HOLIDAY FOOD AND FASTING (wait…what??)

Yeah, yeah, I know. Those two statements don’t even go together… or do they? The holidays are here. We are eyeball deep in them. All around us, at home or work, are delicious things. Cookies! Cakes! Pies! (Yay Pie! Yay Pie!)

Unfortunately, after every holiday season, someone seems to sneak in my room and replace all my pants with other pants that LOOK EXACTLY THE SAME but are one size smaller. SO WEIRD. (Ok. This is what denial looks like, people). But seriously, keeping your waistline in check can be tricky during the time of abundance.

So, what can be done to help our body keep up with the extra intake of carbs? How about intermittent fasting. (Noo! Stay with me! Don’t stop reading now!)

Intermittent fasting can allow our body to recover from the heavy dosing of sugars and sweets we just consumed and dig into our reserves a bit to help rid some of the excess. Obviously, I’m massively simplifying this, but this blog isn’t a pathophysiology lesson. I actually wanted to focus on the experience of intermittent fasting from one of our patient’s firsthand experience with fasting for 2 consecutive days and eating a low carb/normal diet the 5 other days.

He/She shall remain anonymous due to HIPAA regulations; per our conversation here is the synopsis. It was reported that initially it was daunting. We are programmed to eat on a routine schedule since we are children, so breaking this pattern is difficult. Our patient had to figure out what to do with themselves when they got home.  However, after getting through the first day, the second was not as bad as they had thought. There was an issue when someone brought some delicious aromatic food to work, but otherwise, there was very little issue with feeling hungry.

There were some issues that occurred with loose stool. They found that after 36-48 hours of fasting their intestinal habits were out of the norm for them. Diarrhea symptoms also lasted a little after the fast had ended.  They also want to be very clear that when you do start eating, do so slowly. They recommend it is best to take it easy and start with bone broth and maybe a smoothie with protein powder. Overall, intermittent fasting was found to be a pretty easy way to control the amount of calories consumed in a week.

So, there you have it. It seems you can have your cake and eat it too after all…just on separate days.

While fasting is considered safe for most people, please consult with your doctor before initiating any type of timed eating/intermittent fasting diets.

~ Brooke Rieth, NP & Action Medicine team

We are including 2 recipes:

Bone broth,  from Nourishing Broth, Sally Morell

Ginger spice cookies, from Once Upon a Chef, Jenn Segal

Liquid Gold, Bone Broth

Emma Watterson, Hayes, Virginia

The turmeric in this recipe gives not only flavor but also a beautiful yellow color to

the broth: oregano adds a south-of-the-border taste.

Makes about 4 quarts

Ingredients:

About 4 pounds chicken bones and pieces

2 to 4 chicken feet (optional)

¾ cup apple cider vinegar

About 4 quarts cold filtered water

1 large onion, ends cut off, quartered, with skin left on

1 head garlic, sliced in half (no need to peel it)

1 teaspoon ground turmeric

1 tablespoon dried oregano

Sea salt and freshly ground black pepper

Directions:

-Place the chicken bones in stock pot with enough water to cover bones and vinegar over medium heat

-Bring to a bare simmer, uncovered.

-Add the onion, garlic, turmeric, and oregano

-Return to a simmer, then lower the heat to low.

-Cook at a bare simmer with the lid off or slightly askew for 4 to 6 hours, occasionally skimming scum from the top as needed and checking to ensure that the bones remain covered with water and adding more water as needed.

-Remove the bones and feet with tongs with a slotted spoon (when cooled, pick any

meat off the bones and use in soups, casseroles, and other dishes).

-Strain the stock through a fine-mesh strainer into 2-quart glass containers

-Allow to cool to room temp and store in fridge for 5 days or many months in freezer.

-Season individual servings with salt and pepper.

Old-Fashioned Ginger Spice Cookies

Nutrition Information

Look More Youthful with Collagen Induction Therapy

Yes, I’m going for the eye catching title. But, you’re already reading this, so stay with me.

Collagen Induction Therapy is also known as microneedling or (if using plasma) is called the “vampire facelift”. What it is, essentially, is the creation of tiny punctures in the skin that allow the body to start the wound healing process with an influx of growth factors and stimulation of collagen production.

Why collagen? Well, collagen is what allows the face to have a more full, youthful appearance. As we age, we lose 1% of collagen a year after age 18. This leads to skin that can be a little looser, fine lines, etc. By stimulating and reorganizing collagen the skin becomes thicker and tighter allowing for reduction of fine lines and laxity.

What is PRP?

You can pair this with PRP for a more robust response. since PRP (platelet rich plasma) is from your own body, there is no risk of an allergic response. Why, you ask (inquisitive, aren’t you?), well plasma, as we mentioned in the last blog, is full of growth factors which can help stimulate the process of collagen remodeling/formation.

“So you are going to poke a bunch of holes in my face?”. Essentially yes, but here are a few key things you should note. 1) YOU WILL BE NUMB 2) the needles are very small and 3) It should feel like a moderate sunburn. 4) It is done to produce a redness of the skin, but there should not be bleeding.

My experience with microneedling and PRP

I wanted to make sure I knew what I was talking about with the experience, so I decided (against my better judgment) to do this at home, during naptime for my 5 month old. As you can imagine, there was a bit of a race against time on my end but here’s how it went:

I put the numbing cream on. Gave it about 10 minutes as the clock was ticking – he’s tricksy with his naps these days – sometimes you get 20min, sometimes an hour. Anyway, glad I did so I can tell you that even if you do not put the numbing cream on your lips, they will go numb. So there I was, alone with a baby, thinking I was about to drop to the floor due to a massive allergic reaction. Dogs provided no assistance.

However, didn’t have time to panic as clock was ticking and continued on with it. Survived. Lips and throat didn’t swell, just the effects of the numbing cream.

Sorry, back to the story. Started with the under the nose area as I was told this was a very sensitive area and I couldn’t feel a blessed thing there. It was fine. No pain. Proceeded to the cheeks no pain but a little burning towards the 3^rd pass as it was getting slightly irritated. Felt like I forgot I was sunburned and scratched an itch.

Here is where I went wrong, I left the cream on the forehead and was going to wash it off last, since it was the last place I was going and I’ve heard it was sensitive. So, that is what I did, and the microneedling was fine. No pain. However, trying to get the numbing cream off without contaminating the areas that were already done was tricky and I didn’t do a great job (keep in mind, I am absolutely rushing at this point to get done as his lordship in the other room is starting to stir).  We’ll come back to this.

I finish, Ash wakes up, I grab him. I look like I put a swaddle on and went out tanning. Face is red, cheeks are the worst, will submit pics. Don’t judge the no-make up me or we won’t be friends. As the topical numbing agent wears off my face feels hot. Again, like a sunburn. It is also tight. That’s about it.

Now, to circle back to the “where I went wrong”. I went to itch under my right eye – had an eyelash or something- and it was numb. Like REALLY numb. Again, panic ensued. Obviously, I’m stroking out and this is an atypical symptom. Still alone with the baby.  Dogs, still offering no assistance but WILL lick baby mercilessly if I go unconscious. Realized, still had cream there from when I was trying to carefully wipe if off. Removed it. Regained sensation about 15 min later. All was well.

I’m currently typing this at 5 in the morning. Face feels a little tight but no bad. Redness has greatly subsided. Will add these pics as well. Getting the best results requires a few treatments about a month apart, so I’m not expecting to look 20 tomorrow but we’ll see what happens in about 2 weeks when you should start to see some improvement in overall texture of the skin.

Microneedling and collagen induction therapy

I should also mention, whilst I continue on this microneedling conversation, it can be used to minimize or eliminate acne scars (depending on depth), minimize stretch marks and improve the look of the skin of the neck.

If any of this sounds interesting to you, give me a call and we can chat about it. Microneedling can be done with or without PRP.  I promise not to have a napping 5 month old at the office so we will be able to take our time.

If you’re curious about this procedure, sign up for a visit and see how it works for you.

• Brooke Rieth FNP

What is PRP?

PRP for HAIR LOSS

What can I say about hair loss? Hm. Well, being 5 months post partum and going through a massive shed myself at the moment, I can say, with certainty, that it stinks.  I don’t know if you’ve ever run your hand through your hair and came out with seemingly more hair on your hand than your head, but I can assure you, it’s a bit traumatic. Allegedly, the postpartum shedding should stop around 6 months and then I should see regrowth…. we shall see.

It was this weird journey that brought me to want to look into hair loss further. There are all different reasons for people losing their hair, but the more common reason is androgenic alopecia, a hormone driven cause for hair loss, more commonly known as male pattern baldness. But you see, that is a bit of a misnomer. Androgenic Alopecia affects women as well, around 40% after menopause.

The issue with hair loss, aside from the obvious “it blows”, is that while there is help out there for it, a lot of people, especially women, are embarrassed to bring it up. So, if you’re reading this, allow me to break the seal, so to speak, in talking about it. We are currently living with an evil hair fairy in my house that is leaving hair on chairs, on clothes, on other family members, in the drain, on the sink…you get the idea. I’m currently in competition with my lab mix who sheds like crazy (although I think I’m winning. Worst. Competition. Ever.)

So, where am I going with this? As I mentioned above, this got me interested in hair loss. I have found that aside from medication, there are procedures that have been shown to be helpful in either stopping the shed or helping to regrow hair. This would be PRP or Platelet Rich Plasma.

Basically, you are using your own body to help hair loss. You get your blood drawn, just like any other lab work you’ve had done. The blood is spun to separate the platelets from the red blood cells. The platelets are then drawn up into a syringe and injected into the scalp around the area of concern. The rationale is that platelets contain growth factors which can then stimulate hair follicles.

It usually takes a series of 3 sessions, one month apart and then maintenance every 6 months. It does take about 4 months to see results. It works best for more recent loss, around 3 years or less.

Now, will this work for everybody, no. Some people may just see a stop in the shed. Others will see regrowth, and some may see no difference. Can I predict who will fall into what category? No. Is it worth the money? That is entirely up to you.

Typically, these treatments run into the thousands of dollars. We will be offering it here at Action Medicine, DPC   at a discounted price for our existing patients and a competitive price for non-patients.

If you are interested, and would like to schedule an appointment to talk about whether it is a good option for you, please call the office 781-767-0910

~ Brooke Rieth, NP & Action Medicine team

Viruses vs. bacterial respiratory infections

As we make our way into the fall and winter months, also known as the “flu season,” it is important to understand the differences between viral and bacterial respiratory infections.

The common cold, influenza, and coronavirus are all caused by viruses, not bacteria. Therefore, antibiotics do not work for these viral illnesses. Furthermore, taking antibiotics for viruses can actually increase your risk for resistance to antibiotics, meaning that antibiotics can eventually lose their effectiveness to treat certain bacterial infections.

Viruses can cause cough, runny nose, sore throat and fever. The course of viral respiratory infections typically look like this:

• Day 1: mild onset of symptoms
• Day 2: peak of fever and sore throat, can last up to 1 week
• Day 4: peak of cough and runny nose, can last up to 2 weeks
• 1-2 weeks: gradual decline and resolution of symptoms

Call your primary care doctor if your symptoms do not follow this pattern or persist beyond 2 weeks. Infections that continue over 2 weeks could have developed into a bacterial infection, and then would benefit from an antibiotic.

It is important to also call your primary care or emergency services with any chest pain, shortness of breath, and fever over 102 degrees Fahrenheit.

All viruses are contagious and it is important to avoid contact with others if you are ill. Additionally, frequent hand washing, wearing a mask, and cleaning of shared surfaces should be done to avoid transmission.

Drinking plenty of fluids and 2000 mg of Vitamin C daily can be helpful in recovering from a viral infection. Keep in mind that a bit of a fever helps your body destroy the virus. I don’t usually recommend anti-inflammatories or aspirin for fever less than 102 degrees Fahrenheit unless you’re having difficulty sleeping due to aches and pains.

When in doubt, call your doctor’s office with any questions or concerns. There are many similarities between the common cold, influenza, and COVID-19. COVID-19 can also cause fatigue, muscle aches, headache, loss of taste or smell, nausea, vomiting and diarrhea. It is best to get a COVID test at a local testing center before assuming that it is a common cold.

• Dr. Mike

Back to School Season

Ok, “back to school” isn’t really a season, but I’d imagine you’d rather hear me say
that as opposed to “fall”. The reality of summer ending is a bit much for some.

Anyway, let me get to the real reason I’m bothering everyone today. I actually
have an important question to ask that impacts the children of the south shore.

There are around 24,000 public school students impacted by homelessness. Sadly,
the average age of a homeless person in Massachusetts is 8. Just getting basic
school supplies, necessary for success, is a struggle.

Action Medicine, DPC is working with “School on Wheels”, a non-profit
organization located in East Bridgewater. Their team focuses on helping students
get the supplies and help (by tutoring and mentoring) that they need for
successful academic careers.

We are ever so kindly asking our patients, and general community, to please
donate backpacks, notebooks, pencils, crayons, erasers, folders, etc. to help
children in need succeed with their education. We are accepting drop off
donations at our 2 nd floor lobby area of our office. You may also go directly to the
website sowma.org and click on the “donate supplies “option.

We are always impressed by the generosity of our patients and thank you in
advance for your kindness. As always, stay safe and be good to one another.

The Action Medicine team

Guess who’s back??!

Hello Action Medicine family! It’s been several months of living in a bubble with a tiny demanding tyrant (who couldn’t be cuter if he tried), but I am back in the office. Are my clothes on inside out? Maybe. Could there be baby drool on my shirt? Possibly. Am I still going to see patients? You betcha.

I would like to thank everybody for their well wishes during maternity leave. Being a mom has been awesome and you better believe I am attaching baby photos to this blog.

I hope everyone has been enjoying their very hot, very wet summer. Fingers crossed for some nice days in the upcoming weeks. I look forward to seeing you in the office soon.

– Brooke Rieth FNP

Action Medicine DPC: Info on fiber

Fiber supplements made from psyllium such as Metamucil can help with constipation and regularity, lower cholesterol, and even reduce appetite. Tests by the organization, Consumer Lab, show that many are contaminated with lead and animal by-products.

For many years I have been telling my patients to use Metamucil as a fiber supplement on a daily basis. Recent testing has shown that this product is contaminated with significant levels of lead. If you are using this product you should stop and use one of the following instead.

Yerba Prima Psyllium, whole husk

Now Psyllium husk capsules

Organic India Ramgi

Although they did not test all psyllium products, the other ones that were tested had lead levels that were not acceptable.

The husk of the psyllium seed is about 90% fiber, most of which is soluble fiber. This can attract and bind water, absorbing about 10 times its weight in water. In the gut, the soluble fiber occupies volume and slows digestion leading to fullness and helps regulate blood sugar. It also softens and adds bulk to the stool. This can help prevent both constipation and diarrhea. The gel may also bind to and reduce the absorption of a variety of compounds and can lower your cholesterol.

I suggest taking a teaspoon of one of these fiber products on a daily basis with a good amount of water. I no longer recommend Metamucil.

• Dr. Mike

Mark your calendars: Spring arrives March 20th!

Yes, I know. We live in Massachusetts where we could very well be having a blizzard that day, but something to look forward to is nice. So, listen, my gardening friends. This is a blog where I am going to turn the microphone to you. I’d like to know what you are planning on growing and when you would start seeds indoors.

Is this a thinly veiled attempt to gather knowledge from people much more experienced than I am? You betcha. Listen, I have to battle woodchucks, turkeys, squirrels, the occasional deer, and rabbits. Generally, they win. They exploit my weakness as an animal lover and know I won’t harm them. Clearly, they are emboldened and eat any seed spread out of unprotected areas with reckless abandon. I’m just trying to get an advantage before it is officially “game on.”

Also, while I’m at it, if anyone has good tips for keeping pests away, I’m all ears. I’m down for anything from sprays to dressing in a giant woodchuck outfit to lure them to a different location. The repellent spray didn’t work. Well, it repelled my husband and I, the animals, including my weirdo dogs, seemed to find it awesome and took it upon themselves to wear it as a new and fashionable cologne.

So that’s it. No talk of medicine, politics, vaccinations, or our current pandemic. Just plants. Help a girl out. The struggle is real.

~Brooke Rieth, NP & Action Medicine team

“Don’t tell secrets in the garden.

The Potatoes have eyes, the Corn has ears, and the Beanstalk”