[UPDATED 2/5/24] Unlocking the Mystery: How a Newly Discovered Autoantibody Sheds Light on Chronic Fatigue and Hashimoto’s Thyroiditis

[UPDATED 2/5/24] Unlocking the Mystery: How a Newly Discovered Autoantibody Sheds Light on Chronic Fatigue and Hashimoto’s Thyroiditis

by | Sep 20, 2023 | Endocrine/Hormone Health, Prevention

Unrelenting fatigue in patients with Hashimoto’s thyroiditis, despite “normal” thyroid functions tests is an extremely common complaint in my patient population, many of whom have Chronic Fatigue Syndrome. Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a debilitating condition characterized by severe, unexplained fatigue that lasts for at least six months and is not improved by rest. It often comes with a myriad of other symptoms, including muscle pain, cognitive difficulties, and sleep disturbances. Despite its significant impact on the lives of those affected, CFS remains poorly understood and effective treatments are limited. However, recent research has shed light on a potential link between CFS, selenium, and thyroid hormones, opening new avenues for understanding and managing this enigmatic condition.

Yet Another Antibody that Affects Thyroid Function

I recently came across some research by Sun and colleagues that sheds light on why the fatigue for CFS patients with Hashimoto’s might be unrelenting. Interestingly, in 2021 Sun’s research group discovered a new autoantibody that affects thyroid function. Their research verified their hypotheses that the body has natural autoantibodies to the selenium transporter selenoprotein P (SELENOP) in thyroid patients which impair selenium transport and thus negatively affect glutathione production in the thyroid, which is so essential to help protect the thyroid from the oxidative stress that occurs in the thyroid with thyroid hormone production. Their most recent research from 2023 unveiled a fascinating connection between CFS and selenium in the form of autoantibodies targeting selenoprotein P (SELENOP-aAb). [CORRECTION] They discovered that there is a subset of patients with chronic fatigue syndrome with autoantibodies to selenoprotein P (SELENOP-aAb) which hinders normal transport of selenium to target tissues and causes reduced selenoprotein expression [in my originally blog I misstated that these patients not also had Hashimoto's thyroiditis, which the article does indicate - there was no mention if they screened or excluded participants with Hashimoto's]. This disruption had far-reaching consequences on the health of CFS patients.

Selenium Connection

To understand their findings, we need to understand the connection of selenium to thyroid function. Selenium is a trace element that plays a crucial role in various physiological processes within the body. It is an essential component of selenoproteins, a family of proteins that function as antioxidants and help regulate the immune system and thyroid hormones. Selenium helps to protect the thyroid from oxidative stress that occurs normally during thyroid hormone production. If selenium isn't able to be properly transported, oxidative stress and tissue damage ensues and thyroid (and body) cannot function optimally.

Thyroid Hormones and the Impact on Chronic Fatigue Syndrome (CFS)

To fully grasp the implications of SELENOP-aAb in CFS, researchers examined the interplay between selenium, selenoproteins, and thyroid hormones (TH). The thyroid gland produces TH, essential for regulating metabolism, energy production, and overall health. Thyroid hormones come in two primary forms: T4 (thyroxine) and T3 (triiodothyronine). T3 is an active thyroid hormone that has metabolic effects in our body and derives from T4 (inactive thyroid hormone) through a process known as deiodination 1 (DIO1) and deiodination 2 (DIO2). DIO1 occurs mostly in the thyroid, but also in the liver and kidneys, whereas DI02 activity has been detected in areas of the brain (pituitary and hypothalamus), ear (cochlea), brown adipose tissue, bones, muscles, heart, and central nervous system. The T3 produced by DIO2 in these peripheral tissues persists longer in the body for reasons that are not yet fully understood. We also have DIO3 which helps to protect fetal tissues and adult brains (central nervous system) from excessive TH production by converting T4 to inactive reverse T3 (rT3) and T3 to inactive 3,3’-diiodothyronine (T2).

Sun et al introduced two indices to evaluate thyroid gland activity and peripheral deiodination: the SPINA GT index (secretory capacity of the thyroid gland, indicates DIO1 activity) and the SPINA GD index (total deiodination activity, indicates peripheral tissue DIO2 activity). These indices offer valuable insights into how SELENOP-aAb impacted TH metabolism. Patients with SELENOP-aAb displayed lower SPINA GD values, indicating reduced TH activation as well as lower active thyroid hormone (fT3) levels and higher levels of inactive thyroid hormone (rT3). Furthermore, their 24-hour urinary iodine concentrations were significantly lower, pointing to suppressed TH deiodination. This collective evidence suggested that SELENOP-aAb disrupted regular selenium supply to target tissues, resulting in reduced selenoprotein expression, elevated oxidative stress, and impaired TH activation.

Sun et al’s 2023 study is frankly one of the most useful studies on thyroid function that I’ve come across. It sheds so much light onto several different and previously perplexing aspects of thyroid health. Clinically, I tend to recommend 24-hour urine iodine testing to my hypothyroid patients who upon dietary review have a low iodine diet. However, this study helps us understand that iodine levels can be low in patients even with adequate dietary intake because of the SELENOP antibodies making it so iodine cannot be freed from the tissue. Thus, 24-hour urinary iodine might be a helpful test for all patients with Hashimoto’s thyroiditis and if low in a patient with normal iodine consumption, may point towards SELENOP-aABs. Their findings also help to explain why supplementing with high dose iodine in patients with Hashimoto’s can go south for some patients. I’ve never had clinical success with this approach – iodine is very oxidizing to thyroid tissues, especially in the context of low selenium, and there is even more oxidative stress with SELENOP-aABs which creates a functional iodine deficiency. Iodine is like fuel to the fire in this situation. Furthermore, their study helps us better understand why selenium supplement is vital for patients with Hashimoto’s but is not a cure-all in this situation. Other studies have demonstrated that selenium supplementation helps to improve thyroid function and lower thyroid antibodies in patients with Hashimoto’s for several months but without significant improvements after this. Repletion of selenium helps to counter the oxidative stress from SELENOP-aAB, but may not resolve the SELENOP-aABs, this research hasn’t yet been done. Deficiencies of selenium and iodine we may see with SELENOP-aABs appear to be functional and related to these autoantibodies. Finally, this study helps us to better understand why some patients do so much better while on active thyroid replacement than others, particularly those with chronic fatigue syndrome, as their peripheral conversion of inactive (T4) to active thyroid (fT3) is impaired by SELENOP-aAB lending to more brain fog and bodily fatigue.

Implications and Future Directions

The discovery of SELENOP-aAb in a subset of CFS patients opens a promising avenue for understanding and managing this perplexing condition. It suggests that CFS may have an autoimmune component that affects selenium transport and thyroid hormone metabolism, leading to characteristic symptoms of fatigue, pain, and cognitive dysfunction. While naturopathic doctors have long appreciated the nuances of thyroid function in different patients, and that a personalized approach is needed, we didn’t understand all the whys. I was excited to see if SELENO-Abs and SPINA GD discussed in Sun et al’s study, were available through standard commercial medical labs, sadly they are not yet available. I expectantly await additional research with larger study groups and more longitudinal studies that will hopefully pave the way for additional commercially available tests that can help clinicians better understand the nuances of thyroid function in individual patients and more targeted approaches to underlying immune dysfunction.

An Aside - Bio-Energetic Testing!

As an aside, while I was writing this blog this week, another interesting study on chronic fatigue syndrome came across my newsfeed on a blood-cell based diagnostic test for chronic fatigue syndrome that appears to have extremely high accuracy.

These results demonstrate that Raman profiles of blood cells can distinguish between healthy individuals, disease controls, and ME/CFS patients with high accuracy (91%), and can further differentiate between mild, moderate, and severe ME/CFS patients (84%).

Given that so many patients with CFS go through the ringer prior to getting a diagnosis, often being told their symptoms are “all in their head”, obtaining access to an accurate diagnostic test would be a game changer for these patients. The method of testing, called single-cell Raman spectroscopy (SCRS), measures the vibrations of the cell providing a type of energetic fingerprinting of all the biomolecules in the cell. Vibrational energy is being found to help identify imbalances at a cellular level - amazing, right?! Different types of bio-energetic testing and balancing machines (ie EKG, heart rate variability, TENS, etc) have been available for some time, but this is the first time I’ve seen such technology aid in diagnosis so specifically and at a cellular level. As energetic beings, it makes so much sense that medical research is beginning to look at energetic vibrations to provide additional insights on underlying cell function and aid in the diagnosis, monitoring and potentially treatment of disease.

 

 

Dr. Sarah Giardenelli is a naturopathic doctor, herbalist, acupuncturist and the owner of Collective Health Center in Leesburg, Virginia. She loves diving into the medical literature in order to help patients get to the root causes of their troubling health conditions and getting them back with their health. She is grateful to all of the researchers who do the hard work that helps clinicians do better.

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Reverse Aging: Reanimating and Slaying Zombie Cells Naturally

Reverse Aging: Reanimating and Slaying Zombie Cells Naturally

by | Aug 28, 2023 | Brain Health, Healthy Aging, Herbal Medicine, Prevention

Time goes by so quickly, in a blink really! I felt this so much last week as my son, Vincent James, started his first day of second grade! We may feel like we are in a time warp, our cells don’t and as time marches on, our cells undergo a complex series of changes that lead to decreased functionality and increased vulnerability to diseases. One of the key players in this process is cellular senescence, a state in which cells lose their ability to divide and function properly, contributing to chronic inflammation, tissue dysfunction, and age-related diseases. Yes, time marches on and various stressors contribute to the aging process, however, one of the things that I get excited to see is the important role that lifestyle and natural medicine have in combating healing our bodies at a cellular level and helping to slow this aging-process, helping us to age well! Cellular senescence is one of the many topics I had the privilege  of learning more about this past spring at Medicines from the Earth in Ashville, North Carolina with the amazing naturopathic doctor and herbalist, Dr. Mary Bove. She shared some of the recent scientific research that have unveiled natural compounds, such as quercetin and fisetin, as powerful senotherapies capable of rejuvenating senescent cells and promoting healthier aging. She also discussed the so-called ‘hit-and-run’ dosing that seems to make these senolytics most effective. Hit and run dosing = less supplements to support well-aging. Interested to learn more, read on!

The Underlying Mechanisms of Cellular Senescence & Zombie Cells

Cellular senescence is a double-edged sword. While it serves as a protective mechanism against cancer by halting the growth of damaged cells, it also contributes to chronic inflammation and tissue deterioration. Senescent cells accumulate over time due to various factors including DNA damage, oxidative stress, and telomere shortening. These cells enter a state of persistent inflammation and release harmful molecules that can negatively impact neighboring cells and tissues, creating what is often referred to as the "senescence-associated secretory phenotype" (SASP). Because they are not yet dead, but not functional, and create havoc in the body, these senescent cells are also know as zombie cells.

Reanimating versus Slaying Zombies

SASP inhibitors (senomorphics) and senolytics are both approaches aimed at addressing aging-related cellular changes, but they work in different ways. Senomorphic agents morph the signals coming from the zombie cells, while senolytic agents directly target and eliminate these problematic aging cells. SASP inhibitors can be thought of agents that help to turn back zombie cells into healthy cells, like in science fiction zombies being reversed or reanimated back into healthy humans, whereas senolytic agents are the zombie slayers in this analogy. Another difference between SASP inhibitors and senolytics is related to how these agents are dosed. Daily dosing seems best for SASP inhibitors, while senolytic agents appear to work best with intermittent or ‘hit-and-run’ dosing.

Hit & Run Dosing

I know, know, zombie cells and ‘hit-and-run’ dosing, what is going on! While I didn’t come up with these terms, I cannot deny they are catchy and on-point. I was particularly excited to learn about how hit and run dosing seems to make these senolytic agents most effective. Hit and run dosing is exactly what it sounds like, using a higher dose of these agents for just a few days and repeating for at least several months in a row. I am always excited to learn about health supportive strategies that are relatively easy to implement and involve less pills!

Slaying the Zombie Cells with Lifestyle & Botanical Agents, Quercetin and Fisetin

Foundational lifestyle measures are pivotal for maintaining cellular health and combating cellular senescence. Regular exercise, a balanced diet, stress reduction, and other healthy practices play a crucial role. Intermittent fasting has garnered attention for its potential impact on cellular rejuvenation. By cycling between eating and fasting periods, intermittent fasting stimulates processes like autophagy, aiding in the removal of damaged cells. This approach shows promise in reducing the presence of senescent cells and supporting prolonged cellular vitality. Two natural compounds that have garnered significant attention as helping to improve cellular heath are quercetin and fisetin, through their actions as both SASP inhibitors and senolytics.

Quercetin

We’ve heard a ton about quercetin in recent years because of its immune supportive and anti-viral benefits. Quercetin is a plant compound called a flavonoid found abundantly in fruits and vegetables and some medicinal herbs (ie elderberry syrup and green tea), quercetin has been extensively studied for its antioxidant and anti-inflammatory properties. Recent research has highlighted its potential as a senolytic agent. By interfering with pathways that promote cell survival in senescent cells, quercetin helps induce apoptosis, or programmed cell death, in these cells. This remarkable action contributes to the removal of senescent cells from tissues, reducing inflammation and potentially delaying age-related diseases.

Fisetin

Another flavonoid and senolytic agent, found to help our bodies as well , not as well know by the general public is fisetin, found in foods like strawberries, apples, grapes, onions, cucumbers, and in higher amounts in the many trees such as various Morus species (Mulberry leaf), Cotinus coggygria (Smoke Tree) and Rhus succedanea fruit wax (the fruit of a sumac tree native to Japan). The fruit of North American species of sumac also contains fisetin, but have not been as well studied - yet. Fisetin, through its ability to modulate the senescence signaling pathways research suggests it can help our cellular ‘powerhouses’ or mitochondria function despite stress, combats aging in brain clean-up cells called microglia by increasing the production of the important antioxidant called glutathione and thus decreasing inflammation. All these actions work together to slow down age related changes in our aging bodies and brains!

The effects of quercetin and fisetin as senolytics are profound. Not only do these natural compounds aid in the elimination of senescent cells, but they also exhibit the potential to rejuvenate surrounding cells and tissues. As senescent cells are cleared away, inflammation decreases, and the tissue microenvironment becomes more conducive to healthy cellular function. What I find so exciting is that when dosed regularly in lower doses quercetin and fisetin can help to manage inflammation and cellular damage, but at when dosed intermittently and in higher doses the so called ‘hit-and-run’ dosing they act as senolytics, slaying the zombie cells that contribute to our aging.

Beyond Cellular Senescence

The implications of quercetin, fisetin and other botanical senolytics (ie gingerenone A from ginger and piperlongumine from black pepper) extend beyond their senolytic properties. Those of you who have worked with me for years, likely already know how much I appreciate natural therapeutics that are “multi-fers”, a term I’ve lovingly coined for natural agents that have multiple health promoting properties. I’ve long appreciated quercetin for being one of these agents. Both quercetin and fisetin have been studied for their potential in reducing the risk of chronic diseases such as cardiovascular disorders, neurodegenerative conditions, and cancer and research on botanically derived senotherapeutics is on the horizon. Their antioxidant and anti-inflammatory actions may contribute to overall wellness and longevity.

Conclusion

The discovery of natural senolytics such as quercetin and fisetin represents an important advancement in the field of aging research. By targeting and removing senescent cells, these compounds offer a unique opportunity to rejuvenate aging tissues and potentially delay the onset of age-related diseases and are with a relatively low side-effect profile compared to the pharmaceutically based senolytics. The potential for healthier aging through a well-aging lifestyle and the application of these natural therapeutics is good news for those of us who want to both optimize our health and age as well as we can.

 Dr. Sarah Giardenelli is a naturopathic doctor, acupuncturist, herbalist, owner of Collective Health Center. She is passionate about optimizing patients’ health, including strategies to age well. If you are interested in aging-well with lifestyle, natural medicine, and personalized supplements, including senotheropeutic and senolytic agents, please feel free to schedule or reach out to her office.

References

Bove, Mary. Sencescene, Senolytics, and Aging. Medicines from the Earth Herb Symposium Conference Proceeding Notes, 2023. https://www.botanicalmedicine.org/

Chaib S, Tchkonia T, Kirkland JL. Cellular senescence and senolytics: the path to the clinic. Nat Med. 2022 Aug;28(8):1556-1568. doi: 10.1038/s41591-022-01923-y. Epub 2022 Aug 11. PMID: 35953721; PMCID: PMC9599677.

Liu X, Wang Y, Zhang X, Gao Z, Zhang S, Shi P, Zhang X, Song L, Hendrickson H, Zhou D, Zheng G. Senolytic activity of piperlongumine analogues: Synthesis and biological evaluation. Bioorg Med Chem. 2018 Aug 7;26(14):3925-3938. doi: 10.1016/j.bmc.2018.06.013. Epub 2018 Jun 18. PMID: 29925484; PMCID: PMC6087492.

Moaddel R, Rossi M, Rodriguez S, Munk R, Khadeer M, Abdelmohsen K, Gorospe M, Ferrucci L. Identification of gingerenone A as a novel senolytic compound. PLoS One. 2022 Mar 29;17(3):e0266135. doi: 10.1371/journal.pone.0266135. PMID: 35349590; PMCID: PMC8963586.

Rayne S, Mazza G. Biological activities of extracts from sumac (Rhus spp.): a review. Plant Foods Hum Nutr. 2007 Dec;62(4):165-75. doi: 10.1007/s11130-007-0058-4. Epub 2007 Oct 2. PMID: 17909971.

Tsurudome N, Minami Y, Kajiya K. Fisetin, a major component derived from mulberry (Morus australis Poir.) leaves, prevents vascular abnormal contraction. Biofactors. 2022 Jan;48(1):56-66. doi: 10.1002/biof.1798. Epub 2021 Oct 23. PMID: 34687255; PMCID: PMC9298084.

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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.

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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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Chocolate, Flaxseeds & Cadmium, Oh My!

Chocolate, Flaxseeds & Cadmium, Oh My!

by | May 4, 2023 | Bone health, Environmental Health, Naturopathic Medicine, Prevention

Two of my favorite foods have been in the news in the past several months, dark chocolate and flaxseeds because sadly, high levels of the toxic metal have been found in many brands. Cadmium transfers to plants from soil at a higher rate than other toxic metals and thus it's ubiquitous in our food supply and there is no safe level of cadmium in food. If you are someone with bones (kidneys or lungs) you should care. I see many women with osteoporosis and in many cases cadmium is an issue. In this article I will share some more information about cadmium, its impact on bone health, and discuss the Consumer Reports on cadmium levels in chocolate and the recent Consumer Labs report cadmium in flaxseed and share which brands have the lowest and highest levels.

For too long, the way we have learned about the ill effects on human health of such toxicants has been through the fall out of pollution. Such is the case with cadmium. In 1968, Toyama Prefecture, Japan, recognized the harmful effects of cadmium on bone when metal mining contaminated the water supply with cadmium, which then spread to the rice grown in the water. Those who ate the rice developed itai-itai (it hurts, it hurts) disease, which caused kidney stones, kidney failure, hypercalciuria, bone pain, and osteoporosis. Measuring body load of cadmium is difficult, as the level in urine only indicates current exposure and weakly correlates with body load. Cadmium has a long biological half-life and accumulates in kidneys and bones. Even a low urinary cadmium level of 0.5 μg/g creatinine increases the risk of osteoporosis, fracture, kidney disease, and various cancers. Safe levels of cadmium in humans have not been established.  

A study in Sweden showed that women with higher cadmium levels, even non-smokers, had a higher risk of osteoporosis. Another study showed that women with urinary cadmium levels between 0.50 and 1.00 μg/g creatinine had a 43% higher risk for hip-BMD-defined osteoporosis compared to those with lower levels. Increasing evidence suggests that in the US female population aged 50 years or older, the primary cause of cadmium-related osteoporosis risk is dietary cadmium rather than tobacco. Another challenge for women is that low iron stores, common in those with heavy periods and multiple pregnancies, can lead to higher cadmium retention, and thus toxicity. While comparable research on bone health has not yet been conducted on men, I have no doubt that men's bones are susceptible as well.  

How Does Cadmium Cause Bone Damage?  

Environmental Toxins are a Major Cause of Bone Loss by Pizzorno and Pizzorno explains how cadmium negatively affects bone metabolism through several mechanisms, with the most significant being the impairment of essential kidney functions and direct damage to osteoblasts. Vitamin D requires two hydroxylations, one in the liver and the other in the kidneys, to produce its most active form, vitamin D3, also known as calcitriol. 1) Cadmium disrupts this process by poisoning the kidney enzyme responsible for the conversion of inactive vitamin D (25-OH-D) to active vitamin D3 (1,25-OH-D3) which then acts on the small intestine, bone, and kidney to regulate calcium and phosphate metabolism. Active vitamin D3 enhances calcium and phosphate absorption from the intestines, promotes bone mineralization, so important for bone health. 2) Cadmium also impairs the kidney's ability to excrete toxins and reabsorb essential molecules and minerals, leading to increased calcium loss in urine. So, if you have high urine calcium, cadmium toxicity could be a potential cause. Moreover, cadmium inhibits the activity of alkaline phosphatase, produced by osteoblasts, which deposits calcium into newly formed bone. 3) Cadmium also decreases bone collagen content by stimulating osteoclast formation and activity, which breaks down the collagen matrix as part of normal remodeling. 4) Finally, cadmium activates toxic response pathways in bone cells, further stimulating osteoclast bone resorption.

Cadmium in Food

The amount of cadmium intake in an average person can be estimated through the Total Diet Study (TDS) and food frequency questionnaires (FFQ). TDS is a food safety monitoring program that collects samples of foodstuffs from supermarkets and retail stores to analyze food additives, pesticide residues, contaminants, and nutrients. This program provides an effective way to determine the contribution of each food item to the total intake of cadmium, with staples that are frequently consumed in large quantities found to have the highest levels of cadmium. TDS data is available for limited countries such as the United States, Australia, Sweden, France, Chile, Spain, Serbia, and Denmark, and indicates that the average consumer's cadmium intake ranges from 8 to 25 μg/day, with staples like rice, potatoes, and wheat contributing 40-60% of the total dietary cadmium intake. Other sources of cadmium include shellfish (ie clams, oysters, mussels, scallops), crustaceans (ie shrimp, lobster, crab), mollusks (ie squid, octopus, snails), offal (organ meats), and spinach. This information was reviewed in a study by Satarug et al. 

The amount of cadmium present in food is not the only factor that determines dietary exposure to the metal; consumption patterns are also important. Some foods, such as organ meats, have high cadmium levels but are not frequently consumed by the general population and therefore do not significantly contribute to overall intake. On the other hand, foods with low cadmium levels but high consumption rates in certain populations can be major sources of cadmium. For example, I and many of my patients consume A LOT of dark chocolate and flaxseed, which is why the recent December 2022 Consumer Reports study findings on cadmium (and lead) in popular brands of dark chocolate bars and the Consumer Labs report on cadmium in flaxseeds stood out to me and prompted me to share this information with you all. 

The Consumer Reports study on lead and cadmium in dark chocolate found several brands to be safer including: Mast Organic Dark Chocolate 80% Cocao, Taza Organic Deliciously Dark Chocolate 80% Cacao; Ghirardelli Intense Dark Chocolate 86% Cacao and Intense Dark Chocolate Twilight Delight 72% Cacao, and Valrhona Abinao Dark Chocolate 85% Cacao. These brands had lower levels of both lead and cadmium compared to other brands tested in the study. In the Consumerlab.com report on flaxseeds, the 365 [Whole Foods Market] Whole Flaxseed was found to be the safest choice for adults and children. Several other brands had either toxic levels of cadmium or levels known to be unsafe for children. However, it's important to note that even these "safer" brands still contain measurable levels of these heavy metals. 

Strategies to Decrease the Body Burden of Cadmium 

We cannot hide from it as cadmium is naturally occurring at low levels in the earth's crust, and as a result, all foods may contain small amounts of cadmium, particularly if the soil is deficient in zinc. However, crops grown with high-phosphate fertilizers typically contain higher levels of cadmium, as these fertilizers can have cadmium amounts of up to 300 mg/kg. Exposure to cadmium can be increased by living close to a smelter or mining operation. 

Per Environmental Toxins are a Major Cause of Bone Loss by Pizzorno and Pizzorno, there are three ways to decrease the body burden of cadmium.

1) The primary strategy for reducing exposure to cadmium is to avoid it. This includes stopping direct and indirect exposure to cigarette smoke, avoiding the consumption of oysters, scallops, and shellfish from coastal waters contaminated with cadmium, and avoiding all foods grown with high-phosphate fertilizers (ie non-organic soy beans). Additionally, air particulates are an under considered source of cadmium (and other toxins) by the average person. Not allowing outdoor shoes to be worn inside the house, dusting regularly, and using air filters such as MERV-12 (preferred) or above in whole house forced-air systems or HEPA filters in frequently used rooms are other ways to minimize exposure. Further, children's jewelry imported from China should be avoided since a 2010 analysis by the US Consumer Product Safety Commission found that 12% of 103 analyzed items contained at least 10% cadmium, with one item containing a staggering 91% cadmium.

2) The second strategy is to ensure adequate consumption of foods rich in trace minerals that compete with cadmium, such as copper, iron, zinc, and selenium.

3) The third strategy is to increase excretion, but this must be done with great care to avoid increasing tissue release of cadmium faster than excretion, which can cause redistribution and further toxic effects. At this point, based on the research of Dr. Stephen Genuis and his team, saunas seem to be the safest and most effective method, though they are slow.

The majority of chronic diseases can now be attributed to toxicant exposure. This quote by my colleague Joseph Pizzorno, ND really strikes home for me as more and more we are seeing how we cannot hide from these environmental toxins:

"Somewhat independent of people’s choices, the things which in the past have been normally considered healthy, or at least neutral, are now becoming significant sources of toxins for people." ~Joseph Pizzorno, ND

All of us are exposed to cadmium and due to dietary, health and genetic differences, some of us have a larger body burden than others. Exploring the body burden of environmental toxicants is an important aspect of prevention. The good news is that naturopathic doctors, like myself, are trained in this and naturopathic medicine has a lot to offer those who are dealing with a high burden of cadmium and other toxicants. If this is an area that you have yet to explore, it's important and I'd love to help. Environmental medicine is a passion of mine, when we can remove even just one burden from a person's toxic load, it is amazing how the body can shift back into balance and so many other areas of health then improve!

Dr. Sarah Giardenelli is a naturopathic doctor, acupuncturist, and owner of Collective Health Center in downtown Leesburg, Virginia, with a passion for helping people explore root causes of their health concerns, including environmental toxicants which are now a driver of most chronic disease. When we identify and address root causes healing can begin.  

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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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