Why Great Hair, Skin & Nails Comes From A Balanced Endocrine System First

hair skin & NailsThe quest for great hair, skin and nails seems a lot more difficult to achieve in the winter months. Dry itchy skin, brittle fly-away whispys, chipped nails – sound familiar? The tell tale signs of winter are in the air! Understanding why colder temps affect our skin can go a long way to help remedy the problem areas, but it is important to understand the role a balanced endocrine system plays as well.

Inflammation is the single most important contributor that affects our skin, hair and nails due to the stimulation of free radicals, which accelerates aging by attaching to and damaging cells. In addition, studies have shown that there is a connection between sugar and inflammation in the body.

The main hormones that play a direct role in contributing to the decline from inflammation include:

  1. Estrogen
  2. Progesterone
  3. Testosterone
  4. Thyroid
  5. Cortisol

I have written in the past about how these hormones become imbalanced, which leads to external changes we see. But for this month, I would like to focus specifically on how colder temperatures become a factor.

As we have understood, the fundamental rudimentary cause for the external changes we see is due to hormonal imbalances. The same carries true during winter months.

The longer, darker days lowers our Vitamin D levels. The waxing and waning of the temperatures directly impacts our thyroid levels. Estrogen, Progesterone and Testosterone levels ebb and flow to try and keep the body in balance. This endless cycle causes a rise in cortisol, therefore triggering an inflammatory response which leads to cellular inflammation, disruption and malfunction.

Other contributing factors include:

  1. Drier air from vents
  2. Poor hydration
  3. Increase in consumption of comfort foods (mainly sugar)
  4. Lack of exercise
  5. Prolonged hot showers/baths
  6. Irregular sleep patterns

Until Spring can shine upon us, here are some simple tips to help :

  1. Increase hydration. It is vital to keep the body hydrated with at least 90 oz/water/day. Without the essence of water, cellular healing cannot begin.
  2. Humidifier. Worth the investment. Having one by the bedside and in rooms that are frequently occupied helps prevent skin dry out.
  3. Limit hot showers/baths. Skin that is immersed for prolonged periods of time in hot water strips the natural oils causing hair and skin to become dry. It does feel great to stay for extended time in that warmth, but that causes more harm that good. Limit showers to 7 minutes at most.
  4. Coconut oil/butter. Nothing like solid saturated fats to hydrate the skin. Apply to hair and skin and allow it to soak for 45 minutes to an hour and shower afterwards. Or leave it on overnight for better absorption.
  5. Limit sugar intake. This is not specific to winter only! Refined sugar causes insulin levels to spike thereby leading to inflammation. Be mindful of this hidden culprit.

These are very simple, yet effective means to help control and possibly prevent winter skin ailments.

As the saying goes, we can’t stop the clock. Spring will be here before we know it as soon as we get through the craziness of St. Louis winter swings!

Dr. Raman’s Concierge Medical Practice is focused on holistic care and good health maintenance. For more information on healthy eating habits and achieving and maintaining OPTIMAL health,  CONTACT our office today to schedule your appointment. You can also learn more by following Dr. Raman on FacebookTwitterLinkedIn and Pinterest.

With All The Choices Out There, Which Diet Should I Be Following?

which diet should I be followingThe world of nutrition can be just as overwhelming as choosing your pizza toppings.

Keto? Paleo? Carnivore? Mediterranean?  Vegan? Vegetarian? Lacto Vegetarian? Ovo Vegetarian? Lacto-Ovo Vegetarian? Pollotarian? Pescatarian? Flexitarian?

I am seriously not making this stuff up. There really are such things, but is there truly only one path that leads to success? Trying to pick just one is like trying to pick your favorite child. The fitness and nutrition industry continues to be a multibillion-dollar revenue stream that promises to FINALLY get you the results when other “diets” have failed to do so.

If we really believe that to be true, how come the US still has the highest obesity rate compared to all other nations? That is because we have created a societal culture of believing there is only ONE right way that is superior to the other. Because we are so desperate for results, we have failed to realize that every time we “diet” hop, we are disrupting the homeostasis of the human metabolism.

There are no bad foods. Let me repeat. THERE ARE NO BAD FOODS! THERE ARE ONLY BAD CHOICES.

THE POISON IS IN THE DOSE!

As part of a Sports Medicine Internship program I am currently in, I have the privilege of learning and being mentored by some of the industry’s best nutrition scientists. The science is clear and the equation is on point:  1 + 1 does equal 2. This means your weight loss journey comes down to one simple formula:

CALORIES IN CALORIES OUT.

It is simple math. If you are taking in more calories than you are putting out, you will gain weight.

It really is just that simple.

We underestimate how much we eat and overestimate how much we workout. This may sound harsh.  I prefer to call it tough love. Don’t let the promises of a marketing agenda discourage you from following where science has always had it right.

If you want what you set out to seek, then you must put in the work. Diets are excuses that only take you further away from your goal. Be honest with your intentions. And get real with your expectations. Better yet, don’t have any. There is two parts to the equation. Both are equally important. There is only so much you can succeed with nutrition alone. – and you can never outrun a bad diet.

Blaming aging metabolism is a distraction. You must become comfortable with the discomfort of the process. Face the reality of how much you are really consuming versus how much you perceive to be consuming.

No foods are off limits. There is no need for extreme elimination, unless there are medical conditions that require it.

Our bodies didn’t get here overnight. So, how is it fair to demand change in two months? It is not. That is why we are in this tsunami of failure.

YOU can stop this vicious cycle!!

It is not going to be easy, and the reason it won’t be easy is because you are going to have to do something that you may not have done before. Let go of the idea that the answer is in some best selling book. It is not! It has always been within you.

Would you rather have short term results or long-term success?

This sounds great in theory, but what about in real life? I hear you. I could workout 24 hours a day, no problem, but if you asked me to give up my favorite desserts, you would see a very hangry person.

It has taken me 21+ years to get out of my comfort zone and open up to trying a new way of eating. I was always one of those, ‘I am going to eat whatever I want because I work out hard’ people. While part of that is true, there are so many better ways to do it. You really can have your cake and eat it too. You have to just be willing to try a different approach than what you are used to.

Here are just a few of the things I do for myself that help me stay the course:

  1. Hydrate. I strive to maintain a minimum of 90oz/water day. Some days are better than others. But on those off days, I do not sulk into self-judgement. I look at it for what it is and remind myself I get tomorrow to try again. And more times than not, tomorrow will be better.
  1. Measure your food. Uggh! Not going to lie! This is painful. Early on in my journey, I learned about portion control through measuring and weighing food. I was able to visualize what a “serving” looked like. For one month, I weighed everything I ate. I was shocked to see that 1 tablespoon of peanut butter is actually not ½ the jar. It was not easy to do this, but this was the turning point that has kept me consistent for the last 21 years.  Unless you are an elite athlete or competitor, you don’t have to do this every single day. But try it for a month. I guarantee anyone that tries it will be reaching out to me after a month telling me how much this experience has changed them.  It does take work, but it will be worth it.
  1. Strength train. In my opinion, this is actually the most important aspect to getting real. There is no other form of exercise that physiologically has as much of an effect on our health like resistance training. Designing a strength training program that incorporates progressive overload and movement pattern exercises will result in weight loss for any person at any level.  Cardio is fine if you need a day to zone out, but don’t expect it to get you to the same place that only strength training can.  I totally get it. I am a runner and dancer and I love to swim and spin. Until 2002, Cardio is all I used to do. But once I began to understand the power of lifting and its physiological benefits, my physique took a dramatic turn. It wasn’t until earlier this year that I took my lifting to a different level.  I lift heavier than I ever thought I could and let me tell you, my blood work results have never looked better.  It is not about the number on the scale that matters, it is about getting real on how insignificant that number actually is IF you are putting in the work needed to do this right. Don’t allow yourself to blame external factors. Get real with your intensity. Lift heavy!
  1. Just Eat Real Food. Just EAT people!!! Don’t be so concerned about searching for the best diet. The best one is the one that is sustainable. If keto works for you, great. Stick with it. If you enjoy eggs, great, stick to a Ovo Vegetarian diet. It doesn’t matter. Because at the end of the day, it is CALORIES IN CALORIES OUT. Period.  Don’t underestimate your intake. Don’t overestimate your activity.
  1. Sleep. The body needs time in stillness to restore. You may think you can get by with six hours of sleep, but you can’t. None of us can. There is a threshold of time the body needs to adequately replenish. It is like trying to put gas in your car. If you drive off before it has had a chance to fill up, it can only take you a short distance. But you would get significantly more mileage with a full tank. The body is no different. Don’t rush the restoration process. The body will not take any more time than it needs. Just like the gas pump, it will let you know when it is full and ready to go. Turn off the devices. Quieten the breathing. Settle your thoughts, and make sleep a priority. I promise – you will see a difference.

I used to complicate my life by spending so much energy looking externally to the experts who I thought knew so much more than I did. I trusted their opinion because after all, if it was open to the public, there must be some truth to it, right?

After years of disappointments, I came to realize that only I had the answers. It was I who I was seeking. It was me that was holding open the pages that held the secret code of life.  I didn’t have to reconfigure the formula, I just had to understand the simplicity of it. One Plus One DOES Equal Two.

I keep my realness simple:

  1. Daily workouts
  2. Daily meditation (only few minutes a day)
  3. Adequate hydration
  4. Quality sleep
  5. Eating the way my body guides me, not the other way around
  6. Letting go of expectations
  7. Trusting the process

Please remember that it is YOU who is the real thing.  You don’t need outside influences convincing you that you need their opinions to succeed. Do your own research. Be your own experiment and find what works for you! Makes choices in your life that is a representation of your authenticity and keep it simple. You may not get there in the time you want. But you will get there!!

You just keep doing you!!

Why I Switched To Concierge Medicine

September 2021 will be ten years since changing to concierge medicine. A lot has changed in the last ten years! But the one thing that has remained constant is my belief of how healthcare should be delivered and received.

There was a time in my early years of practice when my patient schedule would be bookmarked with 20+ patients, all spaced in increments of 15 minutes.  I barely had time to say ‘Hi’ to them and next thing I knew, I was walking out the door. There was no time to ask them how they were doing or how the family, kids, work were. We had time to address only one problem at each visit, leaving the rest for a future appointment.

I will never forget the day that I decided I needed to make a change. It was March 2011, and as usual my schedule was double booked with no breaks in sight. As a person who is time conscious, I make it a point to stay on time, but one small set back in the day would put me behind by at least an hour. The day started like any other. I was feeling good that I was on schedule and the stars were aligning.  By late morning, a quick 5 minute break opened. I felt like I hit the jackpot.  I walked into to see my next patient before that break, only to find out her beloved husband had suddenly died.  How could I leave her in the middle of her anguished tears just because the timer on the 15 minutes was ticking down? I couldn’t! So I stayed there to be with her.

I was very well aware of the angry patients that began to line up after her. They also had places to go, things to do, people to see. But I couldn’t bring myself to tell her that our time was finished. I wanted to give her the respect of my time as she began telling me about the special love she shared with her soulmate for over 50 years.

I also knew it was not fair to the others who were waiting after her because their time was just as important and valuable.

The internal tug-o-war was too much for me to handle. Both pulled at my heart strings and I didn’t know what the right thing to do was – stay and comfort or politely excuse myself?

It was in that moment I knew I couldn’t do this anymore.  How was I to take care of somebody in 15 minutes when they were placed so much trust in me to help them? I went home that night 2 hours behind schedule only to collapse into a pool of defeat.

When I graduated from medical school, I took an oath “First Do No Harm” NOT “First Do No Harm, but only for 15 minutes!”

This realization left me with no choice except to make the decision to change to Concierge Medicine.

In September 2011, I began my new practice. There was an exponential learning curve during those initial days.  I had to give myself permission to take my time. I had to get used to the fact that there was no reason for me to rush. What a feeling of freedom and joy I had!!  Nine years later, my patients have become like family. I cherish hearing their stories. I relish in their experiences and I rejoice in their healing.

To me, the most profound experience has been the process of learning together with my patients. I always say I don’t have all the answers, but why not find out together. To engage in dialogue that brings about mutual growth and discovery is the best platform I know how to offer.

The time I now have gives me the chance to earn your trust and I hope it allows you to feel heard.

Why I am writing about this now is because everything around us, outside of us and inside of us is chaos and confusion?  When equal trust spans between physician-patient, you know you have an anchor to always hold onto.

Practicing Concierge Medicine is the reason my bond with each of you allows me the space to say “You know what? I don’t know what is going to happen. I don’t know when things are going to be okay. But together we will figure it out.”

Have You Seen My Metabolism Anywhere?

metabolismWe all know it is coming. We fight it tooth and nail. We don’t give into the relentless annoyance of it. But yet, somehow it always seems to have the upper hand. And by “it”,  I mean your metabolism or lack thereof.

How is it that three little numbers makes us lose so much sleep?

Before starting yet another dieting spree, let’s take a step back and understand what metabolism is and how it changes through the aging process. If we don’t understand it, we can’t change it.

Metabolism is a “series of chemical reactions that sustain the living state of organisms and cells.” Metabolism can slow one to two percent each year after the age of 30.

Nutrition is the KEY to metabolism! Carbohydrates, protein, fats, minerals and vitamins comprise the majority of fuel needed to keep metabolism operational.

Let’s take a brief look at how each one plays a role.

  1. Carbohydrates: This includes starch, sugar and fiber. When eaten in moderation, carbohydrates are broken down to fuel metabolism.
  2. Protein: Proteins are the main tissue builders in the body. They are part of every cell in the body. Proteins help in cell structure and function. They are also vital in supplying nitrogen for DNA and RNA genetic material and energy production.
  3. Fats: Fats produce twice as much energy as either carbohydrates or protein. They help form the cellular structure, help absorb fat soluble vitamins and provide a reserve storage for energy.
  4. Minerals and vitamins: Minerals do not play a direct role in energy needs but play an important role in metabolism. Vitamins are essential compounds that the body doesn’t produce and therefore relies up nutritional intake.

What are some other potential causes of a slowed metabolism?

  • Hypothyroidism and other endocrine issues
  • Inadequate sleep
  • Chronic stress
  • Exogenous hormone intake
  • Hormonal imbalance (low estrogen and testosterone)
  • Medication side effects
  • Excess supplement intake
  • Excess fat intake
  • Calorie deprivation
  • Low muscle mass

The good news is that there are ways to naturally increase our metabolism. But first understand something. Chasing after a “goal” weight or “ideal” size is unrealistic and can lead to frustration and disappointment. The scale doesn’t take in to account skeletal density, muscle mass or fat reserves. It only tells you an absolute number, a number which is false and misleading.

Don’t panic yet. We are not doomed forever. Here are some simple ways (many of which we have seen before) to raise your metabolism.

  1. Assessing the Resting Metabolic Rate (RMR). The Resting Metabolic Rate test (RMR) determines the amount of calories your body is using at rest. The results of a Resting Metabolic Rate test can tell if you have an increased or decreased metabolism, and if your body primarily uses fats or carbohydrates for energy. This information can be used to determine the amount of calories you need to eat each day to maintain or lose weight. The testing is done by breathing into a mask that measures your Oxygen –Carbon Dioxide exchange.
  2. Increase muscle mass. Strength training three to four times a week is mandatory when trying to increase metabolism. Developing and maintaining muscle mass allows the RPR to increase. Every pound of muscle uses approximately six calories a day to sustain itself, while each pound of fat burns only two calories daily.
  3. Eat. Calorie deprivation causes the body to go into crisis mode. As a preservation mechanism, the body slows down its metabolic response by storing fat and calories. Adding protein to every meal allows a constant release of glucose and maintains insulin regulation.
  4. Drink up. Dehydration is the killer when it comes to a slow metabolism. Calories need water to process. Even small levels of dehydration can cause  a slowing of the RPR.  Try for a goal of 90oz/day. If you struggle to get down your daily water quota, consuming fresh fruits that contain natural water is a great alternative.
  5. Sleep. Think of sleep like pulling into the gas station. We have to bring the car to a complete stop before we can fuel up. Just the same, sleep forces us to stop so that the body may refuel. If we compromise on sleep, we wake up on an empty tank of gas and expected to go the same distance as if the tank was full. Not possible. To sustain life, the body saves energy by decreasing metabolism.
  6. Question your medications and supplements. Just because it doesn’t say it on the package insert doesn’t mean it can’t happen. Assume everything going into your mouth is the cause until you proven otherwise. See what lifestyle changes you can make that could help you get off of prescription drugs.
  7. Maintain zero expectations. Our body will never be how it was in our 20’s and 30’s. So how can we expect it to respond in the same manner? Don’t be disappointed because you lost “only three pounds”. Be happy you didn’t gain three pounds. Body fat percentage, changes in clothing fit, how you feel is the REAL goal.

Don’t set yourself up for disappointment by looking for a solution under every advertisement. In the US, the weight loss market is a billion dollar industry! If these companies claim to have the answer, then how come we are still the most overweight nation? These are empty promises. The diet pills, the latest calorie restricted programs that leave you emaciated and crabby, the guaranteed “to lose 20# in 20 days” nonsense.  THEY DON’T WORK.  Don’t waste your money. Our parents and grandparents didn’t seem to struggle as we are now. So how come it is the topic of almost every conversation? What was once a simple seamless process of aging has now become a race against who can promise the fastest results.

If we stop for a second and reflect, in every moment of life our bodies are in constant conversation with us. The symptoms we experience are the body’s attempt to get our attention. A slowed metabolism isn’t something to become consumed by.  It is an opportunity to live a healthier lifestyle. Rather than trying to “fix” it, listen to what it has to say.

There is no fast way to lose weight. Let me repeat….there is no fast way to lose weight. Dropping weight faster than the body can handle is a sure fire way to crash the metabolism to an all-time low.

Be gentle and patient with yourself. No matter what the scale says, you will always be worth more than those three little numbers.

Dr. Raman’s Concierge Medical Practice is focused on caring for each person as a whole, not just a list of symptoms. Our office is committed to helping our patients stay well and maintain good health rather than treating patients only after they become ill.

For more information or to schedule an appointment with Dr. Raman, please contact us today.

Low Does Naltrexone (LDN): An Aide to Immune Repair and Restoration

low dose naltrexoneIn 1984 Naltrexone was approved by the FDA in the US for the treatment of opioid addiction, when used at doses of 50mg to 100mg per day. Acting as a pure opioid antagonist, naltrexone in higher doses blocks the effects of endogenous endorphins, that are seen in our own natural endorphins as well as those in drug abuse. Used in opioid overdose and opioid addiction, naltrexone suppresses the “high” experienced with drug use as well as helping minimize withdrawl symptoms in patients going through opioid recovery.

During the peak of the AIDS epidemic, researchers noted that when naltrexone was given in small doses to HIV/AIDS patients, T-cell levels improved! The increase in circulating T-cells helped regulate the immune system and thereby slowing down the disease progression.

It was this discovery that led to further research on understanding exactly how LDN, also known as low dose naltrexone, could be used in clinical practice as one of the greatest treatments for immune support and restoration.

Since LDN works on the deep cellular receptors, it proved difficult to find consistent ways to measure data and therefore not a lot is known on the EXACT mechanism by which LDN works. Due to the limited clinical trials, LDN could only be studied anecdotally by following the patient’s clinical response to treatment. Because of this, LDN never made it to main-stream medicine, until now.

Recent clinical research has shown that LDN, in doses of 0.5mg-4.5mg, although a pure opioid antagonist, does not appear to suppress the endorphins as seen in the higher dose, but in fact, has shown to stimulate the T-cells within our immune system.

According to LDNResearchTrust.org, LDN

  • Causes increased endorphin release
  • Increased endorphins that modulate the immune response
  • Reduced the speed of unwanted cells growing. Dextro-Naltrexone is an antagonist for at least one, if not more immune cells
  • Antagonizes “TLR,” suppressing cytokine modulated immune system
  • Antagonizes TLR-mediated production of NF-kB – reducing inflammation, potentially downregulating oncogenes

Taking Naltrexone in larger doses of 50-300mg seems to negate the immunomodulatory effect by overwhelming the receptors, so for the effect to work, the dose must be in the range of 0.5-10mg, usually maxing at 4.5mg in clinical experience.

Since LDN will only block opioid receptors for three to five hours, the body experiences a rebound effect which greatly increases the production and utilization of endorphins. Once the LDN has fallen off the receptors and excreted, the increased number of endorphins bind to the now more-sensitive and more-plentiful receptors. As a result, these new and improved receptors assist in regulating cell growth, promoting healing, reducing inflammation, and increasing immunity and autophagy.

So what does this mean for you or me?

A few years ago, I began noticing that many of my patients were being treated with LDN for SIBO/Leaky Gut Syndrome by the Gastroenterologist. In the following months, Rheumatologists began prescribing it to help treat Auto-immune conditions.  What I observed was that when LDN was added to their other medications, overall severity of symptoms and relapse rates in health drastically reduced.  I was truly dumbfounded and confused as to how a medication in lower doses that was used to treat opioid addictions was life changing in autoimmune conditions.

I began my research into this potential “miracle” treatment. Given that LDN is not used in mainstream medical practice, it made me a bit leery to begin prescribing it, but it did not stop me from learning everything I could about it.

In March 2020, when the pandemic first began, I was so troubled to see young healthy individuals affected by the virus to a degree that you would not normally expect.  Why would they have this much of a hyper response of their immune system?

The great Dr. Fauci explained it so eloquently. When the virus enters the host (us), it triggers varying responses in our immune system to be able to fight off the virus. This is normal. This is what the body is supposed to do. Some systems may have a small inflammatory response, while others have a massive explosion of their cells.

Think of this analogy: a small fire (the virus) occurs while you are cooking.  Putting the fire out with a glass of water (normal immune response) would take care of it without causing any serious issues (mild symptoms). However,  if the pipes burst and flood the whole kitchen (severe Covid symptoms) in response to such a small fire, then we have bigger problems (ventilator, death, Covid long-hauler syndrome.)

In essence, the immune system is our built-in sprinkler system. It helps put out any fire that occurs in our bodies.

Exercising, adequate sleep, limiting processed foods, minimizing stress, avoiding excess alcohol etc. keep the fire from being created.

However, due to aging, genetics, poor health choices, medical conditions etc, the immune system finds it difficult to handle even small imbalances and begins to over-compensate the response by releasing excessive cytokines and other chemicals that cause a degree of inflammation that is out of proportion to the minor problem that occurred.

The over production of inflammatory components disrupts the natural defense mechanisms and begins signaling to attack our own cells. The body gets confused as to who is the good guy and who is the bad guy, so it attacks anything that comes in its way.  Hence the term AUTO immune.

The vicious cycle of inflammation-attack-inflammation-attack causes cells to mutate and develop into what we know as the disease state. This mutation further weakens our immune system which makes each cycle of inflammation worse than the one before.

So how do we stop this hamster wheel of destruction? That is the million-dollar question. No one has the definitive answer, but LDN has some promising scope.

Months into the pandemic, the science community began to develop some understanding of the nature of Covid’s behavior. However, my attention and worry turned to the potential long-term effects of the attack on our immune system, irrespective of the severity of the symptoms one experienced.

Have you ever wondered why everyone you know suddenly is affected by some form of autoimmune?

Much research is focusing on “Post Infectious Inflammation” as a potential cause of the rise in autoimmune conditions in the last decade.

Remember when you were a kid and were diagnosed with mono or were around your friends who had it?

One theory is that the Epstein-Barr virus, the virus that causes mono, triggered an initial immune response to the virus. Rather than clearing the body of the virus, the EBV remained dormant in the immune system. When there was an external (environmental or lifestyle choices) or internal trigger, it activated the immune system years after the initial infection. Once again, it was our immune mediated hyper-response that led to a decline in our T-cell function.  Similar findings were also discovered in post Ebola and SARS infections. This is the same pattern being seen in Covid long-hauler phenomena.

The decline in T-cell functioning is thought to be the epicenter of where disruption and breakdown of the body system begins affecting every organ and every disease process.

I am extremely terrified of what this virus could be doing to our immune systems 5-10-15 and even 20 years down the road.  The idea is not to live with the worry of ‘what ifs.’ But if we can understand other viruses’ response to our bodies, maybe we can do the same with Covid.

The symptoms we experience on a day to day basis – headache, weight gain, vision changes, joint pain, problems sleeping, GI issues, hormonal imbalances, and the list goes on and on, is thought to be a step from the exaggerated immune response.

Even as we identify the “cause” of those symptoms, why did the “cause” even happen? Let’s say you have been having weight gain and after blood work we identify the weight gain is coming from low thyroid. So we have an answer to the weight gain, but do we have an answer to why is the thyroid not optimally functioning?

That is how deep into the cells we need to go. LDN is helping us find and fix the cause for the causes at the root – where the real healing occurs –  in the immune system. That is where we need to go. We are not just going to the root. We are going to where the seed was first planted.

On January 28, 2021, a double-blinded placebo-controlled study testing LDN 4.5mg in Covid long haul patients began. The study is scheduled to finish August 2021 with preliminary results 12 weeks from the start of the study. Early indications look promising with patients reporting mild improvement in fatigue and muscle aches. That is a start!!

After seeing the results my patients were having with the LDN and after hours, months and even years of LDN research, I felt confidant to begin prescribing it to patients I felt could greatly benefit from the additional immune support.

Since LDN is not commercially available in the lower doses, it must be compounded at an accredited compounding pharmacy.

Doses can start as low as 0.25mg/day, as tolerated and titrated weekly as tolerated until reaching optimal dose of 4.5mg/day.

For some, the optimal dose may not be as high as 4.5mg/day. The body may respond at 1.5mg or 3.35mg. There is no perfect dose. As long as there is clinical improvement, the dose will remain effective for safe long-term use.

LDN is also used for many autoimmune conditions, MS, various cancers and a wide spectrum of other disease processes.

While LDN certainly does not replace the current standards of diagnosing and treating, nor do I believe this is the “one” pill to fix everything, I remain cautiously and excitedly optimistic.

While nothing can ever take the place of our bodies’ own power to heal, it is nice to know that there is something out there that can potentially help take healing beyond the root of the problem and into where the first break occurred.

There is hope!

Stay well. Stay healthy. Stay present. And remember, just breath.

It is all ok! We got this!

 

 

Natural Ways To Raise And Maintain Your Immune System

Natural Ways To Raise And Maintain Your Immune SystemEight months into 2020, Covid has become a household name. However we cannot forget the other virus that visits us every winter, Influenza A & B.

Public health officials have been warning us since March that this winter will be the year of the double virus whammy, but what does this mean for us and how can we keep ourselves safe and healthy?

Strong theories suggest because of increased compliance with mask wearing, social distancing and aggressive hand washing, this flu season could be one of the lowest infectious years. It makes sense, but we shouldn’t take anything for granted.

As most of you who know me know, I believe in minimizing supplements and medications and would rather allow the body’s natural defenses to protect us.

So, let’s talk about some natural ways we can raise and maintain our immune system this winter season.

  1. Eliminate processed foods. Excessive intake of sugar and other processed foods triggers inflammatory chemicals, such as cytokines and IL-1, Tumor Necrosis Factor. Overtime, this signals a sense of false-alarm in the body and lowers the body’s response to be able to launch a defense against infections. Processed foods also cause a decrease in the white blood cells needed for optimal immune system. Studies have also shown that a diet high in sugar and salt can cause vaccines to be less effective. This is why maintaining a fresh, clean and whole diet is imperative.
  2. Hydration. Our immune system is highly dependent on nutrients in our blood stream and water is the most important nutrient. Staying well hydrated is also very important for detoxification pathways, increasing lymphatic drainage and clearing out any foreign invaders. Dehydration can contribute to muscle tension, headaches, low serotonin production and digestive issues. I recommend drinking ½-1 oz/ pound body weight. Increased and more strenuous activities will require a higher intake. For example, someone weighing 150lb requires a minimum of 75 oz/day. If plain water is not your jive, try sprucing it up with fresh fruits, lemon, ginger, mint or your choice of flavorings. If the day gets away from you and you find it difficult to get in your quota, try setting an alarm every 20-30minutes as a reminder.  It will make a big difference for your immune system.
  3. Sleep. Our immune system releases proteins called cytokines. These cytokines are needed to help keep us healthy. Sleep deprivation causes a decrease in the release of cytokines as well as a decrease in infection fighting antibodies.  I cannot emphasize how crucial sleep is for our overall well-being. Sleep requires discipline.  Make an effort to shut down all electronic devices one hour before bedtime. Wind down with soothing instrumental music and maybe a warm cup of decaf tea or your favorite non-alcoholic beverage. Take five minutes to write in your gratitude journal or just close your eyes and enjoy the flow of your breath. As simple as all of these may seem, they are the most powerful tools we have. And we each have it in abundance.
  4. Don’t worry. Be happy. Life is a canvas of stress. That won’t change. But how we react to can. Acute or chronic stress raises cortisol levels which decreases our abilities to fight off foreign antigens. Stress also inhibits the body to mount an immune response by decreasing the production of lymphocytes. Of course there are things in life that require our constant attention and can lead us into a path of uncertainty and fear.  Remaining on this path will only takes us into a pit of disease and poor quality of life. Best way to neutralize the effects of stress is to identify which coping mechanisms help you BEFORE stressors arise.  Do you feel happy after a five mile run? Do you forget your troubles after laughing to your favorite sitcom or movie? Does reaching out to your BFF put a smile on your face at the end of the conversation? Or can sitting in silence bring you the peace and calm that is needed? Go on the offense before needing to get defensive.
  5. Essential oils. Health care providers are beginning to incorporate more holistic options into the treatment plan. While much research is still needed and ongoing, the NIH in December 2019 stated, “Certain plants possess immunomodulatory properties exerting effects on various parts of the immune system on both cellular and molecular levels: T cells and other immune effector cells, cytokine, and antibody production.” There are of course many variables that need to be factored in when choosing the correct oils. We must understand the quality control and extraction process of the company.  The plant from which the oils are extracted must be from a reliable healthy source. Understanding the compression process of the oils must retain its natural concentration and properties.  Preliminary studies show certain plants target certain parts of the immune system. Although essential oils shouldn’t be a replacement for medical care, it can be a topic of conversation with your physician.  Many of you may know, I am recovering from Covid.  Not knowing what to expect, I spent two weeks in isolation waiting to see what the day would bring. In May of this year, my daughter got me to try Essential Oils for various conditions, just to see what the hype was all about. During my two weeks with Covid, I thought this would be a good time to test out how effective these oils can really be. I used them in various ways (diffused, topically applied, drops in my water, etc.) and much to my surprise, it offered symptomatic relief for each of my symptoms. I only needed to take Tylenol one time in the entire 14 days. Essential oils may not be for everyone and they are not to be used as a substitution for your prescription medications unless discussed at length with your physician, but I do believe this is another resource to natural holistic support.

Whether you follow one or all of these tips, remember WE WILL get through this. We must be diligent, alert, patient and considerate. We are not only protecting our own health, but also the health of every single person.

Please stay safe. Please stay healthy – and know all will be ok.

Think Pink: October is Breast Cancer Awareness Month

breast cancerIt’s likely that you or someone you know has been affected by breast cancer. Studies indicate that 1 in 8 women will be diagnosed with breast cancer in their lifetime. This staggering number makes breast cancer the second leading cause of death among women, and an important reason to pay attention to your breast health, not just in October…but every day of the year.

Women spend a great deal of time tending to the needs of others. Whether you work full time or are a stay-at-home-mom, there’s always something that needs your attention. If a child or family member gets sick, women are usually on the front lines, ready to take action and care for a loved one in need. If the PTA calls asking for an extra two-dozen cupcakes for an upcoming fundraiser, or your boss needs you to attend an after-hours event with a new client, it’s often difficult to “just say no”. Always with good intentions, women end up neglecting their own health and any warning signs that may go along with an illness because they are helping others. It’s important to know, breast cancer does have a higher success rate for a cure when caught early, so awareness is the first step to a healthy, cancer-free you.

It’s still unknown why people develop breast cancer, however experts do know that breast cancer occurs when cells start to develop abnormally. Dividing more quickly than healthy cells, a “lump” can form within the breast tissue, lymph nodes or other parts of your body. Although it’s more common for women to develop breast cancer, it can affect men as well. Obesity, age, sedentary life, and a family history of breast cancer increase the risk for developing breast cancer. More recently, it’s been discovered that certain genetic gene mutations such as BRCA1 and BRCA2 also increases likelihood. Unfortunately these same genes can also increase the risk of other cancers, such as ovarian cancer.

Genetic testing may be considered if there’s a family history of breast cancer. Simple blood or saliva tests are used to identify any inherited mutations in BRCA or other genes.

Because a new lump or mass is the most common sign of breast cancer, it’s important to be aware of changes to your body. Regular mammogram screenings have decreased the number of advanced breast cancers, making it an important appointment to make when scheduling your well visits. Fifteen percent of breast cancers cannot be detected on mammograms, making self-exams another key component of your wellness routine.

Other breast cancer symptoms to watch for include breast size changes, swelling, skin irritation, breast or nipple pain, or inverted nipples, puckering of the breast skin or discharge from the breasts that is not related to child rearing. Breast cancer treatment has come a long way as more and more research and funds are invested into identifying the cause of breast cancer. As women are becoming more in tune with their bodies, they are learning the importance of   putting themselves first.

It’s important to take your health seriously, and scheduling regular well visits offers optimum health benefits that aren’t just essential for your quality of life, but for your family as well.

Dr. Raman’s Concierge Medical Practice is focused on caring for each patient’s individual needs with comprehensive, individualized treatment options and health programs.

For more information or to schedule an appointment, please CONTACT our office today! You can also learn more by connecting with Dr. Raman on FacebookTwitterLinkedIn, and Pinterest.

Healthy Snacks To Get You Through The Pandemic

healthy snacksHaving been vegetarian for most of my life, nutrition was not always an easy path because of the limited food choices available. There weren’t as many plant-based foods as there is now. Back when I was growing up, there was no such thing as a “veggie burger.”  If you wanted a veggie burger, you ordered “Big Mac minus the meat.” Talk about ‘deer in the headlight stares’ every time I placed my order.

Fast-forward to 2014 when gluten sensitivities entered into my already scant food menu. The reactions were severe enough that even one bite of gluten would leave me inflamed and sick for days.

My love-hate relationship with food ended up being the biggest blessing in disguise. To be honest, I enjoyed the study of fitness and body movements more than I did about the role of nutrition in the healing process. But now, I had no choice but to understand why certain foods affected us the way it did.

As I began to understand the process of how crops were grown to how they made their way onto the shelves, I knew it was time for another change in this journey. It was then that I decided to make a conscious choice to eliminate dairy from my diet.

With no meat, no gluten, and no dairy available on my list, I developed a frustration with nutrition. Initially it was a daily struggle to find something that quenched my hunger and satisfied my cravings.

I knew there were endless combinations that would have allowed me to be creative in whipping up some unique delicacies. There were also certainly no limits on the number of online resources had I just googled “gluten-free vegan food.” But the truth was, I didn’t have enough patience to be creative. This led me back to resorting to all of the processed foods I worked so hard to walk away from.

Don’t get me wrong, I do love to cook and am pretty good at it when I take the time and stay present with the process of creating.

A few weeks of eating from a box left me feeling swollen, tired, anxious and imbalanced.

That was when I accepted that nutrition was more than just eating. Nutrition was life.

I had to be realistic and straight and transparent with myself on how much time I wanted to spend in the kitchen. So, I quickly learned to put together recipes that were easy, nutritionally dense and could be made in batches and stored.

No doubt a huge learning curve for someone who would rather be doing anything else other than spending time in the kitchen. But it was where I needed to be!

I am still learning.  The kitchen may look like a tornado struck the same spot twice, but in the whirlwind of the chaos emerges the essence of healing-nutrition!

Listen, the pandemic has knocked us off of everything we knew to be safe. So if you , like many others, put on a few pounds during this time, don’t sweat it. If your anxiety levels are escalating thinking of the winter days ahead, don’t sweat it.

The body is magnificent and can reset with a little discipline and effort.

Just to have some fun this month and to get you motivated in the process, I want to share with you three of my favorite original recipes. These are by no means an elaborate creation. But for me, they satisfy my sweet cravings and bring comfort to my soul. I hope they do the same for you.

 

  1. Banana Energy Bites:

1 banana

¼ cup chopped nuts of your choice

¼ cup sweetened Baker’s coconut

½ cup peanut butter

½ – ¾ cup mini chocolate chips

1 scoop protein powder (optional)

2 tablespoons maple syrup or honey

Mix all ingredients in large bowl. Spread into greased 9 x 13 pan or make into equal size balls. Place in fridge for 3 hours. Can place in freezer if prefer more crunchier texture. Cut into squares.

Enjoy for breakfast or mid-day snack.

 

  1. Indian lentil soup

1 cup lentils (any variety)

Choice of any vegetables-fresh, chopped

1 onion

2 bay leaves

4 cloves

4 cloves garlic

1 inch piece of ginger grated

½ stick cinnamon

1 tsp fennel seeds

2 tablespoons oil

Curry masala powder (available at any ethnic grocery store)

Red chili powder (optional for spicier variety)

Salt to taste

½ can coconut milk (optional)

Chopped coriander to garnish

Soak lentils for 3-4 hours.

In large pain, heat oil. Once heated, add fennel seeds. Allow it to turn slightly brown. Then add onions, bay leaves, cloves, garlic, ginger, cinnamon. Saute until brown. Add vegetables and saute. Add 2 tsp masala powder and salt. Mix so vegetables are fully coated.

Drain lentils and add to mixture. Mix thoroughly. Add 2 tsp more masala powder (adjust to taste) and red chili powder (if desired) and salt.

Add enough water to cover to top of lentil mixture. Cover with lid on medium heat. Stirring occasionally. Continue to add more water until lentils have cooked.

Add ½ can of coconut milk and allow to boil for 5 minutes.

Turn off stove and garnish with coriander leaves.

Enjoy as a soup, with naan or on top of warm fluffy rice.

 

  1. Cream Cheese Sandwich (Can substitute dairy free spread cheese and gluten free bread)

1 tub cream cheese

1 shredded cucumber

1 finely chopped red bell pepper

¼ cup shredded carrots

Red chili powder

Paparika

Indian Chaat masala (optional. Available at Asian grocery stores)

Salt to taste

Mix cream cheese, cucumber, bell pepper, carrots. Whip until frothy. Add desired taste of chili powder, paparika, chaat masala and salt. Store in refrigerator in air tight container.

Enjoy on bread, dollar rolls, crackers. Or use as your favorite vegetable dip.

 

These are just a few fun creations I enjoy having around and hope it will spark the same for you.

Planning ahead and understanding how important nutrition is in our healing allows for us to live a life that can be enjoyed without having to compromise on some our favorites.

I am by no means a recipe developer. I am just a girl with a sweet tooth who values the meaning of living your best life, but knows it is perfectly ok to have your cake and eat it too!

Dr. Raman’s Concierge Medical Practice is focused on caring for each person as a whole, not just a list of symptoms. Our office is committed to helping our patients stay well and maintain good health rather than treating patients only after they become ill.

For more information or to schedule an appointment with Dr. Raman, please contact us today.

Why Am I So Tired? The Truth Behind an Improperly Functioning Thyroid

There are so many articles out there about an improperly functioning thyroid, it is hard to know where to begin! Let’s start at the top. How many of these symptoms describe you?Improperly Functioning Thyroid

  • Extreme fatigue
  • Weight gain
  • Irritability
  • Muscle aches
  • Depression
  • Rapid hair graying
  • Decreased libido
  • And too many other “little issues attributed to aging”

These little issues could be caused by a small gland with some big responsibilities. That gland is your thyroid.

The thyroid gland produces and stores hormones through an integral and complex pathway that is directly linked to your hormones and adrenals. The thyroid plays a part in EVERYTHING AND EVERY CELL IN YOUR BODY. It is butterfly-shaped and is found in the lower part of the neck, wrapped around the trachea.

Hypothyroidism: A Common Condition, But Frequently Misdiagnosed

Hypothyroidism is a condition where the body, for various reasons, doesn’t produce enough thyroid hormone or is unable to utilize the thyroid at a cellular level. No matter what the cause, this diagnosis has debilitating and frustrating consequences.

Being diagnosed with hypothyroid myself in 2002, I have spent the last 13 years researching, studying,
and understanding the complexity of this “little gland.”

According to the U.S. Department of Health and Human Services, about 4.6 percent of the U.S. population (approximately 18 million people) age 12 and older has hypothyroidism. As prevalent as hypothyroidism is, most people are not correctly diagnosed when they first present symptoms to their doctors because there is not a standard interpretation criteria for screening tests—meaning that one doctor may think a slight dip below the normal range is acceptable while others would argue otherwise.

Your thyroid can be affected if your adrenals are not balanced or if your hormones are constantly fluctuating. Due to the minute-to-minute variability of ALL the hormones in your body, patients are often under-diagnosed.

A single thyroid level test is insufficient to make the determination of hypothyroidism.

Many other thyroid levels also need to be checked. These could include TSH, Free T4, Free T3, Thyroid Peroxidase Antibody, Thyroglobulin Antibody, Magnesium, Iron, Zinc, Vitamin D, Hormones and Cortisol.

A patient who self-educates and self-advocates is in the best position to work collaboratively with his or her doctor to determine the best course of treatment for the symptoms and diagnosis of hypothyroidism. Self-advocacy is much easier when you choose a doctor who has experience in recognizing the symptoms of hypothyroidism as well as other hormonal conditions such as diabetes and adrenal gland issues.

Treatment of Hypothyroidism

Once hypothyroidism is diagnosed, there are many treatment options that need to be considered. Synthetic thyroid (Synthroid or Levoxyl) medication is not the only option. There are T3-only medications such as Cytomel or combination of T4 and T3 medications such as Armour Thyroid or Nature Thyroid. Patients even have the option of having their thyroid medication compounded with an accredited compounding pharmacy.

Hypothyroidism is not a cookie-cutter diagnosis and neither should be the treatment.

It is extremely important to work closely with your physician to monitor symptoms and continue to regularly check your thyroid levels.

The discussion of thyroid disease is more extensive than I can capture in a single blog post. In my 15 years of practicing primary care, I have diagnosed and corrected misdiagnoses of many patients with hypothyroidism. I understand and have experienced every symptom you may be having. I know the frustrations, I understand the suffering and I continue to live with this diagnosis everyday.

If you are suffering from any symptoms that are interfering with your life, Please contact our office today to schedule an appointment.

Dr. Raman’s Concierge Medical Practice is focused on caring for each person as a whole, not just a list of symptoms. Our office is committed to helping our patients stay well and maintain good health rather than treating patients only after they become ill.

For more information or to schedule an appointment with Dr. Raman, please contact us today.

Why I Got Into Concierge Medicine

concierge medicineIt feels like every week the world becomes a little more upside-down and inside out. What do we believe? Who do we believe? How do we make the simple day to day decisions that once took mere seconds have now extended into days? When will the vaccine be ready? Will a vaccine be ready? Where do I go to get tested? Can I have my antibody levels checked? What do I do about sending my kids to school in the fall when I am scared to let them out of my sight? And the list goes on and on……

The truth is, I don’t know that any of us have the answers –  it is okay not to know. It is perfectly okay to be feeling everything you are feeling. Don’t dismiss it. Don’t justify it. Don’t talk yourself out of it. Accept that everything you are feeling is legit and valid.

I have spent a great deal of time during these last four months in meditation and introspection.  My intention for these monthly articles is to always in some small way inspire each of you. But what do I write about that isn’t already out there? How can we have a conversation that doesn’t include a left or right or an up or a down? How can I translate my thoughts into words and hope it will inspire a wave of health and healing?

The only way I know how to do that is to be myself. Raw and authentic.

I thought I would share the story of how I came to practice with the principles and beliefs that I hold.

There was a time in my early years of practice when my patient schedule would be bookmarked with 20+ patients, all spaced in increments of 15 minutes.  I barely had time to say ‘Hi’ to them and next thing I knew, I was walking out the door. There was no time to ask them how they were doing or how the family, kids, or work life was going. We had time to address only one problem at each visit, leaving the rest for a future appointment.

I will never forget the day that I decided I needed to make a change. It was March 2011, and as usual my schedule was double booked with no breaks in sight. As a person who is time conscious, I make it a point to stay on time, but one small set back in the day would put me behind by at least an hour. The day started like any other. I was feeling good that I was on schedule and the stars were aligning.  By late morning, a quick 5 minute break opened. I felt like I hit the jackpot.  I walked into to see my next patient before that break, only to find out her beloved husband had suddenly died.  How could I leave her in the middle of her anguished tears just because the timer on the 15 minutes was ticking down? I couldn’t! So I stayed there to be with her.

I was very well aware of the angry patients that began to line up after her. They also had places to go, things to do, people to see. However, I couldn’t bring myself to tell her that our time was finished. I wanted to give her the respect of my time as she began telling me about the special love she shared with her soulmate for over 50 years.

I also knew it was not fair to the others who were waiting after her because their time was just as important and valuable.

The internal tug-o-war was too much for me to handle. Both pulled at my heart strings and I didn’t know what the right thing to do was. Stay and comfort or politely excuse myself?

It was in that moment I knew I couldn’t do this anymore.  How was I to take care of somebody in 15 minutes when they were placing so much trust in me to help them?

I went home that night 2 hours behind schedule only to collapse into a pool of defeat.

When I graduated from medical school, I took the oath “First Do No Harm,”  NOT  “First Do No Harm but only for 15 minutes!”

This realization left me with no choice except to make the decision to change to Concierge Medicine.

In September 2011, I began my new practice. There was an exponential learning curve during those initial days.  I had to give myself permission to take my time. I had to get used to the fact that there was no reason for me to rush. What a feeling of freedom and joy I had!!  Nine years later, my patients have become like family. I cherish hearing their stories. I relish in their experiences, and I rejoice in their healing.

Concierge medicine has allowed me to scale down my patient volume from having a panel of 3000 patients to a panel of 300 patients.  This gave me the opportunity to take care of patients in a way I never thought possible. The concept of Concierge Medicine has only come to the forefront in recent years. As more focus is directed towards preventative medicine, concierge practices will soon become mainstream medicine. The last nine years have offered me the opportunity to engage in full dialogue with each one of you. I no longer feel a sense of urgency to stop the appointments in mid-sentence in an effort to stay on time. For me, the most profound experience has been the process of learning together with my patients. I always say I don’t have all the answers, but why not find out together? To engage in dialogue that brings about mutual growth and discovery is the best platform I know how to offer.

The time gives me the chance to earn your trust and I hope it allows you to feel heard.

We don’t always get it right – but we always have something to work towards.

Why I am writing about this now is because everything around us, outside of us and inside of us, is chaos and confusion.  When equal trust spans between physician-patient, you know you have an anchor to always hold onto.

Practicing Concierge Medicine is the reason my bond with each of you allows me the space to say “You know what? I don’t know what is going to happen.  I don’t know when things are going to be okay, but together we will figure it out.”

Dr. Raman’s Concierge Medical Practice is focused on holistic care and good health maintenance. For more information on healthy eating habits and achieving and maintaining OPTIMAL health,  CONTACT our office today to schedule your appointment. You can also learn more by following Dr. Raman on FacebookTwitterLinkedIn and Pinterest.