A Wellspring for Our Community Renewing Mind, Body and Spirit From Stephanie Taylor, M.D., Ph.D.
“True wellness and deep healing is more than the application of a pill to a diagnosis. I have pioneered a new approach to healthcare that is based on personal and community wellness. Here is what this means:
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. The majority of 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 also 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. Visit Medical Program and Educational Program and see how this unique holistic program can benefit you and assist you in achieving your life’s purpose.”
Simples-home herbal remedies
Mini-Medical School 2018 #2
Stephanie Taylor MD PhD
“Simples” are defined as the use of a single herb or plant in a medicinal way. The use of simples pre-dates the written record and continues in wide use today. The 2016 US sales of simples are greater than $7.5 billion annually. That does not take into consideration the increase in sales due to the recent legalization of cannabis.
Cannabis-History-The oldest written record dates from 2,600 years ago, and the historical record goes back more than 8,000 years. In 1840, Western medicine formally recommended the use of cannabis for muscle spasm and seizures. Cannabis was added to the 3rd edition of the US Pharmacopoeia (USP) shortly thereafter for pain relief, seizure prevention and insomnia. In 1937, the Marijuana Tax Act made cannabis illegal and in 1942 the AMA removed it from the USP.
Plant Taxonomy- Order: Urticales, Family: Cannabaceae (Cannabis and Humulus) Genus: Cannabis (Cannabis sativa and cannabis indica).
Pharmacology- There are more than 100 different cannabinoids primarily in the flowers, leaves and bracts of the female plant. The main psychoactive component is Δ9-THC, and the next most common compound is cannabidiol (CBD) which has quite different properties. There are CB1 receptors for these cannabinoids that regulate appetite, mood, memory, fear extinction, motor responsiveness, posture, and are also present in GI tract, fat cells, liver, and muscle. The CB2 receptors, interestingly, are on microglia (brain), osteoclasts and osteoblasts (bone).
Products- Cannabis products are smoked, vaporized, applied topically and taken orally. Generally speaking, 30% of sales are edibles, 23% resin 20% oil. The standard dose of THC is 5-10 mg and is established by individual states. The average smoked joint yields 8 mg THC but the potency of US plants has increased steadily in recent years.
The FDA approved Pharmaceutical forms are Marinol, Cesamet and Syndros. These are prescribed primarily for nausea and vomiting from chemotherapy and for loss of appetite due to the wasting syndrome of AIDS. Twenty seven other countries also use an oral spray, Sativex, (THC:CBD 1:1), for Multiple Sclerosis. Compassionate use is permitted for Epidiolex, a CBD oil, for certain types of epilepsy.
Therapeutic Applications- The most common indication for cannabis use is chronic pain, followed by nausea and vomiting of chemotherapy, spasticity, epilepsy, Tourette’s syndrome, traumatic brain injury, anxiety, post-traumatic stress disorder and sleep. When used for pain, there is an observed >60% reduction in opioid use.
Adverse Effects and Contaminants-There is one subtype of testicular cancer which is increased with chronic cannabis use, and there is a suggestion that there is an increased risk of cancer in the children of women who used cannabis while pregnant. There is no compelling data on lung cancer in chronic smokers, but chronic cough is common. There is an increase in unintentional overdoses, primarily in children, from edibles. Adults overdose unintentionally from repeated doses because the first perceived onset of action of an edible can be as much as 2 hours from the time of ingestion. An additional concern is the impact of cannabinoids on driving ability. There is at least a 10% increase in motor vehicle accidents under the influence of cannabis. Impaired driving ability is worthy of intensive research to fully assess the impact of wider medicinal and recreational use.
Contaminants are also a major concern as they are a common and under-recognized cause of chronic disease. Common contaminants are pesticides, solvents used in the making of oil extracts, heavy metals (the cannabis plant likes to concentrate cadmium and copper from the soil), lead or glass beads (added to increase weight as cannabis is usually sold by weight), bacteria and molds. Synthetic cannabinoids that are sprayed on the original plant material, such as Spice, have unpredictable mood effects and have caused permanent brain damage and renal failure.
Recommendations: When buying cannabis products, insist on organic (not currently regulated or certified by CCOF or the USDA) and all hemp oils should be supercritical CO2 extracted and not extracted with hexane or benzene.
Hops-Interestingly, in the same family as cannabis: Family: Cannabaceae. Hops are the primary flavoring in beer. Hops are also used as a stand-alone herb for stomach upset, sleep and as a diuretic. A poultice of hops was traditionally used for arthritis, and it can be blended with valerian, passion flower and skullcap and served as a tea for anxiety.
Dandelion- is primarily used as the roasted root for upset stomach, as a diuretic and also to stimulate bile secretion. Leaves are a highly nutritious spring green.
Calendula- is used for topical would healing and is available as a save.
Arnica flower- is also a topical for wounds. Over 300 arnica products in Germany alone.
Cranberry- is a preventive for urinary tract infection.
Milk Thistle seeds-is for restoring liver after hepatitis and fatty liver cirrhosis.
Willow bark- is the source for aspirin with the same indications.
Witch Hazel- is astringent, anti-oxidant and for wounds.
Elderberry (Sambucus)-decreases the severity and duration of flu and colds. (flower and berry)
Echinacea-Treats early colds and flu.
Lavender-Essential oil is used for anxiety as aromatherapy or as a patented oral capsule (Lavela). Flowers for aromatherapy pillows for sleep.
Sassafras and sarsaparilla (root beer)-is a mouthwash, topical antiseptic and for fever.
The Precision Medicine Initiative
Stephanie Taylor MD PhD
Mini-Medical School #1 2018
The Precision Medicine Initiative is a National US research program that is different than anything we have seen before. The Initiative applies massive computing power to analyze complex genetic relationships, aggregate massive amounts of data and discover new approaches to healthcare. Precision Medicine customizes the medical treatment to the person as well as the specific disease. https://allofus.nih.gov/
Three specific applications are:
Pharmacogenomics (the right drug, the right dose)
Assessment of individual genetic cancer risk
Individual tumor profiling for chemotherapy
Drugs are “digested” differently by everyone. It is not just a matter of breaking down the original compound. There are an infinite number of speeds, routes and byways for metabolic pathways to progress. Fortunately, some of those pathways are well described and have a clear genetic basis.
A cheek swab will deliver enough DNA for analysis of the essential enzymes, and an individualized highway can be constructed. The formal name for one of these metabolic families is Cytochrome P450 isoenzymes. Some are fast, some are slow and some go to odd places. Any of these variations can result in too much, too little or abnormal byproducts of a drug causing side effects and a lack of therapeutic effect. These individualized pathways are specifically measured by pharmacogenomics testing. When the report is resulted, there will be a list of preferred drugs, those that need modification and others that should be completely avoided. Because this is genetic, the results last a lifetime.
Right now, this testing is used only in special circumstances. Preliminary data show a dramatic decrease in office and ER visits with correct pharmacogenomics testing. Very soon, no one will be prescribed a drug that they are not profiled to safely consume.
Genetic Cancer Risk Analysis:
There are many reasons to pursue genetic cancer risk testing and the situations are as varied as the individuals tested. Evaluation starts with the family history of cancer. If there is a clustering of cancer in the family, especially early onset cancers, then genetic testing is recommended. If a person is identified as carrying the gene, then increased screening and early diagnosis and treatment can be lifesaving. Knowing the genetic risk also allows screening of other family members, which can be additionally life-saving.
Most people are familiar with BRCA testing for hereditary breast and ovarian cancer. This testing was pioneered by Myriad Genetics. There are now many more identified genes that increase cancer risk and there are now several companies offering genetic testing and counseling services. A cutting-edge local initiative is the Project DNA, a website and initiative, created by a local gastroenterologist, Dr. Dan Luba. This has a wealth of well-organized information. There are fifteen individual syndromes listed as well as educational videos and a smart family history calculator. This can be accessed at: http://theprojectdna.com/about/.
Not all cancer that occurs in a single organ, such as the breast, has the same behavior. Some are lazy and some are aggressive. This tendency can be tested genetically. For example, HER2/neu is a protein that, when present in excess, affects breast cancer management. First, it changes prognosis, indicating a more aggressive tumor. Secondly, it allows a targeted therapy with Herceptin. Only HER2 expressing tumors are treated with drugs that specifically target HER2. There are other HER2/neu targeting agents in clinical trials.
A tumor can also change its genetics over the course of therapy and a sophisticated change of chemotherapy may be lifesaving. Rapid genetic profiling of the current tumor genetics would allow immediate re-design of chemotherapy and is aggressively researched at many major universities.
Pharmacogenomics on the net: https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics
Consider participating in the All of US Research Program of the Precision Medicine Initiative.
You Tube video of Genetic Cancer: Search: “Introduction to Hereditary Cancer”.MORE
Mini-Medical School #6 December 2, 2017
by Stephanie Taylor M.D., PhD.
Fitness historically referred to the ability to complete a task. What we now mean by “fitness” has no formal definition and it is highly context dependent. A concrete fitness goal could be to achieve a specific percent body fat (26-31% body fat is normal for women, and 18-22% for men), or the ability to hike to the top of Garland Park.
One hundred years ago, fitness meant being able to haul wood and carry water and walk to the town when the horse was lame. Our century has a very different definition of activities of daily living. Given our 2st century environment, today’s fitness would be defined as the ability to sit in front of a computer or television for hours!
A recent article in the cardiology journal “Circulation” reported that most adults spend 6-8 hours a day in sedentary activities, and adults over 60 years of age averaged 9 sedentary hours a day. Sitting time increases risk of metabolic syndrome, diabetes, cardiovascular disease and all-cause mortality. Just two hours of extra TV time increases diabetes risk 14%. Fortunately, just 2 hours standing or walking decreases diabetes risk 12%. There is a similar increase in cardiovascular disease from prolonged sitting. All-cause mortality also increases with the degree of sedentary behavior, with the most sedentary (70% of the time) showing a 6 times increased death rate.
The physiology underlying increased morbidity and mortality involves many endocrine glands as well as muscles, fat and inflammatory and endothelial cells. One of the most important and well researched risks is the reduction in insulin sensitivity with sedentary behavior. Glucose from meals is intended to go to the cells for immediately available energy. If there is local resistance to the transfer of glucose into the cells, the level of glucose in the blood increases. If blood glucose goes past a certain threshold, it initiates a cascade of negative events specifically, increased inflammation, oxidative stress, endothelial dysfunction and an increase in sympathetic tone.
How do you get folks to increase their activity when there are so many attractive distractions? There is research support for two interventions: changes in the workplace environment, and use of smart phone apps that remind users to take a walk break. It is ironic indeed that the very technology that caused the problem is being used to solve the problem! Even regular short breaks for a walk reduce risk.
Bones and Muscles
Astronauts can lose as much as 5% of their bone density per month. An extended deployment in space may return them with a bone density close to osteoporosis. This can be mitigated by exercising as much as 2 hours a day while they are weightless. Bones respond to muscle pull even in low gravity environments. Muscle pull and gravity are the two main forces that maintain bone density.
Muscle pull on the bone stimulates bone to remodel. This constant remodeling is essential for good quality bone. There are two types of cells in bone-osteoblasts and osteoclasts. The former build bone and the latter dissolve bone. Usually they are in balance, but if the osteoblasts decrease activity, bone loss ensues. Physical activity is essential for good bone quality, but if there is a loss of bone structure, then it is essential to modify the exercises to prevent micro fractures. Exercises that involve flexion (forward lean) and rotation of the spine are particularly dangerous. You will have to say good bye to your crunches, toe touches, and toe touches with twist. Similar benefits can be obtained by modifying these exercises to maintain an upright posture. It is essential to work with an instructor who is trained to adapt exercises to individuals with low bone mass.
The beneficial effect of gravity can be optimized by maintaining an upright posture. Slumping compresses the anterior aspect of the vertebral bone, and can cause micro-fractures. Slumping and lateral rotation also increase pressure on the intervertebral disc and can even cause it to slip, possibly causing a nerve compression. Slumping also reduces the area for your lungs to expand, and for your bowls to digest. Tai Chi Chuan, some Yoga and the Bones for Life program apply the beneficial effect of posture on bone density.
The Turtle Wins
Whatever you decide to do for exercise, pick something that you enjoy and start out slowly. One ligament tear will put you back six months. Be very mindful of your feet if you are fast walking or hiking. See an excellent podiatrist if you have any foot pain. Chronic foot problems decrease your activity level and always result in the accumulation of a few unwanted pounds.
If you choose to start weight training, start with light weights and more repetitions. A good rule of thumb is to use a weight that fatigues you by about the 15th repetition.
Make it social. You will be more consistent if you are gathering with friends. If you enjoy your private time, you can exercise with an audio book. Just be sure it is a page-turner!
Martin, Margaret. Exercise for Better Bones. Yoga for Better Bones. www.melioguide.com
Switzer, Katherine. Running and Walking for Women over 40: the road to sanity and vanity
Tai Chi ClassesOnline: https://www.onlinetaichilessons.com/
Cognitive Health: food, fitness and community
Stephanie Taylor MD PhD
Knitting, crochet and quilting:
“Our mission is to use knitting and other therapeutic creative activities to improve wellbeing generally, but also to complement medical treatments in the self-management of long-term health conditions. We are working closely with academics and clinicians, and as a direct result, therapeutic knitting and therapeutic knitting groups are being formally acknowledged by leading clinicians and academics for their benefits in mainstream healthcare. We have been successfully using knitting therapeutically in the NHS since 2006, so have a wealth of knowledge to share. This is just the beginning. Low-cost activity groups have the potential to not only revolutionise our individual lives but healthcare systems worldwide because they provide an affordable means of long-term support, motivation and monitoring.” Accessed 10/6/2017 at www.stitchlinks.com
The Benefits of Knitting for Personal and Social Wellbeing in Adulthood: Findings from an International Survey. British Journal of Occupational Therapy 76(2):50-57 · February 2013
“This study aimed to identify the benefits of knitting for individuals' personal and social wellbeing as a prerequisite to investigating its therapeutic use. Method: An online survey was conducted through an internet knitting site. Responses were received from 3,545 knitters worldwide. Quantitative data were analysed statistically to establish relationships and differences among variables and qualitative data for key themes. Results: Respondents came from a virtual community of knitters. The majority were female white adults and frequent knitters, who commonly reported knitting for relaxation, stress relief and creativity. The results show a significant relationship between knitting frequency and feeling calm and happy. More frequent knitters also reported higher cognitive functioning. Knitting in a group impacted significantly on perceived happiness, improved social contact and communication with others. Conclusion: Knitting has significant psychological and social benefits, which can contribute to wellbeing and quality of life. As a skilled and creative occupation, it has therapeutic potential - an area requiring further research.”
Stitch'N Bitch. These groups started more than 100 years ago. Women get together for needle crafts and social commentary. I leave the rest to your imagination.
Learning new things-words, music and language:
There are multiple research studies showing that learning a second language creates new neural networks. Learning a second language increases grey matter density and white matter integrity. This effect is observed in all age groups, including the “elderly”.
There are also many studies that show that listening to and making music also contributes to preservation and enhancement of cognitive capacity. Recent research (Rogenmoser et al., 2017) showed that compared to non-musicians, musicians have lower BrainAGE scores as determined by MRI studies of the brain. Amateur musicians stayed younger than professional musicians, an effect attributed to the stress of professional work or to over practicing a single skill.
In “Apollo’s Gift” Altenmuller reviews the physiological data on music therapy, extending the benefits from the craft to include the subjective pleasure of music. The pleasure one finds in music “provokes motions and emotions”. There are changes in the areas of the limbic system which mediate emotion, motivation and long term memory. This pleasurable component not only makes music listening more frequent, but actually facilitates neurotransmission and new connections.
The Tasmanian Healthy Brain Project found that 93% of the education participants, 50-79 years of age, showed an increase in cognitive reserve compared to a control paired group that did not attend adult university courses. Locally, adult learning experiences are available at: Gentrain (http://www.gentrain.org/) at MPC, and the OLLI at CSUMB (http://olli.csumb.edu/).
Exercise with support groups:
Research on exercise robustly supports increased neuroplasticity and prevention of age related decline in mental capacity. We will return to the science in greater depth in December.
However wonderful exercise is for your brain, there is little benefit if you cannot be consistent. Some of the best ways to exercise and keep exercising is adding a social component. Specifically, join a group. There are many groups, and you need to pick one that suits your temperament and exposes you to people you enjoy. One great idea to find compatible people is to search on Meetup (www.meetup.com) for a hiking, running or sports/fitness group.
If you are a bit of a loner, you can meet your coach on line. There are many apps and on line programs. My Fitness Pal is one of the best apps and integrates with many of the advanced pedometers and sleep moitors. The sharing of success stories is enlightening and motivating, as you experience other people’s joy in achieving their goal.
Stress management with Forest Bathing:
Stress destroys neurons, and stress management is essential to healthy brain aging. Forest bathing therapy was developed in Japan. A forest bath is a short walk in the forest with time for viewing and appreciating the surrounding trees.
The Forest Therapy Association (http://www.natureandforesttherapy.org/) has an excellent website. They have a research page summarizing the current studies, and also have a program to train guides. Overall, forest bathing reduces stress hormones, lowers blood pressure and improves immune function.
Locally Mary Ann Rowe, PhD, will be leading some preliminary walks. If you are interested, you can contact her at at 831-373-1017.MORE
Mini-Medical School #4
Food as Medicine
August 12, 2017
Stephanie Taylor MD PhD
The doctor of the future will give no medicine, but will interest his (her) patients in the care of the human frame, in diet, and in the cause and prevention of disease.” Thomas Edison
What is Food?
Protein, fats and carbohydrates=calories. Add a vitamin pill and you are all set, right? Not quite. Here is a list of the high nutrient value plants and their participating phytochemicals, which are not included in that simple formula.
Phytochemical Food Source Health Benefits
|Red, green, yellow fruits and vegetables
|Antioxidants1, decreased cancer risk
|Most fruits and vegetables, tea
|Strawberries, grapes, raspberries, apples
|Inactivates cancer causing chemicals3
|Citrus, whole grains, berries, tomatoes, most vegetables
|Inhibits cell proliferation induced by carcinogens4, 1,2
|Flax seeds, berries, whole grains
|Garlic, onions, leeks, chives, shallots, scallions
|2,3, pain reduction
|Soybeans, Whole grains, cruciferous vegetables, cucumbers, squash, melons, flax seeds, green tea
|Garlic, onions, leek….
|3, inhibit cholesterols synthesis
|Whole grains, legumes
|3, primarily steroid induced
|2,4, antiviral and antibacterial
Reference: Power Foods by Stephanie Beling, MD, HarperCollins, 1997.
Eat five different kinds of fruits and vegetables every day to recapture the disease preventing phytochemicals missing in the American diet. Taking vitamin and mineral pills will not prevent the diseases associated with a processed-food diet. Scientists cannot formulate into pills nutrients they haven’t yet discovered”. –Dr. James Duke, US Dept. of Agriculture
Step One: Start with Good ingredients:
Water: The Environmental Working Group just released its tap water analysis. Cal Am is in legal compliance, but has levels of arsenic, bromodichloromethane, chloroform, hexavalent chromium, dibromochloromethane, dichloroacetic acid, trichloroacetic acid, total trihalomethanes and above optimum health levels. Optimum health levels are not the same as legal limits. These chemicals are all carcinogens. https://www.ewg.org/tapwater/#.WY3VUVWGPIU
The fundamental error in safety testing is made by testing isolated chemicals for toxicity. The synergistic toxicity of simultaneous low doses of hundreds chemicals over a life-time is not evaluated.
Plants: Local, organic and fresh. Animal protein: Organic/grass fed and humanely raised.
EXAMPLE 1-APPLYING WHAT YOU KNOW TO HYPERTENSION:
Caution: Do not stop any medication without physician supervision!
The DASH Diet is endorsed by the National Institute of Health and research reports a BP reduction of 10.7/5.2 mm Hg, which is comparable or exceeds medication results. More information is at: https://www.nhlbi.nih.gov/files/docs/public/heart/dash_brief.pdf
This table of the pharmacological actions of foods was prepared by a leading cardiologist:
BP Medication Antihypertensive Food with similar mechanism
|ACE inhibitors||Egg yolk, Fish, Garlic, Gelatin, Hawthorne berry, Milk casein, whey and sour milk, Sake, Kelp, Wakame, corn protein
|ARB||Celery, Fiber, Garlic, Olive Oil, Nuts, Avocados, Olives
|Calcium blockers||Hawthorne berry, Celery, Garlic, Olive Oil
|Alpha-agonists||Celery, Fiber, Garlic, Protein
|Diuretics||Hawthorne berry, Celery, Protein
From: Houston, MD, M. Nutrition and Nutraceutical Supplement for the Treatment of Hypertension, 2013, J. of Clinical Hypertension.
EXAMPLE 2-APPLYING WHAT YOU KNOW ABOUT HEART DISEASE: Mediterranean Diet, including the right olive oil. It is the one that tastes peppery. Learn more at the Quail and Olive, Carmel Valley Village. Exercise and social support are essential.
EXAMPLE 3-APPLYING WHAT YOU KNOW ABOUT DIABETES: Refined Sugar is actually a drug and is part of the triad of compounds (salt, sugar, fat) that the processed food industry uses to assure a return customer. Check out: Salt Sugar Fat: how the food giants hooked us by Michael Moss
Lifestyle management is a more complex undertaking than just taking a daily pill. Change in diet, exercise, weight reduction, stress management, supplements are all part of this integrated treatment system.
August is National Coffee Month! Research supports many benefits of coffee and tea drinking, just hold the sugar! Research at the Coffee Institute: http://vanderbilt.edu/ics/coffee-news/ shows a reduction in Parkinson’s disease, colon cancer, liver cancer and Type II Diabetes.
Shanahan MD, Catherine. Deep Nutrition: Why your genes need traditional food. Flatiron Books, 2016.
Houston MD, M. What your doctor may not tell you about hypertension. Warner, 2003.
De La Fort, Rosalee. Alchemy of Herbs. Hay House, 2017.
Chinese Medicine has a rich and complex system of Food Cures. Here are some books from that tradition:
Pitchford, Paul. Healing with Whole Foods: Asian traditions and modern nutrition. Encyclopedic book requiring a basic understanding for five element theory.
Thunderhawk, Denise L. Ac. The 5 Element Guide to Healing with Whole Foods. LuLu Press, 2016. This is a basic and quite good introduction to five element nutrition.MORE