Why Lived Experience Matters in Alpha-Gal Syndrome

Why Lived Experience Matters in Alpha-Gal Syndrome

by | Sep 3, 2026 | Acupuncture, Immune Health, Musculoskeletal Health, Naturopathic Medicine

Sometimes progress in healthcare begins with research.

And sometimes it begins when someone tells their story—and we listen closely enough to recognize that there may be an important question hiding within it.

That is one reason I was drawn to participate in the 2026 LymeX Healthathon, a national initiative designed to elevate the lived experiences of patients, caregivers, clinicians, and others affected by Lyme disease, tickborne conditions, and complex chronic illness.

The goal is not simply storytelling for storytelling’s sake. Real-world experiences can reveal patterns, unmet needs, and questions that may otherwise be difficult to see.

For me, one of those questions involves alpha-gal syndrome.

Why Alpha-Gal Belongs in the Tickborne Disease Conversation

Alpha-gal syndrome, or AGS, is a potentially serious tickborne allergy to a molecule called alpha-gal, which is found in most non-primate mammals.

It is sometimes described simply as a “red meat allergy,” but that description does not fully capture what living with alpha-gal can involve.

Depending on individual sensitivity, navigating AGS may require careful attention to things such as mammalian meat and other foods, dairy products for some individuals, gelatin and mammalian-derived ingredients, certain medications and supplements, restaurant meals, travel and social gatherings, and future tick exposure. Even a vegan diet may not eliminate every possible concern. Carrageenan, a red-seaweed-derived ingredient used in some plant-based foods, has been discussed as a possible trigger in a small subset of people with alpha-gal syndrome. In my own practice, one patient described an apparent reaction during a beach exposure involving Irish sea moss—another reminder of how difficult identifying potential triggers can sometimes be.

And alongside those practical concerns can come something much harder to measure: the mental load of constantly wondering whether something is safe.

In my clinical work with people affected by alpha-gal, I have heard about fear, hypervigilance, frustration, social limitations, and lives increasingly organized around avoiding a reaction.

That lived experience matters.

Alpha-Gal Is More Than Food

For my Healthathon submission, “When Hope Returns After Alpha-gal,” I shared the experience of one family who generously gave me written permission to tell their story anonymously.

Their daughter had experienced years of gastrointestinal symptoms, food restrictions, medical evaluations, and uncertainty. Her family kept searching for answers while trying to understand why ordinary foods could lead to such difficult experiences.

What stayed with me most, however, was not simply what she was eventually able to eat.

It was what her mother said about how life felt different:

“She finally feels included.”

That sentence captures something a laboratory value cannot.

For a child, eating is woven into birthday parties, school events, vacations, family dinners, celebrations, and simply being one of the kids.

When illness changes someone’s relationship with all of those things, improving quality of life can mean far more than changing a food list.

A “Glimmer of Hope”

After years of searching, this family pursued Soliman Auricular Allergy Treatment (SAAT), an auricular acupuncture approach being used by some practitioners for allergy-related conditions.

Following treatment, KJ’s mother reported that foods that had previously caused problems were no longer producing the symptoms their family had come to expect. She described her daughter eating foods she had avoided for years, feeling less different from other children, and participating more freely in everyday life.

Her mother called finding this option “a glimmer of hope.”

Their experience was incredibly meaningful to their family. But it is also important to be clear about what a story like this can—and cannot—tell us.

One patient’s experience does not establish that SAAT is effective for everyone with alpha-gal syndrome.

Instead, experiences like this make me want to ask better questions:

Can we measure what is happening?

Can these results be reproduced?

Who may benefit?

How durable are the changes?

And why might they occur?

Those are research questions.

And I believe they are questions worth asking.

Where Lived Experience and Research Meet

Evidence-based healthcare and patient experience should not have to compete with one another.

Patient stories can help generate hypotheses. Clinical observations can identify signals worth investigating. Rigorous research can then help us determine whether those signals represent meaningful, reproducible effects—and where the limitations lie.

This is particularly important when people living with complex or poorly understood conditions feel that the options available to them are limited.

We should neither dismiss encouraging clinical observations simply because we do not yet fully understand them nor accept them uncritically because the outcome is compelling.

We should get curious and study them well.

That is one of the ideas I most wanted to contribute through the LymeX Healthathon.

Why the LymeX Healthathon Matters

One thing I appreciate about this initiative is the recognition that patients, families, and clinicians may see pieces of the healthcare puzzle that are difficult to capture through traditional research alone.

Lived experience does not replace science.

It can help tell us where science needs to look next.

For alpha-gal syndrome in particular, I would like to see greater awareness of the full burden of the condition, better support for affected individuals and families, and thoughtful research into approaches that might one day expand the options available to them.

Most of all, I want people living with alpha-gal to know that their experiences matter—and that hope and scientific curiosity do not have to be opposites.

When Hope Returns After Alpha-Gal

Community voting is now open for the LymeX Healthathon, and my submission, “When Hope Returns After Alpha-gal,” is available to read and watch.

If you would like to support the story, I would be grateful if you would:

  • Read or watch the submission
  • Vote for it if it resonates with you
  • Leave a thoughtful comment about what stood out to you or why greater awareness and research in this area matter
  • Share it with others who may be interested in alpha-gal or tickborne conditions

View “When Hope Returns After Alpha-gal”: https://lymex.crowdicity.com/post/891694

I also encourage you to explore the stories shared by other Healthathon participants. There is tremendous value in hearing directly from people whose lives have been affected by tickborne and complex chronic conditions.

Sometimes a story offers comfort.

Sometimes it raises awareness.

And sometimes it gives us the next question worth investigating.

Sources & Further Reading

For reliable information about alpha-gal syndrome and the LymeX Healthathon, I encourage readers to explore these resources:

Centers for Disease Control and Prevention (CDC). About Alpha-gal Syndrome.

An overview of alpha-gal syndrome, symptoms, tick exposure, diagnosis, and management.

https://www.cdc.gov/alpha-gal-syndrome/about/index.html

Centers for Disease Control and Prevention (CDC). Fast Facts: Products That May Contain Alpha-gal.

Information about mammalian-derived foods, ingredients, medications, and other products that may be relevant for people living with alpha-gal syndrome.

https://www.cdc.gov/alpha-gal-syndrome/data-research/products-containing-alpha-gal/index.html

National Institutes of Health (NIH). LymeX Healthathon.

Information about the national LymeX initiative and its emphasis on lived experience, tickborne conditions, innovation, and shared learning.

https://www.nih.gov/challenges/lymex-healthathon

LymeX Healthathon. When Hope Returns After Alpha-gal.

My Healthathon submission exploring one family’s experience with alpha-gal syndrome, quality of life, hope, SAAT, and questions for future research.

https://lymex.crowdicity.com/post/891694

About the Author

Sarah Giardenelli, ND, MSOM, LAc, is a naturopathic doctor and licensed acupuncturist at Collective Health Center. Her clinical work includes individualized naturopathic and acupuncture care for people with complex health concerns, including alpha-gal syndrome and other allergy-related conditions.

Medical Disclaimer

This article is for educational and informational purposes only and is not intended to provide medical advice, diagnosis, or individualized treatment recommendations. The experience described here represents one family’s reported experience and should not be interpreted as evidence that SAAT will produce the same results for others. Alpha-gal syndrome can cause serious or life-threatening allergic reactions. Individuals with known or suspected alpha-gal syndrome should work with an appropriately qualified healthcare professional for diagnosis, risk assessment, and management.

 Collective Health Center

Excellence in Naturopathic Medicine, Acupuncture, and Integrative Medicine in Leesburg, Virginia for Complex Conditions and Chronic Pain in a Warm and Nurturing Environment.

Are you frustrated of dealing with your symptoms?

Are you ready to look for the answers & optimize your health with natural medicine?

This is how we help.

Contact Us!

11 + 14 =

Beyond Being Double-Jointed: Thumb Hypermobility and Dysautonomia

Beyond Being Double-Jointed: Thumb Hypermobility and Dysautonomia

by | Aug 3, 2026 | Cardiovascular Health, Digestion/GI Health, Musculoskeletal Health, Naturopathic Medicine, Nerve Health

What We Know About Dysautonomia in Hypermobile EDS and Hypermobility Spectrum Disorders

Many people think of hypermobility as simply being "double-jointed."

Perhaps you've always been more flexible than your peers. Maybe you could do the splits as a child, bend your fingers in unusual ways, or were told you were simply "very flexible." For some individuals, hypermobility is relatively benign. For others, it may be part of a broader condition such as Hypermobile Ehlers-Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD).

What surprises many patients is that the symptoms often extend far beyond the joints.

Dizziness. Fatigue. Brain fog. Digestive problems. Bladder dysfunction. Temperature intolerance. Heart palpitations. Exercise intolerance. Anxiety-like symptoms.

At first glance, these symptoms may seem unrelated. Patients often find themselves seeing multiple specialists, collecting multiple diagnoses, and wondering whether anyone is looking at the bigger picture.

Increasingly, researchers believe that autonomic dysfunction—also known as dysautonomia—may be one of the important threads connecting many of these seemingly unrelated symptoms.

What Is the Autonomic Nervous System?

The autonomic nervous system (ANS) is the body's automatic control system. It regulates countless functions that occur without conscious thought, including:

  • Heart rate
  • Blood pressure
  • Blood vessel tone
  • Digestion and gut motility
  • Bladder function
  • Sweating
  • Temperature regulation
  • Breathing patterns

When functioning normally, the autonomic nervous system continuously adapts to keep the body in balance.

When it becomes dysregulated, symptoms can emerge throughout multiple organ systems.

Why Is Dysautonomia So Common in Hypermobile Patients?

Researchers do not yet have all the answers, but several overlapping mechanisms have emerged that may help explain the connection.

1. Connective Tissue Laxity and Blood Pooling

Connective tissue provides structural support throughout the body, including within blood vessel walls.

In individuals with hEDS and HSD, blood vessels may be more elastic and less able to maintain their shape against gravity. When standing, blood can pool excessively in the legs and lower body.

This reduces blood return to the heart and brain.

To compensate, the autonomic nervous system may increase heart rate and release stress hormones such as adrenaline in an attempt to maintain blood pressure and circulation.

For some individuals, this contributes to symptoms associated with Postural Orthostatic Tachycardia Syndrome (POTS), including:

  • Dizziness
  • Lightheadedness
  • Rapid heart rate
  • Brain fog
  • Fatigue
  • Exercise intolerance

2. Small Fiber Neuropathy

One of the most exciting areas of current research involves small fiber neuropathy (SFN).

Small nerve fibers help regulate many autonomic functions, including heart rate, blood pressure, digestion, sweating, temperature regulation, and bladder function. These nerves also play a role in pain and sensory perception.

Multiple studies have identified evidence of small fiber abnormalities in patients with hypermobile EDS and Hypermobility Spectrum Disorders. This suggests that autonomic symptoms may not simply be a secondary consequence of hypermobility but may also involve direct dysfunction of the nerves responsible for autonomic regulation.

In other words, the body's communication network itself may be impaired.

3. Dysfunction of the Body's Pressure Sensors

The body relies on specialized sensors called baroreceptors to detect changes in blood pressure and help regulate circulation.

Some researchers have proposed that connective tissue laxity may affect these pressure-sensing systems. If these sensors become overly sensitive—or less accurate—the nervous system may overreact to relatively minor changes in position or blood pressure.

This remains an area of ongoing investigation, but it may help explain why some patients experience dramatic symptoms when standing, during heat exposure, after meals, or when dehydrated.

4. Mast Cell Activation and Blood Vessel Instability

Many patients with hEDS and HSD also report symptoms consistent with Mast Cell Activation Syndrome (MCAS).

Mast cells release chemical mediators such as histamine that influence blood vessel tone, permeability, immune signaling, and inflammation.

When these mediators are released excessively, blood vessels may dilate, blood pressure may fluctuate, and symptoms such as flushing, palpitations, dizziness, itching, digestive symptoms, and fatigue may worsen.

While researchers are still working to fully understand the relationship between hypermobility, mast cells, and dysautonomia, clinicians frequently observe significant overlap among these conditions.

5. Deconditioning: Cause, Consequence, or Both?

Many individuals living with chronic pain, fatigue, dizziness, and exercise intolerance naturally become less active over time.

This can lead to cardiovascular deconditioning, including reduced blood volume and decreased cardiovascular fitness.

Unfortunately, deconditioning can worsen autonomic symptoms, creating a frustrating cycle:

Symptoms → Reduced Activity → Deconditioning → More Symptoms

Importantly, this does not mean dysautonomia is caused by being "out of shape." Rather, deconditioning often develops as a consequence of living with chronic symptoms and may further amplify the underlying problem.

Why So Many Patients Also Have Digestive Symptoms

For many years, gastrointestinal symptoms in hypermobile individuals were viewed as separate issues. Today, researchers increasingly recognize that autonomic dysfunction may be one of the major factors linking hypermobility and digestive complaints.

The autonomic nervous system helps regulate movement throughout the digestive tract. When autonomic signaling becomes disrupted, patients may experience:

  • Reflux
  • Nausea
  • Early fullness
  • Bloating
  • Constipation
  • Diarrhea
  • Abdominal pain
  • Delayed stomach emptying (gastroparesis)

The Ehlers-Danlos Society notes that gastrointestinal symptoms are common in both hypermobile EDS and Hypermobility Spectrum Disorders and can significantly impact quality of life. Researchers have identified important relationships among hypermobility, disorders of gut-brain interaction, gastrointestinal dysmotility, and autonomic dysfunction.

For many patients, understanding this connection can be profoundly validating. Digestive symptoms may not be isolated problems but rather another expression of the same underlying physiologic processes affecting multiple body systems.

Why Understanding the "Why" Matters

As a naturopathic doctor, one of the most important lessons I have learned from caring for patients with hypermobile Ehlers-Danlos syndrome and Hypermobility Spectrum Disorders is that symptoms rarely exist in isolation.

Patients may arrive carrying diagnoses from multiple specialists—POTS, IBS, chronic constipation, migraines, bladder dysfunction, chronic fatigue, mast cell activation syndrome, anxiety, or chronic pain—yet still feel that no one has connected the dots.

One of the core principles of naturopathic medicine is Tolle Causam—identify and address the cause. Another is to treat the whole person rather than focusing on individual symptoms or organ systems.

While we do not yet have all the answers regarding dysautonomia in hEDS and HSD, understanding the underlying physiologic mechanisms helps us move beyond symptom management and toward a more comprehensive understanding of why these seemingly unrelated symptoms may occur together.

The better we understand the "why," the better equipped we are to support patients living with these complex conditions.

What New Research Is Teaching Us

One of the most significant developments in recent years comes from a 2025 study by Novak and colleagues that evaluated 270 individuals with hypermobile Ehlers-Danlos syndrome using comprehensive autonomic, neurologic, and cerebrovascular testing.

The researchers identified several important findings, including:

  • Evidence of widespread autonomic dysfunction
  • Reduced cerebral blood flow when standing
  • Frequent symptoms of cerebral hypoperfusion, including dizziness and brain fog
  • High rates of small fiber neuropathy
  • Evidence of cerebrovascular dysregulation

The authors concluded that hypermobile EDS is associated with measurable cerebrovascular, autonomic, and neuropathic abnormalities rather than simply representing a musculoskeletal condition.

These findings are important because they provide objective physiologic evidence supporting what many patients have reported for years—that their symptoms extend far beyond joint hypermobility alone.

At the same time, this study raises as many questions as it answers. Researchers are still working to determine whether small fiber neuropathy is a primary driver of dysautonomia, whether connective tissue abnormalities initiate the process, how mast cell activation fits into the picture, and why some individuals are significantly more affected than others.

While much remains to be learned, the field is moving rapidly toward a more integrated understanding of the relationship between connective tissue, the autonomic nervous system, circulation, immune signaling, and gastrointestinal function.

Looking Beyond the Joints

Historically, hypermobility disorders were viewed primarily through a musculoskeletal lens. Increasingly, however, research suggests that for many patients, these conditions are far more systemic.

The emerging picture is one of a complex, multisystem condition involving connective tissue, the autonomic nervous system, immune regulation, gastrointestinal function, and potentially small nerve fiber integrity.

While researchers are still working to understand exactly how these systems interact, it is becoming increasingly clear that dysautonomia may represent one of the key threads connecting many of the symptoms experienced by individuals with hypermobile EDS and Hypermobility Spectrum Disorders.

For patients who have spent years searching for answers, that recognition matters.

Understanding the underlying mechanisms does not solve every problem, but it provides a framework for more targeted evaluation, more personalized treatment approaches, and perhaps most importantly, validation that these symptoms are real, interconnected, and worthy of further investigation.

The more we learn, the more connected these systems appear to be.

And perhaps most importantly, the more we understand these connections, the better positioned we are to provide meaningful, individualized care for the people living with them.

References

Novak P, et al. Cerebrovascular, autonomic and neuropathic features of hypermobile Ehlers-Danlos syndrome. 2025.

The Ehlers-Danlos Society. Gastrointestinal Problems in Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders.

About the Author

Dr. Sarah Giardenelli, ND, MSOM, LAc is a naturopathic doctor, licensed acupuncturist, and founder of Collective Health Center in Leesburg, Virginia. She specializes in helping individuals with complex chronic health conditions uncover the root causes contributing to their symptoms through an integrative, evidence-informed approach.

Over the years, Dr. Giardenelli has worked with many individuals living with hypermobile Ehlers-Danlos syndrome, Hypermobility Spectrum Disorders, dysautonomia, mast cell activation syndrome, chronic gastrointestinal dysfunction, and related complex chronic illnesses. These patients have been some of her greatest teachers.

"The more I work with individuals living with hypermobility disorders, the more I appreciate how interconnected the body's systems truly are. Their experiences continually challenge us to think beyond isolated symptoms and to look deeper at the relationships between connective tissue, the nervous system, immune function, circulation, and gastrointestinal health. They remind us that good care begins with listening, curiosity, and a willingness to keep learning." ~Dr. Sarah

Medical Disclaimer

This article is intended for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional regarding questions about your health.

 Collective Health Center

Excellence in Naturopathic Medicine, Acupuncture, and Integrative Medicine in Leesburg, Virginia for Complex Conditions and Chronic Pain in a Warm and Nurturing Environment.

Are you frustrated of dealing with your symptoms?

Are you ready to look for the answers & optimize your health with natural medicine?

This is how we help.

Contact Us!

4 + 13 =

Can Alzheimer’s Disease Be Prevented? 14 Modifiable Risk Factors That May Reduce Dementia Risk

Can Alzheimer’s Disease Be Prevented? 14 Modifiable Risk Factors That May Reduce Dementia Risk

by | Jun 12, 2026 | Brain Health, Naturopathic Medicine, Prevention

Nearly Half of Dementia Risk May Be Modifiable—What I Share With Patients

When patients ask me about Alzheimer's disease, the question is often some version of:

"Is there anything I can actually do to prevent this?"

For many years, Alzheimer's disease was viewed largely through the lens of age and genetics. While those factors remain important, research over the past several decades has expanded our understanding of the lifestyle, health, and environmental factors that may influence cognitive decline.

According to the 2024 update from the Lancet Commission on Dementia Prevention, Intervention, and Care, approximately 45% of dementia cases worldwide may be attributable to modifiable risk factors across the lifespan.

That's a powerful statistic—but it's one I think is important to interpret thoughtfully.

Because this is not about eliminating risk or getting everything "right." It's about understanding how the environment your brain lives in over decades may influence its resilience and function as you age.

What "45% Modifiable Risk" Actually Means in Practice

This number comes from something called Population Attributable Fraction, which estimates how many cases of a condition might be reduced if certain risk factors were improved at a population level.

That's helpful from a public health perspective, but in practice, I'm looking at something slightly different:

How are these patterns showing up in the individual sitting in front of me?

Because this doesn't mean Alzheimer's disease is fully preventable, and it doesn't mean any one factor causes the disease. What it does mean is that there are meaningful ways to support brain health over time—and that those efforts are not insignificant.

The 14 Modifiable Risk Factors for Alzheimer's Disease and Dementia

The Lancet Commission organizes these risk factors across the lifespan, which is a helpful way to think about timing and opportunity.

Early Life and Cognitive Reserve

Lower levels of formal education are associated with increased dementia risk. This relates to cognitive reserve—the brain's ability to adapt and compensate over time.

While we can't go back and change early education, we can continue to build cognitive reserve through learning, engagement, and mental stimulation throughout life.

Midlife Risk Factors: Where I Often See the Greatest Opportunity

Midlife is often where I focus clinically because this is where many of the highest-impact, modifiable drivers emerge—particularly those tied to metabolic and vascular health.

These include:

  • Hearing loss
  • High blood pressure
  • Obesity
  • Traumatic brain injury
  • Excess alcohol use

In practice, this is often where I see patterns begin to cluster—changes in blood sugar regulation, shifts in weight, rising blood pressure, or early signs of sensory decline. These are rarely isolated issues and often influence one another.

Later Life Risk Factors

In later life, we're often seeing the cumulative effects of long-term patterns.

These include:

  • Smoking
  • Depression
  • Social isolation
  • Physical inactivity
  • Diabetes
  • Air pollution exposure
  • Vision impairment
  • High LDL cholesterol

At this stage, the goal is less about perfection and more about supporting function, quality of life, and continued engagement.

The Common Thread: The Brain Reflects the Whole System

What stands out to me clinically is how much these risk factors overlap in their underlying physiology.

Many of them converge on a few key themes:

  • Blood sugar regulation and insulin resistance
  • Vascular health and circulation to the brain
  • Chronic, low-grade inflammation
  • Sensory input through hearing and vision
  • Social and cognitive engagement

This is why I rarely think about brain health in isolation. In practice, we're often working on metabolic health, inflammation, cardiovascular function, sleep, and nervous system support—and the brain benefits as a result.

If you'd like to learn more about how I approach this in practice, you can learn more about my Well Aging & Senior Care services.

Alzheimer's Disease and Whole-Body Health

One reason these risk factors matter is that Alzheimer's disease is increasingly understood as a condition influenced by processes occurring throughout the body—not solely within the brain.

Many of the same factors that contribute to cardiovascular disease and metabolic dysfunction—including insulin resistance, vascular changes, chronic inflammation, and reduced physical activity—also appear to influence cognitive decline and dementia risk.

This is one reason I often focus on foundational aspects of health such as blood sugar regulation, cardiovascular health, sleep quality, physical activity, and inflammation. Supporting these systems benefits overall health and may also help support long-term brain health.

Why Hearing Loss is SO Important (and Often Overlooked)

One of the most surprising findings for many people is that hearing loss is consistently among the most significant modifiable risk factors for dementia.

In practice, this makes sense.

When hearing declines, the brain receives less input. Social interaction often decreases. The brain must work harder to interpret sound, increasing cognitive load.

Over time, this can contribute to withdrawal, fatigue, and reduced stimulation—all of which may influence cognitive health.

Addressing hearing changes early is one of the more straightforward—and often underutilized—interventions we have.

What This Looks Like in Practice

When I'm working with patients, I'm often looking at the broader patterns that influence brain health and healthy aging.

Instead, I'm looking at patterns such as:

  • Blood sugar variability or insulin resistance
  • Lipid patterns and cardiovascular risk
  • Inflammatory markers
  • Nutrient status
  • Sleep quality
  • Stress and nervous system load

Often, patients come in for concerns such as fatigue, weight changes, cardiovascular risk, or metabolic health challenges, and we begin addressing these patterns. Over time, we're also supporting many of the systems that influence how the brain ages.

What This Research Doesn't Fully Capture

The Lancet model provides one of the strongest evidence-based frameworks currently available for dementia prevention, but it doesn't address every factor that may influence cognitive health.

In practice, I may also consider areas such as:

  • Gut health and the microbiome
  • Environmental exposures, including mold and heavy metals
  • Mitochondrial function
  • Individual nutrient needs, including vitamin B12 and omega-3 fatty acids

Research in these areas continues to evolve. While they are not currently included among the established modifiable risk factors identified by the Lancet Commission, they may provide additional context in selected patients.

These considerations do not replace the foundational risk factors identified in the research—they simply add another layer of personalization.

A More Grounded Way to Think About Prevention

Rather than asking whether Alzheimer's disease can be prevented, I often guide patients toward a different question:

How can we support your brain's resilience over time?

Because the goal isn't perfect control—it's building capacity.

The capacity to adapt, repair, and maintain function even as the body changes.

Where I Typically Suggest Patients Start

For many people, this work becomes especially relevant in their 40s and 50s—when many of these patterns are still highly modifiable.

Foundational Areas to Support Brain Health

A few foundational areas I tend to focus on include:

  • Stabilizing blood sugar
  • Supporting cardiovascular health
  • Maintaining regular physical activity
  • Addressing hearing or vision changes
  • Supporting sleep and mood
  • Maintaining social connections

These are not quick fixes, but they are meaningful—and they add up over time.

Final Thoughts

The idea that nearly half of dementia risk may be modifiable is not a guarantee.

But it is an invitation.

An invitation to pay attention to the patterns that shape how the brain ages and to make steady, thoughtful changes that support long-term health.

Because in practice, it's rarely one big intervention that makes the difference.

It's what is done consistently, over time.

Concerned About Brain Health?

If you're concerned about cognitive decline, have a family history of dementia, or want to identify modifiable factors that may influence healthy aging, a comprehensive evaluation can help uncover opportunities to support long-term brain health before significant symptoms develop.

Learn more about my Well Aging & Senior Care services to explore a personalized approach to healthy aging, cognitive wellness, and long-term vitality.

References

  1. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet Commission. The Lancet. 2024.
  2. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet. 2020;396(10248):413-446.
  3. Alzheimer's Research UK. Dementia risk factors and prevention resources.
  4. Alzheimer's Disease International. Global dementia reports and statistics.

Photo by David Matos on Unsplash 

About the Author

Dr. Sarah Giardenelli, ND, MSOM, LAc, is a naturopathic doctor and licensed acupuncturist in Leesburg, Virginia. She has a special interest in healthy aging, metabolic health, hormone balance, cognitive wellness, and chronic inflammatory conditions. Through her work at Collective Health Center, she helps patients identify modifiable factors that influence long-term health, resilience, and quality of life.

She combines naturopathic and East Asian medicine with evidence-informed care, focusing on personalized strategies that support healthy aging and long-term well-being.

 Collective Health Center

Excellence in Naturopathic Medicine, Acupuncture, and Integrative Medicine in Leesburg, Virginia for Complex Conditions and Chronic Pain in a Warm and Nurturing Environment.

Are you frustrated of dealing with your symptoms?

Are you ready to look for the answers & optimize your health with natural medicine?

This is how we help.

Contact Us!

9 + 11 =

Perimenopause Isn’t a Problem to Fix—It’s a Phase to Support

Perimenopause Isn’t a Problem to Fix—It’s a Phase to Support

by | May 10, 2026 | Endocrine/Hormone Health, Naturopathic Medicine, Women's Health

We only just start to feel like we understand our bodies… and then things begin to shift again.

For many women, perimenopause doesn’t arrive all at once. It’s more of a slow awareness over time. A few subtle changes here and there—until one day it becomes clear that something is different.

I’ve felt this myself over the past few years.

For me, it’s shown up as changes in body composition—more weight around the midsection, more inflammation. There are clear hormonal waves now, where only part of the month feels like “myself.” Energy dips more noticeably before and during my cycle. And this past winter, the weight gain was more than I expected. Enough to pause and really take a closer look.

This isn’t surprising. I knew this phase was coming. But knowing and experiencing it are two very different things.

And what I see in my own body is exactly what I see in many of my patients.

This Isn’t Just Hormones

Hormones are shifting in perimenopause—that part is true.

But what often gets missed is that this isn’t just about hormones.

One of the biggest underlying shifts I see—both personally and clinically—is increasing insulin resistance.

Even in women who:

  • Eat well
  • Don’t consume much sugar
  • Have “normal” standard lab results

This is where a tool like the QUICKI score can be helpful. It looks at the relationship between glucose and insulin in a way that can reveal patterns not obvious on standard labs.

In my case, my glucose, insulin, and A1c look normal. But my QUICKI score—and the changes in my body—tell a different story.

There are also other factors at play. Some women, myself included, may have androgen patterns that aren’t always easy to track on standard labs, but can still influence metabolism and insulin sensitivity. Diet matters too—even healthy fats, in higher quantities, may not always work well in the setting of insulin resistance.

All of this is happening alongside shifting and declining hormone levels, which further impacts how the body handles blood sugar, energy, and fat storage.

What I See in Practice

In clinic, the patterns are consistent.

Women in their late 30s, 40s, and early 50s often come in saying:

  • “I don’t feel like myself anymore”
  • Sleep is more disrupted
  • Energy is less predictable
  • Mood feels different
  • Libido is lower or absent
  • Weight is harder to lose—despite doing “all the right things”

There are also changes in the menstrual cycle itself:

  • Shorter cycles
  • Irregular timing
  • Skipped ovulation
  • More noticeable hormonal fluctuations throughout the month

And one important clinical reality:

Hormone testing in this phase can be tricky.

Because levels are fluctuating so much, a single snapshot doesn’t always tell the full story. This is often why women are told their labs are “normal,” even when they don’t feel well.

Why This Feels So Frustrating

For many women, this phase feels confusing—not because they aren’t trying, but because what used to work… doesn’t work the same way anymore.

I also see a common pattern:
Years of calorie restriction, dieting, or pushing through fatigue.

Over time, this can make the body less metabolically flexible—and more resistant to change.

So when perimenopause begins, the margin for error gets smaller.

We all want this to be easy.
But for most women in this phase, it’s not.

Common Mistakes I See

A few patterns tend to make things harder:

  • Undereating or chronic calorie restriction
  • Over-exercising
  • Pushing through fatigue instead of responding to it
  • Assuming everything is fine because basic labs are “normal”

These approaches often come from a place of effort and sometimes desperation—but they can backfire in this phase.

What It Actually Looks Like to Support This Phase

If perimenopause isn’t a problem to fix, then what does support look like?

In my practice, it means shifting the focus toward:

  • Metabolic health, especially insulin sensitivity
  • Nourishment, rather than restriction
  • Balanced movement, not overtraining
  • Supporting stress physiology, instead of pushing through

This is not a one-size-fits-all process.

It’s highly personalized—based on symptoms, patterns, lab markers, and how someone is actually feeling in their body.

A Natural and Integrative Approach

There is a lot we can do to support this phase naturally:

  • Nutrition
  • Lifestyle shifts
  • Targeted supplementation

And at the same time, there is also room for an integrative approach.

In many cases, that’s the sweet spot.

This isn’t about choosing one path or another—it’s about finding what works best for each individual.

A Different Way to Look at Perimenopause

If you’re in this phase and things feel off, you’re not imagining it.

Your body is changing.
Your physiology is shifting.
And there are real reasons behind what you’re experiencing.

Your body isn’t broken.

It’s adapting—and it needs a different kind of support now than it did 10 or 15 years ago.

There is a way to navigate this phase with more clarity, more stability, and more support.

You don’t have to just push through it.

About the Author

I’m Dr. Sarah Giardenelli, a naturopathic doctor and acupuncturist at Collective Health Center. My work focuses on helping patients better understand what’s driving their symptoms—from metabolism and hormone balance to inflammation and nutrient status—so we can take a more personalized, root-cause approach to care.

If you’re navigating changes in your energy, hormones, or overall health and are looking for a more individualized plan, you’re welcome to learn more about working together or schedule a discovery call.

Photo by Myles Tan on Unsplash

 Collective Health Center

Excellence in Naturopathic Medicine, Acupuncture, and Integrative Medicine in Leesburg, Virginia for Complex Conditions and Chronic Pain in a Warm and Nurturing Environment.

Are you frustrated of dealing with your symptoms?

Are you ready to look for the answers & optimize your health with natural medicine?

This is how we help.

Contact Us!

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When a Statin Is Recommended Before the Full Picture Is Clear: A More Personalized Approach to Heart Health

When a Statin Is Recommended Before the Full Picture Is Clear: A More Personalized Approach to Heart Health

by | Apr 5, 2026 | Cardiovascular Health, Naturopathic Medicine, Prevention

Understanding Statin Recommendations and Cardiovascular Risk

Every week, I speak with patients who are trying to make sense of a cardiovascular recommendation they’ve been given.

Sometimes they’ve already been started on a statin.
Sometimes they’ve been told they need one—but haven’t started yet.

And often, they’re left wondering:
“How serious is this really—and how did we get here?”

This is not a conversation about avoiding statins. They absolutely have a role, and in the right context, they can meaningfully reduce cardiovascular risk.

But it is a conversation about context, sequencing, and understanding cardiovascular risk more clearly before committing to a long-term plan.

Where Most Patients Actually Start

Most patients don’t come in with advanced imaging or a clearly defined baseline.

Instead, they come in with:

  • A standard lipid panel
  • A recommendation for a statin
  • Very little discussion of what may be driving their cardiovascular risk in the first place

Occasionally, someone has had imaging—most often a coronary artery calcium (CAC) score—and if that score is zero, they’re reassured that everything is fine.

But that’s not always the full picture.

A CAC score detects calcified plaque, which is generally more stable. What it does not detect is soft, non-calcified plaque, which is often more metabolically active and more closely associated with acute cardiovascular events.

This is one of the reasons why a CAC score of zero does not necessarily mean zero risk—particularly in younger patients and in women.

Why Cardiovascular Risk Calculators Don’t Tell the Whole Story

Most commonly used cardiovascular risk calculators in primary care are based on population-level data—using factors like age, cholesterol, blood pressure, and smoking status to estimate risk over time.

While helpful, these tools don’t account for more individualized factors such as ApoB, lipoprotein(a), metabolic health, or direct visualization of plaque.

As a result, decisions are often made based on statistical estimates rather than a more complete picture of an individual’s actual cardiovascular health.

A Shift Toward Personalized Cardiovascular Risk Assessment

One of the most meaningful shifts happening in cardiovascular care is a move toward more personalized and precise risk assessment.

Newer tools, such as AI-assisted coronary CT analysis (like Cleerly), allow us to go beyond simply identifying whether plaque is present. These technologies can help characterize:

  • The type of plaque (calcified vs non-calcified)
  • The total plaque burden
  • How plaque changes over time

This allows for a much more individualized understanding of cardiovascular disease—and a way to track whether interventions are actually improving risk.

Lipids: More Than Just LDL Cholesterol

Traditional cholesterol panels are helpful, but they don’t always tell the full story.

Markers such as:

ApoB (Apolipoprotein B)

Lipoprotein(a)

are increasingly recognized as more accurate indicators of cardiovascular risk.

ApoB reflects the number of atherogenic particles—particles capable of promoting plaque formation within the arteries. This often provides a clearer picture of risk than LDL cholesterol alone, especially in patients with insulin resistance.

Lipoprotein(a) is largely genetically determined and can significantly influence baseline cardiovascular risk, regardless of lifestyle.

Lifestyle and Cardiovascular Risk Reduction

One of the most important—and often overlooked—truths in cardiovascular care is that lifestyle interventions are foundational, not optional.

Research consistently demonstrates meaningful impact:

Given how strongly insulin resistance contributes to atherosclerosis, these changes are not secondary—they are central to long-term cardiovascular health.

The Statin Conversation: A More Balanced Perspective

Statins have been shown in many studies to reduce cardiovascular risk—often cited in the range of 20–30% relative risk reduction—though the degree of benefit varies depending on the individual and their baseline risk.

They can also play a role in stabilizing plaque.

But like any medication, they are not without potential side effects.

Some patients experience:

  • Muscle symptoms
  • Fatigue
  • Changes in blood sugar
  • Neurologic symptoms

One of the more challenging patterns I see is when multiple medications are started at the same time—often a statin alongside something like thyroid support. When new symptoms arise, it becomes difficult to determine what is helping and what may not be tolerated.

When “Worse” Imaging May Not Be Worse

One important concept that is rarely explained to patients:

Interventions that improve cardiovascular risk—whether pharmacologic or lifestyle-based—can sometimes make imaging appear “worse” in the short term.

Statins, for example, are known to:

  • Reduce softer, more vulnerable plaque
  • Promote a shift toward more calcified, stable plaque

This can lead to an increase in coronary artery calcium score over time, even as overall cardiovascular risk is improving.

In other words:
An increase in calcification is not always a sign of disease progression—it may reflect plaque stabilization.

Why Sequencing Matters in Cardiovascular Care

In many cases, a more thoughtful approach to cardiovascular prevention might include:

  • Establishing a baseline
  • Addressing underlying contributors (such as metabolic health or thyroid function)
  • Implementing targeted lifestyle changes
  • Then layering in medication if needed

This allows for better clarity, improved tolerance, and more sustainable long-term outcomes.

Why Time Horizon Matters in Heart Health Decisions

One of the biggest drivers of anxiety is the sense that something must be done immediately.

But cardiovascular disease develops over years to decades.

In many cases, taking time to:

  • Understand your risk
  • Evaluate your response to treatment
  • Make a more informed decision

does not meaningfully change short-term risk—but can significantly improve long-term outcomes.

A More Personalized Approach to Heart Health

This is not about rejecting conventional care.
It’s about expanding the conversation.

It’s about:

  • Using better tools
  • Asking better questions
  • Creating a plan that is both evidence-based and individualized

The goal is not to choose between lifestyle and medication.
It is to understand how they work together—and when each is most appropriate.

The Takeaway

If you’ve been told you need a statin:

  • Take it seriously—but don’t panic
  • Ask what your true cardiovascular risk over time actually is
  • Understand that not all plaque is the same
  • Know that lifestyle changes have measurable impact
  • And if something doesn’t feel right, it’s okay to ask questions

The best preventative care is not rushed.
It is thoughtful, informed, and personalized.

About the Author

Dr. Sarah Giardenelli is a naturopathic doctor and acupuncturist at Collective Health Center in Leesburg, VA. She focuses on a personalized, root-cause approach to care—helping patients better understand their health, interpret lab results in context, and make thoughtful, individualized decisions around prevention and approach to care. Her work often includes advanced cardiovascular risk assessment, metabolic health support, and integrative care for complex conditions.

Photo by Sasun Bughdaryan on Unsplash

 Collective Health Center

Excellence in Naturopathic Medicine, Acupuncture, and Integrative Medicine in Leesburg, Virginia for Complex Conditions and Chronic Pain in a Warm and Nurturing Environment.

Are you frustrated of dealing with your symptoms?

Are you ready to look for the answers & optimize your health with natural medicine?

This is how we help.

Contact Us!

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