Tuesday, June 13, 2017

Lowering Your Blood Pressure

By Vivian A. Kominos, M.D., FACC
Integrative Physician

Hypertension, defined as blood pressure greater than or equal to 140/90 mm Hg, is very common. About one in three Americans have hypertension and only about 60% of these have their blood pressure under control. Hypertension increases the risk for stroke, heart attack and kidney failure. There are many factors that contribute to the development of hypertension. Examples include: poor diet, genetics, inadequate physical activity and too much stress. In addition, blood pressure tends to increase as we age. The good news is that there are many steps you can take to control your blood pressure.

As an integrative cardiologist, I often see patients with hypertension who are looking for natural and alternative therapies and who wish to stop their medications. When I first evaluate a patient with hypertension, or pre-hypertension (130-139/81-89 mmHg) I review their medical history, family history, physical activity, work and home environment, sleep, medications and psycho-social factors. I partner with the patient in their treatment plan - which often includes modifications to diet and exercise, supplementation with micro-nutrients and stress reduction techniques. I also recommend frequent measuring of blood pressure out of the office. This is easy to do and there are many simple, affordable devices available for home use.

There are simple steps you can take right now to optimize your blood pressure:

1. Medications. Take your medications as prescribed and never stop or reduce them without your doctor’s approval. Stopping an anti-hypertensive medication suddenly can cause a “rebound” where your blood pressure rises to dangerous levels. Even if you are unhappy about needing medication, develop a gratitude practice for them. Before taking your pill, invite a smile on your face and look at it with gratitude. This causes your brain to release hormones that recruit the relaxation response. Your blood pressure will lower naturally allowing your medication to work better. Over time you may be able to reduce the amount of medication that you need.

2. Nutrition. Eat a DASH (Dietary Approaches to Stop Hypertension - https://www.nhlbi.nih.gov/health/health-topics/topics/dash/) or Mediterranean style diet (http://www.mediterraneandiet.com/). This eating pattern is high in fresh vegetables and whole grains and low in processed foods, salt, saturated and trans fats, and sugar. Too much sugar causes increased levels of the stress hormone, cortisol that increases blood pressure.

3. Relaxation. All of us have stressors. The stress response is a protective mechanism that gets our body ready to flee or fight danger. The problem is that we often view minor stressors as major catastrophes. Too much stress causes an increase in blood pressure, damages blood vessel function over time, causes dangerous changes to the brain, and destroys our mood. There are simple steps to reduce stress. Try the 4-7-8 breathing technique (Inhale through your nose to the count of 4; hold your breath for a count of 7; exhale through your mouth to the count of 8) or learn how to elicit the relaxation response.

4. Biofeedback. There are several devices on the market that can help reduce blood pressure. One that is specifically approved for blood pressure reduction is RESPeRATE (http://www.resperate.com/shop-resperate). This is an easy to use breathing assisted device that uses a 2 tone melody that causes breathing to become slower and deeper. When used for 15 to 20 minutes most days of the week, BP can be reduced by up to 10 mm Hg!

5. Supplements. Although there are several supplements that can help reduce blood pressure, it is best to discuss these with your integrative practitioner to see what is best for you. Beware that taking too many supplements can cause dangerous interactions. And some supplements such as ephedra, licorice, ginseng, yohimbine, and kola nut can raise blood pressure.

6. Exercise. I cannot say enough good things about exercise. Any increase in physical activity will help reduce blood pressure, improve sleep, increase well-being and reduce risk for most chronic diseases including some cancers.

7. Sleep. Like physical activity, sleep is necessary for health. Practice good sleep hygiene. Stop looking at TV and all devices at least an hour prior to going to bed. Develop relaxing night time rituals such as meditation or breath work, read relaxing material or write in a gratitude journal. Go to bed when you are sleepy. And develop a regular bedtime schedule. If you suffer from excessive snoring, daytime sleepiness and insomnia, get help from a sleep specialist.

8. Excessive alcohol. Drinking more than two alcoholic drinks daily for men or one daily for women can increase blood pressure.

9. Prescription and over the counter drugs. Tell your doctor EVERYTHING you are taking. Oral contraceptives, steroids, ibuprofen and decongestants for example increase blood pressure.

What can you do right now? Put a smile on your face. Your brain will think you are relaxed even if you are not. The relaxation response will be activated, lowering your blood pressure and improving your health.

For more information, visit our website at MeridianIntegrativeMedicine.com and follow us on Facebook and Twitter.

Tuesday, June 6, 2017

Creating Mindfulness in a Busy World

By Judson Chaney, ND, LAc
Acupuncturist

I recently had a great conversation with a friend, discussing his family vacation to Florida. The family drove the entire way down from the northeast, all the way to Florida and back, even though flying was an option available to them. What impressed me was that the family planned the trip to include the voyage down to Florida as a major component of the vacation, taking extra time to stop and see sights, and attractions along the way. They all understood that the stops and excursions during the voyage were just as important as arriving at the destination. To be honest, I too was more interested in hearing about some of the quirky roadside attractions they encountered than the destination. In other words, it was really the journey that mattered. I thought that this was a wonderful metaphor for mindfulness.

Being mindful is to simply be aware or conscious of something. As a passenger on a car trip, it may be the sights out of the car window, feeling the wind through your fingers, or stopping to take in a scenic overlook. In health and healing it is applied to focusing ones awareness to the present moment, and all of the thoughts, sensations and feelings one may be experiencing.

The ancient Chinese labeled the brain as a “curious” organ. The brain seeks to recognize patterns, and cultivates questions regarding not just the present moment, but the past and future as well. This function is crucial to our survival. In my opinion, our ability to seek out information, cultivate questions, and grapple with possible outcomes has been a key component in our advancement and success as a species.

What could go possibly wrong? Many of us may have experienced a time when our problem solving brains do not want to stop. It may surface as insomnia, anxiety, a relative sense of unease, restlessness, or inability to relax. Sometimes, even when there are no problems to solve, our brain is more than willing to imagine something for us to work on in our spare time (isn’t that fun). In doing so, we can miss out on many experiences happening around us because we are focusing on everything else except the present moment.

So what are we to do? Today we are exposed to more information, streaming at a faster pace than ever before in human history. Our natural tendencies towards curiosity and problem solving can be inadvertently set to overdrive. This can be taxing mentally and physically and can be a key contributor to our total overall stress levels. This internal overdrive, although beneficial in intent, can ultimately become an obstacle to our enjoyment of life. I would suggest taking a moment to cultivate mindfulness each day. When you find your thoughts racing, or worries compounding, try to take a step back from the situation and take a deep breath.

Next, employ mindfulness to your advantage by building on your natural tendencies for thought. If you are person who is very visual, and you find it easy to imagine images, pictures and movies, use your eyes to seek something pleasing to look at near you. This can be something from nature, such as a tree or a bird in flight, it could be a painting on the wall, a building you like, a sunset, or the way the rain falls into a puddle. Take a moment and really allow yourself to see and observe. Note the different aspects of it in your mind and let your eyes soak in as much of the beauty and interest they can find.

If you are more inclined to have an internal dialogue, and your mind is full of an ongoing conversation, use your ears to listen to the world around you. If you are outside, pay attention to the wind as it moves through the trees, or the sounds of the rain, or the chirping of birds. Note how many sounds you can distinguish and pay attention to and let the world around you become awake and alive with sound.

What is most important about the above examples is not what you are looking at or listening to, but rather that you are paying attention in the present moment. In doing so we acknowledge and connect with the world around us, and provide our curious brains food for thought. We take a mental break from the streams of thoughts that may become burdensome at times, and allow ourselves to be present.

To utilize the example of the road trip again, the journey is long, and at times the road can make us weary. It is healthy and necessary to pull the car over every once in a while, take a deep breath, stretch our legs, and allow ourselves a moment to take in the sounds and scenery along the way. Happy Travels…

To learn more, sign up for our 5-week Mindful Awareness summer class next month at Riverview Medical Center on Wednesdays from July 12, 2017 to August 9, 2017, 8:00 a.m. - 10:00 a.m.

Tuesday, May 30, 2017

Integrative Medicine is Our Best Hope for Healthcare in America (Part 1)

By David C. Leopold, M.D. 
Medical Director

Healthcare in the United States is in serious trouble. Despite spending far more on healthcare than any industrialized nation, we have outcomes that are no better and, in fact, are often worse (the USA recently ranked last out of 11 similar countries) than countries that spend much less. Americans are also much more likely to have more than one chronic disease condition (e.g. heart disease and stroke, type 2 diabetes, cancer, chronic lung diseases, chronic pain, arthritis, etc.), further complicating care and quality of life. The implications of this issue are massive; chronic diseases are the major reasons for sickness, disability, suffering, death and health care costs in the United States.

Perhaps most unfortunate, the majority of Americans still do not make lifestyle changes that are proven to decrease disease and improve health. We still eat too much sugar and processed foods, not enough fruits and vegetables, we are too sedentary, and most people are under chronically high levels of stress and do not have adequate methods to manage this stress. The totality of this problem has direct health impact but also significant economic impact to our healthcare system; we spend an incredible amount of money treating diseases that are preventable. To paraphrase a cartoon, we are mopping up the floor while the sink is overflowing and the faucets are wide open. But what if someone could reach over that overflowing sink and turn off the faucet?

What if we could change this picture, what if we could actually stem the tide by decreasing the ramifications of these chronic diseases and, even better, what if we could actually stop them from occurring in the first place? This is what Integrative Medicine aims to do. Integrative Medicine is probably our best hope to change the current course of healthcare in this country because it focuses on the prevention of disease and a deep and lasting partnership with the individual to work together to improve our health individually and thus collectively as well.

Let’s take just a brief look at just a few interventions we have been talking about. Dietary interventions are proven to reduce obesity, diabetes, heart disease and cancer. Exercise has been shown to decrease pain, obesity, heart disease, reduce cancer and reduce recurrence of certain cancers. Exercise is also a powerful antidepressant and is an excellent intervention for stress management. MBSR (Mindfulness-Based Stress Reduction) has been shown to help stress, anxiety and lower back pain. Acupuncture has been shown to help many different disease conditions and a multitude of issues relating to many different types of pain.

In fact, every major healthcare crisis in this country (e.g. chronic pain and the current opioid overuse epidemic, obesity, diabetes, heart diseases, cancer, anxiety, depression, insomnia, etc.) can be significantly impacted by the implementation of integrative medical approaches.

Look for my upcoming blog posts where I’ll be discussing this issue in more detail. 

Tuesday, May 23, 2017

PREP: Pre-Hospital Empowerment Program


By Sara Scheller, BSN, RN, CPN, CCRN
Integrative Health Coach

If you knew you were going to the hospital for a planned surgery or procedure, how would you feel? Would you feel stressed, worried, and anxious or would you feel confident and empowered to be the driver of your healthcare experience? The truth is, there is no one-size-fits-all hospital admission. This is a highly individualized, unique process. According to EMPATHie (empowering patients in the management of chronic diseases), “An empowered patient has control over the management of their condition in daily life. They take action to improve the quality of their life and have the necessary knowledge, skills, attitudes and self-awareness to adjust their behavior and to work in partnership with others where necessary, to achieve optimal well-being.” One benefit of having an expected hospital admission (for surgery or other procedure) is that you can plan for it! You may not know exactly what to expect, but you can create and build practices to help you self-regulate this process.

Resilience is the ability to bounce back after adversity. Here are three ways to build more resilience with any challenge in your life:

1. Change your perspective, or how you look at things. You can shift to look at your experience as an opportunity to heal, learn, grow, and/or rest. We are born with a “negativity bias” or fear, vulnerability, and worry as a natural response to negative stimuli. But, you can leverage your ability to re-wire your brain through conscious efforts to find the good. According to Dr. Rick Hanson, author of Hardwiring Happiness, “The brain is like Velcro for negative experiences but Teflon for positive ones.” With support and practice, finding the good can become automatic, leading to more resiliency following tough times.

2. Find what activities or practices create balance or joy in your life. Lissa Rankin, M.D. in her book Mind Over Medicine encourages, “if you’re exposed to stressors you either can’t change or aren’t ready to change, you must prioritize activities that induce the relaxation response as a way to counterbalance the stresses in your life…creative expression, sexual release, being with people you love, spending time with your spiritual community, doing work that feeds your soul, and other relaxing activities such as laughter, playing with pets, journaling, prayer, napping, yoga, getting a massage, reading, singing, playing a musical instrument, gardening, cooking, Tai Chi, going for a walk, taking a hot bath, and enjoying nature.” If you aren’t sure which of these works to induce your relaxation response, try experimenting! Find what works for you.

3. Learn tools which you can practice on your own and/or with support, prior to your admission that you can use both during your hospitalization and in other challenging times of your life. These include mindfulness, 4-7-8 breathing, guided meditation, and other techniques where you can learn to become aware of how you are triggered and respond to stress. Once you become aware of this, you can use these tools to shift your body out of fight or flight. Allowing your body to shift into the relaxation response, you can rest and digest, reduce inflammation, and allow your body to heal naturally.

When you partner up with a health coach or other health care professional for support, you can become empowered to co-manage your health and well-being. You can be responsible for your own health, and tap into the resources of an expert creating a balance between self-management and shared decision-making. Through education and a holistic approach (mind, body and spirit), you can create a plan to optimize your body’s natural response to stress, allowing your body to work for you instead of against you.

PREP (Pre-Hospital Empowerment Program) assists you in preparing for a planned hospital admission for your surgery or procedure. To learn more, please email me at Sara.Scheller@HackensackMeridian.org.

Wednesday, May 17, 2017

Essential Oils 101: Part 1

By Lisa Sussman, PsyD
Health Psychologist

What do lavender, peppermint, lime, cedarwood and clove all have in common? They are essential oils! What are these potent drops which burst with aroma? Essential oils are volatile, aromatic compounds that are found in the leaves, stems, bark, flowers, and/or peels of plants and trees. They protect the plants/trees and help them in their survival. Essential oils have a long history of human use dating back to biblical times, and even further before that! Today, many people use essential oils as a tool along with nutrition and exercise to promote their wellness and self-care. There are many research studies which show that essential oils can help the body and mind in a number of ways. You may find information on the studies done on specific essential oils at www.pubmed.com or www.aromascience.com.

Each essential oil is comprised of hundreds of chemical compounds which give them their versatile uses and multiple purposes. They are naturally anti-bacterial and anti-viral, and because the molecules are so tiny, they can be absorbed into the skin, pass through cell barriers, and in some cases, pass through the blood-brain barrier. Essential oils are much more potent than herbs. For instance one drop of peppermint essential oil is equivalent to 28 cups of peppermint tea! Essential oils have their own intelligence and vibration, and as they help plants, they can help humans, supporting the body to function optimally physically and mentally.

Using a good quality, therapeutic grade essential oil is a must. Although many essential oils are considered GRAS, or Generally Regarded as Safe for Consumption by the FDA, they are not regulated by the FDA. You need to do your homework to make sure the essential oil is safe to use. The three things to consider when choosing an essential oil are purity, potency, and testing. Purity means the essential oil is free of toxins, fillers, and pesticides, and that it contains only what the bottle says it is. Potency refers to the strength and chemical constituents of a given oil. This can vary with where the plant is grown and harvested, the condition of the soil, and the species of the plant itself. Testing refers to the multiple methods of analysis that the essential oil is subject to before getting the green stamp to be sold, and can include tests such as mass spectrometry, gas chromatography, sensory evaluation, and third party testing.

Certain types of essential oils are known for their different properties and historical uses. For instance, lavender, and most florals, have a calming effect on the skin and in the brain. Mints, such as peppermint help focus, uplift mood, and have a cooling effect. Citrus oils, like lemon and orange, serve as gentle cleansers, in and out of the body, while they uplift. These are just samples of the many properties and uses of essential oils. Go to your nearest bookshop or search online to browse all of the books about essential oils and how to use them. You can learn as much as you’d like about different essential oils and the ways they can be used to support your health.

I hope this gives you a better understanding of what essential oils are, how they work, where to look for studies about the benefits of essential oils, and how to check for a good quality essential oil that is safe to use. In my next blog, I will describe the three methods of essential oil application: aromatic, topical, and internal.