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IBS is a digestive disorder characterized by bloating, changes in bowel habits, and abdominal pain which can be caused by digestive insufficiencies, food intolerances, or infections. Many potential treatments are available depending on the cause. Irritable bowel syndrome (IBS) can be classified as diarrhea-predominant, constipation-predominant, or a mixed subtype of either. Studies show that those diagnosed with IBS usually have an altered gut microbiome, increased inflammation/ intestinal permeability, and systemic immune reactivity. Causes of IBS: Digestive Insufficiencies: Digestion imbalance and improper absorption may contribute to bowel symptoms. Gut Dysbiosis: Disruption in your normal gut bacteria are often observed in patients with IBS. History of Gastrointestinal Infection: Research shows that previous gastrointestinal infection is a risk factor to develop IBS. We also have benign gut bacteria that under environmental pressures- such as overuse of antibiotics, poor diet and toxin exposure -can promote unwanted overgrowth and disrupt your gut. Adverse Food Reactions: Studies have shown a correlation between certain foods and the development of symptoms. These foods often contain FODMAPs, lactose, or gluten. Anxiety and stress: Lifestyle and environmental factors can affect the emergence and severity of IBS. Research shows that negative emotions, such as anxiety, play a major role in GI functioning due to the bidirectional relationship between the gut and brain axis. Genetics and Vitamin Deficiency: Vitamin D deficiency and genetics have also been tied to the development of IBS. At Select Internal Medicine we take a root cause approach by offering further analysis with gut microbiome testing and food sensitivity testing and then formulate a personalized protocol for gut healing. Understanding the various factors that affect your gut microbiome helps to optimize the treatment regimen! Written by Dr. Dina Diehl

As we enter the fall and winter months many of us become more susceptible to infections since we spend more time indoors and in colder temperatures. There are numerous ways we can prepare our bodies and boost our immune systems to help prevent infections. Tips to Improve Your Immune System Eat a healthy and balanced diet that is rich in colorful fruits and vegetables. Try to aim for 7-10 servings of fruits/veggies a day. Get moderate, regular exercise to boost your overall health. Exercise increases infection-fighting white blood cells, improves circulation, and decreases stress hormones. Manage stress through relaxation and mindfulness as chronic stress can alter your immune system. Get adequate sleep for your body to recover which on average is 7-8 hours a night. Stay hydrated and if you drink alcohol, only drink in moderation. Maintain a healthy weight since increased weight leads to increased inflammation and can worsen infections. Wash your hands frequently, disinfect surfaces/objects, and avoid close contact with those who are sick. Stay up to date on recommended vaccines. Avoid smoking and limit exposure to pollutants. Supplements to Support Immune Function Quality Multi-Vitamin - A must! Consult with your doctor on recommended brands. Our bodies require certain micronutrients to work that can be difficult to get from your diet alone! Vitamin C- known for antioxidant properties. Regular use can shorten the duration of colds. Higher doses can be taken during illness and can act as an antihistamine and anti-inflammatory. Vitamin D- regulates immune function and can reduce the risk of infections. Vitamin D deficiency is linked to an increased susceptibility to infections. Vitamin A - can support your body's ability to fight respiratory infections when used short term. Zinc- supports immune cell function and can reduce frequency and duration when started within 24 hours of symptom onset. Echinacea- stimulates immune function and can be taken as preventive or for acute infection. Elderberry- could help reduce the duration of cold /flu symptoms. Astralagus- has anti-bacterial and anti-inflammatory properties to support the immune system. Quercetin- shown to decrease viral growth at initial stages. NAC -promotes glutathione which is a potent anti- oxidant that supports immune function. It has been shown to suppress viral replication and reduce inflammation. Probiotics- supports gut health which is linked to your immunity. Consult with your provider on what is best for you! Written by: Dr. Dina Diehl

"Inflammaging" is a term that combines "inflammation" and "aging" and refers to the chronic, low-grade inflammation that tends to increase with age. It's believed to be a key factor in the aging process and is associated with various age-related diseases Factors that contribute to Inflammaging Chronic Infections: Lingering chronic infections can activate the immune system and lead to inflammation. Lifestyle Factors: Poor diet, stress, lack of exercise and other unhealthy habits can contribute to chronic inflammation in the body. Clean up your lifestyle to offset inflammation! Cellular Senescence: As we age cells can deteriorate and stop dividing and can secrete inflammatory markers. Measures to promote autophagy such as fasting and cold plunges/saunas can be helpful to offset this. Immune System Dysregulation: As we age your body's immune system becomes less efficient in distinguishing harmful and unharmful signals leading to inflammation. Dysfunctional mitochondria: Mitochondrial are the power houses is our cells and when these are not functioning optimally it can promote aging and decreased energy. There are supplements that you can take to help optimize your mitochondrial function! Leaky gut: An imbalanced gut microbiome can lead to gut permeability and this barrier dysfunction can lead to inflammation. Obesity: Unhealthy weight, especially fat deposition around the abdomen, contributes to an increased release of inflammatory cytokines that cause inflammation throughout the body. Maintaining a healthy weight is an important factor to prevent this. In the field of aging and longevity , reducing inflammation is imperative. Following an anti-inflammatory healthy diet, getting adequate sleep, proper exercise, managing stress in addition to certain vitamin supplements are the cornerstone in reducing inflammation!  Written by: Dr. Dina Diehl

There are various antiaging supplements available in the market. Some supplements may claim to have antiaging effects but their effectiveness & safety can vary.. below are some common antiaging supplements that have been studied for the potential benefits. 1. Omega-3 fatty acids: found in fatty fish and flaxseed oil they can have anti-inflammatory properties and support heart and brain health- make sure you pick up quality brand of omega-3's as needs to be a pure form. 2. Coenzyme Q 10: antioxidant that helps produce energy in cells and may have skin and heart health benefits. 3. Vitamin C: antioxidant that supports collagen production and helps protect the skin from oxidative stress and damage. 4. Vitamin E: antioxidant that may help protect the skin from damage caused by UV rays and other environmental factors. 5. Resveratrol: found in red wine and grapes it is an antioxidant that has been studied for its potential antiaging effects. 6. Curcumin: derived from turmeric and is an antioxidant that has anti-inflammatory properties. 7. Niacinamide (vitamin B3): vitamin studied for its potential to improving skin elasticity and reducing fine lines. 8. Collagen supplements : there are some studies that suggest collagen could improve skin elasticity and hydration. 9. Green tea extract: contains polyphenol's that have antioxidant properties and could support skin health. 10. NMN ( Nicotinamde mononucleotide): precursor to NAD+ and shown to elevate levels of NAD+ which produces energy. 11. NAD+ ( Nicotinamide adenine dinucleotide): important for energy production and supplementation has been shown to slow mitochondrial decline ( the powerhouses of our cells) and improve health and age. 12. NR ( Nicotinamde riboside): precursor to NAD+ and shown to elevate levels of NAD+ which produces energy. These supplements could offer potential benefits but they are not a substitute for healthy lifestyle which includes a balanced diet, exercise, sleep and proper skin care. Additionally, individual responses to supplements can always vary and supplements can interact with medications.. so always consult with a physician before starting.  Written by: Dr Dina Diehl

Many people suffer from sleep deprivation and poor quality sleep. We have a few pearls to help you on your way to a more restful night of restorative sleep! Sleep is critical to our mental health, physical health, weight management, disease prevention and our longevity. It is a cornerstone to overall health in addition to proper nutrition and adequate exercise. Many of us struggle to stay asleep or have restless, unrestorative sleep. Consequences of Poor Sleep Decreased ability to concentrate/focus Decreased physical performance Decreased productivity Increased cortisol which can contribute to weight gain Irritability Increased risk for chronic health problems such as dementia, high blood pressure, cardiovascular disease and diabetes Slowed reaction times Cortisol We all produce the stress hormone called cortisol . Cortisol is released from our adrenal glands which can play a large role in our sleep /wake cycles. In the morning, our cortisol naturally rises and as the day progresses should naturally fall to prepare for bedtime. Some individuals have the reverse pattern and can't fall asleep at night and are exhausted in the morning. When our adrenal glands are not balanced it can affect our stress response, blood sugar levels, body weight and sleep/wake cycles. If our body is in constant psychological /physical stress and cortisol is running high it can affect sleep and blood sugar levels. Stress How does stress affect our sleep? We may have psychological stress with family, money or work. We may have physical stress either due to lack of exercise or excessive exercise. Physical stress is also caused from poor diet (processed food/sugars), excessive screen time, environmental toxins and hormonal imbalances. These stressors on the body are all factors that contribute to increased inflammation and cortisol. Therefore- it seems that two common factors that could be affecting sleep are cortisol and chronic stress. If you are waking up at 3am we must look at stress and diet (specifically sugar) as contributing factors due to increased cortisol release! Pearls to Optimize Sleep Maintain consistent sleep schedule Try not to eat 3 hours before bed Maintain regular eating schedule Keep a journal and write down your thoughts or worries before bed Magnesium is a relaxation mineral and 200-400mg of the right form of magnesium before bed can be helpful Low dose melatonin can help reset your circadium rhythm Ashwagandha supplement can help regulate cortisol Keep sleep environment comfortable - dark, cool and quiet Eliminate caffeine in the afternoon especially if you are a slow metabolizer Avoid alcohol as this affects sleep quality and interrupts sleep Avoid decongestants at night Expose your eyes to 10-20 minutes of natural sunlight in the morning can help set your circadian rhythm and timing of melatonin release 12-14 hours later Soak in a warm bath using lavendar oil, epson salts and baking soda Avoid exposure to bright light/electronics before bed - can place on night mode to help Dim artificial lights in the evening and consider wearing blue blocker glasses to block the blue light that can affect sleep/wake cycle Allow on average 7-9 hours in bed and try to avoid bedtimes after 11pm Avoid late afternoon naps longer than 45 minutes Try to complete aerobic exercise before 6pm or at least 3 hours before bedtime Don't stay in bed more than 30 minutes after trying to fall asleep and insead go to relaxing area other than the bedroom to meditate or read with low light Learn to meditate to calm the mind Consider investing in a sleep tracking device We hope these pearls will guide you on getting a more restful sleep. At Select Internal Medicine we have specialized functional medicine testing to evaluate your cortisol patterns and can recommend supplements that work with you on achieving better sleep! Dr. Dina Diehl

High Blood Pressure is otherwise known as Hypertension. It is important to know what are some contributing causes for hypertension and how we can adjust our lifestyle to prevent and treat it. High blood pressure is known as the "silent killer" as some individuals are not even aware they have abnormal blood pressure. It is important to have regular doctor visits so that you can undergo proper screening and treatment. Stage I hypertension is when your blood pressure reading is greater than 130/80. The proper way to check your blood pressure is after sitting down, relaxed for 5 minutes without any recent caffeine intake, exercise, acute stress or pain. If left untreated Hypertension can lead to heart disease, kidney impairment, heart failure and strokes. Some signs you could have untreated high blood pressure can be headaches, blurred vision, dizziness, shortness of breath, chest pain, palpitations and fatigue to name a few. What contributes to Hypertension? Insulin resistance/ Prediabetes Obesity Inflammatory/Processed food diet Stress and lack of exercise Untreated sleep apnea Magnesium deficiency/Omega-3 deficiency Heavy metal toxicity Genetics Age/Race Certain medications and over the counter supplements What can you do to improve your blood pressure? Reduce inflammation by decreasing processed food intake Eat a plant rich diet that is high in fiber Increasing omega-3's in the diet ( such as wild caught salmon, herring, mackerel) Limit carbohydrate and sugar intake to improve insulin resistance and prediabetes Limit alcohol/caffeine intake Limit salt intake found in processed foods Ensure adequate sleep by following proper sleep hygiene Stress management and incorporating meditation and other stress relieving measures Regular exercise routine aiming for 30 minutes 5 days a week ( can decrease cardiovascular risk by 30% and lower blood pressure 4-9 points) What are some supplements that can be beneficial? Quality multi-vitamin Magnesium biglycinate or Magnesium citrate Omega-3 fish oils B complex Vitamin D Coenzyme Q 10

Your microbiome is basically a collection of microorganisms and their genetic material that live in your intestinal tract. These microorganisms are critical to your health and wellbeing. How can you be sure that you are eating for your microbiome? What does your microbiome do? Gut bacteria were thought only to regulate bowel movements however more research has shown that the gut bacteria affect your entire body... including your brain! The beneficial bacteria in your gut can help with digestion, reduce anxiety, protect against infection and some forms of cancer, balance mood and synthesize some vitamins. Good bacteria in the gut have been associated with lower rates of medical conditions such as obesity, diabetes and gastrointestinal diseases. If you have too many bad bacteria and too few good bacteria serious health problems can arise. Your good bacteria can be killed by illness, trauma, stress, surgery or unhealthy eating habits. The antibiotics we take for infections kill the bad bacteria but also may kill off your good bacteria. You can keep your microbiome healthy by eating the correct foods that feed the good bacteria and avoiding those foods that encourage bad bacteria. Feed your Microbiome...The foods we eat influence our microbiome. Different microbes thrive on different foods. You can stimulate the growth of good bacteria by taking probiotics and eating specific foods that bacteria are known to thrive on such as prebiotics. Tips to maintain your healthy microbiome: Hydrate- it is important to drink approximately half your body weight in ounces and other noncaffeinated beverages free of sugars. Include prebiotic and probiotic foods in your diet. Eat high-fiber vegetables which maintain a healthy digestive system. Limit or avoid processed foods and other foods that are high in sugar and artificial sweeteners and transfats. Limit or avoid foods which you are sensitive, intolerant or allergic. Some common examples can be corn, dairy, eggs, fish, gluten, soy, peanut and tree nuts. Take antibiotics only when necessary. During and after completing a course of antibiotics eat probiotic foods and take a probiotic supplement as this can help rebuild the population of healthy gut bacteria.