Enhancing Your Immune System This Winter

This year promises to be a difficult flu season.  

Below are some of practical ways to enhance your immune system:

• Self Care Program:
  • Sleep early and wake up early (8 hours)
  • Use food as medicine - Optimize your biochemistry through your choice of food - fresh vegetables and fruits can provide with many of micronutrients such as vitamins.  High quality protein and fat are also important.
  • Deep breathing - I do this first thing in the morning - easier to do when everyone else in the house is still sleeping (see first step - sleep early and wake up early)
  • Walk under the sun 10 - 20 minutes three times a day
• Supplements:
  • For myself, I take a daily anti-inflammatory detox containing essential vitamins using WellJourney Clear.
  • In addition, I take medicinal mushrooms (WellJourney Defend) daily.
  • I also take a Chinese herbal formula containing astralagus when I am giving care to patients with respiratory infection - Bu Zhong Yi Qi Tang.

Please remember that supplements work best in addition to your self-care program.  Be well this Winter.

Yoon Hang "John" Kim, M.D., M.P.H.

Georgia Integrative Medicine

678.814.1333

 

Blog: www.mindfulwise.com

Facebook: facebook.com/georgiaintegrative

Twitter:    @GAIntegrativMed

 

Author: Tao of Healing: A Story of Georgia Integrative Medicine

Instructor: 2015 Winter Integrative Health Studies e-course

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Treating Depression with Integrative Medicine: An Evidence-Based Approach

Yoon Hang John Kim* MD MPH and **Jeanne Bowers LAPC

Georgia Integrative Medicine

www.georgiaintegrativemedicine.com

What is Depression?

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of wellbeing(1). Depressed people can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable and/or restless. They may lose interest in activities that were once pleasurable, experience either loss of appetite or overeat, have problems concentrating, have difficulty remembering details or making decisions, and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present. (2)

According to the CDC, about 9% of Americans report they are depressed at least occasionally, and 3.4% suffer from major depression.(3) The analysis, part of the CDC’s Morbidity and Mortality Weekly Report(MMWR) for Oct. 1, was based on a survey of 235,067 people aged 18 and older in 45 states, Washington, D.C., Puerto Rico, and the Virgin Islands.

Depressed mood may not require any professional treatment, and may be a normal reaction to certain life events, a symptom of some medical conditions, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition, e.g., of a mood disorder, which may benefit from treatment. (4)

What is Integrative Medicine?

Integrative medicine is healing-oriented medicine that takes into account the whole person. In integrative medicine, an examination of the whole extends to exploring a patient’s spirituality, emotional state, relationships, and behaviors as they relate to health and wellness.  Integrative medicine draws from conventional as well as complementary and alternative medicine, and offers an array of treatment and care options from each field that may be used alone or in combination. (5)

Integrative medicine utilizes the strengths of conventional medicine and the wisdom of complementary and alternative healing modalities. Alternative modalities include acupuncture, Chinese herbs, and supplements (5).

Evidenced Based Medicine & Cochrane Library

Evidence-based medicine emphasizes the use of evidence from well-designed and conducted research in healthcare decision-making. The term “evidence-based medicine” was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians (6).

Cochrane Reviews, a database of systematic reviews and meta-analyses which summarize and interpret the results of medical research. The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine (7).

Evaluation of Integrative Medicine Modalities to Treat Depression:

Music therapy for depression
Authors’ concluded that the findings from individual randomized trials suggest that music is accepted by people with depression and is associated with improvements in mood. However, the authors express concern due to small number and low methodological quality of studies (8).

Exercise for depression
Authors concluded that exercise is moderately effective for reducing symptoms of depression, but methodologically robust trials only shows a small effect.  When compared to psychological or pharmacological therapies, exercise appears to be no more effective, though this conclusion is based on a few small trials (9).

St. Johns-wort-for-treating-depression
Authors concluded that the hypericum extracts tested in the included trials a) are superior to in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants (10).

Light Treatment for Non-SAD Depression
Authors concluded that for patients suffering from non-seasonal depression, light offers modest though promising anti-depressive effect , especially when administered during the first week of treatment, in the morning. Authors caution that due to limited and of studies these results need to be interpreted with caution. (11)

Discussion:

The art of practicing medicine is based on science of medicine.  However, the art goes further and deeper than what the current evidence provides the practitioners.  For example, in addition to music therapy, exercise, light treatment, and St. John’s Wort, I have seen impressive results with acupuncture with electrical stimulation.  In addition, Chinese herbs can also provide a valuable additional tool for treating depression.  Lastly, counseling allows patients to experience growth and healing in a time of great suffering.

Conclusion: 

A current review of evidence indicates that music therapy, exercise, St. John’s Wort, and light therapy all have positive anti-depressive effect.  However, the number of studies are small and the quality of the studies are low.

Caution:

If you have symptoms of severe depression or suicidal ideations, you need to seek out an experienced integrative medicine physician, psychiatrist, or counselor.

References:

1. Salmans, Sandra (1997). Depression: Questions You Have – Answers You Need. People's Medical Society. ISBN 978-1-882606-14-6.
2. "NIMH · Depression". nimh.nih.gov. Retrieved 15 October 2012.
3. http://www.cdc.gov/mmwr/pdf/wk/mm5938.pdf
4. Cheog J et al. for PsychCentral.com. Last reviewed August 26, 2010. Frequently Asked Questions About Depression Accessed May 11, 2013
5. http://www.georgiaintegrativemedicine.com/Integrative_Medicine.html
6. Evidence-Based Medicine Working Group (November 1992). "Evidence-based medicine. A new approach to teaching the practice of medicine". JAMA 268 (17): 2420–5.
7. http://en.wikipedia.org/wiki/Cochrane_Library
8. Maratos A, Gold C, Wang X, Crawford M. Music therapy for depression. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004517. DOI: 10.1002/14651858.CD004517.pub2.
9.Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE. Exercise for depression. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub6 - See more at: http://summaries.cochrane.org/CD004366/DEPRESSN_exercise-for-depression#sthash.DrCaPbSh.dpuf
10. Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3

11. Tuunainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004050. DOI: 10.1002/14651858.CD004050.pub2.

* Yoon Hang John Kim, Director, Georgia Integrative Medicine. E-mail: drkim@georgiaintegrative.com

** Jeanne Bowers, Counselor, Georgia Integrative Medicine. E-mail: jeanne@georgiaintegrative.coms

Insured, but Bankrupted by Health Crises

http://www.nytimes.com/2009/07/01/business/01meddebt.html?ref=business

Above is a link about the U.S. healthcare problems faced by millions of Americans.
As health care fix is being investigated by the Obama administration, I hope that it will consider the suffering of its people and come up with a viable solution.

How Safeway Is Cutting Health-Care Costs

http://online.wsj.com/article/SB124476804026308603.html

Above is an article published by the Wall Street Journal written by the CEO of Safeway.

By all accounts, our health care is in deep trouble. The US spends the most of money in health care only to claim 37th in the world right after Costa Rica. There are growing population of the US, more than 48 million people, who does not have insurance. More and more businesses are not able to afford providing insurance to the employees.

The article points out how we can learn from the auto industry. Provide financial incentives for health associated behaviors and provide financial disincentives for illness associated behaviors. It's pretty simple really. When people realize preventive measurements such as blood pressure, cholesterol, and weight result in increased premiums, they have a tendency to want to self correct the behavior.

Safeway implemented this policy and found that they can save 40%. Perhaps, the rest of the U.S. can learn from this experience.

Cost-Effective Ways to Fight Insomnia

http://www.nytimes.com/2009/06/06/health/06patient.html?_r=1&scp=1&sq=insomnia&st=cse

Dalai Lama said "Sleep is best meditation." I agree.
Lack of sleep can easily account for many of the chronic illnesses in the U.S. While, I cannot say that lack of sleep or chronic sleep deprivation causes illnesses, it can contribute to the ill effects of chronic illnesses.

I find that sleeping problems are often the most sensitive indicator of overall health and wellness. Often times, sleep disturbances will precede an episode of illness or a bout of depression or anxiety.

A good sleep resets our body and mind and renews our spirit. I find good sleep to be most cost effective ways for wellness. Integrative Medicine is a wonderful asset to help people to restore a good sleep.

Dr. Rubin Naiman, a faculty at Dr. Weil's faculty, suggest below suggestions for improving sleep:

Recommended Lifestyle Changes for Insomnia Treatment:

from Dr. Weil's website: http://www.drweil.com/drw/u/ART02004/insomnia

The following are some of the best possible insomnia remedies:

• Establish a consistent bedtime routine. This is one of the most important factors in insomnia treatment and maintaining good sleeping habits. Routines may include taking a warm bath or a relaxing walk in the evening, or practicing meditation/relaxation exercises as part of your regular nighttime routine.
• Try to go to bed at the same time every night, and get up at the same time each morning. This includes weekends.
• Get plenty of exercise during the day. Studies have shown that people who are physically active sleep better than those who are sedentary. The more energy you expend during the day, the sleepier you will feel at bedtime. Just be sure not to engage in vigorous exercise too close to bedtime as that can make it more difficult to fall asleep.
• Reduce your intake of caffeine, particularly in the evening.
• Avoid stimulants like caffeine and limit alcohol. Both, even when consumed early in the day, can affect sleep and inhibit insomnia treatment.
• Use your bed only for sleeping and sex. Don’t use it to do work or watch TV.
• Avoid large meals late in the evening.
• If you can’t fall asleep within half an hour of going to bed, get up and read or do something calming until you feel sleepy.
• Learn and use a relaxation technique regularly.Breathing exercises, meditation and yoga are not insomnia cures, but do lead to a state conducive to sleep.
• Use “white noise” devices to block out surrounding environmental noise.
• Take a hot bath before bedtime. Try a few drops of relaxing oil of lavender in the water.
• Short naps are good. Try to get into the habit of napping for insomnia treatment: ten to twenty minutes in the afternoon, preferably lying down in a darkened room.
• Spend some time outdoors as often as you can to get exposure to bright, natural light. If you are concerned about harmful effects of solar radiation, do it before ten in the morning or after three in the afternoon or use sunscreen.
• Try to give yourself some time - up to an hour - in dim light before you go to sleep at night. Lower the lighting in your house and bedroom and if other members of the household object, wear sunglasses.
• The two best natural sleep aids are valerian and melatonin. Valerian is a sedative herb, used for centuries. You can find standardized extracts in health food stores and pharmacies. Take one to two capsules a half hour before bedtime. Melatonin is a hormone that regulates the wake/sleep cycle and other daily biorhythms. Try sublingual tablets (to be placed under the tongue and allowed to dissolve); take 2.5 mg at bedtime as an occasional dose, making sure that your bedroom is completely dark. A much lower dose, 0.25 to 0.3 mg, is more effective for regular use.
• Don’t obsess about not sleeping. Not surprisingly, studies have shown that individuals who worry about falling asleep have greater trouble dropping off. It may help to remind yourself that while sleeplessness is troublesome, it isn’t life-threatening and there are insomnia remedies.

If All Doctors Had More Time to Listen

http://www.nytimes.com/2009/06/07/health/07health.html?_r=1&em

Above is an article in NY Times on If All Doctors Had More Time to Listen.

I feel priviledged to be part of the team at Georgia Integrative Medicine. We make the time to listen to our patients. Patients have ready access to Dr. Kim. Patients spend about one hour being treated for each visit. For complex patients, we spend up to four hours performing a comprehensive evaluation known as the team visit.

We have patients who are choosing us over their regular physicians and over other integrative medicine physicians because we choose to listen to our patients. Even our growth is managed to ensure that our existing patients have a ready access to Dr. Kim.

At Georgia Integrative Medicine, we understand that our patients are the experts on their bodies and in order to help, we have to listen and understand to their healing journey. Carl Rogers was a humanistic psychologist who understood the importance of "client-centered" therapy. He understood the importance of listening mindfully to what his clients had to say. At Georgia Integrative Medicine, we honor the Rogerian tradition and perform that mindful listening to the best of our ability.

Jeanne Bowers
Clinic Manager

Helath Benefits of Omega 3 Fatty Acids

http://en.wikipedia.org/wiki/Omega_3_fatty_acids

Above is a link for Omega 3 fatty acids from Wikipedia.
Omega 3 fatty acids is all the rage these days. So, what is omega 3 fatty acids?

First of all, omega 3 fatty acids are essential fatty acids. That means our body is not capable of making them ourselves. We have to obtain it from our nutrition or supplements.

Below are from the Wikipedia article:

• The benefits of omega 3 fatty acids were discovered in the 1970s by researchers studying the Greenland Eskimos. The Greenland Eskimos consumed large amounts of fat from seafood, but displayed virtually no cardiovascular disease. The high level of omega-3 fatty acids consumed by the Eskimos reduced triglycerides, heart rate, blood pressure, and atherosclerosis.
• On September 8, 2004, the U.S. Food and Drug Administration gave "qualified health claim" status to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) n−3 fatty acids, stating that "supportive but not conclusive research shows that consumption of EPA and DHA [n−3] fatty acids may reduce the risk of coronary heart disease." This updated and modified their health risk advice letter of 2001 (see below). Currently regulatory agencies do not accept that there is sufficient evidence for any of the other suggested benefits of DHA and EPA other than for cardiovascular health, and further claims should be treated with caution.

• The Canadian Government has recognized the important of DHA omega-3 and permits the following biological role claim for DHA: "DHA, an omega-3 fatty acid, supports the normal development of the brain, eyes and nerves."
• The 18 carbon α-linolenic acid has not been shown to have the same cardiovascular benefits as DHA or EPA. Currently there are many products on the market which claim to contain health promoting 'omega 3', but contain only α-linolenic acid (ALA), not EPA or DHA. These products contain mainly higher plant oils and must be converted by the body to create DHA and therefore considered less efficient. DHA and EPA are made by microalgae that live in seawater. These are then consumed by fish and accumulate to high levels in their internal organs. If a person is concerned about mercury and oceanborne contaminants in fish, DHA can be produced directly from microalgae as a vegetarian source.
• Some benefits have been reported in conditions such as rheumatoid arthritis and cardiac arrhythmias.
• Some research suggests that fish oil intake may reduce the risk of ischemic and thrombotic stroke. However, very large amounts may actually increase the risk of hemorrhagic stroke (see below). Lower amounts are not related to this risk, 3 grams of total EPA/DHA daily are considered safe with no increased risk of bleeding involved^[and many studies used substantially higher doses without major side effects (for example: 4.4 grams EPA/2.2 grams DHA in 2003 study).

At Georgia Integrative Medicine, the correct use of omega 3 fatty acids form an important part of the treatment protocol. Most plant sources yield ALA not EPA or DHA. Therefore, the preferred sources are from marine animals including Krill, Anchovies, Sardines, and Salmon. One potential problem taking marine based EPA/DHA is the exposure to heavy metal contaminants which can cause health problems. This can be avoided by buying from a reputable producer of omega 3 fatty acids with molecular distillation and asking to see the certificate of analysis.