How the Gut Affects Fatigue

I recently listened to a webinar interview featuring Dr. Michael Ruscio, who has conducted a lot of clinical research in the area of digestion and been widely published in peer reviewed journals. He is the author of Healthy Gut, Healthy You and is a guest speaker at the Fatigue Super Conference. He discusses the importance of good digestion and ways to achieve optimum health through a healthy gut. From my own personal experience dealing with fatigue and energy issues, I was happy that he validated a lot of what I’ve been through and the research I’ve done to date. Here are some key points from his interview:

  • Energy and mood are inextricably linked. When you are tired, you feel depressed. This happens to me – when I have good energy levels, I feel like I can conquer the world. When I’m tired and fatigued, I get depressed and feel like the weight of the world is on my shoulders. This has to do with inflammation and the small intestine. The small intestine is the most immune-active area of the body with the largest density of immune cells. In the small intestine, the immune cells have to be well calibrated to deal with the external environment (coming from food) and the internal environment (the bloodstream). If there are disruptions in the flora with bad bacteria and fungus, the body will trigger inflammation as a response. These excess levels of inflammation affect centers in the brain and cause fatigue and depression.

  • Inflammation in the intestinal tract has an impact on cognitive function and energy levels. There is clinical evidence that probiotics can improve fatigue, anxiety and depression. Also, poor gut health will impact the proper absorption of nutrients leading to deficiency.

  • Inflammation is like the police – it is the enforcer of your immune system. Bad bacteria or viral pathogens are rescued by inflammation that is generated by the body to protect itself.  The right amount of inflammation is beneficial but if the gut kicks out excess inflammation, that’s when you will see a cross-system impact. The gut barrier is inflamed, and it impacts the blood brain barrier and the mitochondria. It alters the environment in the gut to make it hospitable for unsavory guests and creates a more pro-inflammatory setting.

  • Inflammation is not only isolated to the gut. For example, if you have an intolerance to gluten, it can manifest not only in the gut but on skin (acne, breakouts), joints (pain), and brain (fog).

  • Key influencers in digestion:  
    • A low FODMAP diet has been shown in patients with fibromyalgia to improve fatigue and pain. Traditionally used for patients with Irritable Bowel Syndrome (IBS), low FODMAP stands for low Fermentable Oligo-, Di-, Monosaccharides And Polyols. That means eliminating foods like: wheat, legumes, garlic, onions, milk, yogurt, cheese, figs, honey, mangoes, blackberries and low-calorie sweeteners, all of which contain high FODMAP.
    • Gut function and sleep are also linked.
    • Probiotics are a good intervention. They’ve been shown to help improve sleep under stress or those with small intestinal bacterial overgrowth (SIBO).
    • Other factors: stress and exercise, early antibiotic use, lack of exposure to natural environment to seed good bacteria (Cesarean births and non-breast fed infants), overly hygienic practices.

  • The gut is also impacted by hormones. Although the impact on male hormones is not very pronounced, female hormone mediated symptoms are more easily identified. The gut detoxifies hormones like excess estrogen and as a result, women may be more impacted by the gut hormone connection.

  • Dr. Ruscio believes that in this country, doctors over-diagnose low thyroid and under-diagnose gut issues. A lot of people may be getting a hypothyroid diagnosis due to fatigue, constipation, dry skin and depression even if they are within the normal range of hormone levels. Because patients that are ‘hypothyroid’ often take supplements and vitamins, make dietary and sleep changes in addition to their thyroid medication to improve their condition, it’s hard to separate out which variable is truly working. Symptoms of low thyroid can be very similar to a gut problem so it’s possible that the integrative doctors are overlooking gut issues when evaluating the symptomology of the patient. Acccording to Dr. Ruscio, about 10-15% of the US population has IBS-related issues whereas only about 4% of the population has true hypothyroid issues. This was a fascinating insight for me as I’ve been hypothyroid for years. I’m now working with my integrative physician who recognized this – we are evaluating the gut through a comprehensive probiotic/prebiotic program to see if this will improve my status.

  • From a dietary regimen standpoint, your family history, treatment history, and presentation of symptoms should tailor your diet approach – whether it’s being a carnivore or a vegetarian, the most viable diet is one that works for you. You should find out if you are eating too few carbohydrates, for example. Chronic fatigue patients often feel worse on a low carb/keto diet – I felt the same way when I tried the keto program. It made me feel like I had the constant ‘keto’ flu with low energy levels. It’s important to not ‘vilify’ proteins or carbs. Dr. Ruscio is not a fan of any extreme forms of diet but recognizes that different diets work for different people. Even the low FODMAP approach could be an issue for some – too much vegetable and roughage could cause a flare-up for some. I’ve tried just about every diet and after years of experimenting, I noticed that I tend to do best on a “pegan” diet (Paleo but limited meat/fish and lots of vegetables) with some carbs but not too much.

  • Dr. Ruscio cautions that labs are not an exact science – they are only indicators. Clinicians often get tunnel vision when looking at lab work and treat patients based on the numbers. They need to look at the patient’s symptoms and judge from clinical experience what the labs are telling them. He shared some astonishing examples of fraudulent companies that were exploiting lab data to drum up business. 
    • UBiome was under federal investigation for fraudulent practices like using 5-year old stool samples that have been stored in sub-standard laboratory conditions and using the data to give medical advice.
    • Neuroscience Labs and its sister company pled guilty to using unapproved and unvalidated normal lab ranges for tests and manipulating the test data to sell their supplements and nutraceutical formulas.

Regarding lab work as an indicator, I recently had this experience with my integrative MD.  One of my viral load test data wouldn’t budge no matter what I did. However, because my symptoms have improved along with other metrics of health, she decided not to worry about the lab result and to discontinue testing.

  • Probiotics can be put into three categories: The traditional lacto bacillus and bifido strains; yeast strains (Saccharomyces boulardii); and spore-forming strains (bacillus).  Dr. Ruscio has seen pockets of research for these strains helping different conditions. What he’s noticed is that in the Irritable Bowel Syndrome area where probiotics are most studied, there is a trend towards treating patients with multi-species formulas rather than a single type. He sees this as the middle-of-the-road treatment with single species at the low end, all the way up to a fecal transplant as the extreme. His analogy is the 3-legged stool and considers the triple therapy as the most robust and comprehensive way to apply probiotics. Probiotics are actually anti-microbial products and a standard treatment for Small Intestinal Bacterial Overgrowth (SIBO). Probiotics can clear the fungal infection, help with motility and reduce inflammation in a non-invasive way (as opposed to antibiotics). This was very interesting to hear as I am in the midst of a comprehensive probiotic program now under the guidance of my physician – I’ll be anxious to see how it will impact my health after the 3-month experiment.  

  • It’s important to work with a good functional medicine/integrative medicine doctor and build a dashboard of your history, conditions and symptoms to see and understand your response against each of the therapies.

  • If you are on your own and cannot see the doctor, where should you start? 

  • Consider the importance of dietary and lifestyle interventions. What you put in your mouth, how much you move/exercise and the state of your mind and sleep are all contributing factors to a healthy gut.    
    • Mild apnea or sleep disorder breathing can be caused by your gut. Also, congestion that is histamine-mediated is usually caused by problems in the gut. So breathing better will help you sleep better which will give you more energy. Some of your sleep issues can occur independently so not all emphasis should be on the gut.
    • If you’ve had orthodontics like braces and head gear, you may be at higher risk for sleep apnea because the oral archway has been compressed with sub-optimal respiration. If you think you have sleep apnea, you should get checked through a sleep study.
    • If you want to try a ‘self-check’, use the app Sleep Talk. It only records when you are making noises.

It’s a fascinating interview – my belief is that energy is KING and anything we can do to optimize and improve it will help us live with vitality.

Check out Dr. Ruscio’s website for more information about him and his practice.

3 Ways to Humanize the Virtual Health Care Experience

For telehealth to remain a significant force in health care after the pandemic subsides, digital tools will have to take human emotions into account in the ways they support patients and care providers. A growing array of offerings are doing just that. They are aimed at helping both parties build trusting relationships.

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Building Trust into Telehealth

Trust is harder to establish in a virtual conversation than in person. The limits of technology pose a variety of challenges. This article identifies them and makes recommendations for overcoming them.

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More Natural Ways to Lower Your Blood Pressure

According to the latest statistics from the CDC (Centers for Disease Control), if you have high blood pressure, you are among almost half of all American adults. Hypertension (high blood pressure) is a major risk factor for cardiovascular disease, kidney damage, stroke and vision impairment and increases mortality by over 200% compared to those who don’t have high blood pressure. 

So, as a follow-up to my previous blog on the subject, I’m going to share some more evidence-based tips on natural ways to keep your blood vessels healthy and strong. 

Beetroot Juice

Beets get their beautiful red color from the plant pigment known as betanin which has antioxidant and anti-inflammatory properties. Beets are not only delicious but rich in nitrates which get converted to nitric oxide (NO). NO helps maintain healthy blood pressure, is important to vascular dilation and also plays a role in strengthening the immune system by protecting the lungs and lowering the risk of respiratory infections. Beetroot juice is widely used by athletes to enhance their performance.

In this study published in the Hypertension Journal, a cup of beet juice for four weeks lowered systolic blood pressure. 

I love beets in almost every form but am also a fan of adding beetroot juice powder to my daily drink to enhance energy and keep by blood pressure in check. Here is one I love because it’s fermented:


Raspberries, blackberries, blueberries, strawberries – these richly colored berries are high in disease-fighting antioxidants called anthocyanins. Anthocyanins work by suppressing the production of blood pressure-raising angiotensin-converting enzymes while increasing levels of energy producing nitric oxide.

In this study, two servings of berries (~275mg of anthocyanins) consumed daily led to an average systolic blood pressure reduction of 7.3 mm Hg, while helping to raise HDL cholesterol (the good cholesterol, which absorbs cholesterol and carries it back to the liver which then flushes it from the body. High levels of HDL cholesterol can lower your risk for heart disease and stroke.)

When in season, it’s great to enjoy fresh berries. However, I generally prefer frozen options as they are great year-round and I never have to worry about eating them before they expire. I stock my freezer with wild or organic frozen berries and use them for my shake or snack. Here’s a recipe I use for a healthy post-meal dessert:

  • 1 cup of frozen berries
  • A few drops of Stevia or sprinkle of monk fruit sweetener to taste
  • 2 tablespoons of coconut cream or coconut milk
  • Microwave for 20 seconds to soften the berries just a bit. Top with some nuts (walnuts, almonds, cashews) and coconut flakes and enjoy!


Cinnamon is a common herbal remedy used for digestive issues, blood sugar problems and even respiratory infections. One of the active ingredients called cinnamaldehyde is a powerful antioxidant that is also being studied for its ability to decrease blood pressure. In this study, cinnamon had a hypotensive effect on diabetic patients leading to reductions in systolic readings by over 5mm Hg. And this effect can be seen with only 1-2 teaspoons a day.

It’s easy to get in your daily dose by sprinkling cinnamon into coffee, tea, yogurt, smoothie or oatmeal. Here is one to try:


German chamomile (Matricaria chamomilla) has a long history of use as a medicinal herb and is still used today to reduce stress and ease muscle tension. Chamomile tea is also a popular remedy for blood pressure:

  • Chamomile has anti-inflammatory properties and helps blood vessel walls to relax and dilate
  • Chamomile has a natural hypotensive effect by acting as a diuretic to flush fluids out of the body
  • Chamomile has a relaxing and sedative effect that lowers anxiety and stress and promotes calm and sleep

You should wind down with a cup of good chamomile tea to help you relax and get ready for slumber. Here’s one to try.

You can also use chamomile essential oil and add several drops to your diffuser. If you prefer to apply directly to your skin, make sure it’s diluted with a carrier oil like Jojoba.

Here’s one to try that’s already been diluted:


Garlic’s key active ingredient, allicin, has antiviral, antibacterial, antioxidant and anti-inflammatory properties. It also stimulates the production of nitric oxide which helps dilate the blood vessels and reduce blood pressure. Garlic has been studied for its immune boosting properties and improving LDL cholesterol but it’s also great for reducing hypertension. 

In this study, garlic extracts lowered systolic and diastolic blood pressure in hypertensive participants by up to 8.7mm Hg. Meanwhile, in this double-blind, placebo-controlled study, participants with uncontrolled blood pressure taking 960mg of garlic extract daily for three months saw blood pressure drop by 10 points which is comparable to existing blood pressure medications.

Dosages recommended are 4g (one to two cloves) of raw garlic per day. Unless you are chasing away vampires, the easier way to get this in is through a supplement. Here’s an odorless one to try:


Lavender (Lavandula augustifolia) is in the mint family and has long been used to manage mood and anxiety – but did you know it’s also good for blood pressure? In this study, researchers found that inhaling lavender essential oil after heart surgery caused reductions in both blood pressure and heart rate. Add 4-5 drops into your diffuser or you can dilute 3 drops to 9 drops of carrier oil like avocado or jojoba oil and massage it into the back of the neck. Remember, more is not better and make sure you do not ingest lavender oil as it’s not meant to be taken internally. 

Here’s one to try:


Melatonin, a hormone produced by your brain, is an antioxidant that boosts the immune system, protects us from disease and also reduces blood pressure spikes that occur at night and during sleep. This study found that 2.5mg of a melatonin supplement at bedtime reduced diastolic and systolic blood pressure up to 6mm Hg.

It’s best to let your body do the work to produce sufficient levels of melatonin, and nighttime exposure to “blue” light from electronic devices can disrupt the body’s production of this important hormone. So make sure to turn off the TVs, laptops and other light-emitting devices in preparation for shut-eye so your body knows that it’s time to rest and repair. Here’s more on the impact of blue light on melatonin production:

If you feel like you need a melatonin boost at times, you can try low dosages to begin with and go from there. Here’s one to try:

Olive Leaf Extract

The leaves of the olive tree (olea europaea) have been used for centuries to treat viral infections and speed wound healing, and also exhibit the highest content of bioactive compounds. One of the active ingredients known as oleuropein is garnering attention for its ability to modulate blood sugar, reduce cancer risk, boost the immune system and fight inflammation. It is also being studied for its blood pressure lowering effect by improving endothelial function and relaxing artery walls.

In this study, olive leaf extract was similarly effective as a blood pressure medication in lowering systolic and diastolic blood pressures in subjects with stage-1 hypertension.

Olive leaf extracts are readily available in liquids, capsules and tablets – check with your doctor if you are interested in supplementing. Here’s one that I use:

Pycnogenol (French maritime pine bark)

Pycnogenol or maritime pine bark comes from an evergreen tree (pinus pinaster) grown in France and is rich in compounds (procyanidins, flavonoids and polyphenols) that suppress the production of blood pressure-raising angiotensin-converting enzymes while increasing levels of energy-producing nitric oxide. 

This study showed that diabetic, hypertensive individuals taking 125mg of pcynogenol supplements daily for 12 weeks were able to reduce their blood pressure medication by 50%.

When supplementing with pycnogenol, look for a formulation that is standardized to at least 65% procyanidins and check in with your clinician or naturopath to make sure this will put you on the right track. Here’s one to try:


Not only is watermelon a tasty snack, research suggests that the amino acid called citrulline from watermelon significantly reduces blood pressure and oxygen demand in overweight adults.  

Citrulline is converted to arginine which produces nitric oxide that is necessary to maintain healthy vascular tone and regulate blood pressure.

Watermelon is truly a functional medicine food as its hypotensive and vasodilatory effects are pronounced. A cup of watermelon has 250 mg of citrulline which makes it the highest known natural source of this amino acid. Watermelon is also rich in the antioxidant carotenoid called lycopene – the disease-fighting plant pigment also found in red tomatoes.

When shopping for watermelon, look for firmness with a yellow “ground spot” showing where the fruit has rested on the ground. Watermelon should taste sweet but with a firm texture and a sufficient red color (showing off its lycopene content). If buying watermelon off season, check the frozen fruit section.

For more tips on how to eat your way to better health, sign up for my monthly newsletter.

Heart Disease and the Role of Cholesterol

Cholesterol has certainly gotten a bad rap over the years – remember the low fat craze where butter and eggs were considered ‘bad’ for vascular health? Fortunately, medical organizations have reversed their position on cholesterol but many of us are still not looking at the whole picture.

In an interesting podcast by Dr. Elizabeth Boham on the Doctor’s Farmacy, she discusses how cholesterol is only one factor in cardiovascular disease and in lieu of looking at cholesterol as a symptom of heart disease, we need a more comprehensive and balanced approach in considering all the risk factors. So in this two-part blog, I’ll highlight: 1) factors that contribute to heart disease and cholesterol’s role in it, and 2) natural ways to manage heart disease risk factors.

  • Cholesterol is critical for our body to function – it not only makes essential hormones to keep us alive but one quarter of the body’s cholesterol is in our brain so it’s what keeps us mentally sharp. In fact, several studies have demonstrated higher rates of dementia in people with low cholesterol.

  • Cholesterol is composed mainly of two types: high-density lipoprotein (HDL) and low-density lipo-protein (LDL). Lipoproteins are made of fats and proteins and they are the transport mechanism for cholesterol through your body.
    • HDL transports excess fats and oxidized fats back to the liver for recycling and disposal. 
    • LDL carries cholesterol through the bloodstream along with fat-soluble vitamins (A, D, K) and essential fatty acids (DHA, EPA), so it is vital for our body to function. But too much of it can collect in arterial walls and lead to plaque buildup known as atherosclerosis.

  • It’s important to look at triglycerides as they are carried around in your blood by lipoproteins that make up cholesterol. Triglycerides are a type of fat in your blood. Oils and butters and fat are triglycerides but your body also turns excess calories and simple carbohydrates like breads, pasta, sugar and alcohol into triglycerides and stores them in fat cells. Triglycerides are essential to the body but in excess, can lead to obesity, diabetes and heart disease.

  • There is an association of cholesterol with vascular disease but we need to know what the numbers actually mean as the risk factors vary depending on the individual.

  • 75% of patients with heart attacks have normal ranges of cholesterol. However, what’s interesting is that two thirds of patients with heart attacks have either pre-diabetes or diabetes which are un-diagnosed and un-tested.

  • The problem with standard cholesterol testing is that it only gives you the number with no idea how large the particles are. The cholesterol test you should ask your doctor about is particle size testing. It is called the NMR panel (LabCorp) or Cardio IQ (Quest) – it should be covered by insurance. I had mine done about five years ago and it was covered.

  • Size matters! The analogy used to describe cholesterol and particle size was dirt and dump trucks. Cholesterol is the dirt and dump trucks are the particles carrying the cholesterol. What’s desired are big dump trucks (big particle size) to move the cholesterol. Having too many small dump trucks (small particle size) is concerning as this can cause plaque build-up and lead to heart disease.

  • In one patient with a cholesterol of 300, LDL 150 and HDL 110, particle size testing showed that the patient had large fluffy particles (big dump trucks) so the doctor was not so concerned about the heart disease risk in spite of the cholesterol numbers.

  • There is a genetic component – obviously, if you have a strong family history of heart disease, you need to be more careful. But for most of us, it is lifestyle, lifestyle, lifestyle.  Insulin resistance is the key driver in heart disease – 88% of Americans have metabolic inflexibility and 50% have pre-diabetes/diabetes, many combined with excess weight. People with metabolic syndrome and insulin resistance typically have higher triglycerides, lower HDL and more small particle LDL.

  • One easy way to determine if you have insulin resistance is your triglyceride/HDL ratio.  Ideally, your ratio should be below 1. If you are above 1, you should talk to your doctor about getting fasting insulin and other diabetes markers tested.

  • Diet is the key lifestyle component – the Standard American Diet is loaded with white processed carbs and sugar leading to insulin resistance, high triglycerides and high small particle LDL.

  • A whole foods-based, low sugar diet with lots of fiber, good fats, B vitamins, folate, fish oil combined with a vigorous exercise program should be a priority for those wanting to improve their heart disease markers.

  • Inflammation and oxidative stress cause heart disease. Belly fat and/or visceral fat secretes inflammatory markers and leads to oxidative stress. The LDL particles get oxidized due to the excessive free radicals and not enough antioxidants to neutralize them.  The oxidized LDL particles cause plaque build-up. So to understand heart disease risk, it’s not just about the LDL number but the level of inflammation in the body that causes oxidation of these particles.

  • Statins are a powerful anti-inflammatory drug so it can help, but as it comes with side effects there are more natural ways to reduce inflammation in the body.

  • There are also special tests to measure oxidative stress – most likely you will need to see an integrative or functional medicine doctor to get these ordered.

  • There are other factors besides inflammation and cholesterol that affect vascular health and they include: diet, smoking status, calcium and homocysteine levels, vitamin and nutrient status, toxins and pollution, oral health (like gingivitis) and your gut microbiome.

  • And last but not least, heart disease is not a statin deficiency…

To learn more, check out the Doctor’s Farmacy podcast here:

11 Natural Ways to Lower Your Blood Pressure

The American Heart Association estimates that over 100 million American adults have high blood pressure or hypertension. If left untreated, this can lead to serious health conditions. There is evidence that suggests that the risk of cardiovascular disease doubles for each additional 20 mg Hg systolic and 10mg Hg diastolic reading above 115/75 mm Hg. So getting blood pressure under control may be one of the best ways to protect your health.

Blood pressure is measured as the force that is exerted by the blood on the artery walls. The systolic reading (top number) indicates the force of each heartbeat and the diastolic (bottom number) indicates the force in between the heartbeats. The clinical guidelines for “elevated” blood pressure is above 120mm Hg systolic over 80 mm Hg diastolic.

In this two part blog, I’m going to share some evidence-based tips on natural ways to manage blood pressure. 

Bay Leaves

Bay leaves are popular herbs to include in recipes such as soups and stews but did you know that they are also good for supporting the vascular system? This recent study on the Indonesian bay leaf showed it to be effective in reducing blood pressure in hypertensive pregnant women.   

You can easily brew bay leaf tea at home. Put several leaves in 16 oz. of hot water and let steep. Add lemon and stevia or honey to taste. Here’s one to try:

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Cranberries are not only for the holidays – they are a superfruit high in antioxidants, nutrient dense polyphenols and prebiotic fiber, which are all beneficial for your heart. This study suggests that cranberry supplementation is effective in managing systolic blood pressure, body mass index and HDL cholesterol.  Cranberries are readily available during holiday season but the rest of the year, look for unsweetened cranberry concentrate. You can add several tablespoons in sparkling water with some lemon for a delicious drink.

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Also, be careful when buying dried cranberries – most are loaded with sugar which is used in the drying and flavoring process. Here’s a brand without any added sugar:

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Fennel Seeds

These tiny seeds have been used over centuries as a trusted herbal remedy for a variety of ailments. Fennel seeds are rich in minerals needed to regulate blood pressure and they also contain antioxidants and anti-inflammatory compounds. In a study conducted at UC Irvine, researchers found that fennel along with other herbs activate a blood pressure-lowering potassium channel in the blood vessels.

Here’s a fennel seed tea to try: 

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Green Tea

Green tea is packed with polyphenolic compounds called catechins – the main catechin found in green tea is called epigallocatechin gallate (EGCG). Green tea has been touted for a variety of health benefits with cardiovascular disease, cancer, diabetes and weight loss among them. Green tea and its active components have also been studied for lowering blood pressure. In this study, subjects who drank four cups of green tea daily (equivalent to 500mg of catechins) showed lower systolic, diastolic and pulse pressures. 

Here are several brands to try – look for organic if possible and check if it’s been tested for pesticides and contamination:

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Intermittent Fasting

Time-restricted eating or intermittent fasting (IF) has been shown to improve insulin sensitivity and blood pressure. IF is typically done where you eat within a 10 hour window. So if you have breakfast at 8am, plan to have dinner by 6pm – and try to limit snacking because every time you eat, your glucose and insulin levels will rise. Check out my blog on intermittent fasting.


Magnesium is a mineral that is involved in more than 600 biochemical reactions in our body like energy creation, nervous system regulation and muscle movements. Magnesium is critical for our cells to function but deficiencies are common. The National Institutes of Health warns that many older adults don’t get enough of this essential mineral.

Studies have shown that magnesium supplementation is effective in lowering blood pressure in hypertensive adults. You can increase your dietary intake of magnesium with leafy green, nuts (almonds, cashews), black beans, pumpkin seeds, dark chocolate, bananas, avocados, brown rice, yogurt and legumes. Another way to get magnesium is with Epsom salt baths – it is soothing and good for muscles. 

If you are looking for supplements, here is a brand that provides all 7 forms of magnesium our body needs:

I also use this powdered magnesium in the evening to help relax and wind down…

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Omega 3 Fatty Acids

Healthy fats containing Omega-3 fatty acids support heart function and lower blood pressure.  This study found that in adults with hypertension, daily doses of omega-3 fatty acids showed clinically meaningful blood pressure reductions. 

Here is the brand I recommend:

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Potassium is an electrolyte that counteracts the effects of sodium and maintains consistent blood pressure. When diuretics are often prescribed for high blood pressure, it unfortunately accelerates the excretion of potassium by the body which creates the vicious cycle of water retention which was what the diuretic was designed to remove in the first place. The easiest way to replenish potassium is through our diet. Fruits, legumes, vegetables and dark leafy greens are good options.

Here are some foods that are high in potassium:

  • Dried apricots – half a cup of dried apricots contains over 1000mg of potassium
  • Potatoes – a medium baked potato with skin contains almost a 1000mg of potassium
  • Leafy greens – a cup of Swiss chard has almost 1000mg of potassium, a cup of cooked spinach has up to 800mg
  • Lentils – these small legumes have over 700mg of potassium per cup
  • Prunes – half a cup of dried prunes contains 700mg of potassium
  • Carrot juice – a cup of this tasty juice has almost 700mg of potassium

Probiotics have been investigated for their antihypertensive effects; this study shows that supplementation with probiotics resulted in a moderate to significant reduction for either systolic or diastolic blood pressure. Make sure to get plenty of probiotics from fermented foods like kimchi, sauerkraut, miso and yogurt. If choosing supplement form, look for ones with multiple strains and make sure to consume at least 100 billion colony-forming units of probiotics per day for at least two months.

Here are several to try:

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If you like seaweed salad or sushi rolls with nori (seaweed sheets), you are in for a treat.  Seaweed is rich in polyphenols and has a range of health benefits including anti-inflammatory and anti-viral properties which are also useful for high blood pressure. In this study done on children, seaweed consumption lowered diastolic blood pressure in boys and systolic blood pressure in girls.

I enjoy roasted seaweed for a snack – here’s one to try:

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Vitamin D

Experts indicate that over 40 percent of American adults may be deficient in vitamin D and this could have an impact on the epidemic of high blood pressure in the US. Studies have shown that people deficient in vitamin D are more likely to have high blood pressure. Vitamin D metabolism is involved in blood pressure regulation and works by suppressing the production of renin, an enzyme that promotes the activity of a blood pressure-raising protein. It is easy to get this measured through regular testing – talk to your doctor about obtaining your current level. I struggle with low vitamin D levels especially during winter months so supplement with appropriate dosages based on my test results. 

Here are ones to try:

1000 IU

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2000 IU

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5000 IU

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‘We are on a collision course’: As virtual care booms, experts call for new health data privacy protections

A drop in your daily step count. A missed period. A loss of hearing. If it’s collected by a smartwatch or wearable, that health data isn’t protected the same way your medical records are.

And as wearables like smartwatches and headphones sweep up an increasing amount of health data — flagging potential medical issues that could be used for ad targeting or to discriminate against someone — some lawmakers and researchers are calling for a reconsideration of the current approach.

In a sign of the increasing urgency of the problem during the current virtual care boom, U.S. senators last month reintroduced a bill that would make it illegal for companies like Apple, Amazon, or Google to sell or share the data collected by wearables. Violations of the act would be enforced by the U.S. Department of Health and Human Services in the same manner it enforces the Health Insurance Portability and Accountability Act, or HIPAA.

Legal experts consider the move a step in the right direction, but caution that further action is needed to address the vast amounts of information being absorbed by health tech startups and technology giants alike.

“We are on a collision course with how to regulate health data as all the different types of wearables and health tech explode,” said Carmel Shachar, executive director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard.

“HIPAA doesn’t extend to the world of health tech, and it should,” she added.

Sen. Bill Cassidy (R-La.) originally introduced the bill, called the Smartwatch Data Act, together with Sen. Jacky Rosen (D-Nev.) in 2019, but told STAT he felt the need to revive it after seeing a large insurance company offering to provide its customers with smartwatches.

“These watches are collecting data in an environment akin to an exam room,” Cassidy, who is also a trained physician, told STAT. “There is an expectation of privacy.”

When HIPAA was written in 1996, its creators likely did not envision a world in which people trusted large tech companies with tracking sensitive behavioral data such as sleep patterns, menstrual cycles, and activity levels. As a result, there is now a morass of health and health-adjacent information with virtually no shield against monetization or discrimination, outside of the general requirement that companies abide by the privacy policies they share with users.

Harvard law professor Glenn Cohen likens the situation to an iceberg, where the tip represents the data covered by HIPAA and the rest represents all the information that is not shielded by the law. Today, there is nothing stopping an employer or insurer from using that unprotected data to price its products or deny someone a job.

“I like to remind people that the ‘P’ in HIPAA isn’t privacy,” Cohen said. “The law made sense when we were talking about health care information, not health information” more broadly.

The problem has come to the fore amid the pandemic, as moves mount to permanently define the home as a place of clinical care. Earlier this month, Amazon health tech subsidiary Amazon Care joined the hospital chains Ascension and Intermountain Health to create a lobbying organization called Moving Health Home aimed at “fundamentally change the way policymakers think about the home as a site of clinical service,” according to a press release.

While these kinds of shifts would undoubtedly make it easier to access telehealth and other forms of virtual care, they also raise important ethical questions about what constitutes health data and how concepts like informed consent are defined outside of a traditional medical environment.

It’s not clear whether the bill will pass, but there are reasons to believe it may gain more traction than in 2019, given how the landscape has changed. This January, the period-tracking app Flo settled allegations by the Federal Trade Commission that it disclosed users’ personal health information — including when they were having their period and whether they intended to get pregnant — to Facebook, despite promising to keep their data private.

“We are looking closely at whether developers of health apps are keeping their promises and handling sensitive health information responsibly,” Andrew Smith, director of the FTC’s Bureau of Consumer Protection, said in a statement.

Along with collecting vast amounts of health and health-adjacent data, health tech companies are also increasingly playing a role in medical research. Both Google and Apple, for example, make it possible for people to participate in remote medical studies using their phones. As more health tech companies launch virtual research programs, it is time for a new definition of informed consent, said Cohen and Shachar. To them, asking consumers to scroll through a novella of fine print doesn’t cut it.

Another important ethical question to consider with the rise of virtual care is how health data is transferred among the subsidiaries of large tech companies. Although the new bill would stop tech giants from sharing or selling such data with one another, it would not prevent them from sharing it among their own subsidiaries.

For example, there is nothing in the current law — or proposed bill — that would stop an entity such as Google-owned Fitbit from sharing its wearable data with Google Health, the company’s research and wellness subsidiary, or with Nest, its smart thermostat and camera company. In 2019, then-presidential candidate Sen. Elizabeth Warren (D-Mass.) proposed breaking up the subsidiaries of tech companies including Amazon, Facebook, and Google for this reason, arguing that the mergers were anticompetitive.

Cohen and Shachar said they believed because the act does not protect against such intra-company data transfer, it could wind up incentivizing health tech monopolies, adding that they hoped future legislative efforts would block this type of data transfer.

“Would you rather have lots of people know little bits of information about you, or one person know everything about you?” said Cohen. “If that one person is the love of your life, that’s great, but if that one person is the person who sold you your car, maybe it’s not so great.”