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Healthy 850 A Courtesy of The Osher Clinical Center for Complementary and Integrative Medical Therapies FREE Resources for BWH Employees at the Osher Clinical Center Acupuncture Assisted Smoking Cessation November Tuesday / Thursday: 12:-1:00 November 2012 ….Caring for your Immune System…. Immunology 101: A Quick Course in Understanding Our Immune System -Megan Tabor, DC and Donald B. Levy, MD Hatha Yoga for Medical Symptom Reduction Tuesdays, 1:15 – 2:30 To register call (617) 732-9700. _____________________________________ Featured Healthy Links BWH Cardiovascular Wellness Service Welcome to this month’s Healthy 850 newsletter, which is devoted to the Immune System. We thought it a good idea to start off with a “Readers Digest” explanation of some of the components of the immune system and what it does, so you can really appreciate this issue’s content. What is the Immune System? _____________________________________ Additional Services at 850 Boylston Street __________________________ The immune system is a network of cells, tissues, and organs that work together to defend the body against attacks by harmful invaders—such as bacteria or viruses-that can cause infections or disease. Yoga – with Andrea Soler Kripalu / Vinyasa based yoga Mondays 6:30-7:45 at the Fish Bowl $10.00 class or $85.00 for 10 It’s a complicated system that we’ve broken down here into its two primary lines of defense; (1) innate immunity and (2) acquired immunity. Each have their own set of tools and work together to protect us from harm--whether it’s fighting a cold, preventing the flu, responding to an allergic reaction, destroying cancer cells or giving us life-long protection from some diseases. Your Body’s First Defense: Innate Immunity Important Date st World AIDS Day is December 1 . The 2012 theme is “Working together for an AIDS-Free Generation”. Click here for more information. The Innate immune system delivers the first line immune responses when we are exposed to invading microorganisms. These responses are present when we are born and do not need to be adapted or changed over time. This early response mechanism is essential since invading bacteria or viruses can begin reproducing in minutes. There are many components to the innate immune system, including: physical barriers, such as the skin and mucous membranes many types of specialized white blood cells called neutrophils, monocytes, macrophages, mast cells and platelets that secrete thousands of enzymes and other biologically active molecules that activate, modulate and maintain the inflammatory response to invading microbes or damaged cells. The signs of inflammation that we all recognize—redness, heat, swelling and pain—are all generated by the innate immune system. For the most part, we are not aware that this system, with its billions of cells and thousands of chemical mediators, is constantly at work defending our health. When we ingest, breathe in, or are otherwise exposed to viruses or bacteria, the innate immune system goes to work quietly and efficiently and often the infection never blossoms into a perceivable inflammation; we do not even know that we have been “attacked”. When this first line innate immunity needs help, the second defense line, called adapted or acquired immunity, is triggered. Read on for more details. Your Body’s Long-Term Defense: Acquired or Adaptive Immunity The Adaptive (or Acquired) Immune System consists of other white blood cells—mostly “T” and “B” lymphocytes and a huge array of helper cells and secreted chemical mediators. T-lymphocytes perform a variety of tasks. For example, when viruses and some bacteria get inside a cell and reproduce, T-lymphocytes are important in the elimination of infected cells. T cells also attack cells that exhibit odd or unrecognized behavior, such as cancer cells. Unfortunately, they may also destroy therapeutically transplanted cells, causing graft rejections. B-Lymphocytes produce specific antibodies to specific invaders or antigens that they encounter. These cells produce various types of immunoglobulins which can be classified as IgG, IgA, IgM and IgE. Contact with a recognized invader causes the B cells to activate, proliferate and differentiate. Memory B cells may live for many years, circulating inside the body in search of foreign invaders. Upon encountering one they begin their work, but it can take many days to produce enough antibodies to completely ward off an attack. We can take advantage of this process through vaccination. Vaccinations expose the immune system to all, or specific parts, of a common invader such as influenza, measles, polio, or hepatitis virus, etc. to stimulate a primary immune response to the invader. The memory B cells are now ready. They can respond faster and more effectively when exposed to the natural microorganism. Mounting the Immune Response: It Takes a Village In summary, there is a lot to understand about our complex immune system and its many moving parts—billions of white blood cells and thousands of types of chemical mediators and molecules. Each part requires its own building blocks, nutrients and maintenance to operate at peak performance and keep you healthy. The Innate and the Adaptive (acquired) immune systems function very differently but they work closely together and interact to support each other. Knowing some important basics will help you better enjoy the helpful information in this issue as the winter season approaches. Avoid Getting an Upper Respiratory Infection this Winter “I need something to boost my immune system” - Donald B Levy, MD There are many claims about the ability of certain herbs, dietary supplements and lifestyle measures to “boost the immune system” and/or prevent infectious diseases. If you study the immune system, or just read “Immunology 101” above, you quickly realize how broad that statement sounds. Boost the whole thing? One part? Which of the several thousands of moving parts? Here are a few suggestions to help you stay healthy this cold and flu season: two protective behaviors, and two nutritional supplements whose benefit is backed by reasonable scientific evidence. Courtesy of the Osher Clinical Center for Complementary and Integrative Medical Therapies 2 Two Protective Behaviors 1. Wash your hands with soap and water (or use a qualified purifier, such as Purell®) as frequently as you can when sharing touched objects in a public space. Travel Hint: Consider giving an extra wipe of the surface of the parts of the hotel room that have the most germs. Studies show that these are: the TV remote, telephone, alarm clock, bathroom faucet, thermostat, ice bucket, door handles, and yes, the Bible in the drawer! 2. Moderate daily exercise may help prevent upper respiratory infections—so stay active in the cold weather months [but you do not need to train for a marathon]. If you tend to get sick a lot, get a check-up with your PCP and then consider an integrative medicine consultation at the Osher Center. Doctor Levy will be happy to discuss which popular interventions [such as: Airborne™, astragalus, Echinacea, vitamin C , vitamin D, fish oils, Oscillococcinum™, probiotics, zinc, etc.] have some evidence for efficacy and safety, which do not, and the proper doses and formulations to use. Two Useful Nutritional Supplements 1. For Prevention you can try this supplement for 2-3 months: Green Tea Extract—Components of green tea appear to stimulate certain T-lympocytes to produce a powerful antimicrobial molecule called a cytokine. In a randomized, controlled trial of a proprietary formulation of green tea extract - ImmuneGuard®- two capsules daily [equivalent to drinking about 10 cups daily] was taken for 3 months, there was a significant decrease in the incidence of cold and flu illnesses. For those who became ill, there was a significant decrease in the number of days that subjects had symptoms. ImmuneGuard® can be ordered on-line. It is difficult to tell if all similar products would have the same effect. 2. Getting sick? Starting to get that familiar viral feeling? Try this Immediately: Elderberry (Sambucus nigra) Extract Nutrients known as flavanoids contained in elderberry are thought to be responsible for its anti-viral and immune priming effects by stimulating white blood cells called monocytes to produce particular cytokines (not unlike the process for green tea). Certain flavanoids in elderberry inhibit H1N1 to about the same degree as prescription medications such as Tamiflu and amantadine, and reduce symptoms when given to patients with influenza A or B. Take extracts as instructed on the label as some are crude extracts (whole plant) and some are standardized concentrates. Dosing is usually every 6 hours for 3-4 days. Gaia Herbs makes a high quality liquid tincture –30-40 drops in any liquid may be taken 4x daily Sambucol™ is sugar sweetened and found in regular pharmacies. Buy “The Original Formula”. It contains 3.8 g Black Elderberry Extract per 10 ml--Take 2 tsp. four times daily— which finishes the bottle in 3 days. It may be repeated if needed Enhancing Immunity with Dietary Choices and Habits - Caitlin Hosmer Kirby, RD A Google search of "immune enhancing foods" will provide a long list of healthful options (e.g., garlic, fatty fish, spinach, blueberries, yogurt, kale, lentils....and the list goes on). Instead of pinning optimal health on individual foods, here are a couple higher level suggestions for getting you on the right track. Pick one that is new to you and start preparing for winter! Limit sugar and eat a low glycemic diet--that is, one that includes complex carbohydrates and other foods that the body takes longer to break down and turn into simple sugars. Excessive sugar intake not only contributes to the development of obesity Courtesy of the Osher Clinical Center for Complementary and Integrative Medical Therapies 3 and diabetes, but also taxes our immune system’s ability to respond and function properly. High, or rapid rises in, blood sugar promotes inflammation. So, consume quality foods that have a low glycemic index –For more information on low glycemic index foods, go to http://www.glycemicindex.com/index.php Eat more fruits and vegetables! Eat a rainbow of colors. Each and every one packs micronutrients noted below that may provide a boost to one or more of the many aspects of the immune system. Make an effort to choose a fruit or vegetable in a category/color you don't usually eat. Click on the hyperlinks below to learn more about the various benefits of each color category of fruits and vegetables. Green – [Contains EGCG, isothiocyanates, lutein/zeaxanthin, and isoflavones] – green tea, broccoli, Brussels sprouts, spinach, kale, green peppers, green beans Red/pink - [Contains lycopene and ellagic acid] - red bell pepper, tomatoes, strawberries, pink grapefruit, guava White - [Contains allicin and quercitin] - garlic, onions Purple/blue – [Contains anthocyanidins and resveratrol] - blueberry, beets, pomegranate Yellow/orange – [Contains alpha-carotene, beta-carotene, hesperitin, and beta-cryptoxanthin] - carrots, cantaloupe, winter squash How to protect yourself and our patients from the flu! - Louise Schneider, MD Medical Director, Internal Medicine Gretchen and Edward Fish Center for Women’s Health One of the very best ways to prevent the flu is to get vaccinated. Even healthy people can get very sick from influenza and spread it to others. Everyone over six months of age should receive the flu vaccine especially if you live or work with people who are at risk for developing flu-related complications. There are also strategies to reduce the spread of influenza which include: Stay home from work or school when you are sick Cover your mouth and nose with a tissue when you cough or sneeze – If you don’t have a tissue available, cough into your sleeve instead of your hand Wash your hands often with soap and water or Purell Avoid touching your eyes, nose or mouth Practice good health habits like eating well, exercise, stress management, drink plenty of fluids BWH Note: As in past years, all employees are required by the Massachusetts Department of Public Health (DPH) to document in PeopleSoft that they either received a flu vaccination or declined to be vaccinated by Dec. 15, 2012. Those who decline will need to enter a reason for their declination. Flu symptoms may include fever, cough, sore throat, runny or stuffy nose, body aches, headache, fatigue or diarrhea and vomiting. It is important for you to seek medical attention if you experience shortness of breath, pain or pressure in your chest Courtesy of the Osher Clinical Center for Complementary and Integrative Medical Therapies 4 or abdomen, dizziness or confusion, severe of persistent vomiting or if your flu like symptoms improves but then return with fever and worse cough. Once again, obtaining that flu shot is your best defense to ensure you and your family have a healthy fall and winter. Warm Autumn Recipes - Lynda Danzig, Lic. M. T., Lic. Ac. The autumn season is brings lots of transition in the air, the colors, clothes and especially in our menus. In the 5 Element Theory, commonly used in acupuncture and oriental medicine, autumn is represented by the element metal. The corresponding internal organs are the lung and large intestine. It is a good time to support these internal organs by addressing the dry quality of this season and preparing for the cold. The following two simple recipes are used to tonify the lungs, have a warming thermal nature and aid in food digestion (and are delicious!). NOT Y OUR AVERAGE APPLE SAUCE 4 baking apples (Macintosh, Courtland, etc.) 4 very ripe Bosc pears Tablespoon of lemon juice I inch diameter of fresh, grated ginger 1-2 tablespoons of dried Lycii berries (Gou qi-zi) FYI - "Goji berry" and Lycii berry are virtually the same. Quarter the apples/pears and remove the seeds. I use a melon ball scooper for an easy, efficient extraction of seeds, after they are quartered. Place in a large sauce pan, add remaining ingredients, toss to coat fruit with juice and cook until very soft. When it is at your desired consistency, gently mash with a slotted spoon for a satisfying dish. It is suggested to serve warm at this time of year. GINGER SYRUP 2 cups sugar 2 cups of fresh peeled ginger, cut in 1/8 slices 2 cups of water In a medium sauce pan combine ingredients and cook over a high heat until it boils. Reduce the heat to a simmer. Cook until the liquid is syrupy and reduced down to half. Strain out the ginger root and cool the syrup. Store the syrup in a glass jar with a lid. It keeps best in the refrigerator. This syrup is a gentle and delicious way to calm an upset stomach. Ginger is used traditionally for nausea. Use it on toast as part of the BRAT diet (Banana, Rice, Apples, Toast, these are all foods suggested for someone who is suffering with gastrointestinal distress.) A terrific way to start the day may be with oatmeal, ginger syrup and a dash of cinnamon. This is very warming, energetically sustaining and a great way to tonify the energetics of the Earth element represented by the spleen and stomach. Courtesy of the Osher Clinical Center for Complementary and Integrative Medical Therapies 5 Would you like some help quitting? - One more Free trial….. Would you like help with smoking cessation through acupuncture? November is the host month for “The Great American Smokeout”, “Lung Cancer Awareness Month” and “COPD Awareness Month”. We will, again, be offering FREE acupuncture assisted smoking cessation on Tuesday and Thursday from 12:00-1:00 during the month of November. For more information, or to reserve an appointment, please call 617-732-9700. Featured Monthly Acupuncture Point – To Boost the Immune System - Brendan Carney. Lic. Ac. The LI-10 - LI-11 area is known for it's usefulness in stimulating our immune system. You may find that while your arm is at a 90 degree angle it has a crease at the elbow. Towards the end of the crease of the elbow on the outer arm is where the Large Intestine meridian - or "LI" is located. Search in an area with light palpation about one inch away from your elbow crease in a direction towards your wrist and look for little bumps. These bumps are where the active immune points are located. You can massage them of use light pressure on the arm to help stimulate your immune system. Stress and the Immune System - Randall Paulsen. MD Stress is a dualistic term. There is good/bad, acute/chronic, and adaptive/maladaptive stress. One can have too much stress – frantic multitasking, etc. There can be too little stress – retirement with nothing to do. There must be a balance between the two extremes. Unbalanced stress can drive us out of our minds, and, moreover, it can drive our minds out of our bodies. Take a minute right now. Stop reading, close your eyes and observe and count your next 3 natural breaths. …. Welcome home. Now, for a brief example that demonstrates a link between stress or stress-reduction, and the immune system. Richard Davidson, MD director of the Center for Investigating Healthy Minds at the University of Wisconsin conducted a very interesting study involving a simple flu vaccination. Most of us get shots, particularly at this time of year. The flu shot introduces a small amount of killed flu virus into your blood stream in order to alert your immune system to what this year’s flu might look like – sort of a specific preview that allows your system to prepare certain proteins, called antibodies to recognize this year’s enemy (your adaptive immune system). These proteins are prepared by the B lymphocytes in the immune system are called immunoglobulins, and they are ready when we are exposed to the flu virus itself. Courtesy of the Osher Clinical Center for Complementary and Integrative Medical Therapies 6 Dr. Richardson conducted an experiment with 2 groups of patients during July and August prior to flu season. The experimental group was given a full Mindfulness-Based Stress Reduction Course or MBSR (taught by Jon Kabat-Zinn actually) and the control group was given a course in health issues. Both groups had a class with a skilled instructor on a weekly basis. The difference was that the MBSR group was taught meditation, yoga, mindful eating, in short some of the basic skills to bring focused awareness, or “mind”, back into the experience of being in the body. The control group was given good health information, but no practice, no daily meditation homework. At the end of the 8 week programs, both groups were given their annual flu shot. Six weeks later blood samples were drawn from all the members of both groups. The MBSR group showed a much higher level of anti-influenza immunoglobulins in their bloodstream. It seemed that the practice of bringing focused awareness to their bodies on a daily basis had enabled their immune systems to be more efficient in making antibodies as a response to the flu vaccine. The take-home message is that if we can work earnestly at the practice of being more present in our bodies, taking some time daily to focus on something as simple as the breath, or sensations in the skin, we may actually improve the way our immune system functions. The next time you drive home from work, try turning off the radio, driving in the right hand lane, and just enjoy the quiet, maybe pay attention to your natural breath, let your mind muse over the events of the day. When you arrive home, your family may enjoy seeing a more relaxed you, your car will have burned a little less gas, and your immune system may be a little more supple in its ability to respond to the germs your kids have brought home from school. I encourage you to find your way to being more aware and more present inside the home that is your body. * D av i d s o n , R . J. , Ka b at - Z i n n , J . , S c h u m a c h e r, J . , Ro s e n k ra n z , M . , M u l l e r, D. , Sa n to r e l l i , S. F. , e t a l . ( 2 0 0 3 ) . A lte rat i o n s i n b ra i n a n d i m m u n e f u n c t i o n p r o d u c e d b y m in d f u l n es s m e d it at i o n . P sy c h os o m a t i c m ed i c i n e , 6 5 ( 4 ) , 5 6 4 - 57 0 . ) Tai Chi for Parkinson’s Disease Tai Chi integrates gentle movements, rhythmic breathing and imagery to improve strength, balance, flexibility, mental focus and emotional tranquility. Recent research suggests that Tai Chi can significantly improve balance, mobility, and quality of life for individuals with Parkinson’s Disease (PD). Growing out of a unique collaboration between researchers, clinicians and Tai Chi experts representing the Osher Center for Integrative Medicine at Brigham and Women's Hospital and Harvard Medical School, The Parkinson's Disease and Movement Disorders Center at Beth Israel Deaconess Medical Center, and The Motion Analysis Laboratory at Spaulding Rehabilitation Hospital, we offer a program specifically tailored for individuals recently diagnosed with PD. This class is open to both individuals with PD as well as their partners. The course will be offered again in January 2013. Dates and Times – Tue / Thu – 7:00-8:00 PM - October 2, 9, 23; November 6, 13, 20; December 4, 11, 18 Fee - $100.00 / 10 week series Location – 850 Boylston Street – Fishbowl Conference Room Registration – contact Jared Miller – 617-667-9890 Courtesy of the Osher Clinical Center for Complementary and Integrative Medical Therapies 7 Maintaining a healthy body begins with enjoying a healthy attitude. Optimist International is a service club organization with 2,900 clubs and almost 87,000 members in more than 35 nations throughout the world. The international headquarters is located in St. Louis, Missouri. In 1922, the Optimist Creed was adopted as the official creed of the organization. Consider reading this out loud every morning, before embarking on your daily routine. The Optimists Creed Promise Yourself To be so strong that nothing can disturb your peace of mind. To talk health, happiness, and prosperity to every person you meet. To make all your friends feel that there is something worthwhile in them. To look at the sunny side of everything and make your optimism come true. To think only of the best, to work only for the best and to expect only the best. To be just as enthusiastic about the success of others as you are about your own. To forget the mistakes of the past and press on to the greater achievements of the future. To wear a cheerful expression at all times and give a smile to every living creature you meet. To give so much time to improving yourself that you have no time to criticize others. To be too large for worry, too noble for anger, too strong for fear, and too happy to permit the presence of trouble. To think well of yourself and to proclaim this fact to the world, not in loud word, but in great deeds. To live in the faith that the whole world is on your side, so long as you are true to the best that is in you. Click here for a jpg version. Please join us in sharing your health tips and feedback. For comments on the content of this newsletter, please contact Donald Levy, MD at [email protected] To submit ideas for future newsletters, please contact Matthew H. Kowalski, DC at [email protected] Courtesy of the Osher Clinical Center for Complementary and Integrative Medical Therapies 8