Woman's Wellspring

Notice to Patients Regarding the Open Payments Database.

Stephanie Taylor — Thu, 15 Dec 2022 01:21:09 +0000

The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.”

For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.

Mini-Medical School #2 April 2020-Home Remedies

Stephanie Taylor — Sun, 19 Apr 2020 21:11:30 +0000

Mini-Medical School #2 2020

by Stephanie Taylor MD PhD and Brian Ellinoy PharmD

Our recent Mini-Medical School on Home Remedies was our first as an online meeting. It is available here as an audio file. Dr. Taylor discussed natural approaches to enhance immunity, and Brian Ellinoy, PharmD gave an excellent talk on cannabis. Click on the link below to hear the 40 minute podcast:

https://soundcloud.com/user-653121912/skype-podcast-mini-medical-school-april-2020/s-8utb3Noq296

Please excuse any technical limitations in the recording. I am sure we will improve with more experience!

What to Do When Sheltering at Home

This is not meant to be an all-inclusive list, and highly reflects my biases, but here are some ideas for activities. (Of course, I am not endorsing any of the listed services, they are examples. Always exercise appropriate caution)

Make or Do Something:

Make a face mask– The New York Times created printable instructions for making a mask https://int.nyt.com/data/documenthelper/6860-printable-face-mask-tutorial/ded6e67bb78f2599a7ff/optimized/full.pdf#page=1

Knit, crochet-our local supplier, Monarch Knitting in Pacific Grove has instituted an online service in addition to a video consultation, in case you are not sure what you would like to create: https://www.monarchknitting.com/

Make Music:

Dust off that instrument in the closet and try some on-line lessons. The performing community is taking a serious economic hit but is resourcefully using the internet to connect. Google around to find on-line lessons and concerts.

Clean Something

This is a great time to Marie Kondo a closet. Here is her website” https://konmari.com/
and she also has a Netflix series.

Learn something

Since Tai Chi practice improves many health measures, including immunity, you can take on-line classes at https://taichiforhealthinstitute.org/

The Great Courses have a few courses for free and several that are heavily discounted. They can be reached at: https://www.thegreatcourses.com/. They also sell classes on Audible.

Learn a foreign language. Duolingo is a very well designed, fun program that teaches 32 languages for English speakers and has over 300 million users. It has a free and paid premium version. They have been instrumental in the revival of endangered languages. Check out the Duolingo bird at: https://www.duolingo.com/

Snooping with Genealogy research

If you never had time before, now you do. This may be the ideal time to reminisce with relatives and find out exactly what heroic things our ancestors did that only the older members of our family can remember. Our local community is placing more information on-line. Here is a link to their WordPress announcement:
https://mocogenso.wordpress.com/category/meetings/

Keep up with your routine

Folks who keep regular habits tend to have better health. Keeping in touch with your support system is essential, which is why Governor Newsom has made every effort to make telehealth visits with your physician more available. We have two platforms available, Klara and doxy.me (“doc see me”). Call the office and leave a message to make an appointment.

What did we learn?

The Mini-Medical School of 2019 on Stress Management was very well attended with a very engaged group of people. We learned that we need to acquire the skill of resilience in the face of uncertainty and danger.

References on Resilience were shared in the Stress Management Mini-Med, and are posted on the website: https://womanswellspring.com/2019/06/mini-med-3-2019/

We also learned that we need to support our local food suppliers and keep manufacturing capacity local. Check the regulations of the largest farmers market at:
https://www.montereybayfarmers.org/

This spring is unusually beautiful and reminds us of the grace and power of the natural world. The National Trust for Scotland posted cameos of the flowers blooming in the Trust properties. You can take a virtual walk in their gardens at:
https://www.nts.org.uk/campaigns/the-colours-of-our-gardens

When I was growing up, we were constantly reminded to “learn to do for yourself”. This is a bit of folksy wisdom that would be laughable, except that possessing the skills to take care of yourself, your loved ones and your community makes you feel capable and free of anxiety. Note that I did not say you would not be afraid, tired and worried. Those are appropriate responses to wildfire and pandemic. You simply must gather your talents and deal with it.

The pandemic also reveals weaknesses in our current systems, that we should thoughtfully address when we have the resources. We don’t need to be taught this lesson more than once. Stay home, stay safe and make the most of the moment.

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Mini-Medical School 2020 April Skype Instructions

Stephanie Taylor — Sat, 28 Mar 2020 23:21:33 +0000

Skype Instructions 2020

Before you can attend our conference, I need to add you to our group list (Mini-Medical School 2020). Email me your Skype handle well before the event. You can find your Skype name by hovering over the three dots on the upper left side of the Skype screen. A drop-down menu will appear. Click on “Settings”. Your “Account & Profile” will have your Skype name. When you send me your handle, I can send you an invitation to join.

Improved and simplified instructions for Skype access to Mini-Medical School April 4

We intend to start at 1:30 PM, Saturday, April 4^th.

Here are improved Step-by-Step Instructions for logging in.

#1- Log onto your Skype account 5 minutes before class.

#2- I will call you to join the class.

#3- When I call, pick up the handset, not the video camera.

#4- I may need to call everyone individually, so it may take a few minutes.

#5- After you enter “Mini-Medical School”, mute your microphone.

#6- After the presentation, you will be able to un-mute your mike to ask a question.

You can also ask a question by using the text box.

If you are late to class, you can join by doing the following:

Search for the group by typing stephanietaylormd@gmail.com in the search box.

You will see a green button that says “Join Call” in the left side panel.

Click on the button to join the call.

Don’t forget to mute your microphone.

I think you will like Skype. I know many of you are more used to Zoom, and we may eventually need to use Zoom.

We look forward to your participation. Get your questions ready!

Mini-Med #1 2020- Maintaining Cognitive Reserve, Part 2

Stephanie Taylor — Sun, 02 Feb 2020 14:57:57 +0000

Mini-Med #1 2020-Maintaining Cognitive Reserve, Part Two

Maintaining Cognitive Reserve-Part 2
Enhanced Blue Zones
Stephanie Taylor MD PhD
www.womanswellspring.com
Reference: The Blue Zones: 9 lessons for living longer by Dale Buttener.

There have been several stories in the local newspapers about the Blue Zone initiative for Monterey County. This is an excellent first step to better health for all of us. The inspiration and data cited here is taken from The Blue Zones: 9 lessons for living longer published in 2008 through the support of National Geographic. The author visited several communities world-wide noteworthy for very long lived and vital individuals. We will review some of the findings from that book and add updates appropriate for the 21^st-century and our local community.

Findings:

The inhabitants of the blue zone were ordinary people having ordinary lives.

The author estimated that if they followed the United States lifestyle, they would have lost 10 years of good health.

Somehow, they managed to avoid the chronic diseases that afflict Western nations, specifically heart disease, cancer, stroke and diabetes.

These individuals were adults in 1950. How is life different or better at that time?

A common theme expressed in many different languages was the central importance of a sense of life purpose. This was expressed by the elders as “a reason for waking up in the morning”.

There were no institutionalized homes for elders. The family care for the older individuals out of filial duty, affection and community expectations. One individual pointed out that he would lose face with his community if he sent his grandmother away.

Although they are not vegetarians, they have a vegetable-based diet of homegrown and local foods.

They maintain daily activity. They don’t have specific workouts because they are naturally physically active with daily chores.

They have a degree of serenity and handle stress without difficulty.

They have lifelong friends that are maintained through ritualized companionship. This is often done through cultural, social, religious or special interest groups.

They set aside a fixed time weekly for rest, social interaction, reflection and good food.

The Power Nine

The author distilled his research into the Power 9 which consistently appeared to enhance longevity in all cultures studied. Here is his list:

1 – Move naturally. Engage in regular low intensity exercise. Many of the blue zoners were shepherd, gardeners or went on regular nature walks. As falls are a common risk for older individuals, balance training was recommended in addition to the strength from general exercise. This could be yoga, tai chi or simply alternating standing on one foot while you’re brushing your teeth. It’s helpful to develop a walking group through the Sierra Club, Volksmarching or local interest groups.

2 – Stop eating when you feel 80% full. This results in an automatic calorie restriction. Decrease portion size, cup size and plate size. Research shows that with a smaller portion, smaller plate or smaller cup individuals consume 30% less calories without being aware of it. Eat more low caloric density foods. For example, a hamburger, French fries and a Coke has 1500 calories whereas the average meal of the long-lived is 400 cal. They also eat early, and the largest meal is either the first or second meal of the day.

3 – Eat more plants. Avoid processed meat and packaged foods. Emphasize beans, whole grains and garden vegetables. Individuals who eat nuts regularly have a dramatic decrease in heart disease, probably from the essential fatty acids. Recommendation is 1.5 oz of nuts and 4-6 vegetables per day or two vegetables per meal.

4 – Grapes. The long-lived consumed one serving of beer, wine or spirits daily consistently and in moderation and almost always with friends in a social situation.

5 – Sense of purpose. Why to wake up in the morning? Figure out what is personally meaningful for you and find a partner in your activity. This is the section where learning a complex new skill is recommended. Learn to play a musical instrument or learn a new foreign language. This engages more senses than the puzzles and generates a social connection as well.

6 – Downshift. Take a moment to enjoy the day. Meditation also serves this purpose. Eliminate or limit electronic noise. This decreases stress and inflammation which in turn accelerates aging.

7 – Belong – participate in the like-minded community. This could be a faith community or a shared goals community.

8 – Loved ones come first. Maintain closeness in the family. Many of the long-lived have an ancestor shrine or spend time in the company of ancestors and they pass this on to the younger generations. Quote: “We are not islands in time but are connected”

9 – Surround yourself with people who share Blue Zone values. Maintain social connectedness. Find friends who support but also challenge you and check in daily. Don’t be a grump.

References for Mini-Med 2020-1
Stephanie Taylor MD PhD

Real Organic Project

Why the Real Organic Project exists:
The Real Organic Project is a farmer-led movement created to distinguish soil-grown and pasture-raised products under USDA organic. In response to the lack of enforcement of some vital USDA Organic standards to protect soil health and animal welfare, organic farmers rallied together to fight to protect the integrity of the organic label.
Organic farming has always been based on “feed the soil, not the plant.” Real organic farming relies on the microbial activity of the soil to slowly release nutrients to the plant. In recent years, many organic farmers have grown distraught over USDA decisions that have negated this fundamental truth, even though growing in soil is original to the USDA Organic standards. Further, rules have been overlooked regarding the proper care of grazing animals resulting in cruel and unhealthy circumstances.

Where things stand today:
The lobbying efforts of Big Ag ultimately won, allowing the input-dependent confined animal operations and hydroponic industries to bend the rules for their own benefit. Family farmers meeting the letter and spirit of organic law are suffering while consumers are once again in need of transparency in the marketplace.

https://www.realorganicproject.org/

The organic marketplace was a $52.5 Billion in 2019. In contrast, the US profit from illegal drug trade is $100 Billion. As the EU tightened standards, the US became a dumping ground for fake organic grain. Approximately 70% of imported organic soy and 30% of imported organic corn is falsely certified as organic. Turkey and the UAE are primary shippers. Low cost fake grains cause the legitimate farmers to lose market to lower cost frauds, and consumers unwillingly consume non-organic grain products, eggs, meat and dairy. There are more imports from Turkey than it has in certified organic acreage.

This is not a victimless crime, but it is an enforcement free crime. Penalty for organic smuggling is $18,000 and no significant risk of jail time.

What to do: Use the Cornucopia scorecard to track changes in the ratings of organic food producers. https://www.cornucopia.org/

Buy locally from farmers that you know: https://www.montereybayfarmers.org/

Social determinants of Health

The Food is Medicine Coalition http://www.fimcoalition.org/
20% due to medical intervention, 40% SES, 10% environment, 30% health behaviors.
Therefore: Patients receiving Medically Tailored Meals are 23% more likely to be discharged home than to an institution; deliver a 28% savings in monthly healthcare costs for patients with life threatening illness and 50% fewer hospital admissions.

Food Insecurity

What is the relationship of food insecurity to health- after all calories are calories, aren’t they? Well, no. just because something is not counted does not mean it doesn’t count.

The Ceres Project https://www.ceresproject.org/

Ceres operates three kitchens and two organic gardens in the Bay Area. There are 13 affiliate programs in the US and one in Denmark.
Teen Empowerment:
All the meals Ceres provides are prepared by youth ages 14 and up who volunteer in our ¾ acre food production garden and three commercial kitchen sites in Marin and Sonoma Counties. Ceres’ expert mentors give teens the opportunity to learn to cook and eat for health, gain the skills to be successful at school and work, develop leadership, become change-makers in their community, and discover the joy of giving back. The average youth works at Ceres for a year and many for much longer. Two youth serve as voting members on our board of directors and all our youth are authentically engaged in planning and decision-making throughout our organization.

Community Education:
We educate the whole community about the vital importance of a diet based on healthy organic and locally produced foods, and provide the knowledge, skills and inspiration for people to make and maintain real change in how they eat. We publish and distribute Nourishing Connections Cookbook, offer healthy eating classes for the community, partner with local community clinics to teach nutrition through our Nutrition for Wellness Program, offer catering featuring nutrient-rich, organic and locally grown whole foods, and actively work to educate our volunteers, donors and especially health professionals about the difference that whole organic foods can make for themselves and their patients.

Kaiser is leading in value-based food purchasing and is closely followed by Dignity. The latter increased their organics 20% in 2019.
Healthy food in Healthcare: https://noharm-uscanada.org/healthyfoodinhealthcare

Healthy Food Playbook: The “Delivering community benefit: Healthy food playbook” is a suite of resources to support hospital community benefit professionals and community partners in developing community health interventions that promote healthy food access and healthier food environments. https://foodcommunitybenefit.noharm.org/

Changing the Adult Brain

Research show that the adult brain can generate new neurons. This allows the brain to adapt to new learning (neuroplasticity). The ability to renew the brain is affected by many environmental factors. Research supports a supportive role for an enriched environment, calorie restriction, nutritional phytochemicals, specifically curcumin, resveratrol, essential fatty acids, blueberry polyphenols, and grain with high soluble fiber. Inflammation impairs neurogenesis. Inflammation can be from trauma, toxins or bacterial and viral infection. High fat and sugar diets promote dementia probably through production of chemical that cause cell damage. Lack of essential vitamins and other co-factors in the diet are also linked to cognitive decline.

Enriched Environment-Play

Language-Most of the published studies enrolled persons who are bilingual or multilingual from a young age. On average, being multilingual adds years of vital life with the maximum improvement of 10 years. Learning a new language as an adult is less studied, but the current evidence demonstrates the activation of multiple neuronal systems in language learning. This would suggest significant activation of neural plasticity, as language learning requires auditory acuity, verbal capacity, analysis, learning and the verbal engagement of another person.
.
Exercise– Multiple studies show improved cognitive function in individuals with moderate fitness utilizing multiple measures.

Music– Music has a strong effect on neuroplasticity. There are several research papers and reviews of music training on cognitive function, but the field is just beginning to get appropriate attention. The NIH/Kennedy Center Workshop on Music and the Brain published its results in March 2018. The ability of music training to enhance other functions is called a “pour over” effect. Benefits are seen in language development, attention, visuo-spatial perception and executive function. In one study, individuals over age 75 were followed for 5 years. Those who frequently played a musical instrument had a lower rate of dementia. In this study, music’s protective effect was stronger than swimming, reading, writing or puzzles.
In another study, musically naïve adults (60-85) were given 6 months of “intensive” piano lessons. They had a 30-minute lesson each week and practiced a minimum of 3 hours a week. They had “marked” improvement in working memory, perceptual speed and motor skills compared to a matched untutored group.
For those who do not wish to play an instrument, choir singing, and dancing also show a beneficial effect.

You may correctly conclude that there are other factors at “Play” here, specifically the social connection formed by playing a musical instrument, singing dancing or engaging in a sport.

You may enjoy the following lyrics from the hit song by Des’ree:

You Gotta Be” is a R&B and soul song by British singer Des’ree,

Released 1994

Listen as your day unfolds
Challenge what the future holds
Try and keep your head up to the sky
Lovers, they may cause you tears
Go ahead release your fears
Stand up and be counted
Don’t be ashamed to cry

You gotta be bad, you gotta be bold, you gotta be wiser
You gotta be hard, you gotta be tough, you gotta be stronger
You gotta be cool, you gotta be calm, you gotta stay together
All I know, all I know
Love will save the day

Mini-Med #6, Preventing Cognitive Decline, Part One

Stephanie Taylor — Sun, 08 Dec 2019 23:42:26 +0000

Mini-Med 2019 #6

Epigenetics

The term Epigenetics means a change in the expression of the DNA, often due to changes in the environment of the organism. This change can be inherited across generations, but the underlying DNA code does not change. Genes are turned on or off by epigenetic mechanisms which live on top of the DNA code. Think of your DNA as being the digital code for your body, and the epigenetic mechanisms are analog dials that regulate genes up or down. A consensus definition of the concept of epigenetic trait as a \”stably heritable phenotype resulting from changes in a chromosome without alterations in the DNA sequence\” was formulated at a Cold Spring Harbor meeting in 2008, so this is a relatively recent concept. It is likely that a significant percentage of the Blue Zone Vitality is due to epigenetic mechanisms.

Blue Zones-
This term was coined in 2005 in a National Geographic report. The National Geographic Blue Zones were identified as Sardinia in Italy, Okinawa, Loma Linda (Seventh Day Adventists), the Nicoya Peninsula in Costa Rica, and Icaria in Greece. Analysis of the Blue Zones reveals some traits that are common to all Blue Zones, specifically strong family ties and social engagement, no smoking, a plant-based diet including legumes and constant moderate physical activity. Additional longevity and vitality enhancing factors in most, but not all zones, are high polyphenol wine, empowerment of women, gardening, no time urgency, whole grains, culturally isolated, high soy and nut consumption and a strong spiritual community.

Epigenetic Management of Aging

Eat-Although there is a lack of consensus on the one perfect diet, a plant-based diet is a front-runner. That means a variety of fruits, whole grains and vegetables, consumed fresh, seasonally, and with minimal transportation. Organic produce, dairy and meats are more nutritious, period. The lack of a diverse, plant-based food supply is a consistently cited as a major contribution to cognitive decline. Currently we consume about 25 different vegetables at most, when we should have more than 200 in a diversified diet. In “the Old World” many unfamiliar foods such as purslane, sour grass, spring greens, dandelion and a variety of ferments were consumed daily.

Books discussed during the Mini-Med are listed here as evidence-based information sources. Dr. Taylor does not endorse any specific diet.

Gundry MD, S. Dr. Gundry’s Diet Evolution
This is a thoughtful discussion of the evolution of our diet and recommendations for optimizing that physiology. Contains actionable guidelines.

Bredesen MD, Dale, The End of Alzheimer’s: The first program to prevent and reverse cognitive decline
This is a more technical book and is also evidence-based. Dr. Bredesen’s protocol has a certification process for doctors, which is continuously evolving. I would recommend searching for a Bredesen certified practitioner on the Institute of Functional Medicine website https://www.ifm.org/

Just when you thought organic certification was safe, counterfeit organics have arrived. Also, organic hydroponics (grown only in nutrient water) are under consideration for organic certification. This is controversial as the quality of the food depends on the quality of the soil. Aside from the beneficial health issues, a well-managed soil is one of the highest carbon trappers and essential to the health of the planet. Resources for additional help and information in finding quality organics are:

The Cornucopia Institute https://www.cornucopia.org/
The Real Organic Project https://www.realorganicproject.org/

Love- The importance of social connection cannot be under-emphasized. Humans and their dogs evolved to be sociable and friendly.

Play- Many activities are recommended to delay cognitive decline, but they may exercise only one cognitive domain (puzzles for example). You become excellent that skill, but that skill may not generalize to other cognitive capacities. Choose a task that engages as many intellectual and physical capacities as possible. Consider food foraging in a novel environment. Playing music, which is both physical and intellectual, has striking effects on neuroplasticity and brain development. Both Love and Play will be discussed in depth in the next Mini-Medical School.

Epigenetic Management of Aging, Part Two will be Feb 1, 2020.

Important Stuff Newsletter September 2019

Stephanie Taylor — Sat, 14 Sep 2019 20:19:03 +0000

Sept 14, 2019

The Next Mini-Medical School, October 5, 2019, will be on Energy Medicine.

Summary: Energy Medicine has been used worldwide for thousands of years. All the Asian medical practices understand life energy, which is variously called Prana or Qi/Ki. It is difficult to measure scientifically, but it is immediately apparent when it is gone.

There are also contemporary Energy medicine practices such as sound healing, Therapeutic Touch and Western applications of Qi Gong theory. All will be discussed at our next Mini-Medical School on Energy Medicine. We look forward to seeing you.

Important Office News

The Office Visit

Why you need an annual exam? In 2018, the US Preventive Services Task Force stated that Women do not need cervical cancer screening after age 65. The American College of Physicians (which represents ONLY Internists) backed up that statement and added that a pelvic exam was unnecessary. This policy was widely repeated on the news media. This is deeply misguided policy. In a 2017 research paper, US cervical cancer death rates were analyzed. In women aged 40-44, cervical cancer death rates were 3.3/100,000 women. The death rate from cervical cancer in women aged 65-69 was and 8.6/100,000. The cervical cancer death rate is 2.6 times higher in women 65-69.

Not only do women need more risk adjusted pap smears, they also need a physical exam. In other research, women who were regular about their exams and took their medications as prescribed had a much lower death rate. We need you to come for your annual exam and actively participate in optimizing your health.

Let me review the core principles of A Woman’s Wellspring which are summarized on our website:

The First Community is You:

Each person is a composite of their own life experiences and their own circle of support. Every factor needs to be evaluated to develop a picture of the whole person. Each element can then be recruited into the healing process.

The Second Community is where you live:

Most of the public health research shows that the health of individuals is not separate from the health of the community. We have an obligation to ourselves to care for our community. This means taking the ecological initiative and supporting the small businesses that are based in our community, especially our local farmers. Over time the community that you care for will also care for you.

The Center of the Program is the Office Visit:

We offer 30- and 60-minute patient visits. This gives us enough time to really get to know you. The relationship does not end at the office visit. You will enter a supportive community linked by regular newsletters and educational programs. You will have the opportunity to re-discover yourself and the joys of living on the Monterey Peninsula. See how this unique holistic program can benefit you and assist you in achieving your life’s purpose.

New Challenges:

Prior Authorizations At this time of the year, you should receive an electronic or paper copy of your FORMULARY for 2020. This is an important document as it determines the cost of your medications for the coming year. We are experiencing very high prescription drug costs, especially for hormone replacement therapy. We need your help. Please keep a copy of your formulary and bring it to the office for your annual exam especially if you anticipate a change in medications. Please be aware that medication coverage changes every year. Your insurance company or Medicare PDP annually makes the most profitable contracts. They do not have a fiduciary obligation to you.

It takes the office at least 15-30 minutes to file a PA. Many offices in San Francisco are charging $50 per Prior Authorization. If you can help us with the background research, we may not need to charge for this service, or if we do, it will be much less. Background research means knowing what medications you have tried and failed, the dates, and the adverse effect. This information, in conjunction with your 2020 FORMULARY, is essential to a prior authorization or appeal.

Cybersecurity

A Woman’s Wellspring has always invested heavily in cybersecurity, with monthly costs over $1,000. We currently have a state-of-the-art system. However, we now need to invest further to upgrade hardware for 2020.

Why? Your social security number, name, and bank account numbers sell for $25.00 on the black market. Health information (insurance info and medical records) sell for $1,000 (AARP, Sept 2019). If you have ever been burglarized and sought advice on avoiding another assault, the best recommendation is “harden the target”. These thieves are opportunists. If the job is difficult, there is always an easier job nearby. We need to make it as difficult as possible for your information to be breached. Our costs to further harden our target will be about $10,000 in 2020. I am considering adding $20 to everyone’s annual fee to cover the expense. I will keep you posted as we progress.

Additional advice from the AARP Fraud Watch is:

Monitor insurance benefits statements (EOB= Explanation of Benefits) for costs you did not incur. You are probably already doing this for your bank account.
Treat your insurance numbers as you would your Social Security Number and keep them secure.
Shred any medical paperwork you do not need to retain, including prescription drug labels.
Do not reveal on social media any surgery, medical procedure or visit to a specialist. Post vacation pics after you get home.

When we work together to keep our community safe, we will have the best health and the most fun.

Mini-Med 2019 #4- Advanced Nutrition

Stephanie Taylor — Mon, 09 Sep 2019 20:30:35 +0000

Mini-Medical School #4, 2019

Advanced Nutrition

Stephanie Taylor MD PhD

This is a massive topic, but we will start with the familiar and countable, and then review a small sample of the many nutrients that missed being on the label.

The Daily Value is set by the FDA. The RDA is set by the Institute of Medicine.
The recommended daily intake of Fat is 65 grams (20 grams saturated), Cholesterol 300 mg, Sodium 2400 mg, Potassium 4,700 mg, Total Carbohydrate 300 grams and Fiber 25 grams. Protein DV is an optional listing but should be about 55 grams/day for a 150-pound person. There is recent research indicating that adults over 65 need more protein to prevent loss of muscle mass. Preliminary recommendations are 0.68 grams of protein per pound bodyweight, which would be 100 grams of protein daily.

Vitamins (Vital Amines) are nutrients that cannot be synthesized by humans, hence are considered “essential” in the diet. The vitamins were “discovered” between 1913 and 1948. The amount recommended is based on the amount needed to prevent a vitamin deficiency disease. The only Vitamin that you cannot get in your diet is Vitamin D. Biochemical Individuality is not considered in RDAs.

Fatty Acids are also essential and must be consumed in the diet. The essential fatty acids are Omega 3 and Omega 6 EFAs. Primary sources are fish, shellfish, oils, seeds and nuts.

Choline has an RDA of 550 mg daily and is probably one of the most common deficiencies. Dietary sources are meat, poultry, dairy and eggs.

Magnesium is a potential deficiency in anyone who consumes alcohol.

Not Everything That Counts Can be Counted

The nutritional content of a specific food is dependent on the growing environment and especially the soil. Nutrient content is also affected by storage shipping and processing. The inconvenient truth is that the Chinese were right to believe that the life energy of food is damaged by processing and refrigeration. Traditionally, they would shop every day and would never eat leftovers.

Soil quality is of immense importance. We are devastating our fertile soils worldwide. Regenerative agriculture is a very complex process which regenerates the soil. It uses a combination of no-till planting with mulch, rotational grazing, rainwater management, and companion planting with an emphasis on perennials. Rotational grazing, especially, has the potential to be a significant source of carbon trapping. One of the leaders in regenerative agriculture gives workshops at her Paicines Ranch. https://paicinesranch.com/about/conservation.php

Food has been always been used for medicine. A 21^st century example of the scientific application of a food substance to enhance physiology are mushrooms. The initial studies were carried out in Japan in the late 20^th century. Dr. Ikekawa observed that enoki farmers had about a 50% lower rate of cancer. He isolated a compound from enoki, proflamin. This was a low molecular weight polysaccharide that potentiated immunity. Since then there has been an explosion of research. Despite the interest, there is little direct application to patients in the US except by practitioners trained in Asian medicine. Mushrooms are antioxidants, antibiotic and antifungal and antiviral agents, lower blood pressure, regulate blood sugar, but most frequently act as anti-cancer compounds through their immune modulating action. This is a complex area and consultation with a trained professional is advised.

There is a class of root “vegetables” that are used to manage stress and enhance endurance called “adaptogens”. This means they modulate stress and aging. Most are familiar with Asian ginseng, but there are other varieties as well as Siberian ginseng, which is an entirely different species. Another family of root adaptogens are Rhodiola, Maca, and Ashwaganda. Jiaogulan and holy basil are leafy adaptogens.

Cooking foods can also increase nutritional value, specifically bone broths and soups. One hundred years ago, everyone had a soup pot on the stove that started with a rich bone broth and the day’s harvest.

Culinary herbs can be very nutritious and the medicinal power of herbs has been traditionally preserved in vinegars and alcoholic beverages.

This brief survey demonstrates that our health and the health of our environment depends on diversity. Intelligent management of our food supply requires a mind-set that is capable of balancing multiple simultaneous, interdependent factors and events. The days of monoculture are over, both in food production and in food processing. We need to move to a sophisticated, local food system that serves both our needs, the needs of the soil and the larger eco-system.

Mini-Med #3 2019

Stephanie Taylor — Tue, 04 Jun 2019 16:20:34 +0000

Mini-Medical School #3 2019

Stress Management

Stephanie Taylor MD PhD

Stress Survey Results

Clearly, responses to stress cannot be crafted without a clear understanding of the current stressors. The results of the Stress Survey were overwhelming and incredibly heartwarming. Here is a summary:

The five major categories: % of total clicks

Dysfunction in government 26%

Climate change/wildfires 20%

Other 16%

Conflict with close relatives 13%

Financial strains 12%

Work/professional challenges/
disappointments 12%

Written Comments

About 50 % of the written comments refer to external influences (government/climate) that cause emotional stress as well as influencing personal health. Issues cited include health breakdown due to overwork and chronic stress as well as the risk of violence in public places.

About 20% of the written comments refer to personal and family member health challenges including caregiving. The family responsibilities cited include care for adult partners who are failing as well as increased grandparenting demands. Many also noted the challenge of aging in a society that does not value older adults. As women often are the caregivers, they have the additional stress of continuing to give care when their own health is compromised.

The next most common concern is lack of time, especially for activities that they value.

This is not an inclusive listing of responses, and I apologize if your concern was not mentioned in the summary. A few respondents shared that meditation was very helpful.

Management Interventions

Meditation

Meditation comes in many forms. Classical meditation, quietly resting and clearing the mind, reduces stress. There are many forms of meditation and you will benefit most from one that fits your personality. There is also moving meditation, such as Tai Chi Chuan and Qigong.

Cognitive reframing could be considered a meditative technique, as it views problems from a different angle. Obstructions and frustrations are re-framed as an opportunity for a different approach. There are many narratives that illustrate applications of reframing. In martial arts and Celtic society, one hopes for a “worthy enemy”, a challenge that will tests one’s capacities. The danger in constant challenge is the possibility of repeated failure. This may lead to a state of learned helplessness. Learned helplessness has a long history in psychological research. Simply, if you put a fly in a jar with a lid, it tries to escape and fails repeatedly. Eventually, it will only climb on the inside of the jar. If the lid is removed, it will not leave. The fly has decided that option is forever closed. Learned helplessness has also been abundantly proven in mammals. You can see how damaging learned helplessness can be to our society, as it is exactly what despots hope to achieve in order to humble a population.

Social Support

We humans are social creatures, and when deprived of our network become quite vulnerable. Much of our disconnected/connected life leads to isolation. No matter our level of intelligence (which of course must be questioned if we are destroying our own planet), we need warm interaction with our own folk. In a perverse proof, think about the highly successful methods used by colonial governments to destroy indigenous societies. The formula is to ban the native language and native dress, ensure poverty in the target population by taking them from the land and ban any public gatherings. This has been applied with great success in the early Americas, in South Africa and in Scotland. We are only now beginning to see signs of revival of cultures that were broken three hundred years ago. Quick to break and slow to recover. The interest in genealogy, in connecting with one’s own culture and ancestors is a warming trend toward making our society more complete and celebrating diversity.

On a neighborhood level, living in a community that offers support and that values every member is essential for personal health. This can be as simple as the grocer knowing your name and what you like to buy. We had a few respondents who attribute their equanimity to social and family support. Love in its many manifestations is highly underrated as a social force.

External Factors — Managing the Poltergeist

It may be easiest to cast government dysfunction and unpredictable climate factors as naughty house ghosts. They really never leave, but they can be managed. It helps to expect there might be an adverse event, and when it manifests itself, you will manage it. Practically speaking, what choice do you have, so you may as well deal with it. Avoid learned helplessness and just take on what you can manage. That may be voting and writing to congresspersons. Do what gives you strength and peace of mind.

A Few Resources

Resilient: How to Grow an Unshakable Core of Calm, Strength, and Happiness

by Hanson Ph.D, Rick and Forrest Hanson | Mar 27, 2018

Resilience: Hard-Won Wisdom for Living a Better Life

by Eric Greitens | May 3, 2016

Mini-Med #2 2019

Stephanie Taylor — Sat, 25 May 2019 21:23:37 +0000

Mini-Med 2019 #2
Supplements
Dr. Stephanie Taylor

Supplements are an addition that adds to or compliments something when added. For our purposes, we will discuss vitamins, minerals and herbal supplements.

Why would I take a supplement?

If our food supply was perfect, we would not need a supplement, but even in the best of fields, conditions are neither consistent nor ideal. Humans need to obtain many essential nutrients from food or supplements. A classic example is Vitamin C, which is essential for humans, but not other mammals because they generate their own vitamin C.

For us, essential nutrients are: essential micro-nutrients (vitamins), essential minerals, essential amino acids and essential fatty acids. Vitamin tablets became available in the 1950’s and were recommended to prevent vitamin deficiency diseases. A few examples are below:

B1-thiamine	Beriberi
B3- niacin	Pellagra
B9-folates	Anemia, fetal neural tube defects
B12-cyanocobalamin	Pernicious Anemia
D-cholecalciferol	Rickets
C-ascorbic acid	Scurvy

How are supplements regulated?

In the USA, supplements are regulated under the Dietary Supplement Health and Education Act of 1994. Adverse events are reported to the FDA under their voluntary reporting system. In 2007, Good Manufacturing Practices (GMP) were codified to regulate production and quality control standards. The current designation is cGMP (current GMP). Standards for vitamins are set by the United States Pharmacopeia (USP).

The manufacturer pays for the certification, and the cost varies by agency. The range is $3,000 to $8,000 per product. There may be an additional periodic audit fee of $4,000 to $15,000.

In addition to these certifying organizations, several producers have created their own internal quality management systems. Emerson Ecologics, a major distributor of supplements, certifies producers at the gold or silver levels. Silver requires demonstrated cGMP, regular audits, analysis certificates for raw materials and finished products. Raw product is tested for identity, microbiologicals, heavy metals, pesticides, aflatoxins, melamine and residual solvents. Potency testing is required for finished product. The Gold level includes all this in addition to analytic testing on each batch of raw material/finished product, a shelf life stability program, active ingredients present in sufficient quantity and Total Quality (R&D, sustainable environmental practices, clinical trials, good business practices).

Some supplements are sold with quality seals and here are four of the most common:

Quality Seal	ConsumerLab.com	NSF International	USP US Pharmacopeia	UL
Source of test samples	Purchased	Provided by manufacturer	Provided by manufacturer	Provided by manufacturer
Testing frequency	Annually	Once per year both provided and purchased in stores	One to six times a year samples purchased in stores	Twice per year using samples purchased in stores
Products that are not tested	Products known to be unsafe	Products for weight loss or sexual enhancement	Products for weight loss, sports or sexual enhancement	Products containing ingredients known to be unsafe or not recognized as supplements by the FDA

Source- https://www.consumerreports.org/vitamins-supplements/what-usp-verified-and-other-supplement-seals-mean/

What supplements do I really need if I have a good diet?

Vitamin D- You can get Vitamin D from the sun, but we are too far north for this to be totally efficient. Wearing hats and sunscreen to prevent skin cancers decreases sun exposure Vitamin D production. Consequently, Vitamin D is the vitamin that you probably need to take. The RDA is 800 IU (20 mcg). The Institute of Medicine states the upper limit of safe use is 4,000 IU (100 mcg) daily. Remember you can overdose on the fat-soluble vitamins-Vit A, E and D.

Maybe “Activated” B Vitamins- The form of folate, B12 and pyridoxine in most multis need to be activated by MTHFR. Not every one does this well, so some will need the activated forms (methyl-folate, methy-B12, and pyridoxal 5’phosphate) in their multi.

Essential Fatty Acids- Commonly available in fish oil, and to a lesser degree in flax seed oil.

Essential amino acids-Vegetarians can get their essential aminos with food combining. Classically beans and corn, as deficiencies on one food are complimented by their presence in another.

Clearly, there is a host of other supplements to discuss. Resveratrol, turmeric, echinacea……….

Resources:

ConsumerLab.com-quality ratings of a wide range of supplements, and medicinal foods. The latter is the technical term for chocolate. Annual subscription is about $42.00.

American Botanical Council- reliable source of herbal information and the home of the Botanical Adulterants Monitor. http://cms.herbalgram.org/press/2014/Botanical_Adulterants_Monitor.html

Mini-Med 2019 Feb

Stephanie Taylor — Thu, 14 Feb 2019 18:33:45 +0000

Mini-Med #1 2019- Stephanie Taylor MD PhD
Medical Care Systems-How to Access Care

Pre-Medicare:

What the insurance policy covers-specifics are in the contract and are not negotiable. Medications, radiology and procedures are often covered but may need special permissions before coverage is activated.

Medications:

Cost depends on the FORMULARY TIER.
Tier 1 is the least expensive and Tier 4 the highest. Non-listed medications are non-formulary.
If the formulary medication is unacceptable for a medical reason, the physician can ask for a Prior Authorization or Tier exception.

To get the best price, fill prescriptions at the PREFFERED Pharmacy. Here is an example:

MEDICATION DRUG TIER Cost and Requirements/Limits

lisinopril	Tier 1-preferred generic drugs	$1(preferred retail), $19 (Standard)
telmisartan	Tier 3-preferred brand name drugs	$30 (preferred retail), $47 (Standard)
remicaide	Tier 4-non-preferred drugs	$444 (preferred), $500 (Standard)

QL=Quantity limits means there are limits on the amount of drug that will be covered in a specific time period.
ST=Step Therapy means trial of preferred drug required before insurance will cover another drug.
PA= Prior Authorization means your physician must get approval from the insurance company before you can fill your prescription.

Prior Authorization: Health plans use PA to restrict access to costly drugs and services. In 2010 the AMA surveyed 2,400 physicians about PA hassles. This is uncompensated work which means higher medical office overhead. If A Woman’s Wellspring hired a ½ time staffer to obtain insurance permissions, we would need to raise your annual fee by at least $100.00. The estimated costs of this system to a medical office is: 20 hours per week and that translates (in a very large busy practice with 6,000 patient visits/MD/year)) to an average cost of $82, 975 annually per physician.

Procedures may also require prior authorization; for example, sleep studies, MRI and CT scanning. Each insurance company has a different system that can change annually. Prior Authorization affects both commercial insurance and Medicare (PDP) patients.

Medicare:

	ORIGINAL MEDICARE CARD You use your Medicare card for most care. Part A of the card is for hospitals, and Part B is for medical coverage. Original Medicare (Parts A and B), is provided by the Federal Government. There are also Medicare Advantage Plans that bundle A, B and D into a “Plan C”.
	PRESCRIPTION DRUG COVERAGE (PDP) There is a separate card and plan for prescription drugs called “Part D”. These plans help with the cost of medications. Original Medicare does not cover prescription drugs and these plans are purchased from private insurance companies. On the Medicare.gov website there is an excellent program to help you compare drug plans. You can get specific assistance locally from the Alliance on Aging.
	SUPPLEMENTAL COVERAGE You can also purchase a Medicare supplement insurance plan (Medigap) from a private insurance company. After Medicare pays it’s 80%, the supplemental plan covers the remaining 20%. These plans do not over expenses that are not eligible and paid for by Medicare.