Seasonal Agrodolce Sauce

I’ve felt inspired by the gorgeous fruit in the market recently. The plums, peaches and pluots have vibrant color and sweetness that I find especially appealing. “Agrodolce” is a traditional sweet and sour sauce in Italian cuisine. I taught this recipe in a recent cooking class. It is easy to prepare yet makes a dramatic and elegant statement. The recipe captures the flavor of the fruit to make a savory accompaniment to a variety of dishes including fish like salmon or halibut, poultry, pork or even roasted veggies like squash or cauliflower.

Agrodolce

Author: Erica Leazenby, MD 
Makes: 1 cup (4 servings)
Time: 20 minutes

Ingredients:

1-2 Tablespoons olive oil, divided
½ large red onion, sliced thin (about 1 cup)
½ cup raw almonds
½ cup golden raisins
1 tsp fresh thyme
1 tsp fresh rosemary, minced
1 small orange, zest and juice
1 cup diced ripe fruit like apple, plum or cherries
1.5-2 Tbsp balsamic vinegar (more to taste as needed)
Pinch salt
Pepper to taste
Water to thin if needed

Directions:

1. Place 1-2 tsp of oil in a skillet over medium-low heat. Toast the almonds until fragrant, about 3-5 minutes. Set aside.

2. Place the remaining oil in the skillet and add the onion with a pinch of salt. Stir for 3-5 minutes until soft and caramelized. 

3. Add the raisins, fruit, herbs, orange zest and juice. Stir until the raisins are plump. 

4. Add the vinegar and simmer 2-3 additional minutes until the fruit is soft and the sauce has slightly thickened. Add in the reserved almonds. Add 1-2 tablespoons of water if the sauce becomes thicker than desired. Season to taste.

5. Serve warm or cold. 

Consider these additional pescatarian recipes:

ROASTED SALMON WITH LEMON WALNUT RELISH

GRILLED TUNA WITH ARTICHOKES

Back to School Breakfasts

Avocado Toast

The start of the school year means that many of us are getting back to familiar routines that may have become lax in the summer (or during quarantine). For those of us with school age children, late summer is a natural time to reset some of our habits for the upcoming year. Switching up your breakfast is an easy opportunity to increase your energy, control your cravings, encourage mental focus and potentially lose weight. These are benefits that can be enjoyed by the whole family regardless of age.  If you are currently skipping breakfast or not having a healthy breakfast, consider prioritizing this meal for a month and note how you feel. 

What is a healthy breakfast?

The typical American breakfast brings to mind foods like cereal, muffins, waffles, oatmeal and orange juice. Each of these foods and others like them are filled with sugar and carbs, and lack key nutrients such as protein and healthy fats. A meal high in sugar and carbs can temporarily boost energy, but without protein, healthy fats and fiber our blood sugar may spike and then quickly crash. This blood sugar roller coaster leads to more carb cravings, as well as compromised focus and erratic energy. The perfect breakfast is low in sugar and contains protein, healthy fats and plenty of fiber. The combination of these macronutrients ensures that our blood sugars are stable helping to keep us appropriately fueled for our day. 

Consider these sources:

• Protein: Plant-based protein powders (I like rice, pea and hemp), eggs, collagen or well-sourced, high-quality, unprocessed meats

• Fat: Nuts, nut butters, olives, high quality oils (EVOO, avocado oil, coconut oil)

• Fiber: Veggies of all colors and varieties especially greens, flax meal, chia seeds or psyllium husk

Breakfast when fasting:

If you’ve read my blogs or seen me in the office, you know I am a fan of time-restricted eating (AKA intermittent fasting). Not only is what we eat important, but when we eat it also impacts our health. Ideally the first meal of your day, regardless of the time it is eaten, includes protein, fat and fiber to set the tone for balanced blood sugars for the rest of the day.

Easy Swaps for your breakfast favorites:

 We all have favorite foods. Try applying some of these simple swaps to ensure balance in your meal.

• If you are fan of baked goods, including waffles or pancakes, try swapping the white flour for whole grain flour or almond flour to increase fiber. Almond flour can be easily swapped for a portion of the flour in most recipes. The almonds give added fiber and healthy fat to keep you full longer. Another tip for pancakes: if you like syrup, then try swapping with almond butter and cinnamon, applesauce, or berries.

• Include veggies in your favorite smoothie recipe. I recommend kale, spinach, avocado, cucumber or even carrots to add fiber and antioxidants, vitamins and minerals. The goal here is to provide extra flavor and nutrition without sugar. Add only enough fruit to make the smoothie delicious enough for your to have it in your rotation. Bananas and pineapple can send your blood sugar soaring if not balanced with fat, protein and fiber. So, use them sparingly and with enough veggies to balance them.

• Use leftovers from dinner to balance your eggs. If you are only eating eggs, you are getting good protein, but you are missing fiber. Save some extra roasted or steamed veggies from dinner and add to your eggs in the morning. You will gain extra fiber and antioxidants to start your day. Or, serve your eggs with a side of mixed greens dressed with lemon juice and olive oil for a savory early day meal.

• Avocado toast is not just for brunch at your favorite restaurant. Smash an avocado and place on whole grain toast, with lemon, red pepper flakes, sliced radishes and “everything bagel” seasoning to add delicious favor. Experiment and make it your own with your favorite toppings. The avocado provides fat, fiber and antioxidants. For a twist, try hummus on toast.

• Make your oatmeal a complete meal. By itself, it is a good source of carbs and fiber, however it lacks protein and fat. Try adding a spoonful of protein powder, whole nuts or nut butter to make it work for you.

Below I have listed several quick and easy breakfast options to inspire you to have your (breakfast) cake and eat it too. By focusing on one meal at a time you can easily make food habits healthier, and breakfast is a simple place to start. These recipes are nutrient-dense, balanced and most importantly convenient for the morning rush. 

Chocolate Chia Pudding with Berries

Decadent German Chocolate Chia Pudding

Breakfast Parfait with Coconut Yogurt and Nutty Low-Sugar Granola

Avocado Toast with Eggs

Sweet Potato with Chai Spiced Almond Butter

Cured Salmon with Apple 

Smoothie Bowl with Protein Powder

Beet Red Velvet Waffles

Eggs Poached in Spicy Tomato Sauce

Is It Time for a Whole-Body Tune up?

Sugar, wine, comfort food, boredom snacking. Sound familiar? The coronavirus has many of us “coping” in ways that may not be ideal for our long-term health. Finding ways to break the cycle of food cravings and unhealthy habits may be as close as 5 days away. 

What is a Fasting Mimicking Diet (FMD)?

A fasting mimicking diet is a type of intermittent fasting. It was developed by Dr. Valter Longo, an Italian biologist, researcher and expert in the field of longevity. Science has demonstrated that water fasting (drinking only water for a prescribed amount of time) can enhance healthy aging. Unfortunately, many people find skipping meals too challenging for regular practice. Dr. Longo, with his team of scientists at the University of Southern California, developed a FMD protocol using specific amounts of plant-based proteins, carbohydrates and fats that allows the body to “mimic” the beneficial response of a 5-day water fast. These include:

• Improved blood sugar- When it comes to managing blood sugar, intermittent fasting takes center stage. It has been proven to lower insulin resistance and increase metabolism. 

• Weight loss- Weight-loss resistance can often be due to an underlying hormone imbalance. Leptin is a hormone produced in your fat cells. Leptin resistance occurs when your brain stops recognizing leptin's signals to use your body’s fat stores for energy. This causes your body to continually store fat instead of using it. Fasting has been shown to improve chronic inflammation that can dull the brain’s leptin receptor sites. FMD is clinically shown to help individuals with normal-BMI reading to lose an average of 5.7 lbs of fat and 1.2 inches off waist circumference, while overweight/obese lost >8lbs, mainly with visceral fat reduction while protecting lean body mass.

• Curbed cravings- Fasting decreases your hunger hormone ghrelin, which in turn can increase dopamine levels in the brain. Fasting can also help free people from emotional eating and kill cravings by transitioning your metabolism from unstable sugar-burning to steady fat-burning.

• Lower cancer risk- Multiple studies have shown a link between fasting and a reduced risk of breast cancer.

• Enhanced heart health- Intermittent fasting is thought to lower heart disease risk due to its ability to lower triglycerides and blood pressure and raise beneficial HDL cholesterol.

• Improved autoimmune conditions- A fasting-mimicking diet under 1,000 calories a day for three-day cycles has been shown to improve symptoms associated with autoimmune conditions like multiple sclerosis as well as lupus.

How does it work?

During the five days of restricted FMD calories, the body goes into repair and recycle mode. When caloric consumption is low, the body turns to internal sources of stored energy. Not only does the body burn stored fat, it begins breaking down and recycling internal cellular components or entire damaged cells that weren’t working optimally. This process is called autophagy. Toward days 4-5 of the FMD, the body increases stem cell activity triggering a regenerative process to occur. It’s “out with the old, in with the new” at the cellular level.  There are many studies ongoing right now looking at FMD in cancer, cognitive impairment, kidney disease, multiple sclerosis, cardiomyopathy, depression, diabetes, metabolic syndrome and obesity. 

How to complete a FMD?

While there may be multiple ways to complete an FMD on your own, Dr. Longo and his researchers have developed a specific, patented product called Prolon, which I believe achieves the best results. It includes a kit with 5 small boxes containing all the food and beverages you need to complete a 5 days FMD. The meals include a nut bar for breakfast, dried soups for lunch and dinner, various snacks, a special low-calorie drink, as well as herbal teas. After you finish the 5-day cycle, you return to your normal, healthy eating habits for the rest of the month. Each cycle is beneficial, but completing a FMD for 5 consecutive days per month for 3 months shows significant benefits for people with excess weight or metabolic concerns, but even those at their ideal weight will also see benefits. The daily calories are as follows:

• On day one, 1090 calories are provided (10% protein, 56% fat, and 34% carbohydrate)

• On days two through five, 725 calories are provided (9% protein, 44% fat, and 47% carbohydrate).

My experience with FMD:

As a foodie and nutritional expert I did try my hand at recreating the FMD myself. I copied the calories and macronutrients described in the studies and created my own snacks, soups and salads. After comparing my results with my experience using Prolon, I found I had more weight loss and better energy response using the pre-packaged Prolon kit. I have now completed five Prolon FMD cycles. Here is what else I have discovered:

• I loved having the boxes of Prolon food. One of the hardest parts of being on a diet is figuring out what to eat, so this made it simple.  I completed 3 cycles in 3 consecutive months and plan to continue doing 2-4 cycles per year.

• Day 1 is fairly easy, but days 2 (and sometimes 3) can bring fatigue. By days 4-5, my energy and focus skyrocket. I have found that each cycle becomes easier. 

• The food: As a trained chef and foodie I know that my food choices are particular. The nut bar, olives and kale crackers are delicious. The soups are tasty, but I admit that I add a few dried herbs like oregano or basil to liven them up. The choco-crisp bar is a welcome sweet treat. 

• At the end of the five days, my clothes fit better, cravings improve and my sleep is more restful and energizing. I will admit I have been tempted to continue the fast because I felt amazing!

• I lost weight with each cycle. There is a small (and expected) bounce back in weight after resuming regular eating habits. However, over time with multiple cycles under my belt, I have experienced sustained reduction in weight and waist circumference.

Who should try Prolon FMD?

Prolon is best for people who want to maintain healthy levels of:

• Fasting blood glucose

• Cholesterol

• Blood pressure

• C-reactive protein

• Triglycerides

• Reduce excess fat while maintaining body mass.

Prolon fasting mimicking diet is not for everyone. Side effects include weakness and lightheadedness. It is important to keep exercise minimal while completing the 5 day program. Prolon FMD is NOT appropriate for anyone with nut allergy, diabetes or significant blood sugar problems, low body weight, eating disorder, pregnant or nursing women, chronically weak/ill, or the elderly. I recommend working with a healthcare practitioner to decide if it is right for you, especially if you want to monitor your health status with blood pressure and lab work.

Learn more about the various types of fasting.

Schedule an appointment to learn more. 

Prolon kits are available in the office or can be ordered here. 

Roasted Beet Chips

These beet chips are a delicious and elegant nosh for your summer porch party. I serve them with a non-dairy herb dip and a crisp rosé. Happy snacking!

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Beet chips

Roasted Beet Chips:

Author: Erica Leazenby, MD
Time: 45 minutes

Ingredients:

• 3 medium sized, unpeeled beets, cleaned

• Avocado oil

• Sea salt

Directions:

1. Preheat the oven to 350 degrees. Use the convection setting on your oven if you have one. 

2. Remove stalk and leaves from the beets. (Discard the stalk, but set aside the greens for later use.)

3. As thinly as safely possible, slice the clean, unpeeled​ beets with a sharp knife or mandolin. (The mandolin helps ensure the slices are uniform in thickness for even cooking.)

4. Toss the beets with a small amount of avocado oil. Use just enough oil to lightly coat each side of the beet. 

5. Arrange the beets in a single layer on a baking sheet and lightly salt. 

6. Bake the beets for 20-30 minutes or until they are bright red in color and the edges are starting to curl. Time may vary depending on the thickness of your cut. Flip the beets after about 15 minutes of baking. 

7. Be patient as the beets will become more crisp as they cool. But do enjoy them within several hours for the most optimal crunch. 

8. Don’t forget about the nutrient-dense greens. Use the greens from the beets to make delicious chips as well. Use the same method, but bake them for only 5-7 minutes or until crisp. Use them as a base for a beautiful presentation.

How To Roast Veggies Like a Pro

COVID-19 Policy for In-Office Care

As Indiana has experienced a decline of new cases in recent weeks, Relish Health has updated its policy to allow some appointments in the office by request. Relish Health is focused on your well-being inside and outside the office and wherever your travels take you. Virtual appointments will continue to be available and encouraged, especially for all follow-up appointments and for anyone at high risk of Covid-19 complications. However, if you request an in-person visit with Dr. Leazenby, please take note of the new policy below.

Relish Health Covid-19 policy for visits in the office:

• Screening – You will be screened upon arrival for COVID-19 symptoms and risk. This will include a questionnaire and temperature assessment. 

• Disinfecting – Dr. Leazenby is spacing appointments to allow for rigorous disinfecting of the office prior to each patient. It is extremely important you are punctual to your scheduled time and do not arrive early as there is no waiting room. 

• Hand Sanitizing – You will be asked to sanitize your hands upon arrival. 

• No Visitors – Patients will only be seen alone. Exceptions will only be made for minors, who may be accompanied by one adult. Adult patients may have their loved ones join their appointments though speaker phone, video conference, etc.

• Masking – Please wear a cloth face covering or standard medical ear-loop mask to your appointments. A facial covering is required for the entire duration of the visit.

A Playbook For Socializing During SARS-COV-2

Boost Your Immunity with Functional Medicine

A Playbook for Socializing During SARS-COV-2

The illustration highlights the importance of physical distancing in our day to day interaction with each other to "flatten the curve". We win by staying apart while remaining connected, not just as individuals but as a community. Image created by Sukriti Banthiya. Submitted for United Nations Global Call Out To Creatives - help stop the spread of COVID-19.

Many businesses are back open and life is starting to feel more “normal.” The new freedom to move about socially is refreshing. As we emerge from our lockdown it is tempting to assume the pandemic is over. However, the virus is still active and circulating. Unfortunately, there is no official playbook for how we manage the ongoing risk of this virus. See this story in the New York Times which includes excellent tips. Here is a summary below.

Tips for Socializing During a Pandemic:

1. Follow the health of your state and community. Be an informed citizen. Two important indicators of viral activity in your area include the percentage of tests that are positive and the overall trend of cases. For example, if in Indiana, check the Indiana State Department of Health Covid-19 Dashboard for the latest stats.

2. Limit your number of close contacts. Form a “COVID bubble” with a small number of family and friends. Inside this group communicate openly without judgement about what each person or family considers “reasonable precautions” and potential exposures. 

3. Manage your exposure budget. Each activity outside the house carries some risk and the risk is cumulative. The NYT article describes this exposure budget well. “You spend very few budget points for low-risk choices like a once-a-week grocery trip or exercising outdoors. You spend more budget points when you attend an indoor dinner party, get a haircut or go to the office. You blow your budget completely if you spend time in a crowd.”

4. Keep high risk activities short

   • Brief encounters (ie, passing someone on the sidewalk) are unlikely to make you sick.

   • Face-to-face contact with someone outside your “COVID bubble” should be kept short and with a mask. Ideally exposure should be less than 15 minutes to reduce the amount of potential viral exposure.

   • Indoor exposure is best kept to less than 1 hour. In an enclosed space you can still become infected from a person across the room if you share the same air for an extended period of time.

5. Keep taking precautions

• Keep a mask handy

• Practice social distancing — staying six feet apart — when you are with people who live outside your household or “bubble.” Keep social activities outdoors.

• Wash hands frequently and be mindful about touching public surfaces.

• Adopt stricter quarantine practices if you or someone in your circle is at higher risk.

COVID-19 VACCINE FACT CHECK

5 THINGS YOU SHOULD KNOW ABOUT A FACE MASK

Is Bone Broth Worth The Hype?

Simmering Bone Broth

I’m coming to terms lately that I may have a bit of a hoarding problem in the kitchen. I found no less than 9 quarts of homemade organic bone broth in my freezer. I love squirreling away veggie bits (ends of carrots, leeks, asparagus and onions, squash peels) together with bones from organic chicken. All of these scraps, which are often discarded, make amazing flavored broth that adds extra nourishment in many recipes. In my opinion, broth is what separates the good chefs from the extraordinary chefs. I use this broth in all my soups and often use it as the liquid for cooking rice. 

In the world of functional medicine, we LOVE bone broth. It is often cited as a gut-healing food. I frequently recommend its use when I am helping people overcome GI symptoms. It is delicious and well-tolerated, and does seem to anecdotally help people feel better. But, the scientist in me has often wondered if this was just hype or if research has proven this true. Unfortunately, there is very little scientific data about bone broth. 

Why drink bone broth?

Bone broth is a popular wellness product. The purported health benefits include being a rich source of collagen, amino acids and minerals with anti-inflammatory properties. The nutrients are extracted from the bones through a long cooking process that sometimes includes adding acid (vinegar) to the simmering stock.

Unfortunately, there is little published research about nutrients in bone broth. Recipes for broth can vary widely adding to the challenges of creating an accurate representation of the liquid. Small studies suggest broth contains modest amounts of chromium, molybdenum, potassium, selenium and magnesium, all of which are essential for health and healing. Other studies, however, suggest that broth contains only a minimal amount of calcium, phosphorus, iron, zinc, and copper. Adding vegetables to the simmering broth does increase the minerals (and the taste) in the finished product. Of note, simmering bones for long periods of time can also extract undesired elements like lead and other heavy metals. Luckily, studies (linked below) suggest that the levels of toxic elements are low and unlikely to be of concern.

How to make your own bone broth

As evidenced by my freezer, I love to make bone broth. Regardless of the lack of scientific data, I continue to see it as a nourishing and delicious component of healthy, flavorful cooking. I feel accomplished when I turn bits of veggies and bone into food that nourishes my family and creates incredible flavor. This is the “recipe” I follow. It is very adaptable to whatever veggies scraps or bones you have on hand. Many people like to purchase beef bones or chicken feet for the sole purpose of making broth. I prefer to use what routinely comes into my kitchen. Since I use the broth in a variety of cooking dishes, I also prefer to not add vinegar to my recipe. I have success creating a rich, gelatinous broth with the recipe below.

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Homemade Chicken Bone Broth

Author: Erica Leazenby, MD 

Makes: 3 quarts stock

Time: 30 minutes hands-on time (15 minutes prep, 15 minutes packaging)

Ingredients:

• 1 onion*, halved

• 1 large carrot* (clean but it does not need to be peeled)

• 1 celery stalk* 

• 1-2 fennel stalks (optional)

• 5-10 mushroom stems (optional)

• Butternut squash peels (optional)

• 4-5 whole peppercorns

• 1 large bay leaf

• 5-10 parsley stems*

• 2 sprigs fresh thyme or ¼ tsp dried

• 1 1x4 inch piece dried kombu** (This seaweed supplies extra minerals like iodine.)

• Frame of 1-2 organic or pastured chicken or an equivalent amount of bones, preferably previously roasted

• 3 quarts filtered water

Directions:

1.     Place all ingredients in a slow cooker or pressure cooker. 

2.     Allow the ingredients to cook for 36 hours in the slow cooker on low heat or 4 hours in the pressure cooker at high pressure. 

3.     Strain the contents of the broth. Once appropriately cool, place the stock in the refrigerator overnight. The next morning skim off any undesired fat. 

4.     Pour the stock in 1-quart freezer containers. Store for future use. (I also like to freeze a portion of the broth in 1 cup increments** for convenience.)

* Or use an equivalent amount of scraps. I avoid using cabbage, broccoli, cauliflower or other similar brassica family veggies.

Never fear. If this process sounds overwhelming, studies comparing homemade verses commercially purchased bone broth did not show signifiant difference in nutritional contents.

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Culinary primer:

The term broth and stock are often used interchangeably. They are closely related. I have listed definitions below that have been provided by one of my favorite food authorities, Epicurious. What many people term bone broth should technically be called bone stock. I am not sure how bone broth became the popular term, perhaps because it has a better ring to it.

Broth is water simmered with veggies like carrots, celery and onions, aromatic herbs like parsley, bay leaf, thyme and peppercorns and may or may not include meat or bones. It is usually cooked for a short period of time before being strained and seasoned. 

Stock is water simmered with veggies and herbs and animal bones (often roasted). It may also include pieces of meat. The water is simmered for longer periods of time before being strained. The goal is to extract the collagen from the connective tissue of the bones so that the stock has a thicker, gelatinous quality. 

 References:

1. McCance RA, Sheldon W, Widdowson EM. Bone and vegetable broth. Arch Dis Child. 1934 Aug;9(52):251-8.

2. Rennard BO, Ertl RF, Gossman GL, Robbins RA, Rennard SI. Chicken soup inhibits neutrophil chemotaxis in vitro. Chest. 2000 Oct;118(4):1150-7.

3. TIME magazine. January 2016. Science Can’t Explain Why Everyone is Drinking Bone Broth. Accessed at: http://time.com/4159156/bone-broth-health-benefits/

4. Monro JA, Leon R, Puri BK. The risk of lead contamination in bone broth diets. Med Hypotheses. 2013 Apr;80(4):389-90.

5. Hsu DJ, Lee CW, Tsai WC, Chien YC. Essential and toxic metals in animal bone broths. Food Nutr Res. 2017 Jul 18;61(1):1347478.

6. Dr. Kara Fitzgerald Bone Broth White paper: https://gallery.mailchimp.com/36f67b141008ab16392748797/files/76dd7b45-a07a-4c41-bc8d-fd4a497e1710/2019_Bone_Broth_Report_2_.pdf?mc_cid=d7e7a163d7&mc_eid=f46483d568

7. Broth vs Stock https://www.epicurious.com/ingredients/difference-stock-broth-bone-broth-article

8. Alcock RD, Shaw GC, Burke LM. Bone Broth Unlikely to Provide Reliable Concentrations of Collagen Precursors Compared With Supplemental Sources of Collagen Used in Collagen Research. Int J Sport Nutr Exerc Metab. 2019 May 1;29(3):265-272. doi: 10.1123/ijsnem.2018-0139. Epub 2018 Sep 26.

** Amazon affiliate link

Who will you be after COVID-19?

The world looks very different today than it did two months ago.  It is safe to say that we will never return to many habits of the past. Our social interactions will be different for the foreseeable future. Our economy has changed, and for many of us, the work that we use to define ourselves looks very different in practice. 

The Name by Jason Dorsey

The silver lining in this economic and social disruption is that we have the time and opportunity to ask some very intimate and probing questions of ourselves. In all the upheaval, we can reinvent and redefine ourselves. In my practice of medicine, I have come to believe that our biography becomes our biology. Indeed, own stories and life experiences have such a profound impact on us that the science of our bodies are forever changed. The sum of our experiences, good and bad, our changing purpose and meaning in life, and the pursuits we follow can all influence our health as much as the medication we may take. When patients understand the effects of their life on their health, it is only then that lifestyle modifications can begin to assist in healing.

Several years ago, I had my own epiphany of self. I was unhealthy in body and spirit. I didn’t feel well and was burnt out in the traditional practice of medicine. I ultimately made radical decisions to change my lifestyle and transition my career to functional medicine. I left behind a secure practice in conventional medicine to attend culinary school, pursue training in functional medicine and start an independent medical practice that treats people holistically. This helped heal me physically and emotionally. Part of my evolution was to recognize the role and purpose that I have in this world. I have a unique and particular impact to my health, family, community, work and environment. You, too, have a unique and particular role to play in this world. Identifying my purpose was transformative in my health and my career and I know it can be transformative in others as well. 

Making this drastic change in life did not come easy. We humans are spiritual, philosophical and social beings. We are not meant to figure out life on our own nor to go it alone. It is helpful to have wise counsel to help us determine our path. I found wise counsel to determine my purpose by working with two amazing coaches. Jason Dorsey, a Presbyterian pastor, has written a book entitled “The Name” which leads individuals through a process of mapping their core identity and setting goals for each sphere of their life including personal, family, work, community and place. Marcia Newman is a gifted life coach that listens and is an excellent teacher and sounding board as one works out their purpose and goals in concrete details. They can help you too. 

In this unique pandemic time, I invite you to ask the hard questions. What is your purpose? Why are you here? Do you want to continue life as it is? How can you transition to a different lifestyle or career to better embrace your purpose? 

Note that this is not a sponsored post, nor do I receive anything from this endorsement. There are many talented coaches that can speak into your biggest life decisions, and I suggest everyone explore a coach that works for them. However, I do recommend Jason Dorsey and/or Marcia Newman because they are talented, good and decent people that want you to live into your purpose to find joy, contentment and fulfillment. I, too, want this for my patients because it is good for your soul and ultimately, your health. 

Jason Dorsey’s Book “The Name”

Jason Dorsey’s Counseling Service

Marcia Newman and Associates Life Coaching Services

Curious how your biography is affecting your biology? Schedule an appointment with Relish Health to address your health.

Boost Your Immunity with Functional Medicine

Is your bloating caused by SIBO?

Small intestine. Image courtesy S Bhimji MD

You have probably heard that we are what we eat. I believe we are more accurately “what we absorb.” Much of our health and wellbeing hinges on a well-functioning gastrointestinal tract to absorb the nutrients that support the rest of the body. Pesky symptoms like constipation, diarrhea or frequent bloating and gas suggest that the GI tract may be compromised. These symptoms can be associated with small intestinal bowel overgrowth.

What is Small Intestinal Bowel Overgrowth (SIBO)?

Before we look at how the bowels can become overgrown with organisms, it is important to understand how the digestive system works. The intestines are comprised of the esophagus, stomach, small intestine and large intestines (also called the colon). Gastric acid produced in the stomach initiates the digestive process but also acts to suppresses the growth of ingested bacteria and control bacterial counts in the upper small intestines. The small intestines are where the majority of food is digested, and nutrients absorbed. The small intestines have an impressive length of approximately 10-15’ and are home to a large network of immune cells that help fight infection and regulate our immune system. The small intestines have a normal muscular activity which creates waves that move the intestinal contents, like food, through the gut. Our entire digestive tract is populated with trillions of organisms that make up our microbiome. The bulk of these bacteria live in our large intestines. The small intestines have relatively few bacteria in comparison to the large intestine. The normal (beneficial) bacteria are an essential part of the healthy small bowel. They help protect against bad (i.e. pathogenic) bacteria and yeast that are ingested. They also help the body absorb nutrients, and produce several vitamins like folate and vitamin K. Any disruption in the quantity of organisms, or balance of species, in the microbiome can be diagnosed as SIBO.   

What causes SIBO?

An overgrowth of organisms in the microbiome can occur when the stomach has inadequate gastric acid or the motility of the small intestines is slow. Food that nourishes us also feeds the microbiome and is subject to fermentation in the small intestines, especially if it spends prolonged time in the small intestines. This fermentation can produce gas (hydrogen or methane) that can be felt as bloating, belching, flatulence, reflux or the gas can trigger symptoms such as diarrhea or constipation. 

The conditions below are risk factors for SIBO and slow motility:

• Anatomic changes due to surgeries, scaring or small intestine diverticula

• Slow motility due to gastroparesis, celiac disease, scleroderma or pseudo-obstruction

• Metabolic changes such as those associated with diabetes or low gastric acid

• Advanced age

• Organ dysfunction like kidney failure, pancreatitis or liver failure

• Frequent medications use with antibiotics or gastric acid suppressers

How do you test for SIBO?

SIBO is most often diagnosed with a breath test. The test measures how much hydrogen or methane gas are in your breath. Both gasses are a byproducts of bacteria breaking down sugar in your gut. There are no blood or stool tests for SIBO. However, anemia, low B12 levels and markers of malabsorption may be seen on blood testing. 

How do you treat SIBO?

SIBO treatment includes 4 goals:

1. Correct the cause: SIBO is notoriously challenging to treat with a high recurrence rate. If possible, identifying and resolving the condition that initially predisposed one to the overgrowth increases the success rate of treatment. 

2. Provide nutritional support: Adopting a nutrient dense diet, supporting digestion/absorption and occasionally using targeted supplements can support gut healing. There are multiple dietary approaches for SIBO that also help relieve symptoms.

3. Treat the overgrowth: Although some antibiotics can predispose users to SIBO, there are other specific antibiotics and anti-microbial herbs that are useful in treating the overgrowth.

4. Prevent relapse: Sometimes it is difficult to completely resolve the predisposing risk(s) for SIBO. Using targeted pro-kinetics supplements of medications to promote small bowel motility can help prevent SIBO recurrence. 

Need help treating bloating, gas or abnormal stool patterns? Relish Health is here to help. 

Learn more about optimizing your gut health:

7 Steps to Fight Reflux and Bloating

Natural Foods for Gut Health

Promote Digestion and Gain Nutrients with Delicious Bitter Greens

Advice for Staying Regular When You Travel

Is a Low FODMAP diet right for you?

References:

• Collins JT, Nguyen A, Badireddy M. Anatomy, Abdomen and Pelvis, Small Intestine. [Updated 2020 Apr 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459366/

• Dukowicz AC, Lacy, BE and Levine, GM.  Small Intestinal Bacterial Overgrowth: A Comprehensive Review Gastroenterology & Hepatology Volume 3, Issue 2 February 2007 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/pdf/GH-03-112.pdf

• Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978‐2990. doi:10.3748/wjg.v16.i24.2978

Decadent German Chocolate Chia Pudding

Decadent German Chocolate Chia Pudding

I’ve had some extra time to be creative during COVID quarantine. Breakfasts have become slow family affairs which has been a fun time to experiment with new recipes. Chia pudding is a simple make-ahead option that is in our normal repertoire. This week I decided to make it more exciting with a decedent sauce made from whole, nourishing ingredients. Beyond breakfast, this recipe is delicious enough to be dessert!

Chia seeds are the edible seeds of a flowering plant in the mint family. They are rich in soluble fiber and a good source of short-chain omega-3 fatty acids, antioxidants, iron, and calcium.  When soaked, chia seeds absorb up to 12 times their weight in liquid. The soaked seeds have a gel-like texture that can work as an egg replacement in recipes or, in the case of this recipe, create a tapioca pudding-like product.

Enjoy!

Decadent German Chocolate Chia Pudding

Author: Erica Leazenby

Serves: 4

Time: 10 minute plus 1 hour chilling time

Chocolate Pudding:

• 1 cup non-dairy milk of choice (I use cashew milk, but you may try almond milk or oat milk)

• 1/2 cup full-fat coconut milk

• 1/2 cup chia seeds

• 2 Tablespoons cocoa powder

• 2 Tablespoons maple syrup (or try monk fruit syrup for zero sugar)

• 1/2 teaspoon vanilla

• Pinch of salt

Coconut Pecan Date Sauce:

• 4 large Medjool dates, pitted and soaked in warm water until soft

• 1/4 cup water

• 1/4 teaspoon vanilla

• Pinch of salt

• 2 Tablespoons pecans (Optional: toast for richer flavor)

• 2 Tablespoons unsweetened coconut flakes (Optional: toast for richer flavor)

Directions:

1. Drain the dates and place them in a food processor or blender with a 1/4 cup water, the vanilla and salt. Blend until the mixture is a smooth consistency. Stir in the the coconut and pecans by hand.

2. In a mixing bowl whisk together all the ingredients for the pudding. Pour the mixture into four containers. Top with a quarter of the coconut pecan sauce and garnish as desired with extra pecans and coconut.

3. Chill the pudding for approximately 1 hour before serving.

Calories per serving: 310, Fat: 22g, Total carbs: 28.5, Fiber 12g, Sugar 11.5, Protein 8g

References:

• https://www.medicalnewstoday.com/articles/291334#tips

5 things you should know about a face mask

5 things you should know about a face mask

On April 3, 2020 the Center for Disease Control (CDC) updated their guidance for the use of cloth facial masks by the general public as they continue to study the spread and effects of the novel coronavirus across the United States. Scientists now know from recent studies that a significant percentage of individuals with coronavirus lack symptoms or can transmit the virus to others before showing symptoms.  This means that the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing—even if those people are not exhibiting symptoms.  In light of this new evidence, the CDC recommends wearing face-coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.

As we adopt these new recommendations to protect ourselves and our community there are several items to consider.

5 things you should know about a face mask:

1. Wearing a face mask is not a guarantee you will not contract COVID-19. Many face masks do not keep the virus from entering your mouth or nose . They also don’t cover the eyes and a bit of coughed saliva that sprays into the eye can cause an infection. Not all masks offer the same protection. However, a face mask may discourage you from touching your face with contaminated hands.

2. Masks can be effective at capturing many droplets, which is the main transmission route of the coronavirus. Face masks help prevent the infection of others by reducing the number of airborne respiratory droplets created by coughs and sneezes.

3. Medical grade masks are in limited supply. They should be reserved solely for health care professionals and family members caring for someone who is ill.

4. When using a mask be sure the mask covers your nose and mouth. Wash your hands before applying the mask and again after taking it off. If your mask is made of cloth, it should be washed with soap and water after each use. 

5. The information about the transmission of COVID-19 is evolving. The CDC may continue to issue new guidance. 

While helpful, wearing a mask may result in a false sense of security and minimize addressing more essential interventions to reduce risk of infection.

Remember to follow these best practices:

1. Keep your distance. It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus. Do not gather in groups and stay out of crowded places. 

2. Clean your hands often. Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. 

3. Avoid touching your eyes, nose, and mouth with unwashed hands.

4. Cover your cough. Coughing into a tissue then immediately throwing the tissue away and appropriately washing your hands reduces your risk of transmitting viral particles.

5. Stay home as much as possible.

COVID-19 VACCINE FACT CHECK

A Playbook For Socializing During SARS-COV-2

Boost Your Immunity with Functional Medicine

Boost Your Immunity with Functional Medicine

Boost Your Immunity with Functional Medicine

By now we have all heard the public health pleas to stay home and wash our hands to prevent the transmission of COVID-19 and help “flatten the curve.” This public health prescription is vitally important to keeping our communities safe and our healthcare system stable. 

While social distancing is extremely important, many of us want to take additional steps to support our immunity and resilience against this extremely contagious virus. It is estimated that 80% of people will have mild disease, but it is still important to optimize our health for illness prevention and recovery.

Step 1: Eliminate unnecessary inflammation. 

Inflammation is the term doctors give to the immune response our body generates when it is addressing an insult. This insult can take many forms including a virus, bacteria, elevated blood sugar or even toxic food. Inflammation is not just a vague concept but can be measured through blood tests looking at various chemicals and immune cells. Even low levels can be associated with chronic medical conditions like diabetes, heart disease, autoimmune conditions and even depression. In the cases of severe COVID-19 viral illness, the virus seems to be capable of producing an excessive immune reaction in the host that can cause extensive tissue damage. This is sometimes termed a “Cytokine storm.” 

While there are no specific studies on COVID-19 prevention, a plausible way to optimize our immunity is to eliminate as much underlying inflammation as possible. Start with these foundational measures:

• Get your diet on point. You have heard this before, but at no other time has it felt so critical to be well nourished. This means eating a nutrient dense diet that provides us the minerals, antioxidants, adequate protein and healthy fats that make the immune system function well (translation: LOTS of veggies). This also means eliminating the foods that trigger inflammation like fried foods, sugar, highly processed junk food, excess alcohol and sweetened beverages. For many people, gluten and dairy are problematic and trigger inflammation. This is a great time to complete the Whole30 that has been on your to-do list. 

• Get adequate sleep. Since we are working from home it is very tempting to ignore our regular bedtime routine to watch the news or binge Netflix until the wee hours of the night. Sleep is intimately tied to our immune health. Without sufficient sleep, our body makes fewer cytokines, a type of protein that targets infection and inflammation. Getting adequate sleep reduces our risk of infection and can improve our outcomes if we do get sick. Conversely, sleep deprivation weakness our body’s defense system and makes us more vulnerable to illness. Aim for 7-9 hours of sleep each night.

• Stay moving. The gyms may be closed, but there are ample opportunities to keep moving. Get outside for a walk, try simple homemade weights in your basement or check out the numerous classes available online. There is great data suggesting that exercise can help the immune system find and deal with pathogens.  In the long term, regular exercise slows down changes that happen to the immune system with ageing, therefore reducing the risk of infections. High intensity interval training has particularly great data but any form of movement is better than being sedentary. Aim for 150 minutes of purposeful movement per week. Check out some of these free online resources.

• Manage your stress. Life for all of us has been upheavaled in the past month. It is normal to feel stress and anxiety with change. How we respond can help influence our immune health. Cortisol, one of the hormones associated with stress, can suppress our immune response. This is why you may become sick after periods of stress in your past. Acknowledging our fear and frustrations is important, but embracing stress management activities like meditation, journaling, exercise, prayer and yoga can help moderate our body’s cortisol response. If these strategies are not enough, I encourage you to find a professional counselor to help you address your emotions. 

Step 2: Supplement wisely. 

Supplements are just that… supplements. They support an otherwise healthy lifestyle. In this age of uncertainty many of us are tempted to look in the medicine cabinet for options that will boost our immunity. Unfortunately, there are no specific studies available to know how to prevent COVID-19 with supplements or drugs. It is important to stay sensible and not go overboard when considering supplements. Below is a list of supplements that may be foundational for health and immunity.

Please note. This list is not meant to be a prescription. Before starting any supplement talk to Relish Health or your health care provider about which supplements are right for you.

Where to start:

• Multivitamin/Mineral - About 75% of the US population (ages ≥1 year) do not consume the recommended intake of fruit, and more than 80% do not consume the recommended intake of vegetables. Unfortunately, micronutrient insufficiencies are common in the US. A high-quality multivitamin may help minimize the risk of low vitamin and mineral levels.

• Vitamin D - Most cells of the immune system have vitamin D receptors which help regulate the immune response. Vitamin D deficiency is associated with increased susceptibility to infection, and 41% of adults in the U.S. are clinically deficient in Vitamin D while an even greater number have insufficient levels. Vitamin D is a fat-soluble vitamin. Most adults can safely supplement with 1000-2000 IU daily without monitoring vitamin levels with a blood test. Higher doses may be appropriate if indicated by blood tests. 

• Zinc - 30 mg once or twice daily - Zinc has been extensively studied as a treatment for the common cold and other similar respiratory viruses. There is no specific data about zinc use with COVID-19, however zinc has been demonstrated to decrease the replication of other viruses.

Consider adding 1 or more if appropriate:

• Glutathione (GSH) or N-Acetyl Cysteine (NAC) - Glutathione is a potent antioxidant. It can be taken directly as a supplement. NAC helps support our body’s ability to make this antioxidant thereby indirectly increasing GSH. GSH effects the behavior of many cells of the immune system by enhancing their function. GSH may confer protection against microbial, viral and parasitic infections.

• Vitamin C - Vitamin C contributes to immune defense by supporting various immune cell functions. Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. According to some studies, supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections. 

• Probiotic foods or supplements - A large percentage of the body’s immune system is located in our gastrointestinal tract. The billions of microbes collectively living in the gut are called the microbiome. The bacteria in our gut influence our immune system. We can foster a healthy microbiome by eating a fiber rich diet and fermented foods like sauerkraut or kimchee.

• Antiviral herbs - Herbs have long been recognized for their medicinal properties. Herbs have a long history of use and are well-studied in traditional Chinese medicine. There are promising results from herbs including Echinacea, Goldenseal, Astragalus, Andrographis, Quercetin, and Reishi. *Please talk to your doctor to identify which herbs may be best for you.

• Adaptogens - Also from traditional Chinese medicine, adaptogens are herbs that aid our bodies in reacting to or recovering from both short and long-term physical or mental stress. Some also boost immunity and overall well-being. 

Most of these supplements can be found at health food stores; or check out Dr. Leazenby’s curated list of supplements at Fullscripts for examples of high-quality, vetted products. Discuss all supplements with your medical provider before starting.

A phased functional medicine supplement approach to COVID-19 provided by the Institute for Functional Medicine. May 2020. * Always consult your healthcare provider before starting supplements.

A Playbook For Socializing During SARS-COV-2

5 Things You Should Know About a Face Mask

References:

1. Features, Evaluation and Treatment Coronavirus (COVID-19) [Updated 2020 Mar 20].  https://www.ncbi.nlm.nih.gov/books/NBK554776/

2. UpToDate Coronavirus update https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?topicRef=8350&source=related_link

3. How Sleep Affects your Immunity https://www.sleepfoundation.org/articles/how-sleep-affects-your-immunity

4. Regular exercise benefits immunity -- even in isolation  https://www.sciencedaily.com/releases/2020/03/200331162314.htm

5. Micronutrient Inadequacies in the US Population: an Overview https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/overview

6. Prevalence and correlates of vitamin D deficiency in US adults. https://www.ncbi.nlm.nih.gov/pubmed/21310306

7. Vitamin D https://lpi.oregonstate.edu/mic/vitamins/vitamin-D

8. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394849/

9. Glutathione and infection. https://www.ncbi.nlm.nih.gov/pubmed/23089304

10. Vitamin C and Immune Function. https://www.ncbi.nlm.nih.gov/pubmed/29099763

11. The No BS Guide to Adaptogens for Hormonal Balance and Stress https://www.healthline.com/health/stress/smart-girls-guide-to-adaptogens

“An ounce of prevention is worth a pound of cure.” 

Benjamin Franklin 1736

Keep Calm and Moving

There have been so many changes to the world in such a short amount of time. For most of us our weekly rhythms of work, family time, exercise and stress management have been disrupted.  Given current social distancing recommendations, daily exercise might look like streaming an online yoga flow from home, taking a jog outside while responsibly keeping your distance from others, or simply doing some squats between conference calls. Regardless, getting into a groove at home is important for our physical and mental health. Maintaining a regular exercise and mindfulness routine is helpful to relieve anxiety and help build physicial and mental resiliency. Aiming for a least twenty minutes a day is a good target.

Enjoy some of these helpful links to bring some calm and movement back into your routine.

Yoga

Yoga is an ancient meditative practice that has many well documented health benefits. It is easy to do at home and can help promote a sense of calm.

• Indianapolis based “The Yoga Studio” is offering free yoga classes and meditation sessions via Instagram stories (@indyyogastudio). Their schedule is posted here.

• Yoga with Adriene on Youtube is a free on-demand resource that is great whether you are new to yoga or have years of experience.

High-Intensity Interval Training (HIIT)

HIIT is a type of aerobic exercise that involves alternating periods of regular intensity with short bursts of high intensity activity for 30 to 60 seconds duration. HIIT training is very time efficient and offers a great workout in as little as seven minutes. Check out these links to get started:

• The New York Times' Scientific 7- minute workout

• The workout app "Workout for women" offers free 4-60 minute routines that can easily be mixed and matched for variety and targeted body work. There is something for everyone in this app.

Meditation 

The benefits of meditation are numerous and supported by science. Many people start meditating to manage stress, reduce anxiety, and to cultivate peace of mind. But, there are thousands of studies documenting other less-known mindfulness meditation benefits including improved mood, lower cortisol, greater happiness and decreased inflammation.

• Headspace is a subscription-based app. During this trying time, the company is offering free access to supportive guided meditations called Weathering the storm. If you are a healthcare provider or an educator, the company is also offering free access to meditations to target your needs as well. 

Staying home in this season is our way to care for each other. Hopefully these resources help you care for yourself and find small joys in the new routine.

(This post is not sponsored. Relish Health does not receive anything in return from any link included here.)

Protecting Your Health with Shift to Online Care

Due to the challenges presented by COVID-19, the new coronavirus, I want to let you know about some modifications to how Relish Health will be operating through the end of May. Know that as a patient of Relish Health, I am here for you. I am doing my best to stay on top of information from the CDC, WHO, and our Federal and State Government.

Slowing the spread of virus is one of the most important things we can do to protect the health of our loved ones and ensure our health system is able to support those in most need. This means limiting non-essential travel, practicing social distancing and limiting gatherings. This concept is called “flattening the curve.” There’s a great article from The Washington Post which you can read here. 

In an effort to support you and the community, Relish Health is implementing the following steps effective today:

• Through the end of May, all follow-up appointments will be conducted as virtual visits. This will minimize your need to travel and limit the number of your potential viral exposures while moving about. Prior to your visit you will receive an email confirmation with your HIPPA-compliant, secure link and instructions. Please confirm your receipt of that notification through the portal.

• If you are a new patient to Relish Health your appointment will still be conducted in-person at the office. Please know Relish Health is implementing CDC-recommended precautions for screening and hygiene. Please contact the office if you would prefer to delay your appointment for a later time or conduct your visit virtually.

• I have created the opportunity for you to schedule shorter appointments, lasting 15 minutes. These are designed for acute illnesses as an alternative for you instead of visiting local urgent care facilities or your primary care provider. My goal is to minimize your need for travel and reduce your exposure to potentially crowded facilities. I have nearly a decade of urgent care experience to help support you in this season. These will be offered virtually through the HIPPA compliant, secure link on the portal. You may also contact me through the portal to inquire about an in-person visit, which will be considered on a case-by-case basis.

• Please be aware that Relish Health does not have COVID-19 test kits nor will it be designated as a testing facility in the future.

I will be continuing to monitor the situations and will continue to bring you the most comprehensive care and guidance available. We are in this together. 

Warmly, 
Erica Leazenby, MD

A Playbook For Socializing During SARS-COV-2

Boost Your Immunity with Functional Medicine

Is it COVID-19 or a Cold?

What is known about the novel coronavirus (COVID-19) is evolving daily. There are still many unknowns about the actual number infected and the best public health measures to slow population progression. A common concern for the public is the reported similarities of COVID-19 symptoms to a seasonal cold or influenza, other viruses that are still circulating in the community. Based on symptoms alone it can be difficult to differentiate what virus is causing a patient’s symptoms. Here’s how the illnesses differ and what to do if you have symptoms.

How symptoms of COVID-19 differ from the common cold or flu

Coronaviruses are not new. They are a group of RNA viruses that cause a variety of diseases in humans and other animals. Symptoms from different coronavirus strains vary. Some cause common cold symptoms while others can cause more serious respiratory infections like SARS. The specific coronavirus making headlines today is highly infectious and new (novel) to humans meaning we have much to learn about it’s potential effect on our global community.

Many viral infections have similar symptoms, ranging from fever, mucus production, body aches and cough to shortness of breath and fatigue.

Common cold

In most cases, a cold typically comes on gradually. Symptoms typically start with a sore throat and runny nose and may be followed by coughing and sneezing. Fevers are less common. Most people recover in about 7-10 days.

Seasonal flu

Symptoms of the flu differ from colds in that they often start abruptly. Influenza can include fever (over 100.5) or chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue. Some people may also have vomiting or diarrhea, though this is more common in children. Influenza (flu) can cause mild to severe illness.

COVID-19

Data from a recent study of patients in China with confirmed COVID-19 showed that the most common symptoms of this illness are a fever and cough. Shortness of breath is also a hallmark symptom that may peak on days 8-9 . The same study found that a small percentage of patients also experienced nausea or vomiting and diarrhea. 

Immunocompromised individuals are more at risk for developing a more severe version of COVID-19. They may not be able to mount a strong enough initial immune response and are at risk of significant inflammation and tissue damage triggered by the virus.

What to do if you’re sick 

Most importantly, if you get sick with fever, cough, and congestion stay at home. It is wise to reach out to a trusted health care provider for advice on differentiating between the viruses above. If you have not had the flu shot, a doctor may prescribe an anti-viral medication if the flu is suspected. If after a few days your symptoms stabilize—meaning you continue to have cough, low-grade fever, and body aches but no noticeable shortness of breath, you should continue to stay home and rest.

Reports from hospitalized cases of COVID-19 indicate that the potential for clinical deterioration appears to peak in the second week of illness (usually after day 8-9). Patients may develop shortness of breath—a major indicator of respiratory compromise.

If your symptoms worsen, particularly if you experience shortness of breath, it is imperative that you proceed to the closest emergency room. For safety, it is important to take private transportation and call ahead to let the ER know of your condition. 

How to get tested for the coronavirus?

Currently, testing for COVID-19 is being performed at state public health laboratories and The Centers for Disease Control (CDC). The CDC has broadened their guidelines for coronavirus testing so that anyone can be tested for COVID-19 if they have symptoms and a doctor’s orders.

Testing is expected to continue to become more widely available. This, however, does not mean everyone with signs of a cold should be tested for coronavirus.

The CDC is currently recommending that the following patients be tested:

1. Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.

2. Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).

3. Any persons including healthcare personnel, who within 14 days of symptom onset had close contact with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from affected geographic areas within 14 days of their symptom onset.

What if you test positive for COVID-19?

If you are sick and have been diagnosed with COVID-19 or suspected to have COVID-19 because you have been exposed to someone with COVID-19, follow the steps below to help prevent the disease from spreading to people in your home and community. Since the Seattle area faced some of the earliest cases in the United States, the Washington State Department of Health has good recommendations on their website:

• Stay home except to get medical care. You should restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas. Avoid using public transportation, ride-sharing, or taxis.

• Separate yourself from other people in your home. As much as possible, you should stay in a specific room and away from other people in your home. Also, you should use a separate bathroom, if available.

• Call ahead before visiting your doctor. If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed.

• Wear a facemask. You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then people who live with you should not be in the same room with you, or they should wear a facemask if they enter your room.

• Cover your coughs and sneezes. Cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues in a lined trash can; immediately wash your hands with soap and water for at least 20 seconds or clean your hands with an alcohol-based hand sanitizer that contains at least 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water is preferred if hands are visibly dirty.

• Avoid sharing personal household items. You should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After using these items, they should be washed thoroughly with soap and water.

• Clean your hands often. Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water is preferred if hands are visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

• Clean all “high-touch” surfaces every day. High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also, clean any surfaces that may have blood, stool, or body fluids on them. Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.

• Monitor your symptoms. Seek prompt medical attention if your illness is worsening (e.g., difficulty breathing). Before seeking care, call your healthcare provider and tell them that you have, or are being evaluated for, COVID-19. Put on a facemask before you enter the facility. These steps will help the healthcare provider’s office to keep other people in the office or waiting room from getting infected or exposed.

Discontinuing home isolation

From the Washington State Department of Health:

• If you have tested positive for COVID-19, you should remain under home isolation precautions for 7 days OR until 72 hours after fever is gone and symptoms get better, whichever is longer.

• If you have fever with cough or shortness of breath but have not been exposed to someone with COVID-19 and have not tested positive for COVID-19, you should stay home away from others until 72 hours after the fever is gone and symptoms get better.

Additional information for your household members, intimate partners, and caregivers is available here.

Dr. Leazenby has created a hand-picked list of supplements to support immunity. Review or purchase the Relish Health approved supplements through Fullscripts. Discuss all supplements with your medical provider before starting.

Boost Your Immunity with Functional Medicine

Milk and Health

Milk, cheese, yogurt and their many variations are a big part of the standard American diet. Most of us have grown up believing dairy is an essential part of a healthy diet. Americans have been told by the U.S. Department of Agriculture (USDA) that adults or kids over 9 years old should enjoy three 8-oz servings per day of milk or equivalent portions of cheese and yogurt for calcium to reduce the risk of bone fractures. But is this really necessary or even true?

In a recently published review article, The New England Journal of Medicine summarized the research related to one of America’s favorite foods. According to research this is what we know today:

What milk does: 

• If breast milk is not available, cow’s milk can be an important nutrient component of infant formula.

• Milk consumption while growing can increase height. The consequences of this accelerated growth is complex. Taller stature is associated with lower risks of cardiovascular disease but with higher risks of many cancers and hip fractures.

What milk does NOT do:

• Dairy is NOT associated with better bone health and decreased fracture risk. Research shows that countries with the highest intakes of milk and calcium tend to have the highest rates of hip fractures. This correlation may not be causal and might be due to confounding factors, but low dairy consumption is clearly compatible with low rates of hip fracture. In fact, a study found that milk during adolescence was associated with a 9% greater risk of hip fracture later in life for men for every additional glass they consumed per day.

• Dairy does NOT promote weight loss. A meta-analysis of 29 randomized trials showed no overall effects of dairy on body weight. Contrary to U.S. Department of Agriculture (USDA) advice to choose reduced-fat dairy, findings in studies showed that low-fat milk does not appear to have advantages over whole milk for weight control — and in children, available evidence suggests greater long-term weight gain with reduced-fat milk than with full-fat milk. 

• Dairy does NOT help blood pressure, cholesterol and cardiovascular disease. The relatively high potassium content of milk has led to the suggestion that greater milk intake may reduce blood pressure. Randomized trials of low-fat milk have shown inconsistent results with respect to reduction of blood pressure.

Risks associated with milk:

• Milk contains hormones. To increase milk production, cows have been bred to produce higher levels of insulin-like growth factor I (IGF-I) and they are pregnant for most of the time they are milked, which greatly increases levels of progestins, estrogens, and other hormones in milk.

• Dairy increases cancer risk such as breast cancer, prostate cancer and others because of the effects of milk consumption on human plasma IGF-I.

• Milk consumption predisposes to asthma, eczema, and food allergies.

• Foods may influence health both directly and indirectly through the environmental effects of their production. Greenhouse gas production, climate changes, pollution and antibiotic resistance are associated with the milk industry, particularly industrial-scale production.

Consensus: 

This article concludes that the health benefits of dairy products have not been established and concerns exist about the risks of regular consumption. When we evaluate the research, it is important to note that the reported health effects of dairy depend on the foods or beverages to which they are compared. In many studies, dairy foods are better when compared to processed red meat or sugar-sweetened beverages but less beneficial when compared to plant-protein sources such as nuts. The bottom line is to enjoy dairy responsibly and in small quantities, if at all.

How to Replace Butter When Baking

Homemade Almond Milk

Think you know dairy?

Dairy Free, Egg Free Indulgent Eggnog

Homemade Coconut Yogurt

Source: https://www.nejm.org/doi/pdf/10.1056/NEJMra1903547?articleTools=true

Homemade Coconut Yogurt

Homemade 2-ingredient Coconut Yogurt

Probiotics are all the rage in the wellness community. And for good reason, there is very interesting science about their effectiveness. Probiotics, however, are nothing new. Our grandparents and great-grandparents enjoyed them regularly as part of a common, non-industrialized diet. Making foods like yogurt and sauerkraut were simply tasty ways to preserve food. 

I recommend getting as many nutrients as possible through food, even probiotics. Yogurt is found in nearly every grocery, but few people realize how easy it is to make at home. Often the commercially available products include sugar and stabilizers that can be avoided with this DIY approach. Not everyone tolerates cow’s milk, so I’ve written a recipe below for a coconut milk alternative that I make at home.

Enjoy!

Coconut Yogurt

Ingredients:

• 1 can full fat coconut milk (Choose a brand without fillers or stabilizers in a BPA-free can.)

• 1 probiotic capsule containing lactobacillus OR ¼ cup of a prior batch of yogurt (store bought or homemade)

• 1 sterilized glass jar (I use a Ball jar that I first run through the dishwasher to sterilize.)

Directions:

1. Add the coconut milk and probiotic (or yogurt) to the clean glass jar. Stir to combine.

2. Loosely cover the jar with the lid and place the jar in the oven near the oven light. 

3. Turn on the oven light and let the jar sit overnight, but do not turn the oven on. The very low heat from the lamp is all that is necessary.

4. In the morning stir the coconut yogurt as separation is natural. Place the yogurt in the refrigerator to firm. Stir again just before using. 

Notes:

• Be sure to start with clean utensils and hands. 

• Choose a probiotic that includes lactobacillus somewhere in the range of 10-50 billion CFU. You do not want it to contain prebiotics. I use whatever I have on hand, but these are examples: Flora Advanced Adult Formula, Renew life Ultra Flora, Jarrow probiotic.

• The yogurt should have a sweet tangy smell. If it smells off or you see colored bacteria or mold on the surface, then discard it. 

• Low fat coconut can be used, however the consistency will be thin and pourable like kefir.

Check out these additional probiotic foods.

Should you be taking a probiotic?

(This blog post is not sponsored by any manufacturer. However, Relish Health may receive a commission on purchases made through an Amazon link.)

10 Tips for Starting a Plant-Based Diet

Have you made a resolution to make changes for a healthier 2020? I know many people kickstarted the year with a "cleanse" or a specific or restrictive diet. However, a healthier year usually takes a longer-term approach. I recommend setting goals that move your eating in the right direction in realistic and sustainable ways. My one size fits all advice is to simply eat more plants. Whether you are interested in a vegetarian or plant-based diet or simply adding more vegetables to your diet these strategies may be helpful. 

1. Build every meal around a star vegetable, instead of a meat or carbohydrate. How about a roasted cauliflower, veggie tagine or meaty grilled portobella mushroom with romesco sauce?

2. Embrace the 4S's. Soups, salads, smoothies and stir fries are great ways to add more veggies to our meals. 

3. Use the flavor and health benefits of herbs and spices to transform meals from bland to exciting. This Moroccan lentil soup is deliciously spiced with anti-inflammatory turmeric, ginger and cinnamon.

4. Use different cooking techniques to bring out different flavors—for example, roasting a vegetable can bring out sweetness; grilling a vegetable can bring out the smokiness. Check out this roasting guide for perfect veggies every time.

5. Use a variety of textures—build an interesting and satisfying meal by layering different textures, such as crunchy nuts and seeds, chewy shiitake bacon, or silky smooth cashew cream.

6. Add sauce- Pesto, romesco and salsa verde are some of my favorites. They are a great way to add flavor and a few more veggies to your plate.

7. Make cashew cream— many people miss the creaminess associated with dairy products when they transition to a dairy-free or plant-based diet.  Raw cashews, soaked and then puréed, make a great substitute for cream. Add a splash of lemon juice and a pinch of salt for a sour cream like flavor.

8. Caramelize or pickle onions—these make an excellent flavor addition to almost any food and keep well in the fridge for a quick way to elevate a meal.

9. Embrace fermented foods. Sauerkraut, coconut yogurt, kimchee and miso are few of the probiotic rich foods that are easily found in most groceries. They add a punch of flavor while benefiting your gut health. 

10. Make your food beautiful— Embrace the wide variety of colorful fruits and veggies available at the grocery. We also eat with our eyes, so paying attention to presentation makes your food more satisfying. Fruits and vegetables are naturally beautiful.

Here’s to healthy year. Cheers!

Dairy Free, Egg free Indulgent Eggnog

Dairy-free eggnog... it’s that time of year when one of my favorite drinks is available. While you can certainly add bourbon or rum, and enjoy this classic drink by the fire; my preference is to enjoy it without the alcohol. It can be an afternoon treat, a dessert, or sometimes I add a splash in my morning coffee. Whenever I see dairy-free eggnog at my grocery I indulge because that limited time label means “buy now because you won’t see it again this season.” Last year I bought a carton before Thanksgiving and never saw it at the grocery again.  In case you missed the eggnog already, I have an easy recipe below to put on repeat for the season. 

Vegan Eggnog

• 1 13.5 oz can full-fat or lite coconut milk

• 13.5 oz unsweetened nut milk (I like cashew)

• 3 Tablespoons maple syrup or monk fruit sweetener

• 2 teaspoons vanilla

• 1 teaspoon ground nutmeg

• 1/4 teaspoon ground cinnamon

• Pinch of salt

• Bourbon or rum (optional)

Blend until smooth. Chill and enjoy

Dairy-free Eggnog

Additional information about reducing dairy in the diet:

Milk and Health: Research from the New England Journal of Medicine

Think you know diary?

Homemade Almond Milk Recipe

How to Replace Butter When Baking

Homemade Coconut Yogurt

How to replace butter when baking

How to replace butter when baking

Dairy is a delicious and nutrient-dense food, however not everyone can tolerate digesting it. Scientists estimate that 75% of the world’s population is lactose intolerant. Many other people have a sensitivity or allergy to the protein in milk and find their health is better when dairy is left out of their daily diet. 

Replacing dairy milk with a nut milk and foregoing cheese are straightforward solutions to going dairy-free. However, converting a baking recipe with butter to a non-dairy alternative can be challenging. I’ve listed a few tips below to help you convert your favorite recipes with success. 

Tip 1: Determine the role of butter in the recipe. Butter is comprised of 80% fat and 20% water. When used in baking, the fat provides a softer texture and rich mouth feel while the water provides steam that can help create rise and volume. Butter also has a distinct flavor and the ability to brown. In recipes like quick breads or muffins, butter can often be substituted with bananas, applesauce or pumpkin purees to provide moisture. In recipes where a light, flaky or crisp texture is desired; the fat in the recipe must be substituted in order to produce a similar finished product. 

Tip 2: Choose a liquid or a solid fat for substitution. Liquid fats like olive oil and avocado oil can make lovely substitutes in some baked products, especially recipes that call for melted butter. Liquid fats cannot be creamed with sugar to aerate a batter, so they are best to use in products that are moist and dense, like quick breads. Solid fats, however, can be creamed with sugar or rubbed into flour to trap air and provide lift for light, fluffy cakes and flaky crusts. Coconut oil is a plant-based fat that is solid at room temperature, so it behaves similar to butter when baking. One caveat is that butter melts at 90°F while coconut oil melts at 76°F. Coconut oil can easily melt in a warm kitchen thereby losing its ability to aerate your baked products. Chilling the oil in the refrigerator and taking care to not overwork the batter/dough can mitigate this difference. 

Tip 3: Adjust the quantity of fat. Unlike butter, coconut oil and liquid fats are 100% fat with no water content. Baked goods can feel heavy and greasy if oil is substituted 1-to-1 for butter. When substituting coconut oil for butter reduce the quantity used by 20-25%. 

 Tip 4: Add flavor. Olive oil, avocado oil and coconut oil each have their own subtle flavor profiles. Adding vanilla, citrus zest, cinnamon, herbs or an extra pinch of salt can enhance the flavor of the product and make up for the loss of butter flavor. 

Converting recipes is a science and often requires trial and error. Don’t be afraid to experiment. I’ve had my fair share of less than perfect baked goods, but they usually always taste great. Through experimentation you will find the perfect replacement to get the light and fluffy or crispy texture you are after.

Additional information about reducing dairy in the diet:

Milk and Health: Research from the New England Journal of Medicine

Think you know diary?

Homemade Almond Milk Recipe

Dairy Free, Egg Free Indulgent Eggnog

Homemade Coconut Yogurt