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!

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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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Chronic Allergic Inflammation, Heart Disease, and a New Path to Lasting Relief with SAAT

Chronic Allergic Inflammation, Heart Disease, and a New Path to Lasting Relief with SAAT

by | Feb 27, 2026 | Acupuncture, Cardiovascular Health, Chinese Medicine, Immune Health, Naturopathic Medicine, Prevention

Chronic Allergic Inflammation May Affect More Than Seasonal Symptoms

Most people associate allergies with sneezing, congestion, and itchy eyes — not heart disease. However, research increasingly shows that chronic allergic inflammation can extend far beyond the sinuses.

Persistent conditions such as allergic rhinitis and asthma correlate with higher rates of coronary heart disease and cardiovascular events. Research highlighted by Downstate Medical Center  identifies a meaningful connection between allergic immune activation and long-term cardiovascular risk.

In long-term population studies, individuals reporting allergic rhinitis showed approximately a 25% higher likelihood of coronary heart disease. Those with asthma demonstrated even greater associations, particularly following recent exacerbations. Rather than viewing allergies and cardiovascular disease as separate issues, researchers now recognize chronic immune activation as a shared inflammatory driver.

How Chronic Allergic Inflammation Impacts the Cardiovascular System

At its core, an allergic reaction activates the immune system.

When the body encounters pollen, pet dander, or certain foods, immune cells release histamine and inflammatory cytokines. These signaling molecules trigger congestion, itching, swelling, and airway reactivity.

Yet this response does not always remain localized.

Over time, repeated immune activation elevates systemic inflammatory markers. Chronic inflammation contributes directly to vascular stress, endothelial dysfunction, and plaque development. The American Heart Association identifies inflammation as a key factor in atherosclerosis and coronary artery disease progression.

As a result, unmanaged allergic triggers may add to overall inflammatory burden — not just seasonal discomfort.

Why Symptom Suppression Alone Falls Short

Conventional allergy treatment typically focuses on three strategies:

  • Blocking histamine with antihistamines

  • Reducing localized inflammation with steroid sprays or inhalers

  • Avoiding triggers

These tools can provide relief, especially during acute flares. However, they address the downstream reaction rather than the upstream immune misidentification.

In other words, they reduce symptoms without retraining the immune system.

For individuals who experience recurring or worsening allergies year after year, this distinction matters. Long-term immune regulation requires a different strategy.

Where Allergy Immunotherapy Fits Into the Picture

Allergy immunotherapy — commonly delivered through shots or sublingual drops — works by gradually desensitizing the immune system through repeated allergen exposure.

For many patients, this method proves effective. However, immunotherapy typically requires months to years of structured treatment, regular office visits, and ongoing dose adjustments.

Because of this time commitment, not every patient finds it practical.

Soliman Auricular Allergy Treatment (SAAT) offers a different model. Instead of repeated allergen exposure, SAAT uses precise auricular stimulation to influence nervous-system-mediated immune regulation.

Rather than escalating exposure, SAAT encourages recalibration.

Importantly, SAAT does not replace emergency asthma care or cardiovascular management. Instead, it serves as a complementary option for individuals seeking a lower-frequency, minimally invasive immune-modulating approach.

Soliman Auricular Allergy Treatment (SAAT): A Targeted Immune Recalibration Strategy

At Collective Health Center I use Soliman Auricular Allergy Treatment (SAAT) to support patients with chronic allergic inflammation.

SAAT leverages the dense neurovascular network of the ear, which reflects whole-body physiology. By stimulating specific auricular points that correspond to identified allergens, the treatment signals the nervous system to reduce immune overreaction.

A tiny semi-permanent needle remains in place for several weeks. During that time, gentle continuous stimulation supports immune recalibration without daily medications or repeated office visits.

Many patients report substantial and lasting reductions in allergic reactivity — sometimes after a single targeted session.

How SAAT Works in Practice

  1. We identify specific allergens through detailed intake and clinical assessment.
  2. I locate precise auricular points corresponding to each trigger.
  3. I place a tiny semi-permanent needle to encourage immune recalibration.
  4. The patient continues normal daily activities while the stimulation works gradually over several weeks.

SAAT remains minimally invasive and drug-free. Clinicians have used it to address environmental allergies, food sensitivities, histamine intolerance, Alpha-Gal syndrome, and mast cell activation patterns.

Allergic Inflammation and Long-Term Health

When allergic inflammation persists year after year, it elevates systemic stress. Over time, that inflammatory load can influence vascular health and metabolic resilience.

Therefore, addressing allergic triggers may support more than symptom relief. It may reduce cumulative inflammatory burden.

By shifting from suppression to immune recalibration, patients often experience a meaningful change: instead of managing reactions indefinitely, they reduce the reactivity itself.

Learn More About SAAT and Immune Regulation

If persistent allergies, sensitivities, or inflammatory symptoms affect your quality of life, a targeted immune-regulation strategy may offer a new path forward.

Dr. Sarah Giardenelli, ND, LAc, works with individuals seeking a root-focused approach to immune imbalance. At Collective Health Center, care prioritizes long-term immune regulation rather than temporary symptom control.

To learn more about Soliman Auricular Allergy Treatment (SAAT):
https://www.collectivehealthcenter.com/services/soliman-auricular-allergy-treatment-saat/

To explore integrative naturopathic and acupuncture services:
https://www.collectivehealthcenter.com

Photo by Kier in Sight via 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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Breathing Easy: A Guide to Choosing Air Purifiers for a Healthier Home

Breathing Easy: A Guide to Choosing Air Purifiers for a Healthier Home

by | Jul 20, 2023 | Cardiovascular Health, Environmental Health, Naturopathic Medicine, Prevention, Respiratory Health

Weeks of on and off haze here in Northern Virginia have underscored the importance of clean air for everyone. While air purifiers serve as lifelines during hazardous pollution days, they are also effective in addressing common health concerns such as harmful gases, mold, pollen, dust, bacteria, and viruses. While it is unusual for us in Northern Virginia to experience air quality issues related to wildfires, it is not unlikely to be our last go around with this scenario. Most toxicity from our environment comes from what we breath. According to the National Institutes of Health, an estimated 60% of the health problems caused by environmental factors are due to long-term exposure to urban air pollution. Air purifiers are one proactive way to prevent poor indoor air quality, while optimizing your respiratory, cardiovascular, and cognitive health. If you’ve been procrastinating purchasing an air purifier, I urge you to take some action on this today.

Choosing the right air purifier involves three key steps: determining what you want to remove from your air, assessing the area you want to clean and the desired frequency, and considering the associated costs.

Step One: What do you want removed from your air?

Air purifiers employ different technologies to tackle particulates, gases, or both. Assess the issues you face, whether it's dust, smoke, mold, or chemical odors from paint, off gassing carpets, or car exhaust. The market offers a wide variety of air purifiers, making it crucial to explore all the available options to determine the best fit for your family's needs.

HEPA Air Filters

Advantages: HEPA, short for High-Efficiency Particulate Air, meets strict Department of Energy requirements by removing approximately 99% of airborne particulates larger than 0.3 microns. It effectively filters out mold spores, dust, pollen, pet dander, and flame retardants. For these pollutants, HEPA filters are a suitable choice. However, they might not effectively capture viruses, which are smaller than bacteria.

Disadvantages: HEPA filters may not be efficient in trapping gases, fumes, chemicals, or odors or the lung damaging ultrafine particulate. For comprehensive filtration of these pollutants, a disinfecting filtration system is a better option.

Activated Carbon

Advantages: Also known as activated charcoal, activated carbon is highly effective in adsorbing gases and fumes like formaldehyde and VOCs (Volatile Organic Compounds). It efficiently removes odors from the air, providing a fresher environment.

Disadvantages: Activated carbon filters do not remove particles or germs from indoor air. For comprehensive air purification, a combination system is necessary.

Disinfecting Filtration System

Advantages: The disinfecting filtration system is the most powerful on the market, surpassing HEPA technology by around 40 times in efficiency. It can effectively eliminate particles as tiny as .007 microns, including airborne viruses, molds, and bacteria.

Disadvantages: While highly effective, this system can be costly due to its advanced capabilities. However, the benefits justify the investment in cleaner and healthier air.

UV Filters (Ultra-Violet Filters)

Advantages: UV filters have the capability to eliminate bacteria and viruses by employing UV lights for sterilization.

Disadvantages: UV filters are inadequate for removing large particles like HEPA filters or gases and chemicals like formaldehyde, which can be effectively handled by activated carbon filters.

Ionic Filters

Advantages: Ionic filters release negatively charged ions to electrify dust and dander, making the particles attracted to a positively charged collection plate inside the machine.

Disadvantages: Ionic filters may not be effective as the particles can stick to walls, tabletops, and screens. Additionally, they do not absorb VOCs like formaldehyde, and the introduction of ozone into the home can interact with VOCs to create smog, so I do not recommend these.

Ozone Filters

Advantages: Ozone filters use electrostatic plates and ozone to remove odors and freshen the air.

Disadvantages: Ozone filters are hazardous and pose risks to humans and small pets. Even the Environmental Protection Agency (EPA) cautions against their use, making them unsuitable for anyone, so I do not recommend these.

Step Two: How finely do you need to filter particles?

Particulate matter, also known as particulates, is a major concern with wildfire smoke and a key factor in determining air quality. While larger particles can be seen and are easier to remove due to gravity, fine and ultrafine particles, constituting up to 90% of the story, pose a different challenge. These ultrafine particles can penetrate deep into our lungs and even travel through the bloodstream. Understanding the sizes of specific particulates, such as pollen, mold, bacteria, and viruses, helps determine the level of filtration required.

  • Mold Spores: Typically range from 1 to 100 micrometers in size.
  • Mycotoxins: Mycotoxins are produced by certain molds and are much smaller, usually less than 1 micrometer.
  • Viruses: Vary in size but can be as small as 0.02 micrometers.
  • Bacteria: Usually between 0.5 to 5 micrometers in size.
  • Coarser Particulate Matter (PM10): Particles with a diameter of 10 micrometers or smaller.
  • Fine Particulate Matter (PM2.5): Particles with a diameter of 2.5 micrometers or smaller.
  • Ultrafine Particulate Matter: Particles with a diameter of 0.1 micrometers or smaller.

 Ultrafine particulate matter comes from various sources, including combustion processes (e.g., vehicle exhaust, industrial emissions), wildfires, cooking, and certain indoor activities like smoking or using candles. These particles are so tiny that they can remain suspended in the air for longer periods and can penetrate deep into the respiratory system when inhaled, potentially causing health issues. 

Step Three: Evaluating cleaning capacity and costs

Consider the area you need to clean, factoring in both square footage and ceiling height. Understanding the volume of air in the room is crucial for selecting an appropriately sized air purifier. Additionally, assess the air exchange rate, or how often you want the air completely changed, particularly for asthma and allergy relief. It is generally recommended to achieve three to four air changes per hour.

It's important to note that air quality measurements, such as PM2.5, which quantifies fine and ultrafine particles, can vary across different sites. Consulting multiple sources, AQICN.org, AirNow.gov, PurpleAir, and IQAir, provides a more comprehensive understanding of outdoor air quality.

Cost considerations include the initial purchase price, ongoing power consumption, and filter replacement costs. HEPA units typically range from $200 to $900, with additional expenses for specialized units. Filter replacements costs vary depending on usage, fan speeds, and air quality, averaging between about $70 and $175 per year.

Wirecutter provides a thorough review of air filters that they’ve independently tested for quality, several which are excellent. Top of their list for several years running is the well-engineered Coway Airmega AP-1512HH Mighty, which is a more affordable option than some of the specialized units.

However, given my practice where many of the patients I see have compromised health, aggravated by mold, mycotoxins, and other allergens and ultrafine particulates, I’ve considered the following specialized, high quality air purifiers:

Excellent at filtering out ultrafine particles:

  • Intellipure (down to 0.007, has a unique Disinfecting Filtration System, which I appreciate especially for my patients with mold and mycotoxin illness)
  • IQAir (down to 0.003 microns)
  • AirDoctor (down to 0.003 microns)

Excellent at filtering out VOCs – due to heavy carbon filters:

  • AirPura (18 pounds of carbon)
  • AustinAir (15 pounds of carbon)
  • IQAir GC MultiGas (12 pounds of carbon)
  • IQAir Heath Pro Plus (5 points of carbon)

Clean air is a vital aspect of our well-being, especially during periods of heightened air pollution from wildfires. By selecting the right air purifier tailored to your needs, you can effectively address indoor air quality concerns. Don't delay in taking action to protect yourself and your loved ones. With the challenges posed by recurring smoke, prioritize proactive measures and embrace cleaner air for a healthier home. 

Meet Dr. Sarah Giardenelli, an experienced naturopathic doctor and acupuncturist in Leesburg, Virginia, with a specialization in environmental health. With her guidance, you can learn how to optimize both your indoor and internal environment, safeguarding yourself from air pollution. Take a breath of fresh air today and embark on a new journey towards better health! Let's create a cleaner and healthier living environment together.

Contact Us!

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Nurturing Health and Indoor Air Quality During Amid Wildfire Smoke

Nurturing Health and Indoor Air Quality During Amid Wildfire Smoke

by | Jul 20, 2023 | Cardiovascular Health, Environmental Health, Naturopathic Medicine, Prevention, Respiratory Health

As a naturopathic doctor and a mom, I understand the deep concern we have for our family's health, especially when wildfire smoke fills the air.  When outdoor is quality is poor, it inevitably enters our homes, becomes trapped, leading to poor indoor air quality. It's important to take proactive steps to protect ourselves and our loved ones. While we cannot control which way the winds blow the smoke, there are actionable steps you can take to nurture your health and maintain clean indoor air during this unpredictable Pyrocene.

1. Stay Informed and Plan Ahead

Stay updated on air quality reports. As air quality measurements can vary between sources, I recommend cross referencing a few sites, such as AQICN.org, AirNow.gov, PurpleAir, and IQAir, which will provide a more comprehensive understanding of air quality. Signing up for alerts from these sites or using their apps and notifications are a helpful way to stay informed. Plan ahead by having essential supplies ready, including air purifiers and N95 masks.

The metrics used in air quality reports can vary depending on the region, but the most common ones include:

  • Air Quality Index (AQI): The AQI is a standardized scale used to communicate the level of air pollution and its associated health risks. It typically ranges from 0 to 500, with lower values indicating better air quality and higher values indicating worse air quality. The AQI is usually categorized into different color-coded levels, ranging from "Good" (0-50) to "Hazardous" (301-500).
  • Particulate Matter (PM2.5 and PM10): These metrics measure the concentration of fine particulate matter (PM2.5) and coarser particulate matter (PM10) in the air. PM2.5 particles are smaller and can penetrate deep into the lungs, while PM10 particles are larger and may be trapped in the upper respiratory tract.
  • Ozone (O3): Ozone is a gas that can be present in the air, particularly on hot and sunny days. While ozone in the upper atmosphere is beneficial in blocking harmful UV rays, ground-level ozone can be harmful when inhaled.
  • Carbon Monoxide (CO): CO is a colorless and odorless gas produced by incomplete combustion of fossil fuels. It can be particularly dangerous in enclosed spaces or areas with heavy traffic.

Regarding N95 masks and exposure guidelines

  • N95 Masks: N95 masks are designed to filter out at least 95% of airborne particles, including PM2.5 and some viruses.  While the are effective in reducing exposure to harmful particulate matter, they will not protect from the harmful gasses.
  • When to Use N95 Masks: It is recommended to wear N95 masks outdoors when the AQI reaches levels of 151 or higher, which falls into the "Unhealthy" category. N95 masks can also be beneficial for individuals with pre-existing respiratory conditions or other health issues, even at lower AQI levels.
  • Avoiding Outdoor Activities: When the AQI reaches levels of 151 or higher, it is best to limit outdoor activities, especially for sensitive groups such as children, the elderly, and individuals with respiratory or heart conditions. At AQI levels of 301 and above (in the "Hazardous" category), it is generally considered unsafe for anyone to stay outdoors for an extended period.

2. Create a Safe Indoor Haven:

Ensure your home provides a clean and healthy environment by following these tips:

  • Consider using a portable air purifier in main living rooms and bedrooms, particularly for vulnerable individuals such as children or those with respiratory conditions. Learn more on how choose the right air purifier for you HERE.
  • Seal windows and doors to minimize smoke infiltration.
  • Use high-efficiency particulate air (HEPA) filters in your HVAC system and air purifiers to capture airborne particles effectively.
  • Keep windows closed and rely on recirculated air during periods of poor outdoor air quality.
  • Clean regularly to minimize dust and allergens, as smoke particles can settle on surfaces. Dust is one of the main harbingers of toxins in our homes! Minimizing it can help to protect not only our lungs, but also our cardiovascular and overall health. 

3. Enhance Respiratory Health Naturally:

Support your respiratory system with natural remedies:

  • Stay hydrated to maintain healthy mucus membranes. Drink plenty of water, herbal teas, and warm broths.
  • Use saline nasal rinses with xylitol or neti pots (with distilled water, saline solution, and xylitol) to keep nasal passages clear. The xylitol helps to keep the nasal tissues moist.
  • Consider respiratory and immune supportive supplements such as vitamin C, quercetin, and N-acetylcysteine (NAC) with your healthcare provider.

4. Optimize Indoor Air Quality:

Take steps to improve indoor air quality even when smoke is not present:

  • Keep indoor plants known for their air-purifying properties, such as snake plants, peace lilies, and spider plants (not ideal for those with mold allergies, but can be an good option for others).
  • Avoid using chemical-laden cleaning products or ‘air fresheners’. Opt for natural alternatives or homemade solutions. One of my favorite all purpose cleaning solutions is 1 part white vinegar to 3 parts water, 1 tsp of free and clear dish detergent, mixed in a reusable spray bottle (the Zepp brand works well).
  • Open windows during periods of improved outdoor air quality to allow fresh air circulation.
  • Reduce indoor pollutant sources like tobacco smoke, scented candles, or excessive use of cooking appliances. If you have a gas range be sure to turn on your vent with every use – this is important for health – especially respiratory health!

5. Maintain a Healthy Lifestyle:

Support overall health and resilience:

  • Eat a nutrient-rich, anti-inflammatory diet with plenty of fruits, vegetables, and omega-3 fatty acids.
  • Engage in regular exercise to support lung health and strengthen immunity.
  • Practice stress-reducing activities like deep breathing, meditation, or yoga to support overall well-being.

When air quality is poor protecting your health and maintaining indoor air quality is essential. By staying informed, creating a safe indoor haven, supporting respiratory health naturally, optimizing indoor air quality, and maintaining a healthy lifestyle, you can help safeguard your family's well-being. Remember, consult with a naturopathic doctor or healthcare professional for personalized advice and recommendations based on your specific needs. Let's prioritize our health and embrace a proactive approach to navigate through these challenging times with resilience and care.

Meet Dr. Sarah Giardenelli, a dedicated naturopathic doctor and acupuncturist with a passion for environmental health in Leesburg, Virginia. With her expertise, you can learn how to enhance your indoor and internal environment, safeguarding yourself from air pollution. Take a breath of fresh air today and embrace a new approach to your well-being. Let's build a healthier future together.

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Alert: Update on Erythritol, an Artificial Sweetener

Alert: Update on Erythritol, an Artificial Sweetener

by | Mar 5, 2023 | Cardiovascular Health, Prevention

Last week, a research paper from researchers at the Cleveland Clinic came out showing increased risks for major adverse cardiovascular diseases, such as heart attack, stroke or death, associated with the use of certain sugar replacement products. The sugar replacement products studied were sugar alcohols, also known as polyols, and of these erythritol had the highest association to increased cardiovascular risks. This is especially concerning as many individuals using these may already have underlying increased cardiovascular risks, particularly those with diabetes who may be using these products as a sugar replacement. These sweeteners are commonly found in baked products, beverages, and even protein powders!

The researchers found that erythritol caused enhanced platelet reactivity in the lab and clot formation in the participants they studied. In short, more sticky platelets were caused by erythritol consumption and more sticky platelets increases risk for clots. This was a large study of over 4,000 people in the United States and Europe and it highlights the unintended consequences that can occur when newer to human consumption ingredients are brought to market without much human research. 

Of the sugar alcohols, why was erythritol found to have the highest association with cardiovascular risks? I suspect it has to do with how well absorbed it is, but yet how poorly metabolized it is in the human body, where 90% of it is unmetabolized and excreted into the urine. Whereas xylitol and sorbitol, which are other sugar alcohols, have poorer absorption compared to erythritol. Most of what is absorbed by the small intestine is then metabolized by the liver, and what is not absorbed is digested by gut bacteria. For some people, these sugar alcohols can cause flatus and diarrhea, even though erythritol is better absorbed, too much of it can do the same thing. 

What about other natural sweeteners such as stevia and monkfruit, will these have the same issues? Many of the stevia extracts found at the grocery store are a highly refined extract called rebaudioside A (Reb-A) which is much sweeter tasting than table sugar. Because of this many stevia products, such as Truvia and Stevia in the Raw, have added erythritol. Pure stevia leaf does not contain any sugar alcohols and has been used for centuries by the Guarani people of Paraguay and Brazil for ceremonial purposes and as traditional medicine to help control blood sugar and as a cardiac tonic. Similar to stevia, monkfruit is cultivated for its fruit extract, mogrosides, which are also much sweeter than table sugar. Many of the monkfruit products have a long history of traditional use in the Guilin region of China. Because of its sweetness, many monkfruit sweeteners, such as Lakanto or Monkfruit in the Raw, also have added erythritol. Most of the research on pure stevia leaf and monkfruit has been positive, neither have sugar alcohols, nor alter blood sugar, and there is some history of traditional usage. Overall, stevia and monkfruit  seem like safe choices for zero calorie, natural sweeteners when used in their pure form. The important thing is to look at the ingredient list to be sure there are no other added sweeteners, such as erythritol.

Dr. Sarah Giardenelli is a naturopathic doctor, herbalist and acupuncturist and owner of Collective Health Center in Leesburg, Virginia. She is a lifelong learner with a curious mind and loves helping patients get to the root of their ongoing health issues.

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