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.
Nutrition is integral to optimal health and can help treat and manage diseases that threaten the body. Mushrooms come in various shapes, sizes, and colors and have been used for their unique ability to add flavor and taste without sodium or fat. They are also healthy and tasty and contain various vitamins and minerals. Different mushrooms can provide distinct health benefits that can be increased brain function, help with hormonal balance, and as an antioxidant.
Mushroom
Research continues to uncover how mushrooms can improve everyday health and help mitigate the risk of developing health conditions like Alzheimer’s, heart disease, cancer, and diabetes. Mushrooms are recommended because they are:
Fat-free
Low in sodium
Low-calorie
Cholesterol-free
Packed with fiber
Nutritional benefits vary depending on the type of mushroom.
B vitamins
Mushrooms are rich in B vitamins: riboflavin, niacin, and pantothenic acid, which help maintain heart health. Riboflavin supports red blood cells. Niacin assists the digestive system and helps keep healthy skin. Pantothenic acid supports nervous system function and helps the body make necessary hormones.
Minerals
They are a great source of minerals – Selenium, Copper, Thiamin, Magnesium, and Phosphorus. Copper helps the body create red blood cells to deliver oxygen and maintain healthy bones and nerves. Potassium supports heart, muscle, and nerve function.
Antioxidants
Antioxidants help protect the body from damaging free radicals that can cause heart disease and cancer. They also protect against damage from aging and increase immune system function.
Beta-glucan
Beta-glucan is a soluble dietary fiber linked to improved cholesterol levels and supports heart health. It helps the body regulate blood sugar, which helps reduce the risk of type 2 diabetes.
Cordyceps
Cordyceps increases energy levels by utilizing oxygen more efficiently and enhancing circulation. This can be especially helpful for athletes or individuals who regularly work out and has been shown to improve exercise and athletic performance and speed up muscle recovery.
Shiitake
This mushroom has benefits that are particularly good for the heart, as they contain phytonutrients, which aid in:
Preventing plaque buildup
Maintaining blood pressure
Maintaining circulation
Lowering cholesterol
Chaga
Chaga mushrooms are full of antioxidants, making them excellent for fighting free radicals and inflammation. This mushroom combats oxidative stress, inflammation, and aging. And it can help prevent or slow cancer growth and has been found to help lower low-density lipoprotein – LDL cholesterol.
Mushroom Preparation
Mushrooms are almost always available in the produce section of any grocery or health food store. Make sure to wash them thoroughly first. Example: Cremini mushrooms can be:
Eaten raw or cooked, sliced or unsliced.
Simmered in water for 5 minutes until soft
Sauteed – cook the mushrooms in a pan with olive oil on medium heat for eight minutes, frequently stirring until they brown at the edges.
Sprinkled raw over meals to add more texture and flavor.
Ways to add mushrooms to a nutrition plan:
With eggs in the morning.
Mix into cooked beef, chicken, or turkey.
Cook mushrooms with garlic and butter for a side dish.
Add to a stir-fry with other vegetables.
Add to homemade pizza.
As an ingredient in pasta sauce.
Add to salads.
Make cream of mushroom soup.
Always talk to a doctor, nutritionist, or dietician before to confirm whether adding mushrooms is safe, especially if pregnant or using medications, as certain mushrooms can cause side effects like an upset stomach or allergies.
Food as Medicine
References
Fukushima, M et al. “Cholesterol-lowering effects of maitake (Grifola frondosa) fiber, shiitake (Lentinus edodes) fiber, and enokitake (Flammulina velutipes) fiber in rats.” Experimental biology and medicine (Maywood, N.J.) vol. 226,8 (2001): 758-65. doi:10.1177/153537020222600808
Kabir, Y et al. “Effect of shiitake (Lentinus edodes) and maitake (Grifola frondosa) mushrooms on blood pressure and plasma lipids of spontaneously hypertensive rats.” Journal of nutritional science and vitaminology vol. 33,5 (1987): 341-6. doi:10.3177/jnsv.33.341
Kolotushkina, E V et al. “The influence of Hericium erinaceus extract on myelination process in vitro.” Fiziolohichnyi zhurnal (Kiev, Ukraine : 1994) vol. 49,1 (2003): 38-45.
Ma, Gaoxing, et al. “Health benefits of edible mushroom polysaccharides and associated gut microbiota regulation.” Critical reviews in food science and nutrition vol. 62,24 (2022): 6646-6663. doi:10.1080/10408398.2021.1903385
Rop, Otakar, et al. “Beta-glucans in higher fungi and their health effects.” Nutrition reviews vol. 67,11 (2009): 624-31. doi:10.1111/j.1753-4887.2009.00230.x
Tuli, Hardeep S et al. “Pharmacological and therapeutic potential of Cordyceps with special reference to Cordycepin.” 3 Biotech vol. 4,1 (2014): 1-12. doi:10.1007/s13205-013-0121-9
Venturella, Giuseppe, et al. “Medicinal Mushrooms: Bioactive Compounds, Use, and Clinical Trials.” International journal of molecular sciences vol. 22,2 634. 10 Jan. 2021, doi:10.3390/ijms22020634
Dr. Jimenez, D.C., presents what you need to know about venous insufficiency. Many factors and lifestyle habits cause an effect on our bodies, which can lead to chronic disorders that can impact our musculoskeletal system and potentially lead to pain-like symptoms associated with chronic conditions. In this presentation, we will look at what venous insufficiency is, the symptoms, and how to prevent venous insufficiency from affecting the lower extremities. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with Lyme disease. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
What Is The Venous System?
Dr. Alex Jimenez, D.C., presents: So we will go over tackling common cardiovascular problems and venous insufficiency. So let’s discuss this common complication in our practices: venous insufficiency and the functional medicine approach. So if you look at venous or blood flow, you look at the heart. The heart will pump blood to the arteries and the arterials, the arteries and arterials will pump to capillary beds, and venules will go to veins. Veins will then move the blood to the subclavian vein, and the lymph ducts will also drain in the subclavian vein.
The subclavian vein will then go into the heart, and in the process, it continues and circulates. The big difference between veins and arteries is that arteries have muscles within them, and the muscles will contract, regulate blood pressure, and help keep the blood flowing. But veins do not have that luxury. Veins will depend on our skeletal muscles around them; if we contract them a lot, we’re helping with circulation. So, being active, moving around, and flexing our muscles will keep the pressure in the superficial system to about 20 to 30. And then, when it starts going to the deeper system with the valves, what happens is that the valves will stop blood from flowing back. So the blood can only go in one direction.
And that is basically to have a healthy venous system. You want to be often exercising, and you want to have that higher venous pressure and flow. So what is the pathophysiology of chronic venous insufficiency? You have incompetent valves, or you can have incompetent valves, you can have thrombosis, and you can have obstruction. And that can lead to elevated venous pressure. High venous pressure can lead to vein dilation, skin changes, and ulceration, but also elevated venous pressure can worsen incompetent valves, thrombosis, and obstruction. And then you get this vicious cycle, and usually, it’s the lower extremities; they get worse and worse. So if you want to look at the contributing factors, look at the functional medicine matrix. Venous insufficiency pathogenesis hits many places on the functional medicine matrix, multiple places we can look at in the lower body extremities.
Venous Insufficiency & Its Signs
Dr. Alex Jimenez, D.C., presents: So what are the clinical manifestations of venous insufficiency? The symptoms are limb itching, heaviness, fatigue, particularly in the legs, pain in the legs, swelling, and tightness. The skin can get dry and become irritated. You might not be dealing with autoimmunity if you have this dry, irritated skin. You might be dealing with venous insufficiency. They can get muscle cramps. So your muscle cramps might not be a magnesium deficiency. Your muscle cramps might be venous insufficiency pain worse when standing or seated with their legs dangling. So when you’re sitting, the legs are dangling, and the pain improves when you elevate your legs and walk. And that actually can differentiate from arterial insufficiency. Remember, you get claudication in peripheral artery disease and arterial insufficiency. That’s when you walk and exert yourself. And because the blood vessels going to the muscles and the legs are tighter because of atherosclerosis, you get pain from walking.
Whereas venous insufficiency is the other side of the system, you walk and start feeling better. Why? Because those muscles are pumping the veins and moving blood through instead of the blood just being stagnant and sitting there. So edema you can get, which is swelling. Stasis dermatitis, which is dermatitis, red and swelling, and inflamed varicose veins, can be seen in this picture. Now the diagnosis is usually made by clinical signs and symptoms. So the clinical signs, what are the signs to look out for? For this part, go to your favorite search engine and look up every one of these symptoms that we mentioned so you know what it looks like. We are sure you’ve seen it before, but remind yourself what these things look like so that it can help you; it can help you when you’re diagnosing and looking at your patients.
Lymphodematosclerosis
Dr. Alex Jimenez, D.C., presents: Suppose a person has varicose veins. You can have lymphodematosclerosis, which is the champagne bottle sign. When you search that, look at that and see how the leg will look like an upside-down champagne bottle. Why? Because there’s a lot of fibrosis and hard tissue, and that tissue is holding that blood. You can’t get much edema, and you can’t get much swelling because it’s so tight, the blood can’t move in there. So look up the champagne bottle, not just the regular one, but look up a champagne bottle or lymphodematosclerosis, and you will remember that image when you see it. Then you will remember that image. You can get ulcerations because there’s decreased blood movement. So you get ulcers, and you can get hyperpigmentation. We see this often when you have a darkened skin color in the lower extremities from the constant fluid or blood leaking.
That’s hemosiderin deposits or iron deposits from popping blood cells. And you can get skin atrophy. So by typing these clinical signs on the internet that correlate with venous insufficiency, you have a good visual of what these things look like. So what is the functional medicine treatment plan? We’re going to look at the risk factors of chronic venous insufficiency, and we’re going to look at the adaptable ones, and based on that, we can give patients recommendations and plans. So obesity works on decreasing fat, sedentary life, being active, checking estrogen and hormone levels, and reducing estrogen and increasing progesterone. If you have to get out of that estrogen dominance, we want to look at those risk factors, see which ones are adjustable, and start working with them.
Ways To Reduce Venous Insufficiency
Dr. Alex Jimenez, D.C., presents: So you have this person with venous insufficiency. Check on their obesity levels, so you work on lowering their body fat and see if they have a sedentary lifestyle and getting them moving high. Check their hormone levels and see where their estrogen levels are regulated. If you check the IFM hormone module, check it out because it has some really good information on how to balance hormones in a functional medicine way. Make sure that they’re standing for a short period. At least occasionally, have them walk around, and you can have them set a timer. So every so often, every 20, 30 minutes, they walk around to keep their legs and blood flow moving. Work on decreasing smoking. And mentioning these risk factors to the patient can make them aware that this can worsen their venous insufficiency. Other conservative therapies include leg elevation. So have them lay down by putting their legs up to allow gravity to help push the blood down. Compression therapy. So have them wear compression stockings and stasis dermatitis; sometimes, you must use topical dermatologic steroids and some of those agents, which can be helpful there.
You may consider earthing. There was a research study that showed that if you put your feet on the ground outside barefoot, not in the insulated houses, then what can happen is, is the viscosity of your red blood cells will decrease. So the red blood cells will clump less, and you can have better movement and circulation. Pharmacological therapies and supplementations to target venous insufficiency. So what can we do while we’re looking at doing two things? We want the venous tone to be improved. So you want to tighten those veins up. On the arteries, you want to loosen them up. Usually, when an individual has hypertension, we want the veins to tighten those bad boys up so that circulation can happen. And then you want to improve the flow. You want the blood to be able to flow through the veins better.
Supplements For Venous Tone
Dr. Alex Jimenez, D.C., presents: So let’s take a look at the venous tone. This is one of the places where we’re ahead of the game in functional and integrative medicine because if you look at the conventional literature, even up-to-date research, many people are using up-to-date now to see how often they diagnose weak venous tone. So we can take a look at that. But if you look at what you can do for venous tone? It has two supplements. Regarding venous tone and increasing venous tone, two supplements can support the venous system: horse-chestnut seed extract (Escin) and diosmin.
So those are the two things that are mentioned. And we, in functional and integrative medicine, are more prepared to deal with this because we know about pharmacy grade; we learn about giving them a good product that is third-party tested and doesn’t have those toxic fillers and whatnot. The second way of treating venous insufficiency from a medical point of view is by improving venous flow. You want blood viscosity to be thinner. You don’t want the blood not to be as prone to clotting so the blood can flow easier. So here are some agents you can use. You can use aspirin; you can use pentoxifying; you can use nattokinase, which can help lower fibrinogen. Regarding venous insufficiency, it can cause the body to have high fibrinogen. So nattokinase can help lower elevated fibrinogen.
Conclusion
Dr. Alex Jimenez, D.C., presents: If they’re not on aspirin or any blood thinners and have high fibrinogen and venous insufficiency, it might also be a good one to put somebody on omega-3s. We are trying to get their omega-3 levels up, and they are useful when optimizing help with venous flow. You’re going to have people to come and see you, and you’re going to be treating them for other things. And because you’re functional medicine, you’re part of the cool club; what’s going to happen is they’re not even going to tell you about their venous insufficiency, and it’s going to get better just because of the treatments that you’re doing. And it will be epic. And if all else fails, you refer to associated medical specialists to help your patient. So, in conclusion, take care of your veins and look for the signs to prevent venous insufficiency from causing more issues in the lower extremities, and utilize vitamins and supplements to reduce the pain and inflammation in the muscles and joints.
Mindfulness is a valuable tool for reflection and centering/balancing mind and body. Applying mindfulness to fitness can impact the body’s physical well-being and can be incorporated into an existing routine to get the most out of every workout. Applying mindfulness to a fitness routine includes increased satisfaction after a workout and a strengthened commitment to engaging in healthy activity.
Applying Mindfulness
The benefits of applying mindfulness to workouts include the following:
Increased emotional control.
Improved overall wellness.
Increased coping skills to lower blood pressure and reduce stress.
Stay more consistent with a fitness routine.
Workout time builds a stronger relationship between the mind and body.
Mental State
Mindfulness is a mental state that enables individuals to experience their current surroundings uninterrupted by thoughts, worries, or distractions. The objective is to maintain awareness during an activity, such as exercising, and not focusing on judging oneself or the surroundings. It is a form of getting oneself in the zone during their fitness routine that brings an enhanced awareness of the senses like:
Sight
Hearing
Smell
Touch
Taste
Awareness of the location and movement of the body in space.
Meditation
Meditation is a mindfulness exercise that can enhance relaxation, increase the ability to focus, and reduce stress. Different types of meditation range from:
Mantra-based meditation – where a word or phrase is repeated to act as an anchor during an activity.
Movement meditation involves using light exercises like yoga, tai chi, or walking to build a stronger connection with the body.
Benefits
Mental Health
Research has shown that mindfulness is linked to improved overall mental health. One study found that completing a mindfulness-based stress reduction program or MBSR helped increase mental wellness. The analysis discovered that participants who practiced regularly through the program noticed improvements in their quality of life and coping skills during moments of stress. Other mental health benefits include:
One study of individuals with chronic hypertension found that engaging in mindfulness training two hours per week for eight weeks resulted in a clinically significant reduction in systolic and diastolic blood pressure readings. Other physical health benefits include:
Positive physical responses in the body.
Chronic pain alleviation.
Higher sleep quality.
Successful long-term weight loss.
Improved and increased healthy habit-building.
Increased motivation
Feeling more connected to your body
Staying on track with fitness goals.
Workout Implementation
How to apply mindfulness to get the most out of a workout. Exercises like walking, lifting weights, or participating in a fitness class are great ways to practice mindfulness. A few tips for creating a more enjoyable, effective, and mindful workout session includes:
Set A Workout Goal
Before starting a workout, it’s recommended to set an intention (things an individual aims for, strives to achieve, and is related to the mental and physical state. This could be something along the lines of:
Believe in me.
Keep an open mind.
Try my best.
Remember to enjoy the workout.
A simple and short intention can ground the workout process.
It has been proven to enhance commitment and completion of regular physical exercise.
If you begin to struggle or experience a wandering mind during an activity, remind yourself of the intention to focus on the current moment and get back in the groove.
Practice Visualization During the Workout
Visualization is effective for enhancing mindfulness during physical activity, as it allows the brain to create impulses that help complete the task. It is defined as focusing on movement and visualizing performing the physical routine to the best of your ability.
Mix Up the Workout Environment
The workout space plays a significant role in overall exercise efficacy, especially when working out outdoors. Exercising outdoors, like an outdoor class, hiking, or weight-lifting in the backyard, allows the body to attune to nature and the surroundings. This is an effective and simple way to reduce mental fatigue, improve mood, and decrease the perception of the overall effort to maintain motivation to exercise for longer and with more intensity.
Breathe From the Diaphragm
The importance of timing movements with breathing and breathing from the diaphragm can positively impact the autonomic nervous system to promote increased emotional and psychological control. Breathing from the diaphragm while exercising can intensify relaxation and increase the enjoyment of physical activity. The Injury Medical Chiropractic and Functional Medicine Team can educate individuals on applying mindfulness and develop a personalized treatment and fitness program for restoring, improving, and maintaining overall health.
Mindfulness Workout
References
Demarzo, Marcelo M P, et al. “Mindfulness may both moderate and mediate the effect of physical fitness on cardiovascular responses to stress: a speculative hypothesis.” Frontiers in physiology vol. 5 105. 25 Mar. 2014, doi:10.3389/fphys.2014.00105
Mantzios, Michail, and Kyriaki Giannou. “A Real-World Application of Short Mindfulness-Based Practices: A Review and Reflection of the Literature and a Practical Proposition for an Effortless Mindful Lifestyle.” American journal of lifestyle medicine vol. 13,6 520-525. 27 Apr. 2018, doi:10.1177/1559827618772036
Ponte Márquez, Paola Helena, et al. “Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension.” Journal of human hypertension vol. 33,3 (2019): 237-247. doi:10.1038/s41371-018-0130-6
Wieber, Frank, et al. “Promoting the translation of intentions into action by implementation intentions: behavioral effects and physiological correlates.” Frontiers in human neuroscience vol. 9 395. 14 Jul. 2015, doi:10.3389/fnhum.2015.00395
As individuals try to avoid sugar as best as possible, alternative sweeteners are becoming more popular. A new addition is monk fruit sweetener, also called monk fruit extract. Monk fruit is a small, round fruit native to southern China. Unlike some chemically based sugar alternatives, monk fruit extract is considered natural. The sweetener has been around for decades but has become more available in the United States. The zero-calorie extract can be used as a standalone sweetener in foods and drinks and as a flavor enhancer.
Monk Fruit Sugar Alternative
Manufacturers remove the seeds and skin, crush the fruit, and extract the juice, which is then dried into a concentrated powder. Unlike most fruits, the natural sugars in monk fruit are not what gives it its sweetness. Instead, the intense sweetness comes from antioxidants (commonly found in plant foods, antioxidants fight off free radicals that can cause health problems like cancer and heart disease) called mogrosides. The mogroside is the sweetest part of the fruit, with a taste over 100 times sweeter than sugar and no calories.
Safe For Consumption
Monk fruit has the generally recognized as safe -GRAS label from the U.S. Food and Drug Administration with no reported side effects. However, it is advised to read the ingredients label before buying this sweetener. Some of the cheaper products combine other sweeteners with monk fruit extract. Some contain erythritol, a sugar alcohol that can cause stomach bloating or upset stomach.
Use
It has been found to be a healthy option for lowering overall sugar intake. However, consuming monk fruit or any sweetener should be done in moderation and with a healthy nutrition plan. It comes in powder or liquid form. As a natural alternative, it can be used:
As s sugar substitute for favorite baking, cooking, soup, sauce recipes, etc.
For drinks like coffee, tea, lemonade, smoothies, etc.
Added on breakfast dishes like oatmeal or yogurt.
Whipped into frosting or a mousse.
The ultra-sweetness means that little is required as it goes a long way. It is recommended to drink regular water or tea and eat foods without the sweetener because, over time, the taste buds adjust and do not need the sweetener as much. Consult a doctor, dietician, or nutritionist to determine if this sugar alternative is right for you and the benefits.
What Is It?
References
Chen, W J et al. “The antioxidant activities of natural sweeteners, mogrosides, from fruits of Siraitia grosvenori.” International journal of food sciences and nutrition vol. 58,7 (2007): 548-56. doi:10.1080/09637480701336360
EFSA Panel on Food Additives and Flavourings (FAF) et al. “Safety of use of Monk fruit extract as a food additive in different food categories.” EFSA journal. European Food Safety Authority vol. 17,12 e05921. 11 Dec. 2019, doi:10.2903/j.efsa.2019.5921
Lobo, V et al. “Free radicals, antioxidants, and functional foods: Impact on human health.” Pharmacognosy reviews vol. 4,8 (2010): 118-26. doi:10.4103/0973-7847.70902
Pawar, Rahul S et al. “Sweeteners from plants–with emphasis on Stevia rebaudiana (Bertoni) and Siraitia grosvenorii (Swingle).” Analytical and bioanalytical chemistry vol. 405,13 (2013): 4397-407. doi:10.1007/s00216-012-6693-0
Dr. Jimenez, D.C., presents how to find the right diet for cardiometabolic syndrome in this 2-part series. Many environmental factors often play a role in our health and wellness. In today’s presentation, we continue discussing how genes play with the cardiometabolic diet. Part 1 looked at how every body type is different and how the cardiometabolic diet plays its role. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with metabolic connections. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
Omega-3s & Genes
Dr. Alex Jimenez, D.C., presents: We’ve found that fish oils or omega-3s can lower triglycerides, small-density LDL, and sometimes lower LDL and keep HDL regulated. But these studies were back when they were supplementing with more of an even DHA/EPA ratio. But that’s something to be observant of; the study showed that giving them fish oil lowers their small density LDL and triglycerides. They also found that if they gave them a lower fat food plan, and a lower fat diet, they found it lowered their LDL and small density LDL. A moderate fat diet reduced their LDL, but it increased their small density LDL. And they found that average alcohol consumption lowered their HDL and increased their LDL. So that’s not a good sign when that happens. So the opposite of what you want to occur with a moderate alcohol consumption diet or food plan.
So going back to APO-E4 in the body, how would this gene be affected when dealing with viral infections like herpes or cold sores? So research studies have revealed that APO-E4 and herpes simplex one viruses can affect the brain’s cerebral tissues. So the research also indicates that patients with APO-E4 are more susceptible to getting the herpes virus. And remember, herpes simplex one virus is what causes cold sores. What about HSV and dementia? How would that correlate with the body? The research indicates that HSV increases the risk of dementia. And what the thought is is that just like the herpes virus can come out and cause cold sores, it can internally manifest, and you can get these episodes where HSV becomes active in the brain, which can cause some of the pathogenesis of dementia or Alzheimer’s disease.
APO-E & Finding The Right Diet
Dr. Alex Jimenez, D.C., presents: And there was a study that showed that if you gave patients with dementia antivirals, it decreased the risk of getting dementia. So what do we do with the APO-E genotype? If you have APO-E2, APO-E3, or APO-E4, you can start them on the cardiometabolic food plan. If they’re on the SAD diet, the standard American diet, then putting them on the cardiometabolic food plan is just a good idea. It’s going to start shifting them in the right direction. What about additional consideration if they have APO-E3/4 and APO-E4/4? There are a couple of reasons you should jump in on this. They like it more when you customize a diet to a patient’s genetics. So if you can say, listen, we have your genes, and we know that you would do better if you had lower saturated fat, or if you don’t do so well on alcohol X, Y, or Z, it makes them pay attention more.
Because now it’s personalized. It’s not like, “Hey, everybody, just eat healthily.” It’s more personalized to your genetics. So, that would be a reason to start this from the get-go. But get them on the cardiometabolic food plan, and they should begin to feel better. But we would start by putting the whole thing in perspective that this APO-E3/4 and APO-E4/4 is not a death sentence. It’s a clue of how you respond to your environment and what we need to watch out for. It does not mean that you are going to get Alzheimer’s. The majority of people with Alzheimer’s do not have APO-E4. You have a higher risk of getting Alzheimer’s if you have APO-E4. And that’s where functional medicine comes in to risk-stratify them.
Finding The Right Diet For You
Dr. Alex Jimenez, D.C., presents: We recommend a lower simple carbohydrate diet or a higher glycemic index diet. And diet and food plan interchangeably, but patients call it a food plan because diet has negative connotations. So we avoid the word diet because when people hear or speak it, some people are triggered by it. You have people with food disorders and people with bad experiences with diets. A lower fat and a lower saturated fat food plan or recommendation is something to consider and be more aggressive with omega-3s. And if you start giving omega-3s to the patients, it is best to check their omega-3 levels and see if they begin to fluctuate. If they start shifting for the better, then we strongly advise against alcohol and monitor these patients for cognitive decline; there are different tools that you can use.
When it comes to omega-3s, it is best to do a cognitive test to keep an eye on their mentation. So if it starts to decline, you’re jumping in way before you have a major problem. And because of the issue of them not being able to deal with viral infections like herpes. And because the herpes virus may play a role in getting dementia, you may consider lysine supplementation. Arginine can deplete lysine. So if you end up eating a lot of pumpkin seeds and a lot of almonds and whatnot that have higher amounts of arginine, you can counteract that with lysine. And the research suggested that you need about two grams of lysine daily. But remember, every patient is different, so don’t just throw everybody on lysine if they have APO-E3/4, APO-E4, or APO-E44 3 but just something to consider.
So final thoughts on APO-E and nutrition. There are many pieces to the puzzle. Do not be dogmatic and say you have these genes, so you must do this. Just realize there are so many different genes, so many other variabilities, and recognize that it’s not that race can have something to do with how APO-E is affected. For example, they did a study that found that people in Nigeria had higher amounts of APO-E4, and the APO-E4 four did not increase their risk of dementia. So there are other pieces of the puzzle, monitor biomarkers and continue to adjust the plan. Next, we will discuss dealing with people with high triglycerides and high LDL.
What To Do With Abnormal Lipids?
Dr. Alex Jimenez, D.C., presents: So how do you take the abnormal lipid findings that you see on your profiles of your patients, those biomarkers, as all of us check? And how do you adjust the cardiometabolic food plan? What of the highlights of a cardiometabolic food plan that you will do for your patient in response to their lipids? Let’s first review a few things we know about how to modulate the diet’s lipids. First, we know that if you go from a standard American diet to the cardiometabolic food plan. You remove the trans fatty acids, and if you remove the trans fatty acids, then you will see a decrease in LDL cholesterol triglycerides. You’ll get an improvement in HDL; to say it another way, if your diet is high in trans fatty acids, you’ll have a higher LDL you have, you’ll have more elevated triglycerides, and you’ll have lower HDL.
How To Modulate Your Diet
Dr. Alex Jimenez, D.C., presents: What else about modulating the diet? If you have longer chain fatty acids that are not polyunsaturated, you’ll have an increase in your LDL and triglycerides and an increase or no change in your HDL cholesterol. On the other hand, we focus a lot on the shorter chain fatty acids and functional medicine. So if you have shorter chain fatty acids that are less than ten carbons, you’ll have lower LDL cholesterol triglycerides and increased HDL. So you can see with the cardiometabolic food plan, by addressing with the patient, their fat source, you can begin to impact LDL cholesterol without anti-triglycerides, without any other modulation other than dietary habit. And then finally, we know the data early and some of the most recent meta-analyses of changing simple sugars in the diet.
We know that that can, in its own right, increase LDL cholesterol triglycerides, and you get a lowering of HDL. So let’s put this all in context. What do we want to do for our patients to decrease the risk of coronary artery disease or atherosclerosis fat disease? We want their LDL cholesterol to be in a lower range. We do not wish for that LDL to be oxidized. We want the HDL to be higher. And if we can get triglycerides down through dietary change, then that gives us a clue that they might not be dysfunctional in the insulin metabolism. Then finally, with omega-3 fatty acids or adding omega-3 fatty acids or mono-concentrated fatty acids, we’ll lower LDL cholesterol triglycerides, and we’ll get an increase in HDL cholesterol. This is associated with a reduction in cardiovascular risk independent of lipid levels.
Conclusion
Dr. Alex Jimenez, D.C., presents: How is that affecting the body? It is because you have inflammatory drivers independent of your serum lipids that will increase your risk of atherosclerosis disease. It comes to saturated fat and fat content. Balancing the proteins, and the fat, you don’t have as much oxidative stress associated with inflammation after a meal. Thus, even if you have an elevated LDL level, you have less chance of having an increased oxidized LDL. Incorporating fibrous foods, antioxidants, lean meats, dark leafy greens, and supplements into a healthy diet can help lower LDL and fatty acids in the body and reduce all these comorbidities causing issues to your health and wellness.
So, those are just some tips and tricks for diet prescription to reduce cardiometabolic syndrome. And we encourage your patients to add more greens, legumes, nuts, and seeds, making the plant-based diet a mainstay for their heart health.
High Blood Pressure and Physical Activity: Blood pressure flows throughout the body to meet metabolic demands. During periods of physiological stress like physical activity, exercise, or feeling overwhelmed, blood pressure can increase for a short period but is not considered dangerous or unhealthy. However, when an individual’s baseline resting blood pressure readings stay high, the risk of developing serious health conditions increases. High blood pressure is reversible with lifestyle adjustments and physical activity for a more healthy and sustainable level.
High Blood Pressure and Physical Activity
Everything individuals need to know and understand about high blood pressure includes:
Common causes
Healthy readings
Monitoring pressure
Beneficial activities to lower blood pressure and improve health.
Blood pressure measures the force exerted on the circulatory system. Blood pressure changes throughout the day, depending on the following:
Nutrition
Activity levels
Stress levels
Medical comorbidities
Unlike heart rate or temperature, blood pressure is two separate measurements. Typically seen as a fraction, for example – 120/80 mmHg, each number gives the medical provider information about the function and health of the vascular system:
Systolic
Written as the top number of the measurement, systolic blood pressure refers to the force exerted against the blood vessels during a heartbeat.
This value represents the highest pressure on the arteries, veins, and capillaries.
Diastolic
The bottom number/measurement, the diastolic reading, represents the pressure the vascular system is subjected to between heartbeats.
In most cases, elevated diastolic blood pressure values are seen in individuals with high systolic blood pressure.
Readings
According to the CDC, a healthy blood pressure reading is 120/80 mmHg. As blood pressure changes throughout the day, it is recommended to have a baseline level/when at rest to remain as close as possible to these values. When baseline levels remain high, the risk of developing serious medical complications increases. Criteria for different stages of diagnosis include:
Elevated blood pressure – 120-129 mmHg / 80 or less mmHg.
Stage 1 hypertension – 130-139 mmHg / 80-89 mmHg.
Stage 2 hypertension – 140 or higher mmHg / 90 or higher mmHg.
Prolonged exposure to high pressure damages the vessels and heart.
Measurements
The first step to assessing baseline blood pressure is taking regular and accurate readings. An automatic blood pressure cuff and monitor at home can record readings to determine baseline values. Various factors can contribute to inaccurate readings. Here are a few tips for avoiding inaccuracy:
Keep the arm being measured at the height of the heart.
Avoid taking blood pressure after exercise or stress.
Double-check readings on the opposite arm when possible.
Try to take readings at a similar time during a rest period.
After each reading, record values in a journal for the primary care provider.
Performing daily blood pressure readings for a few weeks can be beneficial to determine baseline levels.
Physical Activity
Aerobic activities increase the body’s need for oxygen. Getting the muscles active and moving during physical activity increases the demand for oxygen, which is why breathing and heart rate increase. The cardiovascular system includes the heart, arteries, and veins. Additional stress is added when the system goes through aerobic activity to maintain metabolic levels, improving strength and endurance. Regular aerobic exercise can decrease high baseline pressure because a stronger heart and vascular system do not need to exert as much energy to maintain cell function. Aerobic activities include:
Brisk Walking
A low-impact aerobic exercise, brisk walking, has been shown to reduce baseline systolic blood pressure in individuals who participated in supervised walking sessions over six months.
Gardening
Gardening activities like digging and lifting are considered moderate-intensity exercises. It is a recommended low-impact option for individuals of all ages.
Bicycle Riding
Cycling has been shown to offer short and long-term benefits for managing blood pressure.
It is common for pressure to increase while biking; studies have shown that regular cycling can reduce baseline systolic and diastolic blood pressure over six months.
It is recommended to start slow. As confidence builds and cardiovascular endurance increases, longer and more regular bike rides become easier to integrate into a routine.
Dancing
All forms of dancing can help to improve cardio endurance and strength, which has been shown to reduce systolic and diastolic blood pressure readings.
Whether line dancing, partner dancing, or dancing alone, dancing regularly can help reduce stress and blood pressure levels.
Hypertension Nutrition
References
Cardoso, Crivaldo Gomes Jr, et al. “Acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure.” Clinics (Sao Paulo, Brazil) vol. 65,3 (2010): 317-25. doi:10.1590/S1807-59322010000300013
Conceição, Lino Sergio Rocha, et al. “Effect of dance therapy on blood pressure and exercise capacity of individuals with hypertension: A systematic review and meta-analysis.” International journal of cardiology vol. 220 (2016): 553-7. doi:10.1016/j.ijcard.2016.06.182
Hollingworth, M et al. “Dose-response associations between cycling activity and risk of hypertension in regular cyclists: The UK Cycling for Health Study.” Journal of human hypertension vol. 29,4 (2015): 219-23. doi:10.1038/jhh.2014.89
Mandini, Simona, et al. “Walking and hypertension: greater reductions in subjects with higher baseline systolic blood pressure following six months of guided walking.” PeerJ vol. 6 e5471. 30 Aug. 2018, doi:10.7717/peerj.5471
Sapra A, Malik A, Bhandari P. Vital Sign Assessment. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK553213/
Dr. Jimenez, D.C., presents how chronic metabolic connections like inflammation and insulin resistance are causing a chain reaction in the body in this 2-part series. Many factors often play a role in our health and wellness. In today’s presentation, we will continue on how these chronic metabolic diseases affect the vital organs and organ systems. It can lead to overlapping risk factors associated with pain-like symptoms in the muscles, joints, and vital organs. Part 1 examined how overlapping risk profiles like insulin resistance and inflammation affect the body and cause muscle and joints pain-like symptoms. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with metabolic connections. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
How The Liver Associated With Metabolic Diseases
So we can look to the liver to find earlier cues of cardiovascular risk. How can we do that? Well, let’s understand some liver biochemistry. So in a healthy liver cell hepatocyte, when you have increased insulin being secreted because there was a meal that required glucose to be absorbed, what you expect if the insulin receptor works is that the glucose would go in. Then the glucose would get oxidized and turned into energy. But here’s the problem. When the hepatocyte has insulin receptors that don’t work, you’ve got that insulin on the outside, and the glucose never made it in. But what also happens on the inside of the hepatocyte is it was assumed that the glucose was going to get in. So what it does is it turns off fatty acid oxidation, thinking, “Guys, we don’t need to burn our fatty acids. We’ve got some glucose coming in.”
So when the glucose is not there, and you’re not burning off fatty acids, very common for people to feel fatigued because nothing is burning for energy. But here is the secondary sequela; where are all those fatty acids going, right? Well, the liver may try to repackage them as triglycerides. Sometimes, they stay in the hepatocyte or get shifted out of the liver into the bloodstream as VLDL or very low-density lipoprotein. You might see it as a high triglyceride shift in a standard lipid panel. So, when all of us are talking about getting a triglyceride level to around 70 as your 8+ goal, when I start seeing triglycerides rising, we wait until they’re 150, even though that’s the cutoff for our labs. When we see it at 150, we know they are shunting triglycerides out of the liver.
So that will happen many times before we find impaired fasting glucose. So look at your triglycerides, fasting triglycerides, as an emerging or early biomarker of insulin dysfunction. So this is another diagram that says that if the triglycerides are being created because the fatty acids are being oxidized, they can stay in the liver. Then that makes steatosis or the fatty liver, or they can be pushed out, and they turn into lipoproteins. We’re going to talk about that in just a second. The body is like, “What are we going to do with these fatty acids?” We can’t try to shove them into places because nobody wants them. To that point, the liver is like, “I don’t want them, but I will keep some with me.” Or the liver would have these fatty acids transported and stuck to the blood vessel walls.
And then the blood vessels and arteries are like, “Well, I don’t want them; I’ll put them underneath my endothelium.” And so that’s how you get atherogenesis. The muscles are like, “I don’t want them, but I’ll take some.” That’s how you get the fatty streaks in your muscles. So when the liver is getting bogged down with steatosis, inflammation occurs in the body and produces this feed-forward cycle inside the hepatocyte, damaging the liver. You’re getting cellular death; you’re getting fibrosis, which is just an extension of what happens when we don’t address the core issues for fatty liver: inflammation and insulin resistance. So, we look for subtle rises in AST, ALT, and GGT; remember that it is a liver-based enzyme.
Hormone Enzymes & Inflammation
GGT enzymes in the liver are smoke detectors and tell us how much oxidative stress is going on. Will we look at HSCRP and APOB to see the output of this liver? Is it starting to dump excess fatty acids through VLDL, APOB, or triglycerides? And how it picks that is just genetics, honestly. So I look for liver markers to tell me what’s going on in the liver as a sign of what’s happening everywhere. Because that might be the genetic weak spot of the person, some people are genetically vulnerable just in terms of their lipid profiles. To that point, we can look for something called metabolic dyslipidemia. You know this as high triglycerides and low HDL. You can specifically look for a ratio; an optimal balance is three and lower. It starts going from three to five and then five to eight, like eight is almost pathognomonic of insulin resistance. You’re just reaching becoming more and more insulin resistant.
As the number increases for that trig over HDL ratio, that is a simple, easy way to screen for insulin resistance. Now some people look 3.0 on this but still have insulin resistance. So there are other tests you do. This is a way to find those who show insulin resistance through lipids. And remember, everybody is different. Women with PCOS could have amazing lipids but could express an increase or decrease of hormones associated with insulin, estrogen, and inflammation. So look for something other than one test or ratio to indicate whether they’ve got it. You’re looking to see what could be the place where we will find the clue.
So let’s use the word healthy. A healthy person has VLDL that looks to be a healthy normal size in their bodies, and they have normal LDL and HDL. But now look at what happens when you get insulin resistance. These VLDL ls start to pump up with triglycerides. That’s why they’re fattening up. It’s lipotoxicity. So if you start looking at the VLDL three numbers in a lipoprotein profile, you’ll see that that number is creeping up, and there are more of them, and their size is bigger. Now with LDL, what happens is that the cholesterol amount within the top and the bottom is the same. If I pop all these water balloons, it’s the same amount of LDL cholesterol. However, that amount of LDL cholesterol in insulin resistance is repackaged in small dense LDL.
How Does Functional Medicine Play Its Part?
Now we understand that there may be some of you who cannot or do not have access to this testing, or your patients cannot afford it, and that’s why we answered the questions and looked for other clues of insulin resistance and treat the root cause that is affecting the body. Look for signs of inflammation and other overlapping profiles of insulin resistance. The particle number is higher when they’re insulin resistance. So cholesterol is the same, whereas the particle number is more elevated, and small dense LDL is more atherogenic. Treat it because whether or not you have access to knowing the LDL particle, there should be something in your head that says, “Man, even though this person’s LDL cholesterol looks good, they have tons of inflammation and insulin resistance; I can’t be sure that they don’t have higher particle number.” You might assume that they do this just to be safe.
The other thing that happens in insulin resistance is that the HDL or the healthy cholesterol tends to become small. So that’s not very good because the efflux capacity of HDL is lessened when it’s smaller. So we like the larger HDL, if you will. Access to these tests would give you a solid indication of what’s going on with your patient from a cardiometabolic perspective.
When it comes to these tests, it is important to utilize them to determine the patient’s timeline when they have inflammation or insulin resistance in their bodies, affecting their quality of life. However, many people would often express that these tests are expensive and would go with the gold standard of testing for affordability and be able to decide if it is worth it to better their health and wellness.
Look For Cardiometabolic Risk Patterns
So when it comes to cardiometabolic risk factor patterns, we look at the insulin aspect and how it correlates with mitochondrial dysfunction associated with insulin resistance and inflammation. A research article mentions how two mitochondrial dysfunctions can affect the body. Okay, let’s talk about the first issue, which is the quantity issue. One could be endotoxins that we encounter in our environment, or two; it can be genetically passed along from generation to generation. So the two types could indicate that you don’t have enough mitochondria. So that’s a quantity issue. The other problem is it’s a quality issue. You got plenty of them; they don’t work well, so they don’t have high output or at least normal results. Now how does this play out in the body? So out in the periphery, your muscles, adipocytes, and liver, you have mitochondria in those cells, and it’s their job to energize that lock and jiggle. So if your mitochondria are in the right number, you’ve got plenty to energize the insulin cascade lock and jiggle.
Interesting, right? So here it is in summary, if you don’t have enough mitochondria, which is the problem in the periphery, you get insulin resistance because the lock and jiggle aren’t working well. But if you do not have the mitochondria working well in the pancreas, especially in the beta cell, you don’t secrete insulin. So you still get hyperglycemia; you don’t have high insulin state. When this happens, we know your brain should be hurting, but hopefully, it will come together slowly.
Another article mentions that it connects mitochondrial dysfunction with type two diabetes, and poor maternal nutrition can prime it. This one talks about how fatty liver is associated with lipotoxicity, right? That’s that increased fatty acid, and oxidative stress, which, remember, is the byproduct of inflammation. ATP depletion and mitochondrial dysfunction. When this happens, it can affect the liver, which then turns into the fatty liver, and can also be associated with gut dysfunction, which leads to chronic inflammation, elevated insulin resistance, mitochondrial dysfunction, and many more. These chronic metabolic diseases are connected, and there are ways to reduce these symptoms from affecting the body.
Conclusion
When having a conversation with their doctors, many patients know that the same drivers affect a whole host of other phenotypes, all commonly rooted in inflammation, insulin, and toxicity. So when many people realize these factors are the root cause, doctors will work with many associated medical providers to develop personalized functional treatment plans. So remember, you always have to use the timeline and the matrix to kind of help you know where do you start with this patient, and for some people, it might be you’re just going to tweak a little bit of lifestyle because all they’re working on is changing their body count. So it’s one of the blessings of functional medicine that we were able to turn off the inflammation in the gut, which helps reduce the toxic impact burdening the liver. It also allows the individual to find out what works or doesn’t work with their bodies and take these small steps to improve their health.
We hope you have fresh eyes about inflammation, insulin, and toxicity and how it is at the root of so many conditions that your patients are facing. And how through very simple and effective lifestyle and nutraceutical interventions, you can change that signaling and change the course of their symptoms today and the risks they have tomorrow.
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