Tag: immune system

Former Marathoner and Triathlete Achieves Pain Relief with Dr. Jessica Miller’s Functional Medicine Approach

“On January 23, 2023, I set a personal goal of cumulatively swimming 150 miles (equal to the width of the English Channel.) I will complete my goal this week, November 2024. Determining my next challenge comes next. I could not have achieved this without the care and guidance from Dr. Miller.”

When Stuart had exhausted traditional medicine treatments and medications, he refused to give up and sought the guidance of Dr. Jessica Miller, a Marlboro, NJ, physician specialist specializing in Functional and Integrative Medicine.

“When I met Dr. Miller in 2017, my health was a mess,” recalls Stuart G., a retired optical industry professional and competitive athlete. “I was a competitive recreational athlete for over 30 years until health and environmental issues compromised my ability to participate.”

How does Functional Medicine differ from traditional medicine?

Functional and Integrative Medicine differs from the standard healthcare most Americans receive today. Its practitioners diagnose and treat the root causes of illness; this approach combines personalized, science-based, non-invasive therapies and lifestyle adjustments to optimize overall health.

Patients benefit from this type of holistic care that considers diet, stress, environment, and genetics, promoting long-term wellness and disease prevention.

Frustrated, exhausted and in pain

Stuart met with Dr. Miller in 2017 during a particularly difficult time, personally and professionally. Understandably, his worsening mental and physical health, including a significant battle with chronic pain syndrome, was compromising his ability to enjoy his passion for recreational sports.

“Dr. Miller spent a lot of time with me during my initial visits. She analyzed my health history and symptoms and ordered several blood and gene tests,” Stuart explains. “I quickly realized my health issues were going to be treated very differently, which I welcomed.”

After studying his results, Dr. Miller prescribed a new health plan that included changes in diet and lifestyle and the addition of specific supplements to address Stuart’s health deficiencies. His health improvements were significant and sustained far beyond his previous treatment efforts. As needed, he continued to see the doctor to measure his improvement and address any new concerns.

Seeking renewal after a second Covid battle

After a second Covid diagnosis in 2024, Stuart returned to Dr. Miller for guidance to regain his physical strength to start swimming again, a passion for Stuart. “I admire Dr. Miller’s expertise in Functional Medicine and her desire to continuously learn more about this emerging field of medicine.”

Stuart says. “She is at the top of her field and uses the latest clinical studies to benefit her patients.” Since Dr. Miller prescribed specific supplements for Stuart, he has felt strong enough to get back into the pool again, a major milestone to support his mental and physical health.

“I’m especially appreciative that Functional Medicine is non-invasive and does not focus on prescribing pharmaceuticals for every acute and chronic health issue.”

Dr. Miller weighs in on Stuart’s case

“Stuart arrived frustrated and worried about his worsening health symptoms, which had taken over his life,” Dr. Miller explains. “I was impressed how open he was to adopt a different health strategy to address his specific issues, particularly those related to pain management.” Dr. Miller stated that she admired his zest for many types of exercise, which she knew sustained him physically and mentally.

The peace-of-mind of ‘lifestyle medicine’

Today, Stuart says he won’t change his current health management plan without consulting Dr. Miller first. “She improved my health in countless ways, and I have no intention of returning to where I was before I started working with her.”

Stuart offers words of experience to others considering a Functional Medicine doctor: “If you are unsatisfied with your current health plan, you have nothing to lose by meeting with the doctor and learning more about her approach to health and wellness.”

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Are you getting the healthcare you need to truly thrive in wellness and disease management?

Functional Medicine and Integrative Health take a more proactive approach to helping treat chronic medical conditions and help support optimal health through all the phases of life. If you’d like to learn more about working with Dr. Miller and her team, call our Practice Manager at 732-631-4410 or click the button below for a no-cost New Patient Discovery Session:

This article is for informational purposes only and should not be used in place of an individualized healthcare visit.

Don’t Forget Your Back

Most of us spend a large portion of the day hunched forward.  Think about when you are working on the computer, cooking, driving or even relaxing.  Your typical posture during these activities is head and neck forward, shoulders rounded forward, back curved and hips flexed.    When you remain in this position for an extended period of time, the muscles in the front of the body tend to shorten or contract, while the muscles in the back of the body tend to weaken.    This can be a set up for back, neck and shoulder problems and in addition, tends to make you look shorter, heavier and less confident.

Stretching before and after exercise as well as during the day is often overlooked in the rush to “get your workout in”.   Stretching however, has numerous benefits.   According to a study published in the Annals of Physical Medicine and Rehabilitation Medicine in September 2016, by I Fekhfekh, et al, dynamic muscle stretching of the knee musculature actually resulted in an increase strength gain in those muscles.  Interestingly, this study also found a decrease in the postural stability of the knee after stretching.    In English, it appears that stretching helps your to build strength, but may decrease the stability of the muscles you stretch at least temporarily.

In general, stretching helps to improve flexibility, joint range of motion, and usually is helpful for injury prevention.    Stretching helps by increasing blood flow to the muscles stretched.  This increased blood flow carries important nutrients to your muscles to allow for muscle growth and repair.  In addition, the increased blood flow helps to wash away muscle “waste” which leads to decreased soreness and inflammation of the muscle.

If allowed to remain in a contracted position for a prolonged period of time, our muscles will shorten.  For example if you spend a large portion of your day sitting in a chair or driving, the muscles in the front of the hips, your hip flexors will shorten.  These muscles have a direct effect on both your posture and your back health.

 

So what should you do?

It is important to stretch the muscles in the front of the body at least daily.

Exercises that focus on the hip flexors:

-Kneeling hip flexor stretch  – in the position of a lunge, allow your back knee to touch the floor and drive the hip of your front leg forward.  This will stretch the hip flexor of the knee on the floor

–Pigeon stretch – extend your right leg straight back and bring the heel of your left leg underneath your right hip.  Then drive your hips forward towards the ground.  Stretch and repeat on the other side.

– Yoga poses such as: low lunge, crescent lunge, upward facing dog, and revolving side angle pose

 

Stretches that focus on the chest muscles and prevent rounded shoulders:

– Door Frame stretch- stand in a doorway or at the corner of a room with your arms up like you were going to stop traffic.  Line your arms up from the elbow to the hand with the doorframe or in the corners of the wall.   Step towards the door and you should feel a stretch in your chest (pectoralis “pec” muscles) and hold for 20-30 seconds.

– Wall slides – stand with your back to the wall and keep your shoulders against the wall.  Walk forward 1-2 steps and slide your arms up and down the wall and squeeze your shoulder blades together.  You should feel a stretch in your upper chest muscles.

–Shoulder squeeze stretch –  clasp your hands together behind your back and slowly try to lift your hands.  Squeeze your shoulder blades together to stretch out the chest wall.

– Yoga poses include : bridge pose, camel pose, cobra pose and cow face pose

 

Stretches for your neck:

– Chin Tucks (Neck Retraction) – keep your shoulders back and your head in a neutral position (eyes facing forwards, chin level) slowly move your head backwards until you feel a slight stretch in the back of your neck.  Hold for 10-20 seconds and repeat.  If needed you can apply a gentle pressure on your chin with your fingertips to press your chin backwards and deepen the stretch.

Incorporating these exercises into your daily routine will help to prevent shortening of the muscles in the front of the body which leads to poor posture and often pain of the neck and back.  As always, if you are having pain which persists you should be evaluated by a certified health care professional to ensure that these exercises are safe for you.

This week we primarily discussed stretching exercises to prevent muscle contraction, and next week we will discuss the importance of strengthening the back muscles to further combat the issues of a hunched posture.

Why No Gluten?

Gluten is one of the proteins found in wheat (durum, emmer, spelt, farina, faro, KAMUT ®, Khorasan wheat, and einkorn) as well as rye, barley and triticale.   Gluten is commonly found in breads, baked good, sauces, salad dressings, cereal, pasta, soups and sauces.  Barley is commonly used in malt, food coloring and beer as well.

Gluten has been around for only about 10,000 years.  Its use in food dates back to the Industrial Revolution where it was used as a type of food glue to help foods maintain their shape.  Because gluten was not part of our evolutionary diet, our bodies are not equipped with the proper enzymes to fully digest this protein.  There are no nutritional benefits derived from eating gluten.  In addition, though the quality of the gluten in our foods has not changed significantly over the past few centuries, the quantity found in foods has increased significantly.

Approximately 70-80% of the population are able to tolerate gluten with no problem.  Because we all lack the enzymes to fully digest gluten, gluten is only partially broken down by the GI tract.  According to studies done by Dr. Alessio Fasano, the head of the Department of Pediatric Gastroenterology and Nutrition at Mass General Hospital for Children, the undigested fragments of gluten and gliadin cause transient intestinal inflammation and can release a molecule called zonulin.

Zonulin causes an opening in the barrier of the GI tract.    Essentially the spaces between the cells lining the gut wall open up and allow foods and other toxins to cross into the blood stream, which would not normally get through.  In 70-80% of the population this is not a problem because the immune system works properly and can remove any offending bacteria, toxins, etc.

The immune system is remarkably complex, however essentially it is composed of two branches.  The innate and adaptive immune system.  The innate immune system is the first line of defense in the GI tract.  The innate immune system is immediate and is not very specific. It will release molecules that destroy or eliminate anything it thinks is foreign.  For example, when the innate immune system is exposed to gluten and gliadin fragments, cytokines (small proteins released by cells that are important in cell signaling and can affect the behavior of other cells) are released in an attempt to breakdown these gluten and gliadin fragments.  Cytokines can induce an attack on the gluten, but can also cause a local inflammation in any tissues nearby.  This can cause very microscopic damage to the gut wall which is not always seen on biopsy because repair occurs fairly quickly.

If the innate immune system is unable to handle the “foreign invader”, then the adaptive immune system takes over.  This branch of the immune system is much more specific, sophisticated and takes more time.  The adaptive immune response can lead to either an antibody-mediated attack or to a cell-mediated attack.

In the case of the antibody-mediated the body customizes antibodies to attack the gluten and gliadin protein fragments.    Occasionally, the immune system malfunctions and the antibodies customized to attack the gluten and gliadin can cross-react or get activated by cells in our body.  When this happens, in addition to destroying the gluten fragments, these antibodies also destroy important tissues in our bodies. Depending on which tissue is being attacked will determine a person’s symptoms.  For example, if the antibodies cross-react with joint tissue, a person can develop arthritis.

According to Dr. Fasano, there are three scenarios which could occur when you eat gluten.

  • The gluten is eaten and partially digested. The undigested gluten causes the release of zonulin which opens up the spaces between the gut lining and these protein fragment breach the intestinal barrier.  The innate immune cells respond appropriately and eliminate the fragments and the tiny amount of local inflammation is repaired quickly and the person has no consequences from eating gluten.
  • A person eats gluten and the partially digested fragments activate the immune system as above. However, the innate immune system is unable to eliminate the protein fragments and the adaptive immune system gets activated.  There is a miscommunication between the two branches of the immune system.   The adaptive immune system builds antibodies (or cells) to attack the gluten and gliadin fragments which cross-react with the cells found in the intestinal tract.  The immune cells stay locally in the gut and inflammation persists.  In this scenario the person will develop celiac disease.
  • The third possibility is that the scenario 2 occurs, except that instead of the antibodies (or cells) staying the in the gut and cross-reacting with tissues in the GI tract, the antibodies and/or activated cells travel throughout the body and cross react with different body tissues. In this case, there will be minimal damage in the GI tract, but the personal will have chronic inflammation elsewhere in the body.  Depending on the tissues which cross-react with the antibodies or activated cells, will determine the person’s symptoms.   This scenario is termed non-celiac gluten sensitivity.

Non-celiac gluten sensitivity can cause multiple symptoms.    Symptoms can often be vague, such as abdominal pain, headaches, foggy mind, chronic fatigue, and depression.

People can live for years without any issues with gluten intolerance.  However, it appears that a change in gut flora (as was addressed last week) can be one of the inciting event which can activate gluten intolerance.   There are no nutritional benefits from ingesting gluten, in addition, it causes inflammation in the gut and the release of zonulin leading to increased intestinal permeability.  Interestingly, it appears that zonulin also causes an increase in permeability of the blood brain barrier and may be associated with inflammatory disorders of the brain.

 

Recommended Nutrition For Vegans?

Vegetarians are at risk for certain nutritional deficiencies if you are not careful about selecting nutrient dense foods for your diet.  It is common for vegetarians to be deficient in B12, zinc, calcium, iron and essential fatty acids.  In addition, sources of protein are more limited.

B12 is mainly found in animal products but may be found in fortified tofu and fortified cereals.  It is not always well absorbed and if you are feeling tired or fatigued often, it is a good idea to have your B12 level checked.  Low B12 levels are also associated with nerve pain, numbness and tingling of the hands and feet.   Some people have problems with B12 metabolism and may benefit from methyl-B12 which is one the active forms of B12 used in our bodies for multiple pathways.

Calcium does not need to be obtained from Dairy, and can be found in may fortified foods, or occurs naturally in collard greens, broccoli, edamame, kale, bok choy, figs, oranges and white beans.    Calcium is important for a multitude of functions in the body.  Just a few of roles that calcium plays is to help maintaining strong bones and teeth, nerve signal transmission, muscle relaxation and contraction, modulating hormonal release, maintaining a regular heart rate.

Zinc can be found in beans, legumes, mushrooms, spinach, broccoli, kale, garlic, pumpkin seeds, pine nuts, chia seeds, steel cut oats, and brown rice.  Zinc is important for proper immune system functioning.  It also plays a role in cell division, wound healing, cell growth and carbohydrate metabolism (breakdown).  Zinc is needed during pregnancy and childhood for proper growth.  In addition, Zinc is enhances the action of insulin.

Some recommendations for sources of protein for Vegans include:  Chia seeds,  pumpkin seeds, spinach, broccoli, asparagus, tahini, Spirulina, Chick Peas, almonds, oatmeal, hemp seeds, peas and eggs (if you eat these).

Fish is a very good source of omega 3 fatty acids (essential acids that the body cannot make), therefore, if you are not eating fish, it is important to supplement your diet with either fish oils  (if you will use these), walnuts, flaxseed, flax seed oil and leafy vegetables.  Omega three fatty acids play numerous roles in the body.  They are important for brain function, cardiac function, and are anti-inflammatory.

Vitamin D

Unfortunately, the days of summer are coming to and end. Ever wonder why your mood is so much better in the summer time?   Many of us have significantly less stress because our rigid routines are often more lax over the summertime.   In addition to this decreased stress, the increased length of daylight plays an important role in contributing to our well-being.

When the summer days are long, we are exposed to more UVB light. While an excess of UVB rays can lead to sunburns and may ultimately contribute to certain types of cancers, a small amount of daily sun exposure can improve our health, mood and wellbeing.

This is because when our skin is exposed to UVB rays our skin produces Vitamin D. Vitamin D plays a crucial role in bone metabolism and numerous other bodily functions that will be further described below. Vitamin D can be obtained from foods such as fatty fish, beef liver, egg yolks, and fortified foods such as dairy products, orange juice and cereals. However, it is difficult to consume an adequate amount of Vitamin D just from diet alone.

The Vitamin D that is produced by plants is called Vitamin D2 (ergocalciferol). While the Vitamin D that is produced in human skin and is found in meats and animals sources is called Vitamin D3 (cholecalciferol).   Vitamin D3 is a more suitable source of Vitamin D supplementation because it is easier for the body to convert into the active hormone form than Vitamin D2.   In addition, too much Vitamin D2 intake can be toxic.   It is much more difficult to become toxic from Vitamin D3 because the body has a mechanism to prevent too much Vitamin D3 from being overproduced in the skin.

The active hormone form of Vitamin D, calcitriol, is very important because it controls the calcium and phosphorus metabolism in your body and helps to build strong bones.   Some other important roles of the activated Vitamin D hormone include:

  • Modulates the immune system
  • Improves muscle function
  • Decreases fall risk in the elderly
  • Improves cardiovascular function
  • Has potential anti-cancer effects
  • Improves mood, wards off depression

According to the Mayo Clinic there is strong scientific evident for the use of Vitamin D to treat:

  • Osteomalacia (softening of the bones in adults)
  • Bone pain
  • Psoriasis
  • Some parathyroid and thyroid issues (requires physician oversight)

In addition, there is good scientific evidence for use of Vitamin D to treat:

  • Dental cavities
  • Muscle pain and weakness
  • Fall prevention

Currently the scientific evidence is inconclusive for the use of Vitamin D to treat:

  • Osteoporosis
  • Asthma
  • Auto-immune diseases
  • Bone Density in children
  • Cancer prevention
  • Cognition
  • Infertility
  • Fibromyalgia
  • Inflammatory bowel Disease
  • Cancer prevention in certain types of cancer

According to the National Institutes of Health, it is important to obtain Vitamin D either from the sun or from supplementation, as it appears that we are unable to take in an adequate amount from diet alone. The amount of Vitamin D produced in our bodies is dependent on several factors. The length of time in the sun, the angle of the suns rays, the amount of your body directly exposed to the sun, your proximity to the equator, and the amount of melanin in your skin.

When the sun is directly overhead (you will have a very small shadow) you are absorbing the highest amount of UVB rays. These rays are needed to produce Vitamin D3 in the skin.   Those individuals with darker skin tone, actually produce less Vitamin D3 because the melanin in your skin blocks production, as does the application of sunscreen. At this time, the recommendation is for about 10-15 minutes of direct sun, with a large amount of skin exposure (i.e. chest or back) for optimal Vitamin D production. This should be about ½ the time it takes for your skin to turn pink in the sun. It should not be enough time for you to sustain a sunburn.

At this time, guidelines for vitamin D3 intake differ.   The best way to determine your nutritional needs is to have your 25-hydroxy Vitamin D level checked by your health care provider. In general levels between 30-100 nmol/L are considered normal. However, levels >60 nmol/L appear to be more optimal for promoting health and wellness.   Depending on your level you can determine your need for supplementation or increased sun exposure. If you notice that you are a person who is cheerful during the bright summer days and more depressed during the darker winter days, this might be one indication that vitamin D supplementation may help!!!