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22/Jun/2022

Intro

Fans of Star Trek probably remember Dr. McCoy shinning his red laser beam on both humans and aliens resulting in miraculous recoveries from disease. It’s funny to think of how accurate this depiction of “future medicine” was back in the 1960’s. In fact from its inception, Star Trek had a very deliberate intention of incorporating scientific fact and theory into its paradigm.

Lasers

Lasers are devices that have fuelled imagination and propagated scientific breakthrough for decades. A laser emits light through a process of optical amplification. What we perceive as a laser beam is highly concentrated electromagnetic radiation which can also be thought of as concentrated energy. Industrial laser beams can be so amplified and powerful that they can cut through metal. Many medical lasers are somewhat less amplified but in many cases can cauterize and cut through tissue with amazing precision and accuracy.

Cold Laser Therapy

In my Toronto clinic we use what’s known as a cold laser. This type of laser is more powerful than a laser pointer used for presentations but less concentrated than those lasers used to cut and burn tissue. When this type of laser is applied on the surface of the body it transmits energy (known as Joules) into the underlying tissue. When tissue is exposed to this type of energy we can see increase in blood flow, metabolism, anti-inflammatory effects, neurogenesis and stem cell release.

Laser for Pain Relief

Pain is often precipitated by a decrease in circulation and oxygenation of tissue. Laser therapy works to restore circulation to hypoxic tissue as well as influencing several metabolic processes that decrease inflammation and increase regeneration. Laser therapy treatments are quick (a session typically takes 10-15min) and painless. Laser therapy has been very effective for my patients dealing with both neuropathic and musculoskeletal pain. I have also had success with various neuropathies. I therefore commonly recommend laser therapy as a first line treatment in a variety of conditions for its excellent safety profile and efficacy. For more information or to book an appointment call us today!


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14/Jun/2022

Overview

Acupuncture can be a great treatment for fertility in both men and women. Acupuncture is part of many traditional systems of medicine, especially in Asia. When applied at specific locations on the body it has been proven to help regulate immune, cardiovascular, neurological and hormonal systems. Clinically I have seen improvements in energy, wellbeing and sperm quality in men. I have also se

en improvements in menstruation, cyst formation, egg quality and implantation in women. These effects have also been confirmed through many controlled trials.

In my Naturopathic practice I have seen demand for fertility/infertility treatment rise over the past decade. Aside from increases in environmental toxins and hormone disruptors, stress has become a serious epidemic. Chronically elevated levels of stress hormones can disrupt almost every biological system in the human body. It is no surprise that the couples I see struggling with infertility generally have high levels of stress. Furthermore the anxiety applied to fertility struggles compound on top of the already present stress level. Acupuncture has been an extremely effective tool in regulating the stress response in those individuals affected by chronically high levels of physical and emotional stress.

What to expect

At my Naturopathic clinic in North York Toronto, the protocol for men and women struggling with fertility is as follows:

  1. Initial Consultation: A discussion of medical history along with physical examination and testing.
  2. Review of test results along with acupuncture protocol as well as dietary and nutritional interventions.
  3. Acupuncture 30min once per week for 3 cycles/months.
  4. Repeat testing.

I have been privileged to be able to help many couples conceive and reach their fertility goals over the past decade. Acupuncture is an effective, virtually painless and side-effect-free tool to help with fertility/infertility. I would always recommend this type of therapy as a treatment option to explore before undergoing more invasive pharmaceutical approaches.

For more information please visit the fertility treatment page Natural Fertility Support Toronto

References

Ng EH, So WS, Gao J, Wong YY, Ho PC. The role of acupuncture in the management of subfertility. Fertil Steril. 2008;90:1–13

Effects of electroacupuncture on nitric oxide and trace elements in patient of male immune infertility. Zhongguo Zhen Jiu. 2004;24:854–6

Dieterle S, Li C, Greb R, Bartzsch F, Hatzmann W, et al. A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. Fertil Steril. 2009;92:1340–3

Effects of acupuncture and traditional Chinese medicinal for oligozoospermia and/or asthenozoospermia in male infertility (Chinese) China Mod Med. 2009;16:115–6

Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl. 1997;39:155–61

Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia. 2000;32:31–9
Zheng X, Yu S, Liu L, et al. The Dose-Related Efficacy of Acupuncture on Endometrial Receptivity in Infertile Women: A Systematic Review and Meta-Analysis. Front Public Health. 2022;10:858587. Published 2022 Apr 28. doi:10.3389/fpubh.2022.858587
Lim CED, Ng RWC, Cheng NCL, Zhang GS, Chen H. Acupuncture for polycystic ovarian syndrome. Cochrane Database Syst Rev. 2019;7(7):CD007689. Published 2019 Jul 2. doi:10.1002/14651858.CD007689.pub4
Li F, Qi Z, Hua L, Wang X, Ling M, Juan D. The efficacy of acupuncture for the treatment and the fertility improvement in child-bearing period female with Hashimoto Disease: A randomized controlled study. Medicine (Baltimore). 2020;99(27):e20909. doi:10.1097/MD.0000000000020909
Djaali W, Abdurrohim K, Helianthi DR. Management of Acupuncture as Adjuvant Therapy for In Vitro Fertilization. Med Acupunct. 2019;31(6):361-365. doi:10.1089/acu.2019.1394

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09/May/2022

The mind body connection

The mind and body are closely connected through thousands of chemical messengers. When we have a mental experience the brain sets off a cascade of neurotransmitters and hormones that affects our body. For instance when we experience joy, our body produces the hormone oxytocin. Oxytocin reduces blood pressure, stress hormone, anxiety and promotes growth and healing. Conversely, when we experience an emotion like sadness this can raise stress hormone, increasing blood pressure and eliciting negative effects on the immune system. Psychotherapy can therefore have a big impact on the health of our body by modifying mental outlook and thus inducing positive chemical messengers to the rest our body. An example is cognitive behavioural therapy, which has well documented success in the treatment of depression, anxiety and stress. https://pubmed.ncbi.nlm.nih.gov/ 31004323/

We can also treat conditions of the mind through our body. In pharmaceutical medicine, drugs like anti-depressants can block the breakdown of the neurotransmitter serotonin. Serotonin is involved in mood and therefore in some individuals boosting serotonin activity can improve mood and decrease anxiety. However, some short falls of pharmaceutical medicine is that it can often cause unwanted side effects and have a narrow therapeutic range; meaning that too little may have no effect and too much can be deadly. There are also issues with dependancy and addiction.

On the other hand nutritional and herbal supplementation can be an effective treatment for depression, stress and anxiety without the same safety concerns as drugs.

Supplementation for depression

Depression is both a physical and emotional condition. We know that depression can impact the reproductive system, immune system and our nervous system. Nutritional deficiencies can arise as a result of long standing depression and can be a precursor in the development of a depressive condition. Deficiencies in vitamin B12, vitamin D and protein are associated with depression. https://pubmed.ncbi.nlm.nih.gov/ 23377209/ In my Toronto clinic we can identify and correct nutritional deficiencies and make a big impact on depressive symptoms.

There is also a lot to be said about the impact of chronic inflammation on brain and mental health. Research has shown that chronic inflammation can increase susceptibility to depression. https:// pubmed.ncbi.nlm.nih.gov/32553197/ At the Toronto clinic we treat inflammation using supplements such as curcumin, omega-3 fatty acids and cannabidiol (CBD). These supplements can improve depressive symptoms through modulation of inflammation.

Furthermore many natural health products like CBD can also impact neurotransmitters (brain messenger chemicals) directly associated with depression. Through the interaction of cannabinoid receptors, 5-HT1A (involved in serotonin regulation) and neurogenesis factors CBD can act similarly to an anti-depressant medication but with less potential for adverse effects. At the Toronto clinic I offer cannabis education and counselling when cannabinoids would benefit a patients condition.

Supplementation for Anxiety

Anxiety disorders are the most common mental illness in the United States effecting close to 20% of the population every year. While genetics play a significant role in the development of an anxiety disorder, biological and environmental factors are pivotal as well. We know that there are often disruptions in serotonin and dopamine, cortisol and adrenaline in anxiety syndromes. A common class of drugs used in the treatment of anxiety are the benzodiazepines (Xanax, Valium, Ativan etc…). Although these medications can be very effective, they often have significant side effects (drowsiness, depression, constipation). Benzodiazepines can also be difficult to stop once started. One of the most significant mechanisms in which anti-anxiety medications work is through the GABA receptor system.

GABA is an inhibitory neurotransmitter, meaning that it helps to calm the nervous system and muscular skeletal system. Benzodiazepines have a very strong effect on GABA receptors making them effective but also potentially dangerous.

Many nutraceutical compounds activate the GABA pathway but with a gentler effect than benzodiazepines. Pharma GABA (GABA produced by bacteria), Passionflower, St. Johns Wort, Taurine, 5-HTP and CBD all have well documented effects on GABA and Serotonin. At the Toronto clinic we use these compounds successfully in the treatment of anxiety syndromes with less potential for adverse effects.https://pubmed.ncbi.nlm.nih.gov/ 11679026/

Supplementation for Stress

Every single human being experiences stress throughout their life. Stress can be a healthy natural process in the right circumstances and at the right time. Stress becomes pathological when it is experienced chronically and without appropriate instigation. Long lasting stress can have detrimental effects on multiple biological systems including the immune system, endocrine system (hormones) and cardiovascular system. https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC5137920/

There are no specific pharmaceutical interventions in the treatment of stress. Benzodiazepines are the most common class of drug prescribed for debilitating stress and as I mentioned in the section on anxiety, benzodiazepines can have significant side effects and issues with dependency.

Since there is a wide spectrum of factors that can cause stress a “one size fits all” approach is not always effective. The naturopathic approach is fundamentally holistic and therefore takes into account mental, emotional and physical stressors. For instance a change in work schedule may be contributing to sleep disruption, leading to insomnia, poor work performance and nutritional disruption.

Furthermore, there is an entire class of nutritional and herbal supplements called adaptogens. Adaptogens have the ability to modulate cortisol (stress hormone) preventing peaks and dips in cortisol levels throughout the day. Overtime treatment with adaptogens facilitate a more balanced cortisol output avoiding periods of hyperactivity and burnout. To my knowledge there are no pharmaceutical drugs that act in a similar way. Some common adaptogens are: Ashwagandha, Rodiola and Siberian Ginseng. Vitamins like Vitamin C and Magnesium can help support adrenal function further helping the body to avoid burnout in periods of prolonged stress. At the Toronto clinic I use these adaptogenic compounds in conjunction with other treatments to provide a safe and effective treatment plan for chronic stress.

The mind can be treated through the body. Pharmaceutical interventions can be effective but often come with safety concerns around adverse effects and dependancy. There are many safe and effective natural approaches to mental health conditions through supplementation. At my Toronto clinic we specialize in developing an individualized plan to help achieve your mental health goals.


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13/Apr/2022

Intro

Let’s take a look at 5 of the most common chronic issues that we experience as a a result of modern living: Stress, Insomnia, Anxiety, Depression and Pain. While there are some pharmaceutical medications that can be effective, most individuals would rather seek a safe and effective alternative approach. Here I will outline these conditions individually and describe some of the most effective treatments that I use at my Toronto naturopathic clinic Physic-Logic.

Stress

Stress is an unavoidable biological response to a threat. The human body developed the stress response in order to escape immediately threatening situations like wild animals and hunting for food. The stress response evolutionarily developed to kick the body into high gear in particular situations and for relatively short intervals. Stress demands a lot from our body in order to perform at a very high level. An increased output of hormones, vitamins and minerals are utilized during the stress response.

The reality is that in modern day living we perceive stress from a variety of situations that are outside of our evolutionary makeup. For example, many if not all of us experience financial stress, workplace stress, relationship stress, medical related stress etc… If we do not have effective coping strategies these stressors, overtime, use up our bodies resources and lead to burnout.

Chronic stress can also be a trigger in the development and resurgence of chronic illnesses like autoimmune disease, allergies, gastrointestinal disease, migraine and skin conditions. At our Toronto Naturopathic Clinic we have several therapies that help to support the body through stress. Adaptogenic herbs like Rhodiola and Ashwagandha help to balance cortisol levels, evening out the highs and lows of a stress response. Magnesium, b-vitamins and vitamin C help to support the adrenal glands which can experience a state of fatigue when under prolonged stress. Acupuncture can help to bring the body into a calming parasympathetic state after prolonged periods in sympathetic fight and flight mode. All these holistic modalities work together to bring a patient out of stress induced fatigue while allowing a better more controlled stress response in the future.

Insomnia

One of the most important foundations for health is good sleep. Most adults require 8-10 hours of sleep for optimal performance whereas in reality 5-7 hours seems to be the norm for most many patients. Not only is sleep duration important but quality uninterrupted sleep is important as well. Our body will have trouble healing and functioning optimally without adequate sleep quantity and quality.

There are 3 types of insomnia that I typically see in my Toronto Naturopathic practice: 1. Sleep initiation insomnia (trouble falling asleep) 2. Sleep maintenance insomnia (trouble staying asleep) and 3. A combination of both initiation and maintenance insomnia. Some of the most common issues causing insomnia are due to anxiety, stress, pain and discomfort. Therefore a successful approach to treating insomnia needs to take into consideration the root causes of the insomnia and the type of insomnia.

Many of the pharmaceutical approaches to insomnia have issues with dependency, addiction and grogginess. The pharmaceutical treatments don’t typically consider the issues causing the insomnia or the type of insomnia either. At my Toronto Naturopathic clinic Physio-Logic I use a combination of time tested approaches to pinpoint the specific areas of sleep that have been disrupted. For instance melatonin can be a very effective treatment for insomnia but many patients don’t realize that there is more than one type of melatonin and that dosage is very important. A fast acting sublingual melatonin may be very helpful to initiate sleep but not effective at maintaining sleep throughout the night; whereas a prolonged release melatonin is often much more effective for sleep maintenance issues. Similarly Cannabis and cannabinoids can be used for insomnia but fast acting inhaled forms are better suited for sleep initiation whereas longer acting oral forms are more useful for sleep maintenance. At our Toronto Naturopathic clinic we take into consideration all the nuances in the diagnosis of insomnia to come up with the most effective and safest course of treatment.

Anxiety

Most of us have experienced anxiety at one point or another and like stress, anxiety in specific circumstances and in relatively short durations is perfectly normal. When anxiety becomes a daily or long lasting biological response we simply cannot function optimally and start placing our body at risk of chronic disease.

Stress and anxiety are closely related with anxiety being more of the mental emotional response and stress being more of the physical response to a perceived threat. A big issue with chronic anxiety is that it becomes a vicious cycle perpetuating itself; the experience of anxiety creates more anxiety and the fear of its return creates more anxiety. The brain, much like muscle has a memory and the more times specific pathways are engaged the harder it becomes to break those physiological habits.

Anti-anxiety medications often fail at producing long lasting results without side effects because they where often designed for treating other conditions; as is the case with anti-depressant medications. A recent breakthrough in anxiety medicine has revealed that our endocannabinoid system has a significant role in the maintenance of balanced mental emotional health. Therefore compounds like cannabidiol (CBD) which act to support the endocannabinoid system have been shown to be effective and safe in the treatment of anxiety with minimal side effects.

Promotion of a healthy lifestyle including daily exercise and a healthy diet can further support the endocannabinoid system and are therefore extremely effective strategies in their own rite. At my Toronto Naturopathic Clinic Physio-Logic we combine several strategies including cannabinoid education to formulate an effective strategy to break the anxiety cycle once and for all.

Depression

Depression is a spectrum ranging from mild symptoms to severe symptoms. While pharmaceutical medication is often necessary for more severe forms of depression, functional medicine can be very effective in treating mild to moderate depression.

Most anti-depressant medications work by keeping higher levels of serotonin in the brain and nervous system. There are many natural compounds that can achieve similar results with a less specific but more holistic mode of action. The net effect is something that is gentler than a pharmaceutical drug but with less potential for dependency and side effects. One example is the flower St. Johns Wort which s backed by several studies confirming its efficacy in treating mild to moderate forms of depression.

Nutrition and exercise are also fundamental in treating all forms of depression and unfortunately as symptoms get worse so do the potential for lassitude and malnourishment. Intervention at the early stages of depression can often allow the patient to utilize holistic therapies effectively and prevent the need for a more aggressive pharmaceutical approach. At my Toronto Naturopathic Clinic, we use functional and holistic medicines from both eastern western medical traditions to treat mild to moderate depression safely and effectively. Some of these treatments include: herbal therapy, acupuncture, intravenous therapy and lifestyle counselling.

Pain

One of the biggest obstacles to cure is pain. Chronic pain interfere with the activities of daily living, disrupting sleep and making exercise impossible. Chronic pain also places physical stress on the body, over time leading to physical burnout and deficiency. Unfortunately many of the most effective pharmaceutical strategies for pain management are linked to addiction and long term side effects. Gastritis (inflammation of the stomach) is a common condition I see in practice linked to long term use of Non steroidal anti-inflammatory medications like Advil and Naproxen. Fortunately there are many safe and effective treatment options within naturopathic and functional medicine.

Pain is often linked to a few common phenomena: lack of circulation, inflammation, tight muscles and neurological injury. Many holistic treatments such as acupuncture, cupping, moxibustion, laser therapy and massage work to improve circulation and loosen tight muscles. Many vitamin, mineral and herbal therapies are excellent for controlling inflammation. Curcumin is a compound derived from the spice turmeric and has years of scientific research demonstrating its strong anti-inflammatory properties without side effects. Using electric current in conjunction with acupuncture can be a safe and very effective treatment for neurological injury. At the my Toronto Naturopathic clinic we utilize many different tools and strategies to provide a safe, effective and individualize treatment for both acute and chronic pain.

Conclusion

Many of the health concerns that we experience in modern society can be safely and effectively treated with a Naturopathic approach. I would encourage anyone experiencing stress, insomnia, anxiety, depression or pain to have a consultation with a Naturopath or other functional medicine doctor. Unfortunately it is all too common for patients to first step into my office after years of trying to manage symptoms using only a pharmaceutical approach. It is never too late to try a more holistic approach. You will be surprised at how effective these treatments can be.


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03/Mar/2022

For the past 6-months I have been supplementing with collagen peptides in my morning coffee. I take relatively few daily supplements; Lions Mane mushroom for my brain, Vitamin D for my immune system and Collagen Peptides for my joints. I became focused on protecting my joints (especially my fingers, toes, knees and shoulders) a few years ago as I started training harder in rock climbing. I began to feel stiffness, soreness and occasionally pain after hard training sessions. I decided I needed to do something soon or I would lose the ability to climb at a relatively young age.

Instead of suppressing inflammation with compounds like curcumin, glucosamine and chondroitin I wondered if it would be possible to actually strengthen my tendons and ligaments. I had been aware of collagen supplementation through a number of patients taking it for hair and skin health. I had largely dismissed collagen as a beauty supplement and it was therefore not on my radar as a potential athletic enhancement.

Just over 6-months ago I had received a newsletter about of tendon health for climbers. The physiotherapist/climbing expert outlined specific exercises for warming up fingers and also mentioned the benefits of collagen supplementation for tendon health. At that moment I decided to re-visit the research on collagen, and I am glad I did!

Collagen peptides are small amino acid chains derived from collagen, which is the primary structural protein in ligaments, tendons, bones and skin. The research behind supplementing with collagen peptides seems to support three key areas.

Skin

A few studies, including randomized placebo controlled trials, have shown an improvement in skin moisture, elasticity and wrinkles with daily supplementation of Collagen Peptides. The daily dose ranged from 4-10 grams daily.

Osteoarthritis

Several studies have demonstrated a modest benefit in pain and function with daily supplementation of Collagen Peptides. Most studies focused on osteoarthritis (OA) in the knees but a couple also mention hip and hand. In general the improvement was modest (a little better than chondroitin) and took approximately 3-5 months to appear. Some studies used collagen peptides in combination with other compounds like chondroitin and hyaluronic acid. Most studies used a 10 gram daily dose.

Performance Enhancement

A great systematic review came out in 2021 that looked at the effects of collagen peptide supplementation on body composition, collagen synthesis and recovery from joint injury.

Five studies demonstrated a positive effect on reducing joint discomfort, knee pain , ankle and knee function and recovery from achilles tendinopathy. Those studies used 40 mg-10 grams per day over a 4-6 month period.

Four studies looked at the effects of collagen supplementation on body composition and muscle strength. The studies combined collagen supplementation (15 grams per day for 3-months) with resistance training.The studies, which were conducted on elderly men, active men and untrained pre-menopausal women, found an increase in fat free mass, a decrease in body fat percentage and an increase in hand grip strength.

Two studies assessed the effect of collagen supplementation on exercise performance and recovery from muscle soreness. The studies included recreationally active men, one used 3 grams per day for 6 weeks and the other used 20 grams per day for 7 days prior to intense exercise. There was a strong positive effect on pain with movement and muscle soreness.

Two studies assessed the effects of Collagen peptide supplementation on collagen synthesis. When taken 60min prior to exercise there was a significant increase in collagen synthesis markers following ingestion of 15 grams collagen enriched with vitamin C.

Conclusions

When it comes to preserving joint, ligament and tendon health for myself and my patients, collagen peptide supplementation is now a staple. The evidence in favour of collagen, along with a strong safety profile makes collagen peptides a valuable nutritional supplement in both sports medicine and anti-aging medicine. The recommended dose seems to be between 10-20 grams per day for 3-6 months.

References

Inoue N, Sugihara F, Wang X. Ingestion of bioactive collagen hydrolysates enhance facial skin moisture and elasticity and reduce facial ageing signs in a randomised double-blind placebo-controlled clinical study. J Sci Food Agric. 2016;96(12):4077-81.

Czajka A, Kania EM, Genovese L, et al. Daily oral supplementation with collagen peptides combined with vitamins and other bioactive compounds improves skin elasticity and has a beneficial effect on joint and general wellbeing. Nutr Res 2018;57:97-108.

Asserin J, Lati E, Shioya T, Prawitt J. The effect of oral collagen peptide supplementation on skin moisture and the dermal collagen network: evidence from an ex vivo model and randomized, placebo-controlled clinical trials. J Cosmet Dermatol. 2015;14(4):291-301

Sangsuwan W, Asawanonda P. Four-weeks daily intake of oral collagen hydrolysate results in improved skin elasticity, especially in sun-exposed areas: a randomized, double-blind, placebo-controlled trial. J Dermatolog Treat. 2020:1-6.

Benito-Ruiz P, Camacho-Zambrano MM, Carrillo-Arcentales JN, et al. A randomized controlled trial on the efficacy and safety of a food ingredient, collagen hydrolysate, for improving joint comfort. Int J Food Sci Nutr. 2009;60 Suppl 2:99-113.

Kumar S, Sugihara F, Suzuki K, Inoue N, Venkateswarathirukumara S. A double-blind, placebo-controlled, randomised, clinical study on the effectiveness of collagen peptide on osteoarthritis. J Sci Food Agric. 2015;95(4):702-7.

Trc T, Bohmová J. Efficacy and tolerance of enzymatic hydrolysed collagen (EHC) vs. glucosamine sulphate (GS) in the treatment of knee osteoarthritis (KOA). Int Orthop. 2011;35(3):341-8

Moskowitz RW. Role of collagen hydrolysate in bone and joint disease.Semin Arthritis Rheum 2000;30:87-99

Kalman DS, Schwartz HI, Pachon J, Sheldon E, Almada AL. A randomized double blind clinical pilot trial evaluating the safety and efficacy of hydrolyzed collagen type II in adults with osteoarthritis. FASEB Experimental Biology 2004 Abstracts, Washington DC, April 17-21, 2004; A90.

Amino Acids. 2021; 53(10): 1493–1506.Published online 2021 Sep 7. doi: 10.1007/s00726-021-03072-xPMCID: PMC8521576PMID: 34491424The effects of collagen peptide supplementation on body composition, collagen synthesis, and recovery from joint injury and exercise: a systematic review Mishti Khatri,1 Robert J. Naughton,1 Tom Clifford,2 Liam D. Harper, 1 and Liam Corr1


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01/Feb/2022

Intro

Our world is facing an epidemic of Long COVID over the next decade. Assuming at least 10% of COVID-19 survivors develop long COVID, which is likely underestimated, it is estimated that 5 million people are facing long COVID globally. Long COVID affects multiple systems in the body and therefore requires a multidisciplinary approach. It is a shared opinion amongst several specialists that a functional medicine approach will be needed to rehab these patients back to health. While we are still in the beginning stages of understanding this chronic disease, there are some emerging ideas on how to treat Long COVID as well as some nutritional supplements that may offer a complete or partial solution.

Defining Long Covid

The now accepted technical name for Long Covid is Post Acute Sequelae of CO-V-2 (PASC). While a widely accepted definition is lacking, there seems to be some consensus on the approximate timing of symptoms and the type of symptoms common to a diagnosis of PASC. Onset is typically anywhere from 2-8 weeks after a confirmed or suspected COVID-19 infection and may persist up to 6-months or more. Common symptoms include: fatigue, dyspnoea (shortness of breath), cognitive dysfunction, headache, myalgia, chest pain, joint pain, smell and taste dysfunction, cough, hair loss, insomnia, wheezing, rhinorrhea, autonomic dysfunction (POTS), cardiac and gastrointestinal issues.

Risk Factors

Some of the clearly defined risk factors for developing long COVID include: More than 5 initial symptoms, initial disease severity, female sex, pre-existing comorbidity, prior psychiatric disorder, and old age. There are also certain biomarkers in blood samples that appear to have a correlation with Long COVID including: Increased levels of D-dimer, CRP, IL6, procalcitonin, troponin-1, BUN, neutrophils and decreased levels of lymphocytes.

Pathophysiology

Although the exact mechanisms behind what causes PASC in not completely understood recent research has pointed towards a few mechanisms. For some Long Covid sufferers there seems to be evidence of long term tissue damage in the cardiovascular, pulmonary and neurological systems. There is also prevalence of unresolved inflammation, viral persistence, gut dysbiosis and autoimmunity.

Treatments

The obvious question that everyone would like know is if there are treatment interventions to both prevent and alleviate the symptoms of PASC. The most conventionally accepted treatments thus far are: Personalized rehabilitation programs (light aerobic and breathing exercises), analgesics, antidepressants, ivabradine (for POTS like symptoms) and antihistamines. It is also accepted that treatment to regulate immune and mitochondrial function would be useful. This is perhaps where naturopathic and functional medicine can make an enormous impact.

There is emerging research looking into nutraceutical compounds to help prevent and treat PASC, here is an overview:

Mitochondrial Support: The mitochondria is an energy producing organelle within every cell of our body. In high school science we are taught that the mitochondria is the “power plant of the cell”. Disruptions in mitochondrial function can lead to fatigue, muscle pain, headache and immune dysfunction. COVID-19 infections seems to disrupt mitochondrial function through mechanisms still being investigated but include oxidative stress and alterations in genetic mutation.

Co-factor nutrients that help support mitochondrial function are being investigated for use in treating COVID-19 infection and PASC. These nutrients include: L-Carnitine, Alpha lipoic acid and Coenzyme Q10. A CoQ10 deficiency has been reported in COVID-19 patients and therefore supplementation with this particular compound is of great interest amongst researchers.

Inflammation: Inflammation seems to be driving a lot of the symptomatology in PASC. Inflammatory compounds have been identified in multiple organ systems including the brain, lungs, pancreas and heart. As such one natural anti-inflammatory compound has been identified as being a possible adjuvant therapy in both COVID-19 infection and PASC.

Curcumin is a compound derived from Turmeric and has anti-inflammatory, anti-viral, anticoagulant, anti-platelet and cytoprotective properties. There has been some evidence to suggest that 1000mg of a turmeric supplement restored smell and taste in individuals who lost these senses following COVID-19 infection. Furthermore in vitro studies have demonstrated that curcumin can inhibit coronavirus from entering the cell, and can disrupt some of the signing processes of the virus.

Immune System: Many of the complications of COVID-19 can be attributed to a dysfunctional response of the immune system, either over-reactive or under-reactive. Many compounds that have a direct and indirect role in proper immune system activity are showing promise in treating COVID-19 infection and PASC.

Vitamin D acts as an immune activity regulator, helping to both increase and decrease immune activity as is appropriate to the situation. Some studies have demonstrated that vitamin D supplementation after COVID-19 infection is associated with less ICU admissions and decrease mortality. Another study demonstrated that a combination of vitamin D, selenium and zinc was able to mitigate the course of respiratory complications with COVID-19 infection. It is likely that co-factors and nutrients which help support normal immune activity can shorten the duration of PASC and alleviate symptoms.

Gastrointestinal: Symptoms affecting the gastrointestinal tract are both common in COVID-19 infection and PASC. There is evidence that COVID-19 and its associated spike protein can persist in the gastrointestinal tract for months after confirmed infection.

Autoimmune type syndromes are commonly seen with PASC. One hypothesis for this outcome is a type of molecular mimicry between spike protein and healthy tissue. Spike protein can enter through a compromised digestive tract into the blood stream. Once in the blood stream the immune system can create auto-antibodies in response.

Maintaining a healthy gut/body barrier is emerging as a possible area of treatment in COVID-19 infection and PASC. A healthy environment of commensal bacteria strengthens the gut/body barrier as well as driving the production of healing compounds such as butyrate.

Butyrate is a short chain fatty acid that is produced by beneficial bacteria in our gastrointestinal tract. Butyrate can cross the blood brain barrier and influence regeneration of damaged nerve cells. Probiotic strains belonging to the Lactobacillus and Bifidobactrium categories are

essential for Butyrate production. While probiotic supplementation can assist in developing a healthy gut environment most of the benefit comes from eating foods which help these probiotics thrive. A diet rich in fibre and polyphenols is therefore essential in influencing the growth of beneficial butyrate producing probiotics. Fruit, veggies, and polyphenols like curcumin, luteolin and resveratrol are likely an important part of what will be a holistic approach to treating PASC.

Conclusions: The COVID-19 virus has turned out to be a multifaceted disrupter of homeostasis in a large percentage of those who have been infected. A functional medicine approach to treatment is likely going to have the most profound impact in addressing PASC. We are already starting to see some natural compounds (L-Carnitine, Alpha Lipoic Acid, Coenzyme Q10, Curcumin, Vitamin D, Selenium Zinc and probiotics) having an impact of this ill defined syndrome. More properly funded research in the area of nutraceuticals and functional medicine for treatment of PASC is much needed. In the meantime Naturopathic Doctors and Functional Medicine Physicians have many tools to start treating PASC with safe and effective protocols.

References

Rattis BAC, Ramos SG, Celes MRN. Curcumin as a Potential Treatment for COVID-19. Front Pharmacol. 2021 May 7;12:675287. doi: 10.3389/fphar.2021.675287. PMID: 34025433; PMCID: PMC8138567.

Zahedipour F, Hosseini SA, Sathyapalan T, Majeed M, Jamialahmadi T, Al-Rasadi K, Banach M, Sahebkar A. Potential effects of curcumin in the treatment of COVID-19 infection. Phytother Res. 2020 Nov;34(11):2911-2920. doi: 10.1002/ptr.6738. Epub 2020 Jun 23. PMID: 32430996; PMCID: PMC7276879.

Chabot AB, Huntwork MP. Turmeric as a Possible Treatment for COVID-19-Induced Anosmia and Ageusia. Cureus. 2021 Sep 8;13(9):e17829. doi: 10.7759/cureus.17829. PMID: 34660038; PMCID: PMC8502749.

Alexander J, Tinkov A, Strand TA, Alehagen U, Skalny A, Aaseth J. Early Nutritional Interventions with Zinc, Selenium and Vitamin D for Raising Anti-Viral Resistance Against Progressive COVID-19. Nutrients. 2020 Aug 7;12(8):2358. doi: 10.3390/nu12082358. PMID: 32784601; PMCID: PMC7468884.

Pal R, Banerjee M, Bhadada SK, Shetty AJ, Singh B, Vyas A. Vitamin D supplementation and clinical outcomes in COVID-19: a systematic review and meta-analysis. J Endocrinol Invest. 2022 Jan;45(1):53-68. doi: 10.1007/s40618-021-01614-4. Epub 2021 Jun 24. PMID: 34165766; PMCID: PMC8223190.

Ouyang L, Gong J. Mitochondrial-targeted ubiquinone: A potential treatment for COVID-19. Med Hypotheses. 2020 Nov;144:110161. doi: 10.1016/j.mehy.2020.110161. Epub 2020 Aug 5. PMID: 32795832; PMCID: PMC7403158.

Theoharides TC, Cholevas C, Polyzoidis K, Politis A. Long-COVID syndrome-associated brain fog and chemofog: Luteolin to the rescue. Biofactors. 2021 Mar;47(2):232-241. doi: 10.1002/biof.1726. Epub 2021 Apr 12. PMID: 33847020; PMCID: PMC8250989.

Crook H, Raza S, Nowell J, Young M, Edison P. Long covid-mechanisms, risk factors, and management. BMJ. 2021 Jul 26;374:n1648. doi: 10.1136/bmj.n1648. Erratum in: BMJ. 2021 Aug 3;374:n1944. PMID: 34312178.

Mercola J, Grant WB, Wagner CL. Evidence Regarding Vitamin D and Risk of COVID-19 and Its Severity. Nutrients. 2020 Oct 31;12(11):3361. doi: 10.3390/nu12113361. PMID: 33142828; PMCID: PMC7692080.

Yong SJ. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (Lond). 2021 Oct;53(10):737-754. doi: 10.1080/23744235.2021.1924397. Epub 2021 May 22. PMID: 34024217; PMCID: PMC8146298.


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18/Jan/2022

I didn’t quite get the Christmas present I hoped for this year. On the night of December 19th 2021 my wife started to exhibit the symptoms of a flu; fever, body ache, sore throat and congestion. The next morning, with a reserved anxiety behind a lackadaisical demeanour, I administered a COVID-19 rapid antigen test like I had done for her a dozen times before. However, this time was a bit different. Instead of the red dye settling on the negative C line, two lines appeared…positive! Uh oh, is what I anxiously muttered from the other room. Thats when the gears of my brain went into overdrive, trying to figure out the intricacies of the Ontario isolation policy back in December 2021. After confirming her status with a PCR test, my wife was to be quarantined to our bedroom and I would be taking care of her and the kids in isolation from the rest of the world for 10 days.

As the fast spreading Omicron variant swept through the house, hitting me second and my daughter third, 10 days quickly turned into a full 2-weeks of isolation. Having received a booster vaccine a week earlier, my symptoms were mild and I knew that my body was busy preparing antibodies that would help me fight off the virus rather quietly. It became my mission to do my best to help my wife (who had not yet received a booster) and daughter (3 years old and therefore not vaccinated) get through the infection swiftly, and to do my best to prevent my son (aged 7 with a single dose of vaccine) from contracting it.

Although a COVID-19 infection was something I hadn’t treated the before, the symptoms painted a picture of something I had treated hundreds of times. Fever, congestion, sore throat and body aches are all hallmarks of an activated immune system fighting off an infection, no matter what that infection may be. The most effective tool in destroying a viral infection is our immune system. It’s our job to support the immune system in its fight against the virus. Aside from getting good quality sleep and keeping hydrated, these are my recommended supplements to help support the immune response:

Probiotics – Studies have shown that probiotics affect immune cells throughout the body. When certain strains of probiotics are introduced into our intestine they help to repair intestinal cells and they boost production of antimicrobial substances. One of the most effective and well studied strain for immune support is Lactobacillus Rhamnosus GG.

Vitamin C – Vitamin C is very important for optimal immune system functioning. Vitamin C helps immune cells get to where they need to be, kill pathogens effectively, protect the body from damage and clean up after battling infections. Studies have shown that adequate vitamin C in the blood helps prevent infections, is necessary to fight infections and helps with recovery. The recommended daily intake of vitamin C is 100-200mg/day; however during active infection, the metabolic demand increases and therefore the requirement for vitamin C is likely to be higher. Even in this day and age, vitamin C is the fourth leading nutrient deficiency in North America. Poor diet and increases in free radical exposure due to an unhealthy lifestyle may be contributing factors. Excellent sources of vitamin C are Broccoli, Citrus Fruits and Berries.

Zinc – The importance of zinc for proper immune function has been well established. Zinc deficiency undoubtedly causes immune system malfunction.  The cells of our body are in constant communication. During infection there is a need for effective communication between immune cells in order to get rid of the “bad guys”.  Communication happens in the form of chemical messengers and enzymes. Zinc is an essential component of these chemicals and enzymes. As with vitamin C, during active infection our requirement for zinc is likely to increase. Studies have shown that Zinc supplementation during infection can shorten the duration of the illness. Excellent dietary sources of zinc include: Meat, Shellfish, Legumes, Nuts and Seeds. Supplementation may be important with a vegan or vegetarian diet.

Vitamin D –Vitamin D has many functions in the body, and receptors for vitamin D can be found on many different tissues. One important function for vitamin D is in the modulation of our immune system. Studies have suggested that vitamin D is able to both calm down and rev-up the immune system according to what our body needs it to do. This is why Vitamin D is thought to be as important in autoimmune disorders as it is in infections.

Vitamin D deficiency can cause the immune system to behave erratically. Unfortunately in Canada we have one of the highest incidences of vitamin D deficiency in the world. Our primary source of vitamin D is from sunlight and therefore supplementation becomes important especially during the winter months. Studies have shown that there is a higher incidence of upper respiratory tract infections in athletes who are deficient in the vitamin and who train in the wintertime. Supplementation had preventative and symptom reducing effects. Aside from sunlight, some dietary sources of vitamin D are: fortified foods, fatty fish, beef liver, egg yolks and cheese.

Elderberry – Not only does elderberry syrup taste great, studies have shown that it inhibits the bacteria and viruses associated with common colds and the flu. One study demonstrated that an elderberry liquid extract possesses antimicrobial activity against both streptococci bacteria and influenza viruses. Another study looked at 312 air travellers flying from Australia to an overseas destination.  Those travellers who took an elderberry extract before, during and after travel had fewer colds, less sick days and less symptoms.

Although supplements can offer a much needed support, sleep, hydration and diet are fundamental for a healthy immune response. Using a humidifier at home will also help keep the respiratory membranes moist supporting mucus production (our natural defence mechanism). As for diet, when I’m sick I like to incorporate intermittent fasting into my “get well” regime. Intermittent fasting (IF) is the practice of splitting the day into an eating time (usually 8-10 hours) and a fasting period (14-16 hours). There are many health benefits associated with IF including regeneration of immune cells and modulation of the intestinal microbial environment. If intermittent fasting is not your thing, stick to a healthy balanced diet, like a mediterranean style diet.

I am happy to say that my daughter, my wife and I have fully recovered. My son never contracted the infection, despite being in isolation with three active cases for 2-weeks! Everyone responds to COVID-19 infection differently and so I hope that these tools may help guide some of you through your recovery too.


dr_shawn

Patient focused integrative health care. Utilizing effective natural approaches designed to be used alone or to compliment conventional medical care.


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