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Category: Patient Education

Apple Cider Vinegar, real benefits vs hype
Apple cider vinegar (ACV) has been touted for various health ailments from dandruff to diabetes to high cholesterol. Before you jump on the bandwagon it is important to understand how apple cider vinegar works, its benefits, and its risks.

Image by Jenny Bayon from Pixabay

Apple cider vinegar is made by crushing and fermenting the apples. The sugars in the apples first turn into alcohol. Then, there is a second fermentation process when the alcohol is fermented into vinegar. The second fermentation is done by a type of bacteria called acetobacter. The second fermentation process produces acetic acid.

Vinegar contains anywhere from 5 to 20 % acetic acid.

Many brands of natural apple cider vinegar boast that they still have live and active cultures or “the mother” in the bottle. The live cultures look like the cloudy material in the bottle. While there has not been any research on the benefits of these cultures, many other fermented foods like yogurt, miso, and sauerkraut have been shown to have health benefits.

Many brands of natural apple cider vinegar boast that they still have live and active cultures or “the mother” in the bottle. The live cultures look like the cloudy material in the bottle. While there has not been any research on the benefits of these cultures, many other fermented foods like yogurt, miso, and sauerkraut have been shown to have health benefits.

The specific mechanism of apple cider vinegar has yet to be completely understood. Like many other natural foods, it probably works on many pathways, not just one. Vinegar increases the dilation of arteries. Research has also revealed that it decreased post-meal rises in glucose and insulin (which is a good thing). Insulin is an inflammatory hormone and has been linked to weight gain.

There is published literature that shows that apple cider vinegar can help with the following.
- Diabetes – decreased the HBA1C (a measure of your blood glucose level for 3 months)
- Metabolic syndrome – improves insulin sensitivity (which means your pancreas does not have to secrete as much insulin)
- Atherosclerosclerosis – decreases oxidized LDL (an inflammatory type of cholesterol)
- Obesity – decreases abdominal visceral fat (which is the dangerous fat around the organs)
While there are definite and documented benefits of apple cider vinegar. There have also been associated risks. Some of the common risks include heartburn, esophagitis, loss of tooth enamel, and a worsening of diabetic gastroparesis.

Nevertheless, many experts feel that the benefits of apple cider vinegar outweigh the risks. Here are a few things you should do to limit the risks of apple cider vinegar while enjoying its health benefits.
1. Check with your doctor to make sure apple cider vinegar is okay for you. This is especially important to do if you have diabetes or reflux.
1. Do not take more than 1 tablespoon or 15 ml of apple cider vinegar a day. Also, dilute this with water when you drink it.
1. Take apple cider vinegar 30 minutes before your meal.
1. Rinse your mouth after taking apple cider vinegar to minimize any damage to your dental enamel.
1. Do not sip apple cider vinegar throughout the day. This can be an acidic drink so it is better to have it once a day rather than throughout the day.
References:

J Prosthodont. 2015 Jun;24(4):296-302. doi: 10.1111/jopr.12207. Epub 2014 Sep 14.Antifungal Activity of Apple Cider Vinegar on Candida Species Involved in Denture Stomatitis.Mota AC1, de Castro RD1, de Araújo Oliveira J1, de Oliveira Lima E1.

J Evid Based Integr Med. 2018; 23: 2156587217753004.Published online 2018 May 14. doi: 10.1177/2156587217753004 PMCID:PMC5954571 PMID: 29756472; Diabetes Control: Is Vinegar a Promising Candidate to Help Achieve Targets? Fahad Javaid Siddiqui, MSc, Pryseley Nkouibert Assam, PhD, Nurun Nisa de Souza, MPH, Rehena Sultana, MSc, Rinkoo Dalan, FRCP and Edwin Shih-Yen Chan, PhD

Journal of Medicinal Food Vol. 21, No. 1, Apple Cider Vinegar Attenuates Oxidative Stress and Reduces the Risk of Obesity in High-Fat-Fed Male Wistar Rats, Ben Hmad Halima, Gara Sonia, Khlifi Sarra, Ben Jemaa Houda, Ben Slama Fethi, and Aouidet Abdallah, Published Online:1 Jan 2018https://doi.org/10.1089/jmf.2017.0039

Biosci Biotechnol Biochem. 2009 Aug;73(8):1837-43. Epub 2009 Aug 7.Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects.Kondo T1, Kishi M, Fushimi T, Ugajin S, Kaga T.

Sci Rep. 2017 Jul 27;7(1):6664. doi: 10.1038/s41598-017-06235-7.Anti-obesity and anti-inflammatory effects of synthetic acetic acid vinegar and Nipa vinegar on high-fat-diet-induced obese mice.Beh BK, Mohamad NE, Yeap SK, Ky H, Boo SY, Chua JYH, Tan SW, Ho WY, Sharifuddin SA, Long K, Alitheen NB.

Pharm Biol. 2017 Dec;55(1):43-52. Epub 2016 Sep 5.Fruit vinegars attenuate cardiac injury via anti-inflammatory and anti-adiposity actions in high-fat diet-induced obese rats.Bounihi A, Bitam A, Bouazza A, Yargui L, Koceir EA.

Pharm Biol. 2016;54(2):260-5. doi: 10.3109/13880209.2015.1031910. Epub 2015 Apr 8.Effect of fruit vinegars on liver damage and oxidative stress in high-fat-fed rats.Bouazza A, Bitam A, Amiali M, Bounihi A, Yargui L, Koceir EA.

Mol Nutr Food Res. 2016 Aug;60(8):1837-49. doi: 10.1002/mnfr.201600121. Epub 2016 Jun 27. Vinegar as a functional ingredient to improve postprandial glycemic control-human intervention findings and molecular mechanisms.Lim J, Henry CJ, Haldar S.
September 19, 2022
What is HBA1C?

HBA1C (sometimes also called A1c or hbA1c) is a complicated mash of alphabet soup used to describe glycated hemoglobin. That doesn’t clarify much, does it? What is HBA1C and what does it have to do with you? Well, hemoglobin is a protein found in red blood cells that helps carry oxygen throughout the body as blood is pumped. “Glycated” hemoglobin is hemoglobin that has joined with glucose, a sugar molecule, and will stay that way for the remainder of its cellular life cycle (Diabetes.co.uk, 2015).

This in of itself is nothing to worry about. Sugars naturally interact with the bloodstream all the time. Any time you eat a donut, some of that sugar will end up passing through your blood. But for diabetics, or people at a higher risk of developing diabetes, HBA1C is important to measure at regular intervals.

HBA1C is an excellent barometer for the total amount of sugars in the body. When screening for diabetes or related symptoms, doctors will do several tests of HBA1C levels over the course of a few weeks or months to determine where your sugar intake is at. Those who suffer from hypoglycemic episodes will also become familiar with their HBA1C levels during testing.

If your HBA1C level is too high, changes must be made. The most obvious solution is to cut your sugar intake, sometimes drastically, but some doctors will also recommend further action. Exercise, for instance, is a good way to moderate your HBA1C levels. Studies have shown that strength training is actually the most effective way to do this, though aerobic or cardio exercise also have benefits (Bweir, 2009).

In order to measure your HBA1C levels, doctors usually require a simple blood test. There is no special preparation required before the test, the food items you eat or drink won’t skew the results significantly. One test can give information about the previous three months of HBA1C levels, and if you require regular testing, doctors may recommend you get tested at three month intervals (Medline Plus, 2014).

As a general rule, an HBA1C level of under 5.7% is considered normal. However, you may still be at risk for insulin resistance. A level between 5.7% and 6.4% suggests that you are at risk of developing diabetes. And HBA1C levels of over 6.4% pretty much only occur in diabetics.

If you’re interested in getting tested for high HBA1C levels, talk to your doctor about your options. The test is quick and easy, and there are even kits you can buy to use at home. If you feel like diabetes might be a risk for you, your HBA1C levels are a good piece of info to keep in mind.

You make also be interested in the follow, What is insulin resistance?, a precursor to diabetes.

References

Guide to HBA1C. (2015). Diabetes.co.uk. Retrieved on 7/14/2015 from http://www.diabetes.co.uk/what-is-hba1c.html

Bweir, S. (2009). DMSJournal.com. Retrieved on 7/14/2015 from http://www.dmsjournal.com/content/1/1/27

A1C Test. (2014). Medline Plus. Retrieved on 7/14/2015 from http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm

July 27, 2015
What is Concierge Medicine?

Concierge medicine is a growing trend in the healthcare community, a business model that gives the patient more control over their healthcare and the physician more time to deal with them directly. Simply put, it’s the practice of keeping a medical professional on retainer, usually with an annual or monthly fee, allowing them to address whatever medical needs might arise at any given time. The doctor doesn’t work for the hospital, churning through sixty waiting room attendees before finally giving you fifteen minutes of harried attention. They work for you, and as such, have a vested, personal interest in your health and well-being so that business may continue.

The Downsides of Concierge Medicine

The downside? It’s expensive. Basic healthcare isn’t cheap on its own in the United States, with healthcare premiums for the average family rounding out to over $16,000 a year (KFF.org, 2014), and a concierge doctor’s fees can add anywhere from $1000 to $25,000 a year on top of that (Himmel, 2010). These fees usually cover an annual checkup and ensure quick and effective care, but more intensive procedures will often incur additional fees.

As such, concierge medicine remains a middle to upper class phenomenon. The USA Network TV series Royal Pains satirizes this aspect of the job, portraying down-to-earth doctors often bumping heads with snooty, upper crust clients. This class barrier is a common criticism of the concierge business model. Doctors are in short supply, and with America’s population becoming older and more obese, able physicians dropping poorer clients so that they might cater to the lucrative elite has struck many in the medical profession as morally dubious at best.

The Hybrid Model Solution

It’s a messy situation, but solutions are being proposed. One such method that has gained traction in the past few years has been the “hybrid model” of medicine, wherein doctors can continue to treat their longstanding patients while still offering concierge-style perks to a smaller percentage who want it. The end result is doctors making more money, seeing fewer patients per day, and becoming less stressed as a result. These hybrid programs are still largely experimental, but so far, responses from both patients and caregivers have been positive.

Dr. Cynthia Williams is one such physician who found a hybrid model of medicine to be ideal. “This isn’t a disruptive model,” she wrote. “I continue to take insurance and patients don’t have to look for another provider… I’m not taking on new patients I don’t really have the time to see and can dedicate myself to all the patients I do have while bringing on new patients through normal practice attrition when it makes sense” (Williams, 2015).

None of this should suggest, by the way, that traditional medicine is on the way out. As mentioned before, the extra cost of concierge medicine means it will likely remain an option only for more affluent patients. But if the result is better paid doctors able to take on more reasonable workloads, then we all benefit.

References

Section One: Cost of Health Insurance (2014). Retrieved on 6/28/15 from http://kff.org/report-section/ehbs-2014-section-one-cost-of-health-insurance/

Himmel, D. (2010). Chicago Health Online. Retrieved on 6/30/2015 from http://chicagohealthonline.com/at-your-service-concierge-medicine/

Williams, C. (2015). Modern Healthcare. Retrieved on 6/30/2015 from http://www.modernhealthcare.com/article/20150117/MAGAZINE/301179978

July 23, 2015
Top 10 Anti-Inflammatory Foods

Inflammation, as part of the human’s natural defense system, brings extra nutrients and immune cells to a diseased, infected or otherwise injured area of our body. In this way inflammation protects us and helps to repair damaged tissues. But when inflammation becomes chronic due to an overstressed, overweight or nutrient-deficient body, then it not only stops defending, but it also creates a higher risk of inflammatory associated diseases, including heart disease, cancer, arthritis, diabetes, and allergies.

Foods that exhibit a high level of phytonutrients and anti-inflammatory properties, when combined with a healthy lifestyle, may reduce chronic inflammation and lessen your risks of disease (Hu, 2014).

Here are our top 10 anti-inflammatory foods:

Beets – Beets contain phytonutrients called betalains, which have potent anti-inflammatory and anti-oxidant properties. Sliced thin and lightly steamed (for 15 minutes or less), or grated raw in a slaw, beets combat inflammation and provide essential vitamins and minerals.

Flax Seeds – This plant-based source of omega-3’s has a normalizing effect on blood pressure and helps maintain cholesterol levels, soothing inflammatory conditions. A tablespoon of the ground seed can be added daily to any grain recipe, such as oatmeal or muffins.

Collard Greens – The high level of glucosinolates found in collard greens can help lower your risk of chronic disease by supporting the antioxidant and anti-inflammatory system. One to 2 cups several times per week is suggested.

Extra Virgin Olive Oil – Since olive oil contains an anti-inflammatory specific enzyme, oleocanthal, you can replace butter, lard, and vegetable oils with this naturally anti-inflammatory oil and enjoy its inherent pain relieving capacities.

Oranges – This beautiful, delicious fruit packs in over 170 different phytonutrients, many of which directly affect inflammation. Oranges mediate the inflammatory response to help treat and prevent chronic disease.

Berries – All berries, from blueberries and raspberries, to strawberries and blackberries, contain polyphenol compounds, which have direct anti-inflammatory effects on a cellular level. Adding up to a cup of berries per day can boost your chronic disease defenses.

Ginger – Valued for centuries for its anti-inflammatory properties, ginger mimics the actions of non-steroidal anti-inflammatory drugs (like Ibuprofen) without the harmful side effects. Grated fresh ginger can easily be added to soups and stir-fries.

Shiitake Mushrooms – Because they are rich in bioactive compounds, shiitake mushrooms help block the inflammatory stage associated with cholesterol build up while protecting blood vessels. Sautéed or added to soups, shiitakes make a nutrient dense addition to any meal.

Lentils – Often characterized as the perfect staple food, lentils contain phytonutrients that help lower c-reactive protein levels (CRP), which are used to indicate the extent of inflammation. Lentils make a satisfying meal in a hearty soup, or simmered in curry spice.

Walnuts – Walnuts contain a unique phytonutrient called quinone juglone, which detoxifies cells and provides circulatory protection with anti-oxidant and anti-inflammatory actions. Also high in omega-3’s, a small handful of walnuts each day may work to calm chronic inflammation.

References

Hu, F. (2014). Foods That Fight Inflammation. Retrieved July 2015 from http://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation

July 22, 2015
Benefits of Sprouting: How to Sprout Seeds, Grains, and Greens
There is an expression that good things come in small packages and sprouts are a perfect example of that—a nutritional powerhouse tucked inside a seed.

The process of sprouting involves germinating seeds, which “sprout” or grow into tiny nutritious plants, and are then eaten raw or cooked. Many different kinds of grasses, grains, beans, and greens can be sprouted. Some of the most popular sprouts are mung beans, alfalfa, broccoli, and clover, as well as “ancient grains” and chickpeas. If you look, you can find some of these common sprouts in the produce section of many grocery stores.

Nutritional Benefits of Sprouting

Sprouting can provide many health and nutrition benefits. Back in the 1920s an American professor named Edmond Szekely championed what he called “bio-genic” nutrition saying that sprouted seeds and baby green were the most nutritionally beneficial foods that support cell regeneration (Sprouts-as-Medicine, 2008).

Sprouts are widely praised for being high in dietary fiber, B complex vitamins (particularly B2, B5, and B6) and protein. In addition, germinating seeds produces high levels of vitamin C and increases beta carotene levels.

The changes that that occur during the sprouting process make it easier for the body to digest and derive nutrients from sprouted seed, legumes, and plants. For example, sprouting breaks down complex sugars into simpler glucose molecules and neutralizes enzyme inhibitors allowing for easier digestion. (Harris, 2009) And, sprouting whole grains reduces the amount of starch they contain and boosts their nutritional value.

There are even some claims that particular sprouts have specific benefits such as clover (for menopause symptoms in women), mung beans (for heart and blood health), and cress (for clean skin and blood purification) (Sprouts-as-Medicine, 2008).

How To Sprout

For beginners the sprouting process can seem complicated and intimidating, but once you get acclimated, it is fairly straightforward. The basic process is as follows:
1. Fill a Mason jar 1/3 with seeds and the rest with filtered water.
2. Soak seeds* in a Mason jar with mesh or a screen in place of the metal lid insert.
3. Drain, rinse, and refill with the seeds and 2-3 times fresh water. Repeat this step every few hours or at least twice a day.
4. Flip the jar and/or invert to allow for air circulation.
5. Repeat steps 3 and 4 for as long as necessary until the seeds start sprouting.*
*Soaking times and sprouting times vary for different seeds/plants. There are myriad charts available online (Vegetarian Times) that detail the specific lengths of time required. Generally, most seeds require soaking times between 6-12 hours and the majority sprout within 1-4 days. For example, alfalfa sprouts in 2-5 days, while some plants will begin sprouting in less than a day.

Once the seeds have sprouted, be sure to give them a final rinse and dry them out to inhibit bacteria growth. This is often done by placing in a sunny spot for a few hours, which also helps the plants get greener. Any harmful components that nuts or seeds may contain are eliminated during the initial soaking period, which takes place prior to sprouting.

For more information and reources, we recommend checking out SproutPeople.

References

Harris, Kimberly (2009). Why Sprout? retrieved on July 13, 2015 from www.thenourishinggourmet.com/2009/01/why-sprout.html.

Masters, Tess (2013). How to Soak and Sprout Nuts, Seeds, Grains and Beans retrieved on July 13, 2015 from www.vegetariantimes.com/blog/how-to-soak-and-sprout-nuts-seeds-grains-and-beans/.

Sprouts (2008). Retrieved on July 13, 2015 from www.sprouts-as-medicine.com.

Hot to Sprout: Seeds, Beans, Grains (n.d.). Retrieved on July 13, 2015 from http://tasty-yummies.com/2014/04/22/how-to-sprout-seeds-beans-grains/.
July 20, 2015