Restore Immune Tolerance and Optimize Health with Nature’s pHarmacy

A healthy immune system naturally regulates between defense and repair. But when confronted by unrelenting challenges, it becomes overburdened and the repair functions take a back seat to defense. The result is a “repair deficit” characterized by chronic inflammation—a well-recognized cause and amplifier of chronic disease.

When defense takes precedence over repair, intestinal permeability usually ensues, setting the stage for increased susceptibility to chronic infection, autoimmune reactions, and degenerative illness. Delayed or late-phase sensitivities to food and chemical triggers also contribute to chronic low-grade systemic inflammation. 

With the world coming out of the COVID pandemic, there is a pressing need to focus on the state of the immune system.

In this free webinar, Dr. Russell Jaffe will bring much-needed clarity to this complex picture, sharing insights on which cells to look at, and which high-sensitivity tests are most informative. He will also outline the principles of Nature’s pHarmacy—an approach to personalized nutrition and guided lifestyle change that improves acid/alkaline balance and allows the innate immune system to flourish, quell inflammation, restore, and repair.  

Learning Objectives

• Understand the role of inflammation and repair deficit as underlying causes for practically all chronic conditions.
• Recognize the value of T lymphocytes and their role in influencing immune health.
• Learn about high-sensitivity assessment techniques including tests for detecting delayed hypersensitivities.
• Learn how to choose the right foods and nutrients to create an acid/alkaline balance for optimum gut and immune repair.

SPONSORED BY PERQUE Integrative Health

Russell M. Jaffe, MD, PhD, CCN has more than 40 years of experience in molecular biology and clinical diagnostics. He has pioneered “lymphocyte tests of immune function and hypersensitivity” and is focused on providing functional, predictive tests and procedures to improve diagnostic precision and treatment outcomes. He received his MD and PhD degrees from the Boston University School of Medicine, and completed residency training in clinical chemistry at the National Institutes of Health before starting the Health Studies Collegium think tank and PERQUE Integrative Health, LLC, a company that offers scientifically-proven integrative health solutions that speed the transition from sick care to healthful caring. 

Fine-Tuning the Digestive Symphony

I like to think of digestion as a magnificent symphony in which a diverse array of organs, bacteria, and biochemicals work in concert to transform the foods we eat into the nutrients and energy we need. If any instrument is out of tune, the music suffers.

This notion of the digestive system as an orchestra is an easy metaphor to help patients understand how digestion takes place, why symptoms arise, and how our various therapeutic interventions help restore the proper rhythm and harmony. 

The Overture: Eyes, Nose, and Mouth

Many people don’t realize it, but digestion actually begins with the eyes and nose. Seeing and smelling food in anticipation of eating send signals from the brain to the gut about what to expect. It’s something chefs, restauranteurs, and food marketers certainly understand, which is why they go to such great lengths to present food in the most visually appealing and aromatic ways.

As food enters the mouth, it encounters the teeth and saliva. The act of chewing is very important for mechanically breaking down the food. Saliva contains amylase and other enzymes that begin to break down complex carbohydrates into smaller starches and sugars, and lingual lipase that begins to break down dietary fats. That process gets truncated when people wolf down their food without much chewing.

As peristaltic waves move the food to the end of the esophagus, the lower esophageal sphincter relaxes and lets the food pass into the stomach—a muscular reservoir of strong acid–before squeezing shut to prevent backflow. Gastroesophageal reflux (GERD) results when the sphincter is playing out of tune with the rest of the digestive orchestra, and fails to close properly.

First Movement: Stomach & Small Intestine

In the stomach, the food gets churned with stomach acid and digestive enzymes such as pepsin which breaks down proteins. The resultant chyme is slowly emptied into the small intestine where the bulk of digestion occurs.

Once in the small intestine, the chyme triggers secretion of bile and pancreatic enzymes. Combined, these alkaline secretions break down carbohydrates, fats, and proteins into their smallest components. At least that’s what’s supposed to happen. As any clinician knows, the process is impaired in many people.

Further peristaltic waves through the intestinal smooth muscle tissue move the chyme through the small intestine, where the digested nutrients are absorbed into the bloodstream.

Second Movement: The Large Intestine

The mixture passes through the ileocecal valve into the large intestine, which extracts and absorbs water. The remaining residue of undigestible material, remnants of the digestive juices, and sloughed epithelial cells from the intestinal lining is moved forward into the rectum for storage and eventual elimination as stool.

It is here in the large intestine that we find the largest bacterial ecosystem of the human body. The intestinal microbiome has many functions, including: further digestion of food and breakdown of harmful toxins; synthesis of certain vitamins and neurochemical signals; generation of energy for the gut mucosa itself; protection against pathogens; and “training” of the immune system.

Researchers are still making new discoveries about the gut microbiome, and our understanding of it is far from complete. Suffice it to say that a healthy population of gut bacteria is necessary for optimum health.

Fine-Tuning the Instruments

Let’s face it: in the GI tract, things easily go out of tune and the digestive symphony becomes discordant. GI problems are among the most common reasons people seek medical care. There are several things we can recommend to help patients keep their digestive instruments in tune and operating properly:

Herbal Bitters: Starting in the mouth, the use of digestive herbal bitters can stimulate salivary production and jump-start the whole digestive system. Taking a dose of bitters before a meal is—or was—customary in many parts of the world with longstanding herbal medicine traditions.

There are many different formulas for “Bitters,” using a wide range of herbs. Among the common ones are: Angelica (Angelica archangelica), Fennel (Foeniculum vulgare), Ginger (Zingiber officinale), Dandelion (Taraxicum officinale), and Burdock (Arctium lappa). A few drops of a standardized Bitters formula before eating provides a host of phytochemicals that bind to bitter taste receptors, which then send signals for saliva production, and secretion of cholecystokinin, ghrelin, and motilin. All of these play key roles in the digestive symphony. 

Careful Food Choices: Food choices have tremendous impact on digestive health. Processed foods, high glycemic foods, and foods laden with additives hinder good digestion. Choose a wide variety of predominantly whole foods, preferably organically or biodynamically grown. Patients should focus on plant-based “life-ly” foods: fresh or lightly steamed vegetables and fruits, lightly toasted nuts and seeds, sprouts of grains and beans, fermented foods, sea vegetables, herbs and edible flowers, freshly squeezed fruit juices, and vegetable juices. These retain active enzymes that enhance digestion.

Of course, food choices are highly individualized. It’s important to keep in mind that some people have sensitivities, allergies, or just simple aversions to particular foods that are healthy and enjoyable for others. Delayed hypersensitivity tests can help identify hidden sensitivities to foods, additives, heavy metals and environmental toxins.

Take Time to Chew: I recommend that people chew their food 15-20 times per mouthful. The maxim is, “drink your solids and sip your liquids.” It’s also a good idea to eat half of what one feels one needs, then stop and take a few deep breaths to give the body a chance to register what’s been eaten and whether one needs to eat more.

B Vitamins: The lower esophageal sphincter benefits from vitamins B6, B12, and folate. A good way to get these B vitamins is via sublingual lozenges. In many cases, this simple natural intervention will relieve GERD.

Hydrate, hydrate, hydrate: Our bodies are 50-75% water by weight, depending on age and health status.  Every biological system is dependent upon water. It flushes toxins from vital organs, transports nutrients to cells, regulates body temperature, and keeps tissues moist. I recommend drinking at least 8 glasses of water a day, more if one lives in a dry climate or exercises heavily. Vegetable broth and wet foods are also good ways to hydrate. For those who enjoy them, aperitifs like Campari, organic or biodynamic beer, cider, and wine are permissible in moderation. Physical activity is also important for good digestion. We need to move those fluids around!

Probiotics & Prebiotics: Daily supplementation with a good combination of Lactobacillus and Bifidobacteria strains ensures that helpful organisms predominate in the intestinal microenvironment, and harmful bugs are kept in check. Certain probiotic species also aid in clearing pesticide residues, hormones in foods, and toxic metals like lead and mercury.

Probiotics are especially important after someone has taken antibiotics, which tend to kill off helpful bacteria along with the targeted pathogen(s). Antibiotics are sometimes necessary, but they can definitely throw a lot of sour notes into the digestive symphony.

Healthy bacteria need to eat, and the fiber in our diets is their main source of nourishment. People on plant-rich diets may get enough fiber from what they eat, but many other people will benefit from a prebiotic supplement. Prebiotic fibers also bind toxins and accelerate their safer removal from the body.

L-Glutamine & Pyridoxal Alpha-Ketoglutarate (PAK): The cells of the intestinal mucosa are the body’s main consumers of the amino acid glutamine. This nutrient is especially important for repairing damaged intestinal mucosa. While some people get enough glutamine from their diets, others benefit from supplementation. The problem is that increased intake of glutamine can result in build-up of glutamate, which is an excitatory neurotoxin.

That’s where Pyridoxal Alpha-Ketoglutarate (PAK) comes in handy. This compound is a patented combination of pyridoxine and alpha-ketoglutarate. A fixed combination of L-glutamine and PAK (1,500 mg glutamine plus 500 mg PAK), aids in the recycling of glutamine, increasing its availability to the gut mucosa, the brain, and the muscles while preventing harmful accumulations of glutamate.

L-Histidine: This amino acid is a good source of stomach acid protons, which paradoxically are often lacking in people with stomach symptoms, and those with acute or delayed allergies. A 600 mg dose of L-Histidine prior to each meal can be helpful.

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Russell Jaffe received his MD and PhD from Boston University School of Medicine in 1972. He is a founding chairman of the Scientific Committee of the American Holistic Medical Association. Dr. Jaffe developed the lymphocyte response assays (LRA) that enable physicians to rule in/out 491 common allergenic substances based on delayed hypersensitivity by functional LRA by ELISA/ACT. He is also founder of PERQUE, a practitioner-only nutraceuticals company (www.PERQUE.com)

A 5% Investment in Self-Care Gives Big Health Payoffs

Many people think “getting healthy” requires a total lifestyle overhaul, a major investment of time and money, and a lot of work.  Too often, those expectations solidify into an insurmountable obstacle, people feel intimidated, and consequently they never set out on the journey to better health.

The truth is, devoting just 5% of the day towards acts of healthy living can lead to major improvements in whole body health.

It need not be dramatic. For example, starting the day with stretching in bed, followed by a little bit of yoga or a movement technique like Feldenkrais can really make a difference.

Walk, hydrate, and eat alkaline foods. Don’t forget to stop periodically during the day and practice gratitude for life. And end the day with a relaxing transition to restorative sleep with an Epsom salt and soda bath. These simple things are highly beneficial, they don’t cost much, and they can be deeply enjoyable.

Committing just 5% of each day—that’s roughly 72 minutes—to key acts of self-care can keep stress in check, maintain healthy blood pressure and weight, and improve sleep, all of which nurture the heart while also restoring and rejuvenating the entire body.That 5% investment can pay out a lifetime of functional benefits.

Here are a few easy self-care practices that your patients can embrace to improve well-being and reduce disease risk. And if you’re not already giving yourself the care you need, now’s a good time to start! After all, “doctor” does mean “teacher” and we need to be good role models.

Stretching in Bed: Just 5 minutes of stretching in bed, on arising, loosens up muscles and stimulates circulation. Plus, it feels really good.

Dream Journaling: Take a few moments just after arising to jot down some quick notes about the prior night’s dreams. There is wisdom in that famous teaching attributed to the 4^th century Talmudic sage, Rav Chisda: “A dream which is not interpreted is like a letter which is not read.”  

Eat, Drink (water), and Be Merry: Many people are healthier when they limit food intake to six hours a day, but stay well hydrated and active for the rest of their waking hours. I recommend consuming more than four liters (or four quarts) of water, teas, or (unsweetened) herbal beverages daily.

Begin Meals with Something Warm & Wet: Warm water with fresh lime juice is a good option, as is vegetable, fish, or meat broth (but never bone broth), or fresh vegetable juice.

Eat Foods You Can Easily Digest: Ideally, your diet should consist of foods you can digest, assimilate, and eliminate without putting major burdens on the immune system. This, of course is highly individualized: a food that is easy for one person may be problematic for another. Lab testing—especially Lymphocyte Response Assays aimed at detecting delayed hypersensitivities—is helpful in helping people figure out which foods to include and which to avoid.

10 Minutes in Movement: Give 10 minutes of each day to activities like Hatha Prana Yoga, Tai Chi Chuan, Aikido, Pilates, Trager Mentastics, Feldenkrais / Anat Baniel techniques. Again, the choice is individualized—people should use whichever practices most appeal to them.

Ambling in nature and forest bathing are also greatly restorative. So are walking, gardening, or dancing. Keep a notebook, or video/audio recording device handy for capturing the creative free associations that often arise when walking, dancing, or practicing.

7 Minutes for Gratitude: Take a little bit of time every day to remember what you are grateful for, and send goodwill and good wishes to those about whom you care. This is a valuable practice. Learned optimism is a choice. I find that for myself, this works best in the early morning time. Others may find that mid-day or evening is better.

End the Day with a Personal Restorative Sleep Ritual: Dedicate 30 minutes to making the transition from ordinary waking consciousness to restorative sleep. This process can include:  

• Epsom Salt & Baking Soda soak, coupled with use of aromatic oils (use clean, high-quality naturally derived essential oils)
• Dry skin brushing with an absorbent towel.
• 5 minutes of abdominal deep breathing
• 15 minutes of active mindfulness meditation practice or listening to contemplative, uplifting, harmonious music
• Stretching in bed for 5 minutes before going off to sleep
• Keep the bedroom cool, dark, and WiFi-free.

Dichro Green Light (PAR 38 150 watt dichro): Use of a green light source timed for at least 20 minutes prior to falling asleep and also when awakening helps reset and rebalance the pineal control center.

There are many other small but impactful things that people can do to cultivate health and well-being. 

For those who work outside their homes, I recommend leaving shoes and exterior clothes at the door and changing into comfortable “home” clothes shortly after arriving home.

For people living in urban environments, an ULPA (ultra-low particulate) or HEPA (high-efficiency particulate) air cleaner is usually necessary to ensure optimum air quality. Indoor plants can also help clean the air.

I recommend using a tooth powder rather than toothpaste for gum and tooth health, as well as buffered l-ascorbate as mouthwash to promote healthier oral microbiome. Goat’s milk soap or castile soap are the best choices for body and hair.

There are also a few simple self-assessments that can be very helpful in ongoing self-care. These include:

• First morning urine pH, to assess the body’s magnesium and mineral reserves, and overall acidity
• GI transit time, using charcoal capsules, to assess overall GI function
• Ascorbate (vitamin C) calibration, via the “C Cleanse” or “ascorbate flush” method

In the clinical context, there are eight key predictive biomarkers that we can measure to give our patients a wealth of vital information about their individual epigenetics, health risks, and lifestyle choices. Remember that only about 8% of total disease risk is genetically ‘hard-wired’ by transgenerational inheritance, while 92% of all risk is the result of epigenetic variables, which basically means diet, lifestyle, and environmental factors.

The eight key biomarkers are:

• Hemoglobin A1c (HgbA1c): Ideally A1c should be down under 7%
• High-Sensitivity C-Reactive Protein (HS-CRP): should be at 1.0 mg/L or less
• Homocysteine: Levels over 50 mmol/L signal significant cardiovascular risk. Normally, homocysteine is in the range of 5-15 mmol/L
• pH Level: A healthy pH is on the alkaline side, between 6/5 amd 7.5.
• Vitamin D: The optimal range is 50-80 ng/ml
• Omega-3 Index: We want to see 8% or greater
• 8-Hydroxy-2-deoxyguanosine (8-OHdG): When elevated over 25 ng/mg, this marker of DNA oxidative stress is associated with high risk of autoimmune diseases, Parkinson’s, Alzheimer’s, and certain cancers. The ideal level is under 5 ng/mg.
• High-Sensitivity Lymphocyte Response Assays (hs-LRA): this array of ELISA-based tests detects all major subtypes of food and chemical hypersensitivities, including acute IgE, T-cell mediated, and immune complex mediated forms.

Functional tests, properly interpreted, can be strong patient motivators. They can also provide encouragement and reinforcement, as patients see quantitative changes in their lab values that correlate with their subjective experiences of better health.

Just 72 minutes of daily self-care is sufficientto renew, restore, rehabilitate, recreate, and regenerate. As we individually practice healthier habits of daily living, we inspire those around us to become healthier. Our daily choices and habits really do make a difference.

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Addressing the Repair Deficits That Underlie Chronic Pain

Roughly one in five people suffers from chronic pain of some sort. It is one of the leading causes of disability, reduced productivity, and escalating medical care costs. 

While pain is often multifactorial, there’s a lot we as clinicians can do to help our chronic pain patients once we understand the relationship between inflammation, repair deficit, and the symptoms patients are experiencing.

The Cleveland Clinic defines pain simply as a sign that something is wrong somewhere in the body. Acute pain arises quickly and resolves quickly once the pain stimulus ends or is removed. Chronic pain is pain that persists for longer than six months stretching into years. While many disease states can cause chronic pain, so can injury, and psychological factors. Often, it’s a complete mix of causes.  

Persisting inflammation means there are accumulating repair deficits. The body continues to call for pro-inflammatory responses, even as the immune system machinery is unable to resolve the initial problem. The result is a self-reinforcing cycle of tissue damage.

Since there are usually multiple factors, it can be difficult to identify and treat the “root” cause, especially in cases where pain has persisted for years.

Inflammation & Repair Deficit

Inflammation is a factor in most if not all chronic pain cases, and from a treatment perspective, it’s a good place to start.

Most pain syndromes have an inflammatory profile, whether its rheumatoid arthritis, fibromyalgia, migraines, or interstitial cystitis, to name just a few common conditions. Irrespective of the characteristic of the pain, whether it is sharp, dull, aching, burning, stabbing, numbing, or tingling, it is safe to say that inflammation and inflammatory responses are at work.

But it is important to understand that chronic inflammation occurs when repair deficits persist.  What do we mean?

Think of it like this: following an injury or tissue damage following an infection, the body calls for defense and then repair. But in many people—especially older people or those with poor health status–the first-responder team is unable to complete the defense and repair mission. Recruits are called, via pro-inflammatory signals e.g., cytokines. Typically, in a healthy individual, those urgent signals will diminish as the body heals, and inflammation will subside.

Persisting inflammation means there are accumulating repair deficits. The body continues to call for pro-inflammatory responses, even as the immune system machinery is unable to resolve the initial problem. The result is a self-reinforcing cycle of tissue damage.

Over time, this ongoing unresolved inflammatory response can damage healthy cells and organs, causing constant pain in muscles, tissues, and joints. Silent or unappreciated inflammation is due to loss of tolerance and homeostasis in the immune defense and repair system.

Persisting inflammation means there are accumulating repair deficits. The body continues to call for pro-inflammatory responses, even as the immune system machinery is unable to resolve the initial problem. The result is a self-reinforcing cycle of tissue damage.

Repair deficits account for more than two thirds of all chronic disease including metabolic syndrome, diabetes, heart disease, Alzheimer’s neurodegeneration, autoimmune conditions, and some forms of cancer. Chronic inflammation is quite naturally considered one of the major underlying causes of conditions such as fibromyalgia, chronic low back pain, rheumatoid arthritis, myofascial pain syndrome, and osteoarthritis.

So what can we do?  Here are our top three lifestyle tips to minimize pain:

• Plant-Based Diet: There’s ample research to show that a plant-based diet can improve the status of those with chronic pain and disability associated with musculoskeletal conditions.  One reason for this is that over time a vegetable-rich diet will tend to alkalinize the body, which reduces inflammation. The pH status can be a guiding light for knowing whether the body is in acid alkaline balance. We recommend that patients aim to maintain a healthy first morning urine pH – between 6.5 and 7.5.

• Drink Water: Hydrate, hydrate, hydrate! Slacking on those 8 glasses a day of water can be costly. Not drinking enough may increase pain sensitivity.  In a 2016 study, voluntary hypohydration altered pain thresholds and increased pain perception in a cohort of 17 healthy male subjects.  Drinking enough water can also keep joints healthy and well-lubricated. It also flushes out unwanted toxins and irritants that can cause an undue burden on all of the body’s systems.  

• Integrate Mind and Body: The mind, emotions, and attention play an important role in the experience of pain. Generally, movement-based practices like yoga, Tai chi, even walking, are helpful for people with chronic pain, provided they are undertaken carefully. It is even better if the mind is involved as well. Somatic education techniques like Feldenkrais and Alexander can be particularly helpful in reducing chronic pain. By becoming aware of how one’s body interacts with its surroundings, it becomes possible to relinquish habitual movement patterns that cause or contribute to chronic pain. Other helpful mind-body approaches include progressive muscle relaxation, meditation, laughter, mindfulness meditation, hypnosis, guided imagery, biofeedback, and cognitive behavioral therapy. 

Helpful Supplements

There are many botanical and nutritional supplements that can be helpful for patients with chronic pain. Here are four must-haves: 

• Polyphenols: This group of plant compounds includes flavonoids like quercetin dihydrate and flavanols like oligomeric proanthocyanidins (OPC). They are linked to improved cognitive health and mental function.  They also have a profound antioxidant function and can decrease the extent of inflammation. All of this is very helpful for someone who is fraught with pain.

• Magnesium and Choline Citrate: Magnesium is a grossly under-recognized and under-utilized nutrient. It affects many different physiological systems, and it is so versatile in its function. In the context of pain, magnesium decreases nerve pain and since it offsets the effects of calcium, it acts as a muscle relaxant and helps with muscular pain as well. Magnesium deficiency is often what leads to muscle stiffness and cramps.  I recommend magnesium citrate glycinate and ascorbate, taken along with choline citrate, which optimizes magnesium absorption.Beyond pain itself, magnesium helps to mitigate anxiety, insomnia, chronic stress, and systemic inflammation.

• Omega-3 Fatty Acids: EPA and DHA can naturally help reduce pro- inflammatory signals that play a role in pain. They’re helpful in decreasing  the intensity of joint pain and stiffness in rheumatoid arthritis, neck, and back pain, as well as pain caused by inflammatory bowel disease and menstrual cramps.

• Vitamin B12: This is a must for anyone with pain, especially of the neuropathic type. As detailed in a recent systematic review, B12 can alleviate pain by a number of mechanisms: it promotes myelination, increases nerve regeneration and decreases ectopic nerve firing. We recommend using the hydroxocobalamin form of B12.  

Chronic pain is undoubtedly a complex situation. Some patients may need interventions beyond what we’ve covered here. But we have found that the recommendations above can help many people effectively navigate their way to significant pain relief, better overall health, and improved wellbeing.  

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Rethinking Osteoporosis

Osteoporosis is often called “The Silent Killer,” because in and of itself, it has no symptoms and most people who have it are quite unaware that they are losing bone until they experience a fracture. As we all know, a major fracture in advanced age raises the risk for a wide range of sometimes deadly comorbidities.

The condition we know as osteoporosis occurs when the body loses too much bone, makes too little bone, or both. In essence, it is a loss of proper balance between bone formation and bone resorption. What causes this shift?  Here is my take on the subject.

At the macro level, the quality and health of bone is influenced by gender (estrogen/testosterone status), age, race, activity level, and diet. Lifestyle factors also play a big role: stress, use of steroid medications, smoking, toxin exposures, and even the quality of an individual’s emotional relationships affect bone metabolism.

At the molecular level, osteoporosis can develop as a result of chronic metabolic acidosis, oxidative stress (lack of sufficient antioxidants), and neurohormone imbalances.  

Chronic Metabolic Acidosis

Bone is so sensitive to even small changes in pH that if the pH dips by even one-tenth, changes in bone will ensue. A dip in pH can stimulate excessive osteoclastic activity, inhibit osteoblastic action, and accelerate the loss of bone mineral density. The net result is less new bone-formation, and increased bone resorption.

The best way to keep this in check is to maintain a healthy acid/alkaline balance. That begins by knowing one’s pH. First morning urine pH assessment provides a good indication of overall cellular/ tissue pH and of overnight Net Acid Excess (NAE). This method makes use of paper pH strips, and is much more user-friendly than the longer and more invasive 24-hour urine collection method.

A healthy after-rest urine pH range is in the range of 6.5 – 7.5.  During prolonged sleep, the body concentrates excess acids in the urine and this capacity varies, based on toxin loads and an individual’s ability to actively excrete them.

While some question the value of the first morning urine test, we continue to find that after six or more hours of rest the high contrast Hydrion pH paper (with a test range of 5.5-8) provides a useful measure of net acid status. It is also inexpensive and convenient for measuring mineral reserve status, particularly magnesium and potassium, which are important for acid-alkaline balance.

The foods we eat play the biggest role in regulating acid/alkaline balance. A metabolically alkaline diet includes foods that have a buffering, alkalinizing effect on cell chemistry (Budde RA, Crenshaw TD, J. Anim. Sci. 2003; 81:197-208). This is often different from a food’s ash residue (Gonick HC, et al. Am J Clin Nutr. 1968; (21): 898-903).

Failure to recognize this distinction has led to a lot of confusion among clinicians and among people eager to follow an “alkaline” diet.

For example, citrus fruits are alkalinizing because the metabolism of citrate, malate, succinate, and fumarate generates more than twice as much bicarbonate buffer as there is acid in the food itself. Citrus fruit and similar foods are acidic in their food state (and tart on the tongue) yet alkaline-forming in the body.

The subject of alkalinizing diet is vast. Suffice to say that it is very important to limit intake of dietary sugars and refined flours that lack naturally occurring potassium and magnesium (Tzanavari T, et al. Curr Dir Autoimmun. 2010; 11:145-156.). Diets high in sugar, low in fiber, high in pro-inflammatory omega-6 edible oils (soybean, safflower, canola and corn oil) and lacking in anti-inflammatory omega-3s (fish oil, borage, flax seeds and purslane) increase acidity and impair immune defense and repair functions.

A plethora of nutrients– in food form as well as in supplements– be helpful in promoting bone strength and mitigating the risk of osteoporosis (Table 1)

I’ve developed a comprehensive but patient-friendly approach called The Alkaline Way, which can guide people in making the dietary and lifestyle changes needed to shift acid-base balance toward greater alkalinity.

Oxidative Stress

Oxidative stress is the result of an imbalance between the accumulation of free radicals or reactive oxygen species (ROS) in cells, and the ability to neutralize and eliminate these reactive compounds. Left unchecked, oxidative stress can cause cellular and tissue damage.

In the context of bone health, oxidative stress alters the bone remodeling process causing an imbalance between osteoclast and osteoblast activity. This is a major factor in osteoporosis.

By counteracting the destructive action of ROS, antioxidants promote the activation and differentiation of osteoblasts, foster the mineralization process, and reduce osteoclast activity. In preserving bone strength and structural integrity, antioxidants are valuable allies, with both direct and indirect activity on bone.

In this context, vitamin C (ascorbate) is key. I often refer to ascorbate as the “mother antioxidant.”

To increase antioxidant reserves and to provide a self-assessment of oxidative stress, I recommend a C Cleanse self-assessment. This process shows a patient how much ascorbate he or she needs to take, to manage oxidative stress and stimulate repair.

The assessment involves taking repeating doses of buffered, l- ascorbate powder dissolved in water, in increments of 15 minutes, until there is a complete evacuation of the digestive tract (very watery stools). The buffered ascorbate mobilizes toxins and eliminates them from the body via the GI tract.

The amount of ascorbate needed to induce this flush will tell you a lot about someone’s overall ascorbate status. To begin the C Cleanse, start with 0.5 teaspoon per glass of water if someone is generally healthy; 1 teaspoon if someone is slightly unwell, and 2 teaspoons if someone is ill.

The flush-inducing dose can also be used to calculate how much supplemental ascorbate someone should take on an ongoing basis. I generally recommend taking 75% of the flush-inducing amount daily, although it is fine to start anywhere between 5-50% of the cleanse dose with simultaneous digestive repair.

Flavonoids like quercetin dihydrate and oligomeric proanthocyanidins are also helpful in filling antioxidant requirements. 

Stress Hormone & Neurochemical Balance

Neurohormonal balance–termed “eustress”—enables and promotes bone renewal. In contrast, chronic states of distress–characterized by neurohormonal imbalances—have a blunting effect on bone renewal, and predispose people to bone loss.

Unfortunately, overstimulated and under-functioning adrenals, thyroid, pancreas, and ovaries or testes are all too common in our society. I believe these hormonal imbalances play central roles in the development of osteopenia and osteoporosis.

We know that elevated cortisol interferes with osteoblast formation and dramatically decreases bone-building. People with chronically elevated cortisol may be at risk for osteoporosis.

Similarly, estrogen regulates bone remodeling, and bone is also a “target organ” for thyroid hormone. Irregularities in ovarian or thyroid function will be reflected as changes in bone integrity.  Neurochemicals like epinephrine and serotonin also play a role. In the brain, serotonin acts via the hypothalamus and influences bone growth. In depression and chronic stress, high norepinephrine levels are associated with bone loss.

The musculoskeletal system is especially vulnerable to inflammation, so we want to do all that we can to help patients reduce inflammation and oxidative stress.

Immune hypersensitivity pulls minerals from bones and impairs repair responses. We can identify substances that trigger immune reactions via key lymphocyte response assays, and then use the results to guide people in finding substitutes for the immune-reactive items in their diets.

Consider measuring C-Reactive Protein (hsCRP) in patients at risk for osteoporosis. It is a good predictive biomarker for inflammation and oxidative stress. Higher levels of hsCRP are associated with increased fracture risk.

Exercise, Relaxation & Sleep

There’s no question that physical activity stimulates bone repair and preservation of BMD. Putting it simply, the mechanical stresses of exercise will promote bone-building at any age.  It need not be strenuous or exertive. Even one hour per day of walking will have myriad benefits.

Restorative sleep also helps. So will stress-reducing activities like tai chi, yoga, and meditation. Anything that promotes parasympathetic nervous system activity while reducing sympathetic overdrive will be helpful in promoting bone repair and reducing osteoporosis risk.

Providing Help at the Intersection of Pain Place & Depression Boulevard

Depression, anxiety, and chronic pain frequently co-occur, though the connection between them is not always apparent at the outset.

While most people experience physical pain at some point in their lives, in those with depression or anxiety, pain can become particularly intense and hard to treat. People suffering from depression, for example, tend to experience more severe and long-lasting pain than non-depressed people.

Approximately twice as many people who suffer from chronic pain such as arthritis are also affected by an anxiety disorder. The increased likelihood of anxiety has also been found among those with migraines, back pain, neck pain, and fibromyalgia.

The prevalence rates of chronic pain, depression, and anxiety have been rising steadily over the last decade. What the world is going through today, with the COVID 19 pandemic, has broken all records.  

What Are the Connections?

• People who suffer from chronic pain who also have an anxiety disorder may have a lower tolerance for pain. They may also be more fearful of pain than people who do not have anxiety.
• Chronic pain is depressing, and likewise episodes of major depression may feel physically painful. Depression commonly occurs as a sequelum of chronic pain, and we need to address it, and not just focus on the physical symptoms, if we wish to improve outcomes.
• Research shows that physical pain actually shares some biological mechanisms with anxiety and depression. Serotonin and norepinephrine contribute to pain signaling in the brain and nervous system. They also are implicated in both anxiety and depression. Another neurotransmitter called Pituitary Adenylate Cyclase Activating Polypeptide (PACAP) is released in response to stress, and PACAP levels are elevated in response to chronic pain
• Mood disorders, especially depression and anxiety exacerbate pain perception.
• Anxiety negatively affects thoughts and behaviors, and this hinders rehabilitation. Being in constant fight-or-flight mode, which can happen with chronic anxiety, has negative consequences. Tensed muscles—a reflexive preparation to escape from danger quickly—become problematic when this becomes a constant condition. The chronic tension can result in musculoskeletal pain, tension headaches, and migraines.

The constellation of physical pain, depression, and anxiety creates a complex situation. But there’s a lot we can do to help our patients who suffer from this triad. Here are some tips I’ve found to be helpful in supporting people to reach their desired goals of health and happiness:

• Alkalinize: Maintaining a 1^st morning pH on the alkaline side ensures that the body is in an “acid-alkaline balance” and prevents metabolic acidosis. Increased acidity can affect the amygdala (fear control center), where certain acid-sensing ion channels increase the propensity for anxious episodes and panic attacks. Keeping the 1^st morning urine pH between 6.5-7.5 can also help keep physical pain in check. Choose foods wisely, and incorporate alkalinizing foods like nuts, seeds, sprouts, and green vegetables whenever possible. Do not forget to hydrate with mineral-rich water, and can the canned and bottled sugar-saturated sodas.
• Magnesium and Choline Citrate: The importance of magnesium is grossly under-recognized. It is so versatile in its functions, and it can help mitigate anxiety, insomnia, chronic stress, or inflammatory conditions. Magnesium decreases nerve pain. Since it is a muscle relaxant, it helps with muscular pain as well. Magnesium deficiency is often what leads to muscle stiffness and cramps in the first place. Magnesium also contributes to blocking N-Methyl d-Aspartate (NMDA) receptors, which have a role in pain perception. I recommend magnesium citrate glycinate and ascorbate taken along with choline citrate to optimize absorption.
• Polyphenols: This group of plant compounds includes flavonoids like quercetin dihydrate, and flavanols like oligomeric proanthocyanadins (OPC). They are linked to improved cognitive health and mental function.  They also have a profound antioxidant function and can decrease inflammation. Polyphenol supplementation is helpful for someone who is fraught with pain.
• Amino Acids: The compound s- adenosyl methionine (SAMe) is made by the body from the amino acid methionine, and it is effective in reducing symptoms of depression, anxiety, and even the pain associated with osteoarthritis. While many practitioners prefer using SAMe as a supplement, I recommend using free amino acids like methionine, glycine, and aspartate so the body is empowered to make its own SAMe.
• Support Methylation: Impaired methylation is one of the causal factors in chronic pain syndromes. Consequently, I recommend supplementing with vitamins B12 (hydroxocobalamin form), B6, and folate. This, combined with magnesium and nutrients for SAMe production, will support methylation cycles.

Thinking & Doing

It can be difficult to keep a positive attitude during challenging times such as these, especially if one is experiencing chronic physical pain, depression, or anxiety. I focus on these three approaches, which combined, can help a lot: 

Physical Movement: So many studies have shown that physical activity boosts mood and alleviates anxiety. As little as 30 minutes per day can be really helpful. The challenge is that people with chronic pain tend to avoid exercise. And the less active they become, the greater their risk of injury, worsening pain, and prolonged depression.

For people in this situation, I recommend gentler movement therapies known to be effective for pain relief such as Pilates, Feldenkrais, Trager, Alexander, and Bowen technique. Massage and other such bodywork that re-educates the brain into realizing that it is now “safe” to move freely can also be helpful.

Nurturing Neurochemical Harmony: There are many approaches for balancing neurotransmitters, and creating a better balance between sympathetic and parasympathetic activity. I’ve found the following to be quite helpful:

Green Light Therapy:  Light therapy has been used by scores of therapists for various benefits. I particularly like using dichromatic PAR 38 lamps that emit light in the green part of the spectrum, as these wavelengths play a role in harmonizing and calming the pineal gland. Laying under this type of light, which passes through the retina, for 15-20 minutes per day can improve sleep and concentration, and even support healthy digestion and biodetoxification.

Active Meditation: Meditation helps to balance neurotransmitters such as oxytocin, acetylcholine, norepinephrine and others that are involved in the fight or flight response.

Breathing: People who are anxious tend to breathe in their upper lungs (upper chest) with shallow, rapid breaths. Breathing like a baby, with deep diaphragmatic breaths is what we need to do. Lower chest (diaphragmatic) or abdominal breathing is the ideal way to fill the lungs with air slowly, provides for sufficient oxygen intake and controls the exhalation of carbon dioxide. This technique engenders calmness and can be done at any time. It also has an extremely therapeutic effect on chronic pain, by helping to relax the muscles which tense up under stress.

Positive Thinking: While this can seem impossible at times, it is very important. Positive states can be nurtured by:

• Trusting yourself – most importantly not focusing on negative thoughts
• Feeling gratitude for the things we have. Gratitude can instill happiness and positive emotions, but also improve sleep quality and blood pressure
• Staying grounded- sometimes helping others can help us keep our feet on the ground and release us from our own worries and stressors.

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Remote Patient Monitoring: From Luxury to Necessity

Patient self-assessment tools, along with remote consultation technologies, have evolved rapidly over the last decade. Until recently, they’ve been considered luxuries for highly motivated patients and future-forward clinicians.

In the post-COVID world, where many physicians have closed their clinics and patients are deferring all but the most essential in-person visits, telemedicine and remote monitoring are no longer luxuries, they’re necessities. And they will shape the future of clinical practice—especially in preventive medicine.

Here are a few home monitoring and self-assessment strategies that allow patients to take more active roles in their care, while providing practitioners with pertinent information to guide them along the way.  

Befriend Technology

The current situation is obliging all of us in medicine to befriend new technologies. I have found a few basic tracking devices particularly helpful. These gadgets are user-friendly and built for ease-of-use at home. They can accurately track various health measurements and are compatible with many different wireless and internet platforms. They make it easy for patients and their practitioners to view and manage health data together as a team.

Blood Pressure Monitor: Maintaining a healthy blood pressure is essential. I suggest using a device like the Omron wrist blood pressure monitor. It is lightweight and portable, allowing patients to track their blood pressure on the go. It stores the readings, and the app interfaces with the patients’ computers, so they can keep and share comprehensive records of their recordings. I personally find the wrist version less cumbersome than the arm version.

Digital Stethoscope: Digital stethoscopes such as Eko stethoscopes use Bluetooth to pair with smartphones and tablets through the Eko App. Clinicians can listen to, visualize, and share auscultations of the same quality as if they were listening directly to their patients’ hearts in person, through ordinary stethoscope earpieces. This foregoes the need for close doctor-patient contact. Wireless stethoscope technology makes telemedicine exams much easier.

Assessing Cardiovascular Function

Heart Rate Monitors: The Resting Heart Rate is the number of times the heart beats per minute when someone is at rest. A good time to check this is in the morning after a good night’s sleep. For most of us, the RHR is between 60 and 100 BPM. But this can be affected by factors like stress, anxiety, hormones, medication, and level of physically activity. Athletes and highly active people may have RHRs as low as 40 BPM. When it comes to RHR, lower is definitely better, because it means that the heart muscle is in better condition and doesn’t have to work as hard to maintain a steady beat. Studies show that a higher RHR is linked with lower overall fitness, higher blood pressure, and overweight.

The Peak Heart Rate is 85 to 100 percent of someone’s maximum heart rate. I like to strive for a resting pulse rate of 50 BPM or less while asleep, and not more than 100 BPM when active. 

Most of the current generation of smart phones come with the capacity to monitor both resting and peak heart rates. There are dozens of heart rate monitoring apps that make use of this built-in capacity to provide quick and easy analyses, no math required. I recommend looking for one that suits your patients’ needs. They are very useful.

Detecting Atrial Fibrillation (AFib): The irregular heartbeat patterns associated with AFib can lead to blood collecting in the heart, which can form stroke-causing clots. Tracking Afib at home is pure common sense. Just over two years ago, the FDA approved the AliveCor Heart Monitor— a smartphone app plus a special phone case with a set of sensors. Together they convert the phone into an EKG machine that patients can carry around in their pockets or purses. It allows you and your patient to see a simple version of the heart’s electrical activity in real time on the phone screen.

The system is very easy to use. A patient activates the app, places the index and middle fingers of each hand on the sensor pads, and records an EKG tracing.  In the latest version, called Kardia, the sensors just need to be near–not necessarily on– the phone.

Heart Rate Variability & Autonomic Nervous System Assessment: The effect of heart activity on brain function—and vice versa–has been researched extensively over the past 40 years. Early research mainly examined the effects of heart activity occurring on a very short time scale – over several consecutive heartbeats at maximum. Scientists at the HeartMath Institute have extended this research by looking at larger-scale patterns of interaction between the heart, the brain, and the nervous system.

Heart rate variability (HRV) is a measure of the beat-to-beat changes in heart rate. The normal variability in heart rate is due to the synergistic action of the two branches of the autonomic nervous system (ANS). The sympathetic nerves accelerate heart rate, while the parasympathetic (vagus) nerves slow it down. The sympathetic and parasympathetic branches of the ANS are continually interacting to maintain cardiovascular activity in its optimal range and to permit appropriate reactions to changing external and internal conditions.

With that in mind, analysis of HRV over the course of someone’s day therefore serves as a dynamic window into the balance of the autonomic nervous system. While this seems complicated, it can be tracked fairly easily via a set of user-friendly smartphone-based tools. I recommend looking at Heart Math’s devices & apps that patients can use to monitor their HRV and self-entrain healthier, more coherent, and balanced physiological states.

Remote Lung Assessment

Spirometry & Lung Function Assessment: For patients with asthma, and others in need of frequent and regular spirometric testing, the Aluna Spirometer is the perfect solution. It enables patients to measure their lung function at home, which is a great asset for those who’ve had COVID or who are at high-risk, as it can potentially eliminate clinic visits. 

The Aluna system consists of a special breath test device that links wirelessly to a smartphone, and an app for collecting the spirometry data. It calculates FEV1 instantly, and records, stores, and shares the readings. The app also has a medication utilization tracker, and a video game component—particularly well-suited to children and young patients—that explains what the readings mean and allows users to set lung function goals. 

Aluna gives doctors an online dashboard on which to monitor their patients’ spirometry data as it is being collected. Alternatively, patients can choose to share the results over the internet. Aluna can help doctors and patients work together to build a more precise, customized treatment plan that keeps patients engaged in their own self-care.

In addition to these helpful devices and smartphone systems, there are 5 low-tech self-assessments that I recommend that we all use routinely. You can find complete protocols for these simple self-assessments at https://www.perqueintegrativehealth.com/lifestyle/self-tests/.

Low-Tech Options

First Morning Urine pH: The first morning urine pH is a good indicator of the body’s mineral reserve and its acid/alkaline state. The body routinely uses overnight rest time to excrete excess acids. One’s capacity to do so varies based on toxin load, individual ability to inactivate toxins, and to excrete them. Using a pH test strip, this is a simple, inexpensive at-home test.  Maintaining a pH within 6.5- 7.5 is ideal, indicating that overall cellular pH is appropriately alkaline.  Cells in all tissues of the body function best in an alkaline state. 

Digestive Transit Time: The state of one’s digestive system affects all aspects of health. Measuring digestive transit time gives an idea of how long it takes for food to be digested and for waste to be eliminated. The ideal transit time is between 12-18 hours. Most people who eat the standard American diet have transit times of 36-96 hours, which is detrimental to overall health.

With the help of a few charcoal capsules, patients can easily and painlessly find out how well their digestive organs are doing their jobs. This can help guide decisions about the amount of fiber, probiotics, and other digestive support they need.

C Cleanse: This test uses buffered vitamin C (ascorbate)–the body’s universal antioxidant—to identify a person’s risk of oxidative stress and extent of antioxidant protection.

The process involves taking buffered ascorbate powder in increments of 15 minutes till there is a complete evacuation of the GI tract, or a flush/cleanse is achieved (watery stools). In people who are generally healthy and getting enough vitamin C, this “C cleanse” protocol will give a result of ≤4g. But it is not uncommon to see results of 50, 75 or even 100g, indicating that someone is very deficient in ascorbate. I recommend doing the C cleanse every week.

Wrist Skin Pinch Test: Drinking enough water each day is crucial for many reasons: to regulate electrolyte balance, support kidney function, keep joints lubricated, prevent infections, deliver nutrients to cells, and keep organs functioning properly. Being well-hydrated also improves sleep quality, cognition, and mood.

A simple self-test for hydration status that I like to recommend is called the wrist skin test:

– Gently pull up about ½ inch on the skin on the back of the wrist with the hand extended out (not flexed either up or down).

– On releasing the pinch, if the skin immediately flattens, it is a sign of well-hydrated tissues. However, if the skin maintains a little ‘tent’ i.e., stays pinched and then slowly goes back to normal over 5-10 seconds, it is usually a sign of significant dehydration

Urine Specific Gravity (SG): Urine specific gravity is another important measure of hydration and kidney health that can be used to assess the kidney’s ability to concentrate or dilute urine.  Ideally, urine SG measurements will fall between 1.002 and 1.030 if the kidneys are functioning normally. Numbers above 1.010 can indicate mild dehydration. The higher the number, the more dehydrated someone will likely be.

I like to use a refractometer for this test which projects light into the sample and helps determine the density of the urine.

There’s no question that the COVID pandemic has moved telemedicine and remote monitoring from the margins of healthcare into the mainstream. In many ways, this shift provides new opportunities for patient empowerment and practitioner emancipation.

Office visits will always have a prominent place in medical practice, but they need not be the default setting for everything.

Telemedicine is not the be-all, end-all solution to the problem of healthcare access—many people do not own smartphones or computers—but this technology can help many people improve their health and wellbeing in ways that are convenient and affordable. It opens exciting new possibilities for how we practice and experience healthcare—possibilities we are just beginning to explore.

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