Drs. Rollow and Cooper and PAs Tammy Jett-Parmer and Maria Shesiuk talk with nutritionist
Mollie Nelson about why achieving and sustaining weight loss can be challenging, strategies for
addressing the challenge, and how working with Mollie can complement work with your
physician.
on COVID-19 diagnosis and prevention/severity reduction. This update
provides information relating to current topics of concern.
Testing
Most people are now familiar with the three types of COVID testing. Rapid
and PCR testing based on nasal swabs are used to test for current infection.
Antibody testing is used to assess for prior infection. Patients often ask if
antibody testing can be used to determine if they are immune from
infection, and whether a vaccine or booster would be appropriate.
Unfortunately, current testing methods do not enable a determination of
immunity to be made. As a consequence, antibody testing is generally not
of value at this time.
Preventing and Reducing Disease Severity
The currently accepted methods for preventing COVID-19 are immunization,
wearing a mask, and social distancing. Most patients are knowledgeable
and do not have questions regarding the latter two methods.
We are often asked for our advice on whether to vaccinate. In our view, this
is an individual decision based on assessment of benefits and risks. For
most adult patients, benefits of immunizing are reduction in likelihood of
severe illness, hospitalization, death, and post-illness complications. Risks
are generally low and related to adverse effects that are self-limited; we
assess them on an individual basis based on prior and current history.
Alongside of this, it may be helpful to take steps to minimize biological risk
and the severity of infection. Maintaining or achieving a healthy body
weight and optimizing blood sugar, nutrition, and physical fitness are the
cornerstone of this approach. Additionally, it is known that COVID-19
involves an initial period of a few days of generally low symptoms, which in
some individuals then gives rise to an immune response that has the
potential for life-threatening illness and post-illness long-term
complications (fatigue, cognitive and mood issues, respiratory or
cardiovascular deficits). In other words, like some other infections such as
Lyme (which we see a lot of in our practice) the “host response” (individual
biological health) is important in determining the course of the illness.
Although evidence is evolving regarding interventions that may have the
potential for ameliorating COVID-19 severity, among integrative and other
practices an approach that includes the following has been used:
Increasingly, monoclonal antibody treatments have also become available
in Maryland. Should you develop symptoms, we recommend that you
consider the information in this post and communicate with your IHP
physician or PA on your specific situation.
Bone is a dynamic structure, constantly being remodeled by cells that remove it (osteoclasts) and renew it (osteoblasts). Once adulthood is reached, these two processes should stay in relative balance, but as hormonal status changes over time, the removal process predominates. For some people, hormonal-mediated bone removal may be predated or augmented by other conditions.
Predominance of bone removal results in low bone density (sometimes referred to as osteopenia). When bone density declines, the structure of bone is altered and it loses some of its strength and flexibility. Severe bone loss is referred to as osteoporosis; osteoporotic bone has thinner outer cortex and trabecular supporting structure.
Low bone density and osteoporosis are associated with increased risk of fracture. Other factors, however, are also important in predicting fracture risk: age, smoking status, body size, alcohol use, etc. The FORE Fracture Risk Calculator (https://americanbonehealth.org/bone-health/introducing-the-fore-fracture-risk-calculator/) can be used to calculate fracture risk. Importantly, the radiographic assessment of bone density by DXA scanning, which is the most widely used method of predicting fracture risk, does not take into account all of the factors that are relevant to this prediction. The quality of bone (how it is structured and what its mineral composition is), as well as its density, is also important. Bone quality is not generally assessable through non-invasive testing.
It is common for patients to undergo DXA scanning, be told that their bone density is low, or that it is declining rapidly based on serial scans, and that as a result prescription medications are recommended to reverse the process of bone loss. Although for some patients this may be appropriate – particularly when the risk of fracture is very high – for others it may not be for several reasons:
When a DXA scan shows low bone density, it is appropriate to do lab testing to assess for conditions that are associated with bone loss (imbalance between removal and renewal). Testing includes the general assessment that we use for most patients in integrative care (for hormonal status, nutrients, gut health/celiac status, and inflammation), as well as assessment of factors that are more specific to bone, including PTH, serum calcium, Vitamin D levels, 24 hour urine calcium, C Telopeptide (CTX) and osteocalcinin. The latter three factors assess balance between bone removal and renewal, and are used in initial assessment of causes of low bone density and to monitor impact of treatment over the short run, with biannual DXA scanning and fracture risk prediction over the long run.
There are multiple causes of low bone density from imbalance between resorption and formation of bone:
The approach to treatment is as follows:
Helpful resources are:
Nutrients given by intravenous infusion have been used by many alternative and integrative medicine practitioners for decades. The rationale for their use is that the blood levels of such nutrients when given orally is limited by the ability of the gut to absorb them, whereas with IV nutrients blood levels can be substantially increased. This has been confirmed by clinical studies.
In considering use of IV nutrients, two questions must be asked: are they effective in achieving their intended therapeutic purpose, and are they safe. Ideally, the answers to these questions would be based on clinical research, but unfortunately the amount of such research is limited.
Four types of IV nutrients are in common use: Vitamin C infusions, glutathione infusions, multinutrient (Meyers’) infusions, and phosphatidylcholine infusions.
Vitamin C infusions are the best studied. Vitamin C has many effects: it is an antioxidant that protects against damage caused by free radicals, boosts the immune system’s effect on wound healing and infections, and is toxic to some types of cancer cells. There is some evidence that such infusions are beneficial in cancer patients in improving quality of life, and possibly that there are effects on tumors that reduce size and increase time to relapse. It may also have benefit in patients with infection, shingles, and with chronic fatigue. Used in patients without contraindicated medical conditions, IV Vitamin C is safe.
Like Vitamin C, glutathione is an antioxidant. Most literature on its use is not based on clinical research, but instead based on case reports. It may be effective in increasing the effectiveness of manual therapies in patients with musculoskeletal conditions, in reducing symptoms of parkinsonism, and in improving symptoms associated with autoimmune or other inflammatory response. It appears to be safe.
Multinutrient infusions were popularized decades ago under the name Myers infusions, based on the work of a Baltimore physician named John Myers, and a modified version of this infusion has been used with thousands of patients across the country. The infusion includes Vitamins C, B complex, B12, B5, B6, calcium, and magnesium. It has been shown to have some benefit for patients with fibromyalgia, and based on case reports may result in improvement in fatigue, pain, and depression in patients with such issues. Multinutrient infusions are safe.
Phospholipids are a key component of the membranes that surround all of our cells. When such membranes are disrupted by toxicity or injury, particularly in nerve cells, illness results. IV phospholipids are widely used in Europe, and based on experience, may be of benefit to patients with brain injury and inflammatory/degenerative conditions. They are safe.