Healthy Living

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Why We’re Switching from NAD+ to Niagen IV (And Why It Matters for Your Health)

If you’ve been following our IV therapy offerings, you know we’re always seeking the most effective, comfortable treatments for our patients. Today, I’m excited to share a significant upgrade to our NAD+ therapy – Niagen IV – that’s already transforming patient experiences in our center.

The Problem with Traditional NAD+ IV Therapy

For years, NAD+ IVs have been the gold standard for cellular energy restoration, anti-aging support, and neurological health. But here’s what we’ve observed (and what you may have experienced):

  • Lengthy treatment times – up to 4 hours per session
  • Uncomfortable side effects – headaches, nausea, stomach pain
  • Inconsistent absorption – the NAD+ molecule is actually too large for direct cellular uptake
  • Treatment fatigue – many patients dreaded their sessions despite knowing the benefits

The science behind NAD+ is solid, but the delivery method had room for improvement.

Enter Niagen IV: The Next Evolution

After extensive research, we’re now offering Niagen IV, a revolutionary approach that delivers superior results with dramatically improved patient comfort.

What Makes Niagen IV Different?

The Active Ingredient:
Niagen IV contains pharmaceutical-grade nicotinamide riboside chloride (NRC) – a patented, highly bioavailable NAD+ precursor that solves the absorption problem traditional NAD+ IVs face.

The Science:
Instead of trying to force the large NAD+ molecule through cell membranes (which requires breakdown first), NRC passes directly through cell walls and converts to NAD+ inside the cell with fewer steps. This means:

  • More efficient absorption
  • Faster conversion to active NAD+
  • Better utilization by your cells

The Remarkable Results

20% Higher NAD+ Levels – Compared to traditional NAD+ IV at 3 hours post-infusion

75% Faster Treatment Time – Complete your session in minutes, not hours

Zero Adverse Side Effects – No headaches, nausea, or stomach discomfort. Many patients find it actually relaxing!

Sustained Energy Boost – Peak NAD+ levels occur much sooner and maintain better

What This Means for Your Health Goals

Whether you’re seeking Niagen IV for:

  • Energy optimization 
  • Anti-aging support 
  • Cognitive function 
  • Recovery support 
  • Metabolic health 

You’ll now experience these benefits with greater efficiency and comfort than ever before.

Your Next Steps

If you’ve been considering NAD+ therapy but were deterred by the time commitment or side effects, Niagen IV removes those barriers entirely.

If you’re already receiving NAD+ IVs, we recommend transitioning to Niagen IV for your next session – you’ll immediately notice the difference in comfort and efficiency.

Ready to experience the future of NAD+ therapy?

Both new and current patients can come to Blum Center for Niagin, but if you aren’t sure, we recommend messaging your provider, or if you are new to us, then schedule a FREE IV consult with Marie to decide if this IV is right for you.  

Call our office at 914.652.7800 to schedule your Niagen IV consultation


Questions About Niagen IV?

Q: How often should I receive treatments?
 A: Treatment frequency depends on your individual NAD+ needs and health goals. During your consultation, we’ll create a personalized protocol that optimizes your results.

Q: Is Niagen IV safe?
 A: Absolutely. Niagen IV has an excellent safety profile with no reported adverse effects in studies. It’s manufactured to pharmaceutical standards in FDA-compliant facilities.

Q: Can I switch from traditional NAD+ IV immediately?
 A: Yes! Many patients transition seamlessly and immediately notice the improved comfort and efficiency. We’ll guide you through the transition during your consultation.

Infusions given at Blum Center for Health in Westchester County, NY pack in more vitamins at higher doses than walk-in centers and can make a real difference for your health, especially if you are dealing with a complex chronic issues like getting sick a lot, autoimmunity, neurology, headaches, arthritis, heavy metals or other toxicity, lyme disease, to name a few.

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Why Taking More Calcium Won’t Fix Your Bone Loss (And What Actually Will)

Crossing the menopause milestone can be extremely challenging for most women, given the falling hormone levels, and symptoms that can be experienced during this transition time. Often the focus is on getting through “the changes”, and conversations around bone density happen later, or not at all until many years later and a bone scan shows osteoporosis.  

Whether or not you will develop osteopenia (mild bone loss) or osteoporosis (increasing your risk of fracture), is very individual and not guaranteed. Women are often told that their bone density is all about calcium and falling estrogen levels. The reality is that the root cause of weakened bones is much more complex than the duo of needing to take more calcium and the onset of perimenopause. To understand the root cause better, let’s dive into the functional medicine understanding of Osteoporosis. 

What is Osteoporosis?

Osteoporosis is a condition where your bones have lost enough density to put you at a higher risk for having a fracture. Ultimately, fracture is the biggest concern and the end game is to prevent you from breaking any bones if you were to fall. Osteoporosis affects millions worldwide and is often referred to as a “silent disease” because it progresses without symptoms until a fracture occurs. Prevention and early detection are critical to keep your bones strong as you age.

Most people have the impression that bones are static, or fixed and never-changing. This is the opposite of the truth. 

The fact is that bones are a metabolic organ that are always breaking down, which are known as the osteoclasts. And, they are also building up, which are known as your osteoblasts. The balance between the activity of your osteoblasts and your osteoclasts are what determine whether or not your bone builds or breaks down. Our goal is to increase the blast activity and decrease the osteoclast activity to help your bones build. This is how we improve bone density using functional medicine. We lean into the dynamic nature of bone metabolism by improving this dynamic balance. 

So, if you’ve been diagnosed with a loss of bone density, there is so much more you can do than just take calcium!

Root Causes of Osteoporosis from a Functional Medicine Perspective

There are many potential reasons why osteoporosis occurs.  Your bones are a dynamic, active, metabolic organ, and uncovering your root causes is critical to creating a plan that will support bone growth.

Here are some of the most prevalent underlying issues that affect bone density:

Underlying Inflammatory Health Conditions: Autoimmune conditions, such as Rheumatoid and Psoriatic Arthritis, Multiple Sclerosis and Celiac Disease increase the risk of osteoporosis, as does Crohn’s Disease, ulcerative colitis, and endocrine disorders such as diabetes, hyperthyroidism, and hyperparathyroidism. Chronic kidney and liver diseases also undermine bone health. Using Functional Medicine, we inflammation by addressing the gut microbiome, optimizing your nutrition, looking at your detox pathways and addressing stress. Yes! Stress plays a role. (There is more on nutrition, the gut, detoxification and addressing stress below – all of these are essential ingredients to autoimmune conditions, and addressing inflammation generally). 

Impaired Gut Health: An unhealthy gut can affect nutrient absorption, leading to deficiencies that compromise bone health. Conditions like Leaky Gut Syndrome, Candida Overgrowth and Small Intestinal Bacterial Overgrowth (SIBO) are all associated with malabsorption of nutrients. If you are struggling with reflux, gas, bloating, constipation and/or diarrhea, these are tell-tale signs that point to an impaired gut microbiome. We’ll take a look “under the hood” so to speak with a comprehensive stool test to help us address and heal your gut imbalances. 

Nutritional Deficiencies: While nutrient deficiencies are often associated with poor gut health, so is the Standard American Diet, which tends to be low in antioxidant-rich produce and high in packaged foods, animal proteins, too much sodium, sugar and bone-robbing alcohol and coffee. Food is medicine, afterall, and has a direct effect on your bone health. We will create a bone-healthy food plan that emphasizes alkaline-rich foods and reduces acidic foods and drinks that rob bones of their minerals, including calcium – the very mineral that you’re often told to consume in a supplement. 

Hormonal Imbalances: Contrary to popular belief, estrogen is not the only hormone that plays a role in bone density. So does testosterone (yes, for women too!) Vitamin D (which acts as a hormone in your body), thyroid hormones, cortisol (a stress hormone– more on that below), and insulin, among others. Your hormones operate in a symphony and balance is key. Hormone testing will give us the answers we need to create a personalized hormone support plan, which based on your results could include hormone-balancing nutrition, fitness and stress-reduction. And, if warranted, there’s always room for a conversation about hormone replacement therapy (HRT).

Medications: There is a plethora of medications that impact bone health. Some of the most commonly used are: steroids, such as prednisone, as well as proton pump inhibitors (PPIs) that are often prescribed to treat acid reflux. Over-the-counter medications that fall in this category include Prilosec, Mylanta, Prevacid, Tagamet, Zantac, Maalox, Tums and Rolaids. To get off these reflux medications, we go back to addressing gut imbalances! We start with a comprehensive stool test and create a personalized plan based on your results.

Toxic Exposures: Heavy metals (such as cadmium and lead), pesticides, air pollution, environmental “forever chemicals” and cigarette smoke all negatively impact your bone health. Wondering if this applies to you? A toxin evaluation is a great place to start. You’ll learn how to reduce your exposure, open your detox pathways through food, and if warranted, utilize supplements to reduce your toxin load. 

Sedentary Lifestyle: Here’s a fact: Regular weight-bearing exercises promote bone density, and a lack of physical activity is highly correlated to bone loss. The good news is, you don’t have to spend hours and hours in the gym. We will create a plan to get you started – low and slow! – and build on it over time.  We can help you create an exercise plan as part of a comprehensive bone building strategy.

Stress and Mental Health: The mind-body connection is a marvel of human physiology, showcasing how mental well-being influences physical health. This connection extends to bone health as well. Recent studies show a direct relationship between stress, cortisol levels, and osteoblasts – bone cells that are responsible for building new bone tissue. Chronic stress inhibits osteoblast activity, which impairs the body’s ability to form new bone and repair micro-damage. Need to find ways of bringing down your stress hormones? It’s not always about medication. The trick is helping you discover modalities that you enjoy and can stick with over time. Let’s do it!

Genetics: While it’s true that some people have the genetic propensity for osteoporosis, it’s important to remember that having the genetic risk doesn’t mean it will manifest. All of the above play a role in the genes becoming expressed!

And lastly, here’s a biggie that few people talk about: 

Dieting: 

The old adage, “You can never be too thin” has created generations of bone density issues among yo-yo dieters and those following calorie-restricted, low-fat fad diets. There is even emerging research that suggests that low carb, high fat diets, such as the ketogenic diet depletes bone density. It’s time to recalibrate and adopt a bone-healthy diet full of plants, appropriate protein and healthy fats. 

Here’s your takeaway: Osteoporosis isn’t just a factor of aging or calcium deficiency.

As you can see, it’s a multifactorial condition that requires a health partner to help you determine your root causes and how to create a tailored approach to strengthening your bones in a way that’s effective and sustainable over time. 

Ready to get started? Make an appointment with Melissa Rapoport, MA, CFMC in our BoneStrong 6-month program. Walk tall knowing you are reducing your likelihood of fractures and living a vibrant, active life well into your “golden” years.

– If you are a current patient at Blum Center for Health, call the Center at 914-652-7800.

– If you are new to Blum Center, reach out to our New Patient Coordinator, Sabrina DeGregorio, at sabrina@blumcenterforhealth.com 

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A Guide to Summer Grilling

Pop quiz: What’s one of the most popular summer food-related activities? Grilling! Who doesn’t love an outdoor meal with friends and family?

Grilling, however, comes with a side dish of caution, and my goal here is to provide you with the information you need to make your summer grilling as healthy and non-toxic as possible. 

Here’s the ditty on grilling: Grilling or barbecuing meat at high temperatures leads to the production of heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs). These two compounds are known as “mutagens,” meaning they damage your DNA and may increase the risk of developing cancer. HCAs are formed when amino acids and sugars, which are present in meat, react under high temperatures. Then the liquid fat drips into the flame of a grill and creates smoke which is filled with PAHs and coats the surface of the meat.

Yeah, I know, Ewwwww!

8 Ways to Minimize the Health consequences (and your worry) of Summer Grilling: 

Select Healthier Cuts of Meat: What you grill matters

Grass-Fed and Pasture-Raised: Opt for grass-fed beef, pasture-raised poultry, and wild-caught fish. These options tend to have higher omega-3 fatty acids and fewer unhealthy fats.

Lean Cuts: Choose leaner cuts of meat which produce less fat and reduce the risk of exposure to PAHs and smoke.

Skinless Poultry: Removing the skin from poultry before cooking will reduce HCA formation.

Marinate Wisely: Not only does marinating meat impart more flavor, it can also be protective again carcinogenic compounds.

Use Antioxidant-Rich Marinades: Marinades made with herbs, spices, and acidic components (like lemon juice or vinegar) can reduce the formation of harmful compounds during grilling.

Avoid Sugary Marinades: High sugar content can lead to excessive charring and the formation of harmful substances.

Add Herbs & Spices: Herbs and spices have been shown to reduce the formation of HCAs when meats are grilled. Mint, onion, turmeric, garlic, rosemary, ginger, thyme, andred chili pepper are all great choices. These herbs can be used in marinades,mixed into ground meats, or used as a dry rub.

Avoid Charring and Overcooking: The amount of time your meat cooks makes a difference. 

Monitor Cooking Times: Cook at lower temperatures and avoid overcooking or charring food, which can produce harmful HCAs and polycyclic aromatic PAHs.

Consider Smaller Cuts of Meats: like cubed (kabobs!) or quicker-cooking proteins, such as shrimp or fish.

Turn Your Meat Frequently: to cook the center without overheating the surface. 

Use a Meat Thermometer: Aim for safe internal temperatures without overcooking, which can lead to charring.

My Personal Favorite Tip: Vegetables and Fruits Are Your Friends!: Not only are they antioxidant rich, they also mitigate the activity of HCAs and reduce the DNA damage caused by those compounds.

Loads of Benefits: Grilling vegetables and fruits can add variety and health benefits. Fiber-rich, antioxidant-dense foods can help mitigate some of the adverse effects of grilled meats.

Use Skewers: This is an easy way to create meals that incorporate both veggies and protein! Thread veggies, shrimp, or lean meats onto metal skewers.

Let Your Imagination Go Wild:  Try zucchini, bell peppers, okra, sweet potatoes, asparagus, peaches, pineapple, or even watermelon for a fun addition to your meal.

Use a Grill Pan or Basket: Use a grill pan or basket for smaller items and vegetables to avoid direct exposure to flames and smoke.

Summer Grilling: The Fuel You Use Makes a Difference

If Possible, Use Natural Charcoal: Avoid lighter fluids and chemically treated briquettes. Choose high-quality natural lump charcoal or untreated hardwoods.

Consider Giving Up or Minimizing Propane: If possible, prefer natural wood or charcoal over propane, as it may contain additives.

Clean Your Grill: Clean the grill grates before and after use to minimize exposure to burnt-on residues that can harbor harmful compounds.

Finally, in my experience, many people think about grilling as being a meat-heavy experience. Think about flipping this switch: Enjoy a small amount of meat, such as the palm of your hand, and enjoy lots of vegetables and fruits. Make all your sides the big features.

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How Genetics Can Solve Your Medical Mysteries

In the past decade, genetics testing has become a huge and expanding field, filled with exciting promise for helping us understand our health challenges in a deeper way.   But it’s often hard to sort out which tests to use, how they can help you, and whether it’s worth the money they cost.  Recently, we’ve started using IntellXX Genetics testing at Blum Center, and I have been very impressed by how much the test results have helped me figure out my next steps when working with a patient who’s situation just doesn’t make sense.  

Let me give you a clinical example of how I’ve used the testing and how it’s helped me figure out what’s going on.  

Leslie (not her real name) and I had been working together for about 2 years.  Her main concerns were related to her heart disease risk, given a strong family history.  In her early 50’s, she loved going to the gym and included both strength training and aerobics most days.  Being very disciplined by nature, she was willing and able to implement all the changes we discussed that were needed:  she was eating a whole foods, low sugar, low processed food diet; was being mindful of her stress and sleep, and followed different strategies for her weight training and aerobic training routine.  But no matter what we did, she could not get her Hemoglobin A1C below 5.9.  This blood test tells us about the risk for diabetes and the health of the blood sugar system. Diabetes is one of the biggest risk factors for heart disease.

After seeking and following guidance from our nutritionist Vicki Kobliner, RD, (including wearing a continuous glucose monitor), and working closely with her Cardiologist, this number still didn’t budge.  I decided to do the Intellx testing.  It was a game changer!  Leslie’s genetic code was working against her.  She had 8 different genes that gave her a high risk for diabetes, and another 7 that gave her a higher risk for all sorts of other metabolic issues like obesity, and having the ability to feel full.  After we saw these results, it was such a relief!  Just to know that we have an explanation for WHY she couldn’t get this under control, and for her, to feel vindicated that this isn’t her FAULT! 

Each personalized Intellx Genetic report provides recommendations for what interventions would work best to help improve the functioning of each gene that is identified as increasing your risk for a particular health condition.  And, they back up all their recommendations with lots of research articles.  And so, for Leslie, with all the new ideas for treatment, I was able to create an updated plan, including supplements, medication, and specific exercise and nutritional approaches tailored to her genetics.  And now she’s doing better than ever!  Game changer!

A little more info about genetics testing

Here is a brief primer about the different kinds of genes that are tested.

DNA is the molecule that contains all our genetic information, and genes are specific sections of DNA that code for particular traits or proteins. IntellxxDNA™ allows us, as your clinicians, to look at over 600 DNA sequence changes (or variants) that affect specific genes. These genetic variations make you unique and are modifiable with lifestyle changes, supplements and medication. That’s the good news.  The bad news is that left unattended, they can contribute to chronic diseases such as cognitive decline, diabetes, heart disease, obesity, gut issues, and more. Genetic testing using Intellxx also allows us to look at gene variants related to how various nutrients and hormones are transported throughout your body and into your brain and identify which nutrients and hormones you may need more or less of than others.  

More good news! Chronic illness is not due to one gene. It is the result of a combination of many small gene variants and how they interact with our diet, lifestyle, and environment.  This means your genetics doesn’t guarantee an outcome, and instead, with our guidance, you can improve the functioning of these genes and reduce your risk of chronic disease. And if you are worried about things that run in your family or want to create a plan for overall wellness and personalized prevention, this tool can be hugely beneficial. 

IntellxxDNA™ also looks at Inflammation and genes involved in repairing your body and removing harmful chemicals and mold. From our experience, we have not met anyone who did not benefit from having access to their genomic information. Genomics is a powerful tool for finding the root contributing factors of complex health issues. I have used this many times for my toughest inflammation and autoimmune patients.  

Ready to learn more about yourself?  Unravel the mystery that is you?  Schedule a consult with our Functional Medicine providers. Please call 914.652.7800 to learn more.

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A YEAR IN REVIEW – MEDICAL WEIGHT LOSS WITH GLP-1’s 

Do you often wonder if weight loss medication is the right fit for you?  There is so much confusing information in the news that it’s hard to know what is true and what isn’t.  Read on for the answers you are looking for on GLP-1’s.

WHAT WE’VE LEARNED THIS YEAR

It has been over a year since we launched the Medical Weight Loss Program at Blum Center for Health, and over five years since Ozempic first hit the market and changed the weight loss landscape.  As a Functional Medicine provider managing medical weight loss, I have witnessed firsthand the transformative impact GLP-1 receptor agonists such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro, Zepbound) have had on patients.

Not only are people reporting weight loss, but we have also observed that the medication dramatically reduces cravings, and “food noise” – that incessant voice in the back of your mind, often driving your food choices. This quieting of the mind provides the “space” needed to change ingrained behaviors. As an example, once night eating is no longer irresistible, you have the space to work on new strategies that will keep you out of the cookie jar once you wean off medication. New tools, new life!

Herein lies the power of weight loss with us at Blum Center. The reality is that while these medications represent a major breakthrough in weight management, and they feel like a magic bullet in the short run, we think of these medications as just one piece of the puzzle.  For your weight loss journey to be successful in the long run (and the key to keeping the weight off), is to spend equal time on the other puzzle pieces – lifestyle, nutrition, body composition, stress management, hormone balance, gut health. 

In other words, discovering the root cause of your metabolic imbalance, and treating that, will give you the tools you need to maintain it.

IN ADDITION TO WEIGHT LOSS…

What do we witness with this multi-pronged approach? People who are more confident, stepping into their power, feeling good in their bodies, and healthier as evidenced by their blood labs and functional medicine testing before and after.

And just to thread the needle, it appears there are other benefits besides weight loss and reduced cravings, which are currently being explored by researchers.  And we’ve been seeing these improvements, too, in our office: 

  • Reducing sleep apnea
  • Dementia prevention/neuroprotective (Evoke and EVOKE+ trials) 
  • Treating addiction and addictive behaviors (helps with cravings, reduces food “noise”) 
  • Boosting immune function (The Select Trial) 
  • Reducing cardiovascular risk including lowering blood pressure (Select trial) 

Pretty cool, right?

Here are some of the most common questions we receive about GLP-1’s:

What if I’m not obese or diabetic – can I still use these medications? 

Many of the patients we see feel stuck in a rut with weight loss despite trying their usual diet and exercise tricks. Using a GLP-1 agonist as a tool to kick start weight loss for even a few weeks or months can often be beneficial to jumpstart the process while also investigating the root causes of the possible metabolic issues.  

Will I just gain the weight back? 

Well, here’s the truth bomb that you’re likely not hearing: the data across America shows that if no lifestyle changes are made, patients who discontinue GLP-1 agonists will regain about 2/3rd of their lost weight after stopping. This illustrates why root cause and lifestyle medicine is critical to sustained weight loss!

At Blum Center our patients successfully use GLP-1 Agonists and are able to maintain weight loss  after they discontinue the medication.  Why is that? 

  • Our Functional Medicine Approach:  We look at the whole patient and do extensive testing including blood work and often gut testing. So, while we use the medications to jump start the process, we simultaneously shine the light on root cause medicine: gut health, hormone health, toxins, stress, nutrition and exercise, to name a few. 
  • Health Coaching: All our patients on GLP-1’s meet with our Health Coach Melissa Rapoport who walks patients through every step of the process and helps you create a plan for sustainable long-term changes. 

This is indeed personalized weight loss!

Will I lose all my muscle? 

This is a big fear of many patients — understandably! And, one that we take seriously. With all weight loss (even with diet alone) there is some lean muscle mass lost but there are several key ways we can ensure you maximize the weight loss coming from fat and not muscle. This can be completely avoided with proper nutrition and exercise. 

In fact we have an awesome tool – the InBody scanner – that tracks your body composition and shows us exactly what you’re losing. Are you losing visceral fat (yes!) and maintaining and maybe gaining muscle mass (yes!). Your lean muscle mass will maintain your metabolism during and after using these medications – muscle is your biggest friend in weight loss maintenance! 

Do I have to stay on this medication forever or can I use it short term? 

While these medications are completely safe to stay on long term (they are designed for that) – the vast majority of our patients are just using these for short term use. Again,we don’t think of Wegovy or Monjouro as the solution – they are just a tool — the solution is to get to the root cause of why you are “stuck” or gaining weight. 

Are there side effects?

The most common side effects are nausea, diarrhea and constipation, though they are usually short-lived and avoided by sticking to the “start low and go slow” strategy – starting at a low dose and slowly titrating up.

Less common but still on our radar – gallbladder issues (as with any rapid weight loss), thyroid concerns and pancreatitis – while rare, these can be serious and we always monitor for these. 

How do supplements fit into the plan? ? 

We will recommend a personalized supplement plan for any health issues or imbalances we discover, if needed, based on your test results.  

Ready to take the next steps in your weight loss journey? Request a Consultation

Resources: 

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Menopause and Heart Disease: What every woman should know

Heart disease is the most frequent cause of death in the United States.  We have not outgrown it, or cured ourselves as a nation, even though cholesterol medication has been the number one most prescribed drug in the United States.  For women, the data is even more startling.  After menopause, heart disease is the #1 killer of women.  While we all get our annual mammograms to prevent breast cancer, most women after menopause don’t realize that they need to be focusing as well on their annual evaluation for prevention of heart disease.   

Here are some details about this risk, which is related to “missing” the benefits of estrogen:  

Young women who have early surgical menopause (they had their ovaries removed) have a higher risk for heart disease independent of conventional risk factors

In the cardiovascular system, studies show that Estradiol reduces:

  • Inflammation in injured arteries
  • Oxidative stress in arteries and vascular smooth muscle cells
  • LDL oxidation (which increases the risk of plaque)
  • Insulin resistance, 
  • Cardiac hypertrophy (thickening of heart muscle) 
  • Blood pressure by increasing vasodilation in vascular endothelium, helping reduce blood pressure.

Given this information, it appears that after menopause, women lose the protective effects of estrogen that they have enjoyed until that time.  The questions now become, does estrogen replacement reduce CV risk? And if it does reduce CV risk, is the risk/benefit a net positive?

The results of studies have been mixed.  Observational evidence has suggested that there might be a protective effect of menopausal hormone therapy on coronary heart disease; however, the WHI and other trials of menopausal hormone therapy have not demonstrated such an effect.  And so it appears the jury is still out on this one.  Regardless of whether you take hormone therapy or not after menopause, it’s critical that you have your risk of heart disease assessed by a knowledgeable clinician.

HOW TO ASSESS RISK OF HEART DISEASE

Because we truly don’t know who is at risk for a heart attack based simply on family history, or blood pressure, or cholesterol levels, it’s critical that you understand how to be properly evaluated.  

To prove this point, a recent July 2024 article by Faridi et al, adults ages 40-65 without any traditional risk factors (hypertension, diabetes, medications for hypertension or diabetes, tobacco use) found that even in these low risk people, almost 40% had plaque in their arteries (atherosclerosis) present on coronary CT angiogram, and 25% had calcifications on a coronary artery calcium scan. Even in individuals with optimal risk factors, which is to say BP <120/<80, fasting blood glucose <100, A1c <5.7%, BMI<25, healthy HDL and triglycerides and no tobacco use, 21% of participants had coronary plaque detected.

Many clinicians determine your risk for heart disease by using a 10-year calculator that adds together all the above risk factors.  This is often how a decision is made about whether to start you on a statin (medication for lowering cholesterol).  However, I hope this paper has now convinced you (like it convinced me) that you need further risk assessment beyond vitals signs and basic blood markers for a complete picture.  This often includes imaging and more advanced lipid testing. 

THE BEST TESTS TO CHECK YOUR HEART HEALTH BEFORE OR DURING MENOPAUSE

At Blum we frequently use the following tests to really know the status of your coronary arteries and thus your risk for heart disease and heart attack:

  1. Imaging recommended after menopause (or sooner for high risk patients):  CT Calcium score as initial screening; followed by CT Angiogram with Cleerly if indicated
  2. Advance blood testing for lipids and oxidative stress.  
  3. Cutting edge genetic testing to help us personalize treatment, for example:
    • 16% of people carry polymorphisms (genetic variants) in the CDKN2A (9p21) gene which leads to increased calcification in the arteries
    • Polymorphisms in the IL1RL1 and IL33 genes can combine to lead to a 2 to 5-fold increased risk in coronary artery disease, in addition to increased risk for hypertension, due to the body’s decreased ability to stop inflammation and fibrosis. 

Knowing all of this, some people avoid doing the testing because they are worried about the side effects of taking a statin, which is the common treatment after discovering some of these high risk issues. To be clear, statins are highly effective in lowering LDL, reducing plaque and lowering one’s risk for atherosclerotic heart disease. However, in some people, they can also cause myalgias, raise glucose, and elevate liver enzymes, in some people. The fantastic thing about medicine today is that even if these side effects occur for you, and are intolerable or undesirable enough to prohibit statin use, multiple other oral and injectable therapies are available such as PCSK-9 inhibitors, ezetimibe, and bempedoic acid, not to mention the exercise and lifestyle patterns we can recommend.  I encourage you to get evaluated, and then we can figure out together where to go from there and which approach is best for you.

THE OZEMPIC REVOLUTION

One of the more interesting recent options we have for treating or preventing heart disease are GLP1 receptor agonists, or the Ozempic family of medications. We now have evidence that GLP1s like Ozempic lower the risk of heart attack, stroke, and cardiovascular death in patients who are overweight or obese. We know that GLP1 receptors are located in multiple organs, including heart muscle cells (cardiomyocytes).  We are learning all the ways that these medications can help reduce your risk of heart disease, outside of their glucose lowering and weight loss effects, all of which suggests we may start using this for primary prevention in the right cardiovascular patient someday.

Here are just some examples of what we are learning.  GLP1’s have been found to:

  • Have a direct effect on the cardiomyocytes, improving their ability to use glucose for energy, and inhibiting apoptosis (cell damage and death).   
  • Stimulate the lining of blood vessels to produce nitric oxide, thereby lowering blood pressure. 
  • Lower lipid levels 
  • Reduce blood clots by having anti-atherothrombotic properties
  • Reduce oxidative stress (the free radicals that run around your body causing damage to cells and blood vessels)

I hope this overall message feels optimistic, because coronary artery disease is preventable with the right therapies. At Blum Center for Health, the Proactive Heart Health Program is designed specifically for us to consider each person’s individual cardiac risk and come up with a plan to keep your heart healthy. We look forward to helping you choose the best approach to protect your health.

Dr. Jane Andrews is a Functional Medicine doctor with a background in internal medicine physician doing both inpatient and outpatient clinical medicine for 12 years prior to joining Blum Center. Dr. Andrews received her MD from the Johns Hopkins School of Medicine, her MPH at Johns Hopkins School of Public Health with a concentration in biostatistics and epidemiology, and is a graduate of the NIH-funded Predoctoral Clinical Research Training Program. She completed residency at Tulane University and was faculty at Tulane, followed by Yale School of Medicine, and finally at UT Health where she was an Associate Professor. 

Citations: 

https://pmc.ncbi.nlm.nih.gov/articles/PMC10739421/ https://www.jacc.org/doi/10.1016/j.jacadv.2024.101049 https://pubmed.ncbi.nlm.nih.gov/39116093/

Xiang D, Liu Y, Zhou S, Zhou E, Wang Y. Protective Effects of Estrogen on Cardiovascular Disease Mediated by Oxidative Stress. Oxid Med Cell Longev. 2021;2021:5523516. Published 2021 Jun 28. doi:10.1155/2021/5523516

Rosano GM, Vitale C, Marazzi G, Volterrani M. Menopause and cardiovascular disease: the evidence. Climacteric. 2007 Feb;10 Suppl 1:19-24.

Menazza S, Murphy E. The Expanding Complexity of Estrogen Receptor Signaling in the Cardiovascular System. Circ Res. 2016;118(6):994‐1007. doi:10.1161/CIRCRESAHA.115.305376 

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Ready to Boost Mitochondria and Kick your Energy into High Gear?

You’ve likely heard about the perils of consuming processed foods – It can make you tired, promote muscle weakness, impair your vision and hearing, provoke digestive issues, migraines, diabetes, and cardiovascular disease.  You might be wondering what all these things have in common?  Too much processed food can damage the functioning of your Mitochondrial! 

You might be wondering … how are processed foods connected to my mitochondria?

First, let’s define mitochondria. You might have recently read about these little powerhouses inside your cells. They take the fats, carbs and protein that you eat and combust them for cellular energy much like how the engine in your car burns gasoline. Mitochondria provide the energy to keep your body running, and are the prime driver of metabolism, which you need to maintain low levels of body fat and to keep a healthy weight.  

NUTRIENTS THE MITOCHONDRIA NEEDS

To be functioning at their best, your mitochondria need very specific nutrients.  They need B vitamins, antioxidants, and amino acids (the building blocks of protein).  Just like your car engine, the mitochondria throw off “sparks” as its combusting your food for energy, and it needs a constant supply of rainbow colored foods to provide the antioxidants needed to quench these sparks also called free radicals. If you aren’t eating enough antioxidants, the sparks become a flame and not only can you end up with inflammation, but your mitochondria stop working optimally.

In addition to antioxidants, B vitamins are critical.  When you eat lots of vegetables, and whole foods (the food looks like it did when it was grown, picked, slaughtered) you get a lot of B vitamins.  Remember, you are also eating what the animal ate, and so how you source your animal protein matters too for it’s nutrient density.

NUTRIENTS THE MITOCHONDRIA DON’T NEED

OK, now that you know what you should feed your mitochondria, what shouldn’t you feed it?  Processed foods!  Not only are these foods missing the nutrients you need, but they have “anti-nutrients” that are damaging to the body.   Sugar is clearly inflammatory and damaging, but these processed foods also have loads of added chemicals, bad fats, and toxins that are hitchhiking with the food when you eat it.  This is why it’s critical to read nutrition labels to discern whether your favorite crackers, breads, canned goods, and even products marketed as healthy, are really ok.  Remember, if your mitochondria are ok, your cells and then your body will also function at its best. 

Be a Nutrition Label Detective:

Examine the ingredient list: Would you find every ingredient in your grandmother’s kitchen? If not, step away. Is there any kind of sugar in the first three ingredients – anything from cane sugar to honey to date sugar – it’s a desert.

Take a look at the grams of added sugar: We recommend staying under 24g of added sugar daily. What does that mean? 4g of sugar equals 1 teaspoon. It adds up fast.

For grain and grain replacement products, such as breads, crackers and gluten-free products: How many grams of fiber does it have? There should be a minimum of 3 grams per serving.

What processed foods should you avoid unequivocally? Seed oils, such as canola (rapeseed), corn, cottonseed, peanut, grapeseed, rice bran, soybean, safflower and sunflower. Using extra virgin olive oil for cooking? Make sure you do not expose it to high heat – it converts to an “anti-nutrient” trans-fat! Our favorite high heat oil is avocado.

Foods to Eat for Healthy Mitochondrial Function:

Eat a wide variety of fruits and vegetables, you have heard this before –but it is critical. Be sure to include red, blue, purple, yellow and green fruits and vegetables, the deeper, darker colored food are the best. Gradually increase the number of servings that you have a day to reach 9 cups a day. Find your farmer’s market and get to work. You can do it! Be sure to add some seaweed into the mix for iodine.

Eat more omega-3 rich foods. We do not make omega-3 fatty acids in the body so they must come from the diet daily. Include wild fish, grass-fed meats and omega-3 rich eggs. Boost this brain food — the brain has lots of mitochondria — by adding one to two tablespoons of flax or hemp oil, or seeds, to your vegetables.

Build your meal from the foundation of vegetables up, then add your omega-3 rich protein, some legumes, like your favorite beans, for fiber, toss in some dulse or seaweed, sprinkle with nuts and seeds, douse with a healthy oil for dressing and you are good to go – literally go, because eating this way you will give you more energy to go!

Two Other Factors that Boost Mitochondrial Function:

Intermittent fasting and calorie restriction increase your ability to generate energy while increasing the number of mitochondria in the cells.  A simple way to practice intermittent fasting is to eat no food (you are allowed to have herbal tea or broth) for 12-14 hours overnight, from dinner to breakfast. Calorie restriction can be done by eating only vegetables for 600 – 800 Calories in one day, perhaps one day each week. 

Reduce your intake of carbohydrates. This shift causes your body to switch to using ketones (produced by burning fats) instead of glucose as its primary source of fuel. Ketones are efficiently used for the generation of energy in the mitochondria while increasing the number of new mitochondria.

But Food is Only One Aspect to Boost Mitochondria Function

Mitochondria are especially damaged from Covid or other viruses; Lyme or other tick or bacterial infections; and Environmental toxins, especially mold; as well as aging. Often, the chronic fatigue experienced by people trying to recover from a significant illness comes from damage to the mitochondria.  Because of this, we have created a Mito Recovery Program. 

Testing and Repairing Your Mitochondria Damage: 

Our Mito Recovery program is a comprehensive evaluation and treatment approach for  your mitochondria, to help them recover and to finally restore your health.  

The first step is to identify why and how your mitochondria got damaged, and then to help you eliminate these exposures if they are environmental or infectious.  Common culprits are infectious disease, mold, and environmental toxins. 

We will check the functioning of your mitochondria with MitoSwab testing. The test is done with a simple scrape from the inside of your cheek, and results show us your mitochondrial biogenesis (total numbers of mitochondria) and the functioning of Complexes 1, 2, 3 and 4.

We measure levels of oxidative stress and glutathione.

Treatment:  Based on these results we offer targeted treatments, which may include Infusions (NAD, glutathione, lipoic acid, CoQ10, carnitine, B vitamins and magnesium), supplements, and intermittent caloric restriction/fasting (great for mitochondria function!).   For example, low Complex 1 responds well to NAD.  Riboflavin is good for Complex 2, and CoQ10 for Complex 3.  And both Glutathione and lipoic acid are great for treating oxidative stress, which is an issue for all the 4 complexes if they are damaged.

Suspect your Mitochondria Need Help? Schedule an appointment with one of our Functional Medicine practitioners. Call 914-652-7800 to book your appointment. 

Meet Melissa: Melissa Rapoport is the Manager of Health Coaching and Lifestyle Programming at Blum Center for Health in Rye Brook, NY. She combines her graduate work in Developmental Psychology with her education in nutrition, health and coaching to create highly individualized programs that result in lifetime change. A contributing author to three international bestselling books, Melissa’s greatest joy is her relationship with her two daughters. To learn more about Melissa’s coaching practice at Blum Center for Health, click here.

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Emotional Wellness and the Stress Effect

In 1998, I attended my first training program with the Center for Mind-Body Medicine (CMBM.org), and began a lifelong journey exploring and understanding how our emotions, thoughts, feelings, stress, and  trauma are dramatically linked to changes in our physical and mental health.  There is no separation.  Look below the surface of a physical illness and you will find stress, trauma, or emotional distress in varying degrees, sometimes going back many years.  

The same holds true for those with emotional or mental health issues.  There are almost always root causes to be found…sometimes physical (think nutritional for example), but often there is underlying stress or trauma to be unearthed and healed.   

Over the many years that I have worked with CMBM (I am still part of the Senior Teaching Faculty), I have traveled and worked in traumatized populations (Haiti after the earthquake, New Orleans after Katrina, Northern California after the Wildfires, Military/Vets, First responders after 9/11) and in stressed out populations of health professionals experiencing severe burnout and every day trauma in their own lives.  And because this understanding of the mind-body-stress-trauma connection is now woven into the fabric of who i am and the lens with which i see the world, over these past 20+ years, I have uncovered and witnessed how stress and trauma have caused physical and emotional illness in all the people I meet and treat in my medical practice.  

When I opened Blum Center for Health almost 15 years ago, my goal was always to bring Functional Medicine, Mind-Body Medicine and Nutritional Medicine all together under one roof.  And I have a deep sense of satisfaction, knowing that yes, these are the services you will find when you explore our website or walk in our door.  But more importantly, this is that attitude and approach you will find as you work with all our providers, because this has now become the fabric of who WE are.

SUPPORT FOR EMOTIONAL WELLNESS, STRESS AND TRAUMA

To support our community and to offer tools for our patients to explore their mind-body connection and resolve underlying stress and past trauma, we offer many services that we invite you to take advantage of.  

  • Weekly meditation classes
  • Mind-body groups led by facilitators trained by CMBM
  • Health coaching for exploring stress and sleep with Melissa Rapoport
  • Ketamine consult and then treatment with Dr Greenman
  • We also work with local integrative psychiatrists and therapists for a team approach for optimal treatment outcomes.
  • And of course, we also use functional medicine to look for underlying causes of imbalances that affect your mood and emotional health, including optimizing gut microbiome, hormones, nutrient deficiencies, and more. 

We’re here to help. If you are unsure of where to start, feel free to contact us at info@blumcenterforhealth.com and we’d be happy to guide in the direction that fits your desired outcome.

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Nutrient Packed Smoothie Guide

Functional Medicine Smoothie Recommendations

Smoothies can be a quick, simple and refreshing complement to your nutrition program, helping to make food as medicine delicious and healing.  However, many typical smoothie recipes are heavy on fruits, limited in protein and miss the boat on opportunities to add fantastic antioxidant and antiinflammatory options. 

Use this template to take your smoothies to a new level! 

Use 4-6 oz. for your base liquid for your smoothie. Place it in a blender.

o Green tea – let it brew for 10-15 minutes

o Good, clean, filtered water

o Almond milk or another nut milk ( use one without added gums or sweeteners) 

Add 2 oz. of organic, unsweetened liquid:

o Pomegranate juice

o Tart cherry juice

o Acai juice

o “Morning blend” or any Knudsen Organic “just” juice

Add ½ cup of frozen wild blueberries, blackberries, or raspberries (preferably organic).

Add 1 cup of spinach, kale, romaine or any green leafy vegetable

And/or a carrot, ½ beet or ⅓ cup cauliflower 

Add a protein

o ½ cup coconut yogurt

o ⅓ cup white beans or chickpeas 

o 2Tbs nut or seed butter

o 1 scoop of protein powder 

Add additional nutrients:

o Add 1-2t of freshly ground flax seeds. Store extra ground flax seed in fridge. It will keep for 3-4 weeks.

o 1 scoop of Fiber

o 1 teaspoon of fish oil 

You may want to use the herbs below: 

1T of fresh rosemary chipped 

1t of fresh ground turmeric or ginger

½t of fresh ground cinnamon, clove or nutmeg 

Add ¼ cup of crushed ice if you like your smoothie cold 

Blend as desired and enjoy!

Download the guide as an image and save it for future use:

Vicki Kobliner is a Registered Dietitian/Nutritionist with over 20 years of expertise applying a Functional Nutrition approach to the care of children and adults. She utilized her wealth of experience with both traditional and integrative modalities, incorporating the power of food, herbs and targeted nutrition support for both prevention of and healing from both acute and chronic illnesses.    Vicki sees pediatric patients and their families, and has extensive experience in addressing a wide variety of childhood illnesses.

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RECIPE: Sunrise Nori Wraps

Text excerpted from EATING CLEAN, © 2016 by AMIE VALPONE. Reproduced by permission of Houghton Mifflin Harcourt. All rights reserved.  Screen Shot 2016-03-06 at 2.55.53 PM

Sunrise Nori Wraps with Spicy Tahini Drizzle   Serves 4

If you like California rolls, you’ll love these nori wraps (though personally, I think they’re so much better!). The tahini dressing is truly addictive—you’re going to want to dress everything in it—and the cabbage provides a nice crunch. If possible, use a food processor to slice the cabbage so you can get it super thin.

Also, make sure the vegetable strips are all the same width and length so that they don’t hang over the edges of the nori sheets; this will make rolling up the wraps easier. Use leftover tahini drizzle as a dressing for salads or as a dip for crudités.

Sunrise Nori Wraps 

4 nori seaweed sheets

¼ small head red cabbage, very thinly sliced

1 large carrot, peeled and julienned

1 small yellow summer squash, julienned

1 small cucumber, julienned

1 large ripe avocado, pitted, peeled, and sliced

1 recipe Spicy Tahini Drizzle

Spicy Tahini Drizzle 

2 tablespoons freshly squeezed lemon juice

1 ¼ tablespoons chickpea miso paste

1 tablespoon raw tahini

2 medjool dates, pitted

1 garlic clove, minced

¼ teaspoon crushed red pepper flakes

Water, as needed to thin the drizzle

Place the nori sheets on a flat surface. Divide the cabbage, carrot, squash, cucumber, and avocado among the sheets. Top each pile of vegetables with a heaping tablespoon of the Spicy Tahini Drizzle, and then roll up the nori sheets into a tube shape.

Make the tahini: Combine all of the ingredients except the water in a blender. Blend, adding water 1 teaspoon at a time as you go, until the mixture becomes a thin sauce.

To purchase Amie’s new book click here.