stress
Dr. Alex Jimenez, D.C., presents: People have all sorts of maladaptive behaviors to stress, whether 20 friends in this pack of cigarettes, eating this Cinnabon because it makes me feel good right now, or all the cortisol will make me fat and diabetic. Lipids go up under stress; blood pressure goes up under stress. So every one of these risk factors is impacted by stress hormones. And, of course, we know that with the turning on of the RAS system or the renin-angiotensin system, we always see a worsening in heart failure. And this is very much described in the literature. And, for those of you who may work in the emergency room, ask your patients what they were doing before coming in with their episode of congestive heart failure or chest pain. And you’re going to hear stories like, I was watching a bad movie, or I was watching a war movie, or I got upset over the football game, or something like that.
We’ll talk about heart rate variability, which gets impacted by stress. And, of course, stress affects our ability to resist infections. And we know that people are under stress when they’re vaccinated. For example, Cleco lasers work but don’t produce antibodies to the vaccine when they’re under stress. And, of course, as you’ll see in a minute, severe stress can cause sudden cardiac death, MI, and so on. So it is a bad player that’s overlooked. And for many of our patients, stress drives the train. So when we’re talking about eating brussels sprouts and cauliflower and, you know, lots of green leafy vegetables, and someone is under so much stress that they’re trying to figure out, “How am I going to get through the day?” They’re not hearing any of the other things that we’re recommending.
So, chronic stress and affective disorders, whether depression, anxiety, or panic, put our foot on the accelerator and rev up the sympathetic nervous system. We know that the same things we see with aging, as you’ll see in a minute, are linked to increased levels of stress hormones, especially cortisol. So whether it’s osteoporosis, decreased bone density, endothelial dysfunction, platelet activation, hypertension, central obesity, or insulin resistance, this comes from a stress response. And we have to have a plan for our patients on how to handle this. American Institute of Stress says that 75 to 90% of all healthcare provider visits result from stress-related disorders. And that’s way too high, but by looking at the patients and where they were coming in with, they tell their stories to their doctors. The results are the same; it doesn’t matter whether it was headaches, muscle tension, angina, arrhythmia, or irritable bowel; it almost always had some stress trigger.
Acute & Chronic Stress
Dr. Alex Jimenez, D.C., presents: There’s a difference between acute and chronic stress with our perception and social connection. Even though we gain some strength from a higher power, stress can impact anyone, and most of us might not be able to handle it well. So a great study was done many years ago by Dr. Ray and Holmes that stated, 50 years ago, put together a method for quantifying life-changing events. So let’s look at some areas, such as life-changing events. How do life-changing events and how do they rank? Which are the big ones, and which are the little ones?
And how does that ranking lead to major medical problems like cancer, heart attack, and sudden death in the future? So they looked at 43 life-changing events, ranked them originally, and re-ranked them in the 1990s. And some of them remained the same. They gave an adjustment score to the event, and then they looked at numbers that would be linked to major illness. So, for example, a life-changing event. Number one, 100 life-changing units, is a death of a spouse. Anyone could relate to that. Divorce was number two, separation number three, and the end of a close family member. But also noticed that some things got ranked that are, you might not equate with, being a major life-changing event that can impact a stress response like marriage or retirement.
Conclusion
Dr. Alex Jimenez, D.C., presents: So it wasn’t the actual single event that made the difference. It was the adding up of events. And what they found after looking at 67 physicians was if you had a life-changing unit score of somewhere between zero and one 50, not a big deal, no real major illness, but once you hit that 300 mark, there was a 50% chance of major illness. So this timeline of events in the patient’s life. We want to know what was going on in their life when their symptoms started and then bring it back earlier to understand the environment in which this individual was living. The impact of stress can make many individuals develop chronic conditions and mask other symptoms that can lead to muscle and joint pain. In part 2, we will dive in more about how the impact of stress affects a person’s body and health.
There are various reasons for getting sick, but stress is one of the most common. Stress from family, work, school, traveling, etc., wreaks havoc on the body and mind. Working odd or different hours and staying up late disrupts routines and schedules and can generate significant stress. Trying to keep on top of everything and still trying to manage the usual responsibilities and duties can result in a weakened immune system that contributes to persistent illnesses. Chiropractic care combined with functional medicine can strengthen the immune system and restore optimal function.
Weakened Immune System
The immune system is a network of organs, white blood cells, proteins/antibodies, and chemicals. It protects the body from bacteria, viruses, parasites, and fungi that cause infection, illness, and disease. It’s normal for healthy adults to get sick a few times a year, but constantly being sick signals a weakened immune system. Individuals with weak immune systems also experience digestion issues. This could be constipation or frequent diarrhea. Approximately 70% of the immune system is in the gastrointestinal tract, where the healthy/beneficial bacteria and microorganisms live. If the amount of healthy bacteria is low, it is harder to protect the body from viruses, chronic inflammation, or autoimmune disorders.
Properly Working
When the immune system works properly, it can tell which cells are the body’s and which substances are foreign and don’t belong there.
It activates, mobilizes, and destroys the outside germs.
After exposure, the immune system stores the germs’ identities to develop antibodies to protect the body.
Depleted Immunity
Chronic stress wears down and prematurely ages the immune system. When the body must constantly adapt to changes from stress, it makes the immune system less responsive.
Depleted immunity is when the cells that should be ready to activate and fight viruses and bacteria are low in numbers.
Ongoing stress, over time, can make the body more vulnerable to illnesses, from colds and flu to chronic diseases like diabetes and heart disease.
High-stress levels can cause depression and anxiety, leading to higher levels of inflammation.
Chiropractic Restoration
Chiropractic care can help strengthen the body’s natural ability to heal and recover from illness by realigning the spine, improving circulation, and releasing toxins. Chiropractic works on the central nervous system, which comprises the spine and brain. As proper function and communication are restored, the central and peripheral nervous systems work together to help control the body’s ability to perceive and handle internal and external stress. Injury Medical Chiropractic and Functional Medicine Clinic treatment include:
Massage therapy
Spinal realignment
Decompression therapy
Health Coaching
Nutritional assistance
Stress Impact
References
Childs, Caroline E et al. “Diet, and Immune Function.” Nutrients vol. 11,8 1933. Aug 16, 2019, doi:10.3390/nu11081933
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How does the immune system work? [Updated 2020 Apr 23]. Available from: www.ncbi.nlm.nih.gov/books/NBK279364/
Nicholson, Lindsay B. “The immune system.” Essays in biochemistry vol. 60,3 (2016): 275-301. doi:10.1042/EBC20160017
Segerstrom, Suzanne C, and Gregory E Miller. “Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry.” Psychological bulletin vol. 130,4 (2004): 601-30. doi:10.1037/0033-2909.130.4.601
Dr. Alex Jimenez, D.C., presents how hypertension affects the human body and some causes that can increase hypertension in many individuals in this 2-part series. We refer our patients to certified medical providers who provide multiple available treatments for many individuals suffering from hypertension associated with the cardiovascular and immune systems affecting the body. We encourage each of our patients by mentioning them to associated medical providers based on their analysis appropriately. We understand that education is a delightful way when asking our providers questions at the patient’s request and understanding. Dr. Jimenez, D.C., only makes use of this information as an educational service. Disclaimer
How To Look For Hypertension
Dr. Alex Jimenez, D.C., presents: Let’s go back to the decision tree so you can begin to think about how you will apply the go-to-it model in functional medicine to hypertension and how you will start better assessing somebody with hypertension rather than telling them that their blood pressure is elevated. Is the body influenced by inflammation, oxidative stress, or immune response? Is it affecting endothelial function or vascular smooth muscle from those three categories of reactions, inflammation, oxidative stress, or immune response? Do we choose a diuretic calcium channel blocker or an ACE inhibitor? And so to do that, it’s really important in our gather section. Taking the medical history and the timeline of their hypertension, you get a clue about the organ damage to the questionnaires. You’re looking at their anthropometrics.
This includes the following questions:
What are the inflammatory markers?
What are the biomarkers and clinical indicators?
Those are outlined through the clinical decision tree. And already just doing that, you’re going to expand and fine-tune your lens on what you might see in your hypertensive patient. Let’s add to the timeline when does hypertension begin? The timeframe of hypertension begins actually in prenatally. It’s important to ask your patient if they were early or large educational age. Was their mother stressed? Were they born early or premature? Was there nutritional stress in their pregnancy? If they know that, you can have two people with the same kidney size, but the person who didn’t have enough protein during pregnancy can have up to 40% less glomeruli. Knowing that will change how you adjust the medication decades later if you know they possibly have 40% less glomeruli.
The Timeline For Blood Pressure
Dr. Alex Jimenez, D.C., presents: So it’s important to take the timeline of their blood pressure. Then it’s also important to recognize what is happening when we begin to organize and collect data through the biomarkers; the basic biomarkers will give you clues about whether they have issues with insulin lipids, whether they have problems with vascular reactivity, autonomic nervous system balance, imbalance, coagulation, or immune toxin effects. So this is a reasonable thing to print off because, in your hypertensive patient, this is through just the biomarkers you can begin to get a clue as to what areas of dysfunction affect inflammation, oxidative stress, and immune response and how these biomarkers reflect that information for you. This is very reasonable to have in front of you to help change your thoughts about hypertension and also enables you to refine some of the characteristics of the person on the other side of your stethoscope in a more personalized, precise way.
But let’s start at the very beginning. Does your patient have high blood pressure? We know that depending on the end organ effects of their comorbidities, you may run someone a slightly higher blood pressure if you have a profusion issue in the brain and the kidneys or the heart, but some guidelines are there. Our 2017 American Heart Association guidelines for blood pressure categories are listed here. They’ve waxed and waned back and forth over the last couple of decades, but this is very clear. Having elevated blood pressure, anything above 120, really shifted how many people we start seeing or considering addressing the root causes of their blood pressure. So we will come back to this, especially in the case to help us look at how we categorize people with blood pressure issues.
The Criteria To Mesure Blood Pressure
Dr. Alex Jimenez, D.C., presents: What is the first step? It’s how do you have the blood pressure taken in your patient? Do they monitor it at home? Do they bring those numbers to you? How do you monitor blood pressure in your clinic? How do you get accurate readings in your clinic? Here are the criteria to accurately measure blood pressure and the questions to consider whether you’re doing all these.
Do you ask your patient whether they’ve had caffeine in the last hour?
Whether they’ve smoked in the previous hour?
Were they exposed to smoke in the last hour?
Is the place where you’re taking blood pressure warm and quiet?
Are they sitting with their back supported in a chair with their feet on the ground?
Do you use the roll-around side table to rest your arm at the heart level?
Are they sitting at the exam table with their feet dangling, and a nurse aide elevates their arm and puts in their axillary fold to hold their arm there?
Are their feet on the ground?
Have they sat there for five minutes?
Have they exercised in the previous 30 minutes?
You may have systolic blood pressure if everything is in the criteria. Here’s the challenge. There are 10 to 15 millimeters of mercury higher when it comes to sitting and taking blood pressure. What about the cuff size? We know last century; most adults had an upper arm circumference of fewer than 33 centimeters. Over 61% of people now have an upper arm circumference greater than 33 centimeters. So the size of the cuff is different for around 60% of your adult patients, depending on your population. So you have to use a large cuff. So take a look at how blood pressure is collected in your office. Let’s say the blood pressure is elevated in your patients; then we have to ask, is it normal? Great.
The Different Types Of Hypertension
Dr. Alex Jimenez, D.C., presents: Is it elevated because of white-coat hypertension? Do they have normal blood pressure, elevated outside the clinic, or masked hypertension? Or do they just have sustained hypertension which is a challenge? We’ll talk about that. So when you interpret, it is also important to consider ambulatory blood pressure monitoring. So if you have somebody who’s hypertensive and don’t know whether the blood pressure goes down and you’re trying to figure out whether they have sustained hypertension, you can use 24-hour blood pressure monitoring. The mean daytime blood pressure above 130 over 80 is hypertensive the mean nighttime blood pressure above 110 over 65 is hypertensive. So why is this important? The average blood pressure dips to around 15% at night because of the issue with blood pressure dipping. Failure to have blood pressure drop while you sleep at night could develop problems that can affect a person throughout the day.
If your patient sleeps at night, it should drop about 15% when they sleep. If they have non-dipping blood pressure, it is associated with comorbidities. What are some of those comorbidities in non-dipping blood pressure? Some of the conditions correlated with non-dipping blood pressure include:
Congestive Heart Disease
Cardiovascular Disease
Cerebrovascular Disease
Congestive Heart Failure
Chronic Renal Failure
Silent Cerebral Infractions
Co-morbidities Associated With Non-Blood Pressure
Dr. Alex Jimenez, D.C., presents: These are the comorbidities associated with non-blood pressure. All of us agree that elevated blood pressure is not necessarily good in all those conditions. So when you look at different people groups or other comorbidities, non-dipping blood pressure is most commonly associated with sodium-sensitive folks, people who have renal insufficiency, people who have diabetes, people who have left ventricular hypertrophy, people who have refractory hypertension or autonomic nervous system dysfunction and finally, sleep apnea. So, non-dipping blood pressure increases your association with subclinical cardiac damage. Okay, Reverse dipping means you are more hypertensive at night and is more ascent associated than during the day is more related to hemorrhagic stroke. And if you have somebody with nocturnal hypertension, you have to start thinking about things like the carotid arteries and increased carotid, internal medial thickness. You start thinking about left ventricular hypertrophy and may see it on EKG. Here’s what we know about nocturnal hypertension. Nocturnal hypertension is a nighttime blood pressure greater than 120 over 70. It is associated with greater predictability of cardiovascular morbidity and mortality.
If you have nocturnal hypertension, it increases your risk of mortality from cardiovascular disease by 29 to 38%. We must know what’s happening at night when we sleep, right? Well, what’s another refinement? Another refinement is recognizing that resting blood pressure is controlled by your renin-angiotensin system. Waking blood pressure is controlled by your sympathetic nervous system. So let’s talk about how their renal angiotensin system drives their nighttime hypertension, and you think about what medication they’re taking. You might change the medication dosing to nighttime. Well, studies have shown that if you have nighttime hypertension and are a non-dipper, it’s best to take your ACE inhibitors, ARBs, calcium channel blockers, and certain beta blockers at night before bed. But it makes sense that you wouldn’t move your diuretics to nighttime, or you will have a disruptive sleep.
Addressing Daytime & Nighttime Blood Pressure
Dr. Alex Jimenez, D.C., presents: So if we don’t address daytime and nighttime blood pressure, we have to consider the effect of blood pressure load. What is your average daytime blood pressure and your moderate sleeping blood pressure is. We know that blood pressure load in young adults is hypertensive only about 9% of the time. So meaning the systolic load is about 9% versus in the elderly, about 80% of the blood pressure load is systolic. And so when you have a higher systolic load, you have more complications and end-organ damage. So what we’re talking about is helping identify your patient with hypertension; what is their timeline? What is their phenotype? Are they only hypertensive during the day, or they’re hypertensive at night also? We have to look at what helps balance that.
Here’s the other point, only about 3.5% of people with hypertension do it have a genetic cause. Only 3.5% of people their genes cause hypertension. The power is at the bottom of the matrix and recognizing these patterns, right? So you look at exercise, sleep, diet, stress, and relationships. So we know that these four autonomic balances help determine blood pressure. We will examine the renal angiotensin system, plasma volume where they hold onto too much fluid, secondary salt load, and endothelial dysfunction. Abnormalities in any of these can lead to hypertension. We’ve been talking about another one that can lead to hypertension: the link between insulin resistance and hypertension.
This diagrammatically gives you an idea of the physiologic interactions between insulin resistance and hypertension. It affects increasing sympathetic tone and increasing renal-angiotensin system balance. So let’s spend a few minutes on the renin-angiotensin system pathway angiotensinogen down to angiotensin two. We take advantage of these enzymes by giving inhibitors to angiotensin-converting enzymes in our hypertensives patients. Elevated angiotensin two leads to cardiovascular hypertrophy, leads to sympathetic phase constriction, increased blood volume, sodium fluid, retention, and aldosterone release. Can you inquire about your patient biomarkers? Can you ask whether they have elevated renin levels?
Look For The Signs
Dr. Alex Jimenez, D.C., presents: Well, you can. You can check plasma renin activity and aldosterone levels. It’s important to do this if your patient is hypertensive and has never been on medication because this is where nitrous oxide is so important. This is where your endothelial nitric oxide synthase is present. This is where you have sheer and hemodynamic stress. This is where dietary intake of arginine or the environment that affects nitric oxide plays such a role in the health of this layer of endothelia. If you lay it all together somehow, miraculously, or at least in your mind’s eye, it’ll cover six tennis courts in the average adult. It’s a huge surface area. And the things that cause endothelial dysfunction are not new news to people in functional medicine. Increased oxidative stress and inflammation are two things we mentioned that play an effect.
And then, look at some of these other components, your ADMA being elevated and correlated with insulin resistance. It all begins to form together in a matrix that interacts. So you look at one comorbidity in cardiometabolic syndrome, and it affects another comorbidity. You suddenly see the interrelation between them or hyperhomocysteinemia, which is a one-carbon metabolism marker, meaning you’re looking at the adequacy of folate, b12, b6, riboflavin, and that activity of your one-carbon metabolism. So let’s look at some of these emerging risk markers to improve and track in patients with hypertension. Let’s reanalyze ADMA again. ADMA stands for asymmetric dimethyl arginine. Asymmetric, dimethyl arginine is a biomarker of endothelial dysfunction. That molecule inhibits nitric oxide synthase while impairing endothelial function, and in all of the comorbidities associated with cardiometabolic syndrome, ADMA can be elevated.
Conclusion
So, as a quick review, L-arginine is converted to nitric oxide via nitric oxide synthase, and nitric oxide adequacy leads to vasodilation. ADMA blocks this conversion. And if your ADMA levels are elevated and your nitric oxide levels are low, then you have decreased nitric oxide platelet aggregation increases in LDL oxidation. So many things reduce nitric oxide or are associated with lower nitric oxide levels, sleep apnea, low dietary arginine, protein, zinc insufficiency, and smoking.
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Weakened Immune System
