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I CAN'T AFFORD THAT!��The Paradigm of �Functional Medicine Lab Testing

A MODEL FOR INTEGRATING

THE CONCEPTS OF FUNCTIONAL MEDICINE

IN UNDERSERVED POPULATIONS

WITHOUT FUNCTIONAL MEDICINE LAB TESTING

Rita Wadhwani, RN, MSN, ACNP, CNS, RNC-NIC

Holistic Nurse Practitioner

IM4US 12^th Annual Conference | Virtual, October 6–8, 2022 | www.im4us.org

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ABOUT ME

I have been a Registered Nurse since the year 2000.

I obtained a Bachelors of Science in Chemistry in 2003.

Nurse Practitioner & Clinical Nurse Specialist since 2005.

I graduated the UCLA School of Nursing,

and was privileged to be the only nurse at UCLA be a recipient of the:

"2005 Outstanding Graduate Student Award."

After over 20 years of experience in the traditional healthcare setting;

I found myself stepping outside of the traditional systems of health to learn about cutting edge, Functional Medicine.

I have obtained Post Masters Education & Training through

the Institute of Functional Medicine.

I am very passionate about investigating the root cause of dis-ease, and then fixing it using holistic principles of Functional Medicine.

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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OBJECTIVES

The learner will identify the pitfalls of functional medicine testing.
The learner will be able to name 2 low-cost Functional Medicine interventions for gut health.
The participant will be able to identify allopathic lab data that can be utilized in place of functional medicine testing
The participant will be able to create a personalized & holistic plan of care for patients, without expensive functional medicine testing

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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2020: US Spending reached $4.1 trillion

U.S. health care spending grew 9.7% from the year before
Health spending accounted for 19.7 % of the nation's Gross Domestic Product,
$12,530 per person

OUT OF POCKET COSTS �HOW MUCH ARE AMERICANS SPENDING

IS THIS YOU?

Data Obtained from: CMS.gov Date; 8.15.22

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

NHE grew 9.7% to $4.1 trillion in 2020, or $12,530 per person, and accounted for 19.7% of Gross Domestic Product (GDP).

Medicare spending grew 3.5% to $829.5 billion in 2020, or 20 percent of total NHE.

Medicaid spending grew 9.2% to $671.2 billion in 2020, or 16 percent of total NHE.

Private health insurance spending declined 1.2% to $1,151.4 billion in 2020, or 28 percent of total NHE.

Out of pocket spending declined 3.7% to $388.6 billion in 2020, or 9 percent of total NHE.

Federal government spending for health care grew 36.0% in 2020, significantly faster than the 5.9% growth in 2019. This faster growth was largely in response to the COVID-19 pandemic.

Hospital expenditures grew 6.4% to $1,270.1 billion in 2020, slightly faster than the 6.3% growth in 2019.

Physician and clinical services expenditures grew 5.4% to $809.5 billion in 2020, faster growth than the 4.2% in 2019.

Prescription drug spending increased 3.0% to $348.4 billion in 2020, slower than the 4.3% growth in 2019.

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U.S. HEALTH EXPENDITURE

�	Public Spending	Private Spending	Out-of-Pocket Spending
NEW ZEALAND	3,108	309	506
UNITED KINGDOM	3,107	207	629
AUSTRALIA	3,132	597	837
FRANCE	4,111	357	463
CANADA	3,466	759	749
NETHERLANDS	4,343	376	570
SWEDEN	4,569	71	807
GERMANY	5,056	192	738
NORWAY	5,289	21	877
SWITZERLAND	4,545	533	2,069
UNITED STATES	4,993	4,092	1,122

Roosa Tikkanen and Melinda K. Abrams, U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? (Commonwealth Fund, Jan. 2020)�

U.S.COMPARED TO OTHER COUNTRIES

The �American

Report Card

#1

#2

Saper,R. Global Adv Health Med. 2016;5(1):5-8), There Are 4 Categories Of Barriers To Integrative Services: Awareness-Availability-Accessibility-Affordability.

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

The U.S. spends more on health care as a share of the economy — nearly twice as much as the average OECD country — yet has the lowest life expectancy and highest suicide rates among the 11 nations.

The U.S. has the highest chronic disease burden and an obesity rate that is two times higher than the OECD average.

Americans had fewer physician visits than peers in most countries, which may be related to a low supply of physicians in the U.S.

Americans use some expensive technologies, such as MRIs, and specialized procedures, such as hip replacements, more often than our peers.

The U.S. outperforms its peers in terms of preventive measures — it has the one of the highest rates of breast cancer screening among women ages 50 to 69 and the second-highest rate (after the U.K.) of flu vaccinations among people age 65 and older.

Compared to peer nations, the U.S. has among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.

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U.S. HEALTH OUTCOMES�LIFE EXPECTANTCY

U.S. LIFE EXPECTANCY 2017

🡪 Americans = 78.6 years

-2 years lower than the international average

-5 years lower than Switzerland

US LIFE EXPECTANCY and race disparity

Non-Hispanic Black Americans = 75.3 years

-3 years lower than the American average

Non-Hispanic White Americans = 78.8 year�

The �American

Report Card

Roosa Tikkanen and Melinda K. Abrams, U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? Commonwealth Fund�

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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U.S. HEALTH OUTCOMES�COMPARED TO INTERNATIONAL HEALTH OUTCOMES

THE HIGHEST CHRONIC DISEASE BURDEN

LOWEST LIFE EXPECTANCY

HIGHEST SUICIDE RATE

HIGHEST RATE OF OBESITY

HIGHEST RATE OF MRI SCANS

US PERFORMS MORE HIP REPLACEMENTS AMONG OLDER ADULTS

Roosa Tikkanen and Melinda K. Abrams, U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? (Commonwealth Fund, Jan. 2020).

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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U.S. HEALTH OUTCOMES�MATERNAL MORTALITY

Maternal mortality rates in the United States, 2019 Hoyert, Donna L.

National Center for Health Statistics (U.S.). Division of Vital Statistics.

Maternal mortality rates in the United States, 2020

CDC

Leaders

in:

MATERNAL

MORTALITY

2020: 861 DIED OF MATERNAL CAUSES

2018: 658 DIED OF MATERNAL CAUSES

2019: 754 DIED OF MATERNAL CAUSES

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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WHAT IS FUNCTIONAL MEDICINE?

Functional medicine determines how and why illness occurs and restores health by addressing the root causes of disease for each individual.
The functional medicine model is an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness. It requires a detailed understanding of each patient’s genetic, biochemical, and lifestyle factors and leverages that data to direct personalized treatment plans that lead to improved patient outcomes.
By addressing root cause, rather than symptoms, practitioners become oriented to identifying the complexity of disease. They may find one condition has many different causes and, likewise, one cause may result in many different conditions. As a result, functional medicine treatment targets the specific manifestations of disease in each individual.

INSTITUTE OF FUNCTIONAL MEDICINE

N=1

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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FUNCTIONAL MEDICINE TESTING�CONCEPTS

Root cause approach to healthcare
Factors such as diet, genetics, lifestyle components, and hormonal
Biochemical individuality
Detailed and comprehensive overview of
Cellular body performance
Centered around optimal lab values (standardize normal lab values)
Uses an upstream approach

INSTITUTE OF FUNCTIONAL MEDICINE

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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CLASSES OF TESTING

Gastro - Intestinal
Adrenal & Stress Tests
Mold & Toxins�Internal & Environmental
Basic Laboratory Markers
Allergies and Sensitivities �Food & Environmental
Metabolic Function
Lyme and Tickborne Diseases

PANELS

ARE

OUTSIDE

THE REALM

OF

STANDARD

ALLOPATHIC

TESTING

N=1

Male and Female Hormones
Oxidative Stress
Infection
Genetics
Hepatic
Immune System
Pregnancy and Prenatal Care
Renal
Sleep Assessment
Thyroid
Tumor Markers
Metabolic Function

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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FUNCTIONAL MEDICINE TESTS�AVERAGE COST – NOT COVERED BY INSURANCE

TOP COMPANIES

Genova Diagnostics

Precision Analytical Diagnostic Solutions.

Doctor's Data

Spectracell

Great Plains Laboratory

Vibrant America

ZRT

GI Effects (Stool) $500- $600
DUTCH PLUS (Dried Urine) $500.00
Organic Acids Test $300 - $400
SIBO Breath Test $200-300
IgG Food Sensitivity Panel $200 - $900

Data Obtained from: RUPA HEALTH

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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SPECIFICITY/SENSITIVITY

SENSITIVITY

The proportion of true positives tests out of all patients with a condition

SPECIFICITY

The percentage of true negatives out of all subjects who do not have a disease or condition

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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Sensitivity: 80% Specificity: 26%

GI MAP�ONE REPORT - INDEPENDENT 2020 STUDY

Gingras BA, Maggiore JA. Performance of a new molecular assay for the detection of gastrointestinal pathogens. Access Microbiology. 2020 Aug 19;2(10)

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

Significant variability was found when the GI-MAP assay was used to test normal stool matrix with and without known bacteria and parasites at densities well within the expected limits of detection. The GI-MAP assay displayed a sensitivity of 80% and a specificity of only 26% due to many false positive results. This assay also reported quantitative numbers for pathogens. The BioFire FilmArray Gastrointestinal Panel achieved a sensitivity and specificity of 100%.

. Because of multiple organisms being detected by this assay in the 23 samples, an overall specificity of just 27% was realized. Of the seven samples with no organisms added, two were correctly reported as nothing detected (

It doesn’t have to be specific

Its not going to be negative because there are so many ranges

A test with low specificity can be thought of as being even when it is not present, and may give a high number of false positives. This could result in a test saying that a healthy person has a disease, even when it is not actually present.

What is the risk of a low specificity, well these tests are very expensive, and patients get really really excited for certain results and the thing is, the balancing of microbes is not an easy task, and it’s the patient who has to be highly motivated to do the work. So we just lead their way.

It may seem logical that both a false negative and false positive should be avoided. But its never that simple. For the underserved. Food sensitivity tests are less than perfect and when you have an inflamed gut. You will likely test positive for so much and I have received patient's from other providers who have had heavy testing and heavy

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Barriers to Integrative Medicine

Awareness
Availability
Accessibility
Affordability

EDUCATION

Saper,R. Global Adv Health Med. 2016;5(1):5-8), There Are 4 Categories Of Barriers To Integrative Services: Awareness-Availability-Accessibility-Affordability.

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

Poverty is a risk factor for premature mortality and increased morbidity. Across all races and ethnicities, greater life expectancy is associated with higher income.³ In the United States, non-Hispanic blacks are 50% more likely to die from cardiovascular disease than non-Hispanic whites.Health-related quality of life in blacks with chronic medical conditions is associated with greater and longer impairment in activities of daily living than whites.Morbidity and mortality from heart disease and diabetes is greatest in individuals with lower education.Health literacy—the ability to comprehend information needed to make informed appropriate decisions about one's health—is a strong predictor of health.Persons with low or limited health literacy utilize more treatment services than prevention services.

I am an NP, I have a cash business, per the Board of Registered Nursing, in ca we must have a collab agreement with an MD

I see pts independently with a functional eye, and started out on my own in the last year. However I have been an NP and CNS for over 15 years and a nurse for over 20.

Currently for this work, I am out of network.

I spend a large amount time educating and helping patient's just reprioritize themselves…..and getting to know their individual life and make adjustments to that. For example, I have a few night shifters I work with and I try and time their diurnal rhythm around their lives. Currently I use 100% FM and am not a prescriber of pharma but if needed, I am capable. Most of the time I detaper my patients from their allopathic regimen and I do something called a physician engagement letter, where I write a letter describing my holistic interventions with supporting literature. Its extra time on my cases but I believe its important because there is some quackery out there and it breaks my heart when folks think this is quackery

Personalization is a key tenet of functional medicine

HOW I STARTED AND I could not afford it, so I studied what I could I bought a few books started with AIP and went from there. I have taken 2 IFM modules and am hopeful to obtain certification one day, because that too is costly.

I was raised in a very low income neighborhood and my family of origin is a poor Indian family so spreading the word about this work in the low in come community is important to me

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RHNP Holistic Tools�PRACTICE MANAGEMENT - SERVING THE UNDERSERVED

LOSS OF TRUST IN HEALTHCARE

TRUST + GOALS (Awareness)

HEALTH INSURANCE

CASH PAY SYSTEM (Availability)

HIGH COST CLASSES

NO COST EDUCATION (Accessibility)

FUNCTIONAL MEDICINE TESTING

QUESTIONNAIRES + ANTHROPROMETRICS (Affordability)

MANAGING

EXPECTATIONS

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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The Provider

“I am here to guide your way.”

“The work is yours to do.”

“There must be 2-way communication”

The Patient

“I know I have some changes to make”

“They have to be reasonable & work around my life’s needs and low cost”

I LEAD - YOU FOLLOW

TRUST & ESTABLISH GOALS

RHNP Holistic Tools�PRACTICE MANAGEMENT - TRUST & GOALS - AWARENESS

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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SLIDING SCALE FEES

For patients below the federal poverty line

GROUP VISITS

For patients who are highly motivated lifestyle changes

BARTERING

For patients who have a skill

HEALTH INSURANCE

CASH PAY

WITH

STRICT

QUALIFICATION

GUIDELINES

RHNP

Business Plan:

For every 10

cash pay patients,

I will take 1 highly motivated

Low Income

Patient

PLEASE CHECK WITH YOUR STATES AUTHORITY ON

BARTERING POLICY FOR YOUR INDIVIDUAL LICENSE

RHNP Holistic Tools�PRACTICE MANAGEMENT - CASH PAY SYSTEM – AVAILABILITY/ACCESSIBILITY

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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�

FUNCTIONAL MEDICINE TESTING

QUESTIONNAIRES + ANTHROPROMETRICS

An inflamed gut will be intolerant of many and

most foods

MORE

TIME

CONSUMING

THAN �TESTING

QUESTIONNAIRES

7 Day Food Diary

Symptom Tracker

Medical Symptoms Questionnaire

and many more

RHNP Holistic Tools�PRACTICE MANAGEMENT - TOOLS FOR ASSESSMENT - AFFORDABILITY

ANTRHOPROMETRICS

Weight Scale

Calibration Weights

Stadiometer

Knee Caliper

Skinfold Calipers

Nonstretchable Tape Measure

Infantometer

Casadei K, Kiel J. Anthropometric Measurement.

Updated 2021 Oct 1. StatPearls. Treasure Island (FL); 2022 Jan

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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THE LOW HANGING FRUIT

Allopathic Labs
Gut Health

Microbiome Protection
Triggers

Circadian Rhythm

Routines and Patterns

COST

EFFICIENT

FOR

THE PATIENT

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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THE LOW HANGING FRUIT

Allopathic Labs

CBC
Chemistry
CRP, serial…..
ESR, serial…..

Ferritin……
Thyroid Antibodies
HgA1C
Thyroid Panel, +RT3
Fasting Insulin??

COST

EFFICIENT

FOR

THE PATIENT

OPTIONS FOR ALLOPATHIC LAB DATA THAT IS COVERED BY MOST INSURANCE PLANS

*IF YOU HAVE A PROVIDER WHO WILLING TO ORDER

B Sikkine, et al., Bovine Ferritin in Bioavailability. Eur J Clin Invest. 1997 Mar;27(3):228-33

Wang, et.al, Serum Ferritin: Past, Present and Future. Biochim Biophys Acta. 2010 Aug; 1800(8): 760–769

Nindy, S. et. al., Serum Iron:Ferritin Ratio Predicts Healthy Body Composition and Reduced Risk of Severe Fatty Liver in Young Adult Women Nutrients. 2017 Aug; 9(8): 833

T Ashraf et al., Chronic Anemia and Thyroid Function. Acta Biomed. 2017; 88(1): 119–127

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

CBC: WBC

Chemistry: Dehydration

CRP, serial…..

ESR, serial…..

Ferritin protein that store iron,……If a ferritin test reveals that your blood ferritin level is lower than normal, it indicates your body's iron stores are low and you have iron deficiency. With nl rbc h/h, and mcv (wnl) Eur J Clin Invest

. 1997 Mar;27(3):228-33.

Thyroid Antibodies

HgA1C

Thyroid Panel, adding an RT3

Fasting Insulin: Goiter, A1C of 5.2 and fasting glucose of 80 whose fasting insulin was 37, on the verge of type 2 diabetes. Without the fasting insulin wouldn’t have known, A1C being an average does not pick up the large highs with the large lows only the average which looks great, it’s not a sensitive test.

Nutrients. 2017 Aug; 9(8): 833. -- Fatty Liver

When an RT3 is trending up I think of inflammation, infection, low carb too low protein

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FUNCTIONAL MEDICINE TESTS�COVERED BY SOME INSURANCE COMPANIES

GI EFFECTS- COMPREHENSIVE STOOL

SIBO BREATH TEST

X-RAYS/ RADIOLOGY TESTS

SERUM TESTS

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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FOODS

Eat Whole & Fresh

Remove Processed & Sugar Foods

HgA1C

CRP

Creatinine

AST ALT

Fasting Insulin

Chemistry

Thyroid Ab

Brain Fog

Fatigue

Heart Rate

Pain

Blood Pressure

Sleep

THE LOW HANGING FRUIT

GUT HEALTH

Cena H, Calder PC. Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease. Nutrients. 2020 Jan 27;12(2):334.

Matana et al, Dietary Factors Associated with Plasma Thyroid Peroxidase and Thyroglobulin Antibodies Nutrients. 2017 Nov; 9(11): 1186.

Babiker, et al., Sudan Journal of Paediatr. The role of micronutrients in thyroid dysfunction 2020; 20(1): 13–19.

INFLAMMATION

BUY ORGANIC

Start with the Patients Diet

Start with BREAKFAST

If you can change this one meal

Then you can move the metrics

More color

More plant points

Start with Simple Changes:

�A bag of Chips →

A bag of Carrots

One Soda →

One Glass of Water

There can be some level of personalization here also

10,001 Dalmation region of S Croatia participants and divided them based on dietary habits.

Thyroid med ot thyrsoid surg pts were excluded

Out of 462 cases, five had other autoimmune diseases: four had psoriasis, and one had psoriatic arthritis. In the control group, one out of 1388 participants had systemic lupus erythematosus.

Plasma TPO-Ab and Tg-Ab

Squid Octopus Root Veggies Pure Plant Oils + Internal Organs

This study has shown that the dietary group with frequent consumption of animal fats and butter was associated with positive plasma TPO-Ab and/or Tg-Ab, while the dietary groups (factors 1 and 12) with frequent consumption of different sorts of vegetables, dried fruit, nuts, and muesli were associated with negative findings of TPO-Ab and/or Tg-Ab.

Iodine, a main constituent of thyroid hormones (T3 and T4), deficiency is one of the commonest causes of hypothyroidism in children and adults, worldwide. Other micronutrients, such as Cruciferous vegetables, Pearl Millet, Soy products and Cassava, were also attributed to cause thyroid dysfunction. (target this to be very disease specific)

There are also quite a few patients out there that actually have elevate AB and have been treated via traditional pathways that possibly could have undone dis-ease processes with food

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FLUIDS

Remove Fructose Fluids

Replete Hydration with Water

Reduced blood volume | Decreased CO

Increased blood viscosity�

Reduced venous blood return to the heart�

Impaired thermoregulation�

Reduced heat tolerance

Earlier onset of fatigue due to activity

Hypotension-Hypertension

THE LOW HANGING FRUIT

GUT HEALTH

Cena H, Calder PC. Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease. Nutrients. 2020 Jan 27;12(2):334.

Matana et al, Dietary Factors Associated with Plasma Thyroid Peroxidase and Thyroglobulin Antibodies Nutrients. 2017 Nov; 9(11): 1186.

Babiker, et al., Sudan Journal of Paediatr. The role of micronutrients in thyroid dysfunction 2020; 20(1): 13–19.

EDUCATION

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

BUY ORGANIC

Hydrated

Increased thirst

Dry mouth

Fatigue, sleepiness

Decreased urine output

Headache

Dry skin

Dizziness

Drink half of your body weight (in pounds), in ounces. For example, if you weigh 200 pounds, you should drink 100 ounces of water per day. Drink more if you perspire due to heat or exercise. Urine should be a light a yellow/straw color. If your urine is darker, you may be under-hydrated. If your urine is clear, you may be taking in too much fluid, or under-absorbing the water you drink.

Remember, caffeinated beverages don’t count in your daily fluid intake, since caffeine can be dehydrating. If you’re going to choose an additional caffeinated drink, we recommend green tea, which has less caffeine and lots of other benefits.

Try this tip to stimulate the thirst response: Take a shot glass (or small bathroom cup), fill it with the water, and “shoot” 3 shot glasses of water in a row when you wake up. Set an alarm to do this again at mid-day, and again around 5pm. Try to shoot the water instead of sipping. This helps awaken your thirst mechanism.

�For patietns with poor gut integrity they sometimes cannot handle water and you have to work your way up to this

1 liter of filtered water (see our preferred filter options below)

1/4 tsp iodized sodium chloride (table salt)

3/4 tsp sodium bicarbonate (baking soda)

1/4tsp potassium chloride (Morton’s Lite salt)

Adding lemon or berries can be heloful

Water safe containers (ACV bottles are great)

If you are drinking amounts of water according to the general rule above, and you experience dark or clear urine, frothy urine, visible blood in urine, frequent urination, or interrupted sleep due to the need to urinate, let your healthcare provider know.

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“THE FOOD YOU EAT CAN EITHER �BE THE SAFEST FORM OF MEDICINE �OR THE WORST FORM OF POISON.”

Ann Wigmore

Lithuanian–American holistic health practitioner, naturopath and raw food advocate.

The Ann Wigmore Natural Health Institute

Is a non-profit natural healing retreat center near Rincon, Puerto Rico.

Ann Wigmore, created the Living Foods Lifestyle™ program to encourage all people to learn the way to optimal health using chlorophyll-rich and cultured foods.

It was Wigmore who popularized the notion that a raw food diet was not merely health-giving, but disease-destroying. It was she who first launched wheatgrass into the realms of superfood and even curative medicine. Wigmore died in 1994, she altered the American concept of food as medicine.

But you may also look her way when the anti-vaccination movement engenders a measles outbreak, when practitioners promise simple nutritional remedies for illnesses like multiple sclerosis (MS) and HIV/AIDS, and when children with a 98% chance of remission if medically treated end up dying of cancer.

her grandmother was a respected village elder and healer, who devoted her home and her life to care for the sick and injured. Wigmore had been a sickly baby herself, and thus was raised on her grandmother’s remedies. When World War I broke out, Wigmore began to assist her grandmother, treating both wounded soldiers and civilian casualties. It was there, in war-torn Lithuania, that Wigmore first came to believe that grass was nothing short of a miraculous source of nourishment and medicinal power. Her grandmother had always used it in wound care (crushing it under a glass, then pressing it into an open gash before sewing it up). But during the war, it became an even more vital resource.

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Some patients have

NO GASTROINTESTINAL SYMPTOMS, but they have severe GASTROINTESTINAL DIS-EASE

Other Manifestations of Dysbiosis

Rash | Brain Fog | Fatigue

Heart Rate | Pain | Blood Pressure | Sleep

THE LOW HANGING FRUIT

GUT HEALTH

Cena H, Calder PC. Defining a Healthy Diet: Evidence for The Role of Contemporary in thyroid dysfunction 2020; 20(1): 13–19.

EDUCATION

MISINFORMATION��OLD INFORMATION

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

UNDERSTANDING SYMPTOMOLOGY

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THE LOW HANGING FRUIT�GUT HEALTH

Avoiding Caloric Restriction

Nutrient Dense Foods

Seasonal Eating

EDUCATION

MISINFORMATION��OLD INFORMATION

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

BUY ORGANIC

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ADD FAT

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are believed to be important for cardiovascular health. Many investigations have been carried out in an attempt to examine the effect of n-3 PUFAs intake, in the form of supplementation or fortified foods, for the management of cardiovascular disease (CVD) and risk factors for CVD.

THE LOW HANGING FRUIT

GUT HEALTH

Cena H, Calder PC. Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease. Nutrients. 2020 Jan 27;12(2):334.

Matana et al, Dietary Factors Associated with Plasma Thyroid Peroxidase and Thyroglobulin Antibodies Nutrients. 2017 Nov; 9(11): 1186.

Babiker, et al., Sudan Journal of Paediatr. The role of micronutrients in thyroid dysfunction 2020; 20(1): 13–19.

OMEGA3s

ALA�EPA

DHA

EDUCATION

MISINFORMATION��OLD INFORMATION

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

BUY ORGANIC

We were told that traditional fats like butter, lard, and coconut oil caused high cholesterol and clogged arteries, leading to heart disease. Experts advised us to avoid saturated fat and eat more polyunsaturated fatty acids (PUFAs), especially omega 6 fats.

Following this type of advice means swapping out butter, meat, and lard for vegetable oils including corn, soybean, sunflower, canola, and safflower oils, which are all omega 6-rich, inflammatory polyunsaturated fats.

wild foods are very rich in omega 3 fats. The main source of omega 3’s today is fish, yet wild game and wild plants, which are very high in omega 3s, used to be a much bigger part of our diet.

Wild meat and grass-fed beef contain about 7 times as much omega 3 fats as industrially raised animals, which have almost none. Virtually all of the beef and animal products your great grandparents ate were pasture-raised, organic, grass-fed, and contained no hormones or antibiotics.

refined oils into our diet and moving away from grass-fed and wild animals increased our omega 6 fat intake. Corn, soy, cottonseed, and canola oils skyrocketed, while omega 3 fats have dramatically declined. In that surge, many Americans sadly became deficient in these essential omega 3 fats.

Maternal nutrition guidelines have always stressed a diet including sufficient caloric and protein requirements, but recently fatty acids have also been deemed important (17). This is partially due to the fact that EPA and DHA supplementation during pregnancy has been associated with multiple benefits for the infant.

During pregnancy, the placenta transfers nutrients, including DHA, from the mother to the fetus (18). The amount of omega-3 fatty acid in the fetus is correlated with the amount ingested by the mother, so it is essential that the mother has adequate nutrition (19). The 2010 U.S. Department of Health and Human Services dietary guidelines recommend that women who are pregnant or breastfeeding should “consume 8 to 12 ounces of seafood per week from a variety of seafood types” (12). Ingesting 8–12 oz of seafood per week, depending on the type of fish, is equivalent to ∼300–900 mg EPA+DHA per day. Unfortunately, this amount is not being met by most mothers in the United States and Canada, which means that infants many not be receiving adequate amounts of these vital nutrients in the womb (20).

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THE LOW HANGING FRUIT�GUT HEALTH

PLENTY VERTICAL FARM IN COMPTON, CALIFORNIA

Credit for Photos: LA List 2022

Date 8.16.22

VERTICAL GARDEN

PLENTY

LETTUCE UNDER LED LIGHTING

COMPTON,

CALIFORNIA

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

Plenty is an indoor vertical farming company that uses less space and fewer resources to grow flavorful, healthy, fresh, and clean produce year-round.

The goal for Plenty's Compton outpost, once it's running at full capacity, will be to create enough produce to make regular deliveries to hundreds of grocery stores. In early August, the company reached an agreement with Albertsons to provide 430 of its California stores with assorted leafy greens. It wants to combat food apartheid by bringing healthy, locally-grown crops to communities that lack access to nutritious produce. Created jobs.

There is nothing wrong with a clinic having a small garden in the back and sending a patient home with a lemon with each visit. This is my goal

Given the way the planet has evolved with this pandemic, more and more are turning towards a farm to table lifestyle.

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THE LOW HANGING FRUIT�RON FINELY PROJECT

Credit for Photos: https://ronfinley.com/

Date 8.16.22

OUTDOOR GARDEN

RON FINELY

LOS ANGELES,

CALIFORNIA

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

In 2010 Ron set out to fix a problem in his South Central neighborhood parkways; those often neglected dirt patches next to our streets. He planted some vegetables there. Soon after he was cited for gardening without a permit by the apparent owners of those dirt patches: the City of Los Angeles. Queue the beginning of a horticulture revolution.

Ron fought back, and won. He started a petition with fellow green activists, and demanded the right to garden and grow food in his neighborhood. Having grown up in the South Central Los Angeles, Ron is familiar with the area’s lack of fresh produce.

food prison

He knew what it was like to drive 45 minutes just to get a fresh tomato. Boldly and tenderly, Ron’s vision to rejuvenate communities around the world through gardening, knowledge, and togetherness has taken root.

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THE LOW HANGING FRUIT�GUT HEALTH

Starting from seeds is cheaper, instead of buying seedlings/transplants
Reuse containers for seeding
Create a cheap grow light setup
Use old perforated buckets for growing
Use free grow bags
Build a strawberry crate tower
Use free or cheap raised bed materials

RHNP

BIOHACK:

Add Epsom Salts

to Soil

A

SHARED

NEED

with

SHARED

WORKLOAD

BUY ORGANIC

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

Ideal for community health centers

Fruit trees

Lemon trees

Kale and Lettuce

(Schools)

-6 seedlings $5.00

-Yogurt Containers, Egg Cartons, Styrefoam Meat Trays

Clamshell containers

Yoghurt containers work well, the one-serving size for starting seeds and the larger size for repotting seedlings to allow them to grow larger before they get transplanted outdoors

Styrofoam meat trays can be used as trays to put my pots and containers on to keep water from dripping on the ground

newspapers can be made into pots by rolling them up and crimping the bottoms and then placing them in a plastic container

egg cartons can be used with each egg compartment holding one seed but there is concern for salmonella with these

-Small fluorescent fixtures or simple bulb holders. Add some LED bulbs that will last almost forever. They don’t need to be special grow light bulbs.

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Buy a seed blend

Share seeds with community

Focus on buying seeds of veggies that can be picked easily

Go to a local seedy Saturday or seed swap

Save your own seeds by harvesting seeds from

your plants and keep them to reseed the following year

Get extra seedlings from gardeners that overseed

Make your own seed tape and sheets

THE LOW HANGING FRUIT�GUT HEALTH

Koay WI, Dillon D. Community Gardening: Stress, Well-Being, and Resilience Potentials. International Journal of Environmental Research Public Health. 2020 Sep 16;17(18):6740.

“BUILDS RESILIENCE”

“CREATES HEALTHY STRESS ADAPTATION”

BUY ORGANIC

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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THE LOW HANGING FRUIT�GUT HEALTH

“It could be found that the production of acetic acid, phenethyl acetate, and isoamyl acetate gradually increased in the apple vinegar fermentation broth with the fermentation time.”

“16S rDNA were sequenced and analyzed in this work.”

“The results showed that bacterial diversity was rich and exhibited a certain variation during the dynamic fermentation process of apple vinegar.”

Song J, Zhang JH, Kang SJ, Zhang HY, Yuan J, Zeng CZ, Zhang F, Huang YL. Analysis of microbial diversity in apple vinegar fermentation process through 16s rDNA sequencing. Food Science and Nutrition. 2019 Feb 27;7(4):1230-1238.

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

SUPPLEMENTS

PROBIOTICS

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THE LOW HANGING FRUIT�GUT HEALTH

“The present systematic review and meta-analysis suggested that ACV consumption yielded beneficial effects on serum Total Cholesterol & Post Prandial Glucose levels. “

�“Several studies indicate apple cider vinegar (ACV)’s usefulness in lowering post- prandial glycemic response, specifically by slowing of gastric motility, which would seem paradoxical with respect to its potential value for upper GI symptoms.”

�“Acetic acid (a major component of vinegar) was suggested as a key to slowing down of gastric emptying and decreasing of disaccharidase activity in the small intestinal, intestine maltase, lactase, and sucrose activities. Additionally, it promotes the uptake of glucose by muscle performance consequently, decreasing fasting blood glucose.”

�ACV was used in the gum formulation mentioned above, and while subjects found beneficial effects in relief of heart- burn and acid reflux, it is challenging to elucidate whether this effect was due to the ACV or the other ingredients.�

HADI ET AL. THE BENEFITS OF ACV ON LIPD PROFILES (SYSTEMATIC REVIEW) BMC COMPLEMENTARY MEDICINE AND THERAPIES (2021) 21:179

SCHULZ, ET. AL., EFFECTIVENESS OF NUTRITIONAL INGREDIENTS ON UPPER GASTROINTESTINAL CONDITIONS AND SYMPTOMS: A NARRATIVE REVIEW NUTRIENTS 2022, 14, 672

OUSAAID D, ET AL., BENEFICIAL EFFECTS OF APPLE VINEGAR ON HYPERGLYCEMIA AND HYPERLIPIDEMIA IN HYPERCALORIC-FED RATS. JOURNAL OF DIABETES RESEARCH. 2020 JUL 10, 2020: 9284987

BROWN, R., ET. AL., A NOVEL GUM, ON SUBJECTIVE RATINGS OF GASTRO ESOPHAGEAL REFLUX FOLLOWING A REFLUXOGENIC MEAL.

J. DIET. SUPPL. 2015, 12, 138–145

RHNP HOLISTIC TOOLS

Apple Cider Vinegar

Benefits For Dis-ease Management

ORGANIC

APPLE

CIDER

VINEGAR

16 OZ

$4.99

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

SUPPLEMENTS

PROBIOTICS

Ancient roots date back to 5,000 B.C. when the Babylonians used the fruit of a date palm to make vinegar. hey used it as a food source and as a preserving, or pickling, agent. Vinegar residues have been found in ancient Egyptian urns traced to 3,000 B.C. During biblical times, vinegar was used to flavor foods, as an energizing drink and as medicine.

SEVERAL STUDIES HAVE SHOWN THE UTILITY OF ACV on GUT HEALTH

Cardiovascular Health as an improvement in lipid profiles and also in diabetes

1) nine studies, including 10 study arms, were included in this meta-analysis. We found that ACV consumption significantly decreased serum total cholesterol (− 6.06 mg/dL; 95% CI: − 10.95, − 1.17; I²: 39%), fasting plasma glucose (− 7.97 mg/dL; 95% CI: − 13.74, − 2.21; I²: 75%), and HbA1C concentrations (− 0.50; 95% CI: − 0.90, − 0.09; I²: 91%). No significant effect of ACV consumption was found on serum LDL-C, HDL-C, fasting insulin concentrations

If a patient cannot tolerate ACV, this tells us much about the status of their gut lining and that some repairtive work is necessary

2) Review of 2282 studies….found beneficial effects in relief of heartburn and acid reflux, it is challenging to elucidate whether this effect was due to the ACV or the other ingredients

3) The main objective of this study is to determine the effects of apple vinegar on the metabolic changes caused by hypercaloric diet in Wistar rats. Apple vinegar was first analyzed to find out the total acidity, the polyphenolic and flavonoid contents, the total antioxidant capacity, and the free radical scavenging activity. In vivo study on adult male and female Wistar rats was conducted by administering a drink containing either 10% D-glucose or water (control) for five weeks. five weeks of treatment with D-glucose caused a significant increase in blood glucose level () ( mmol/L and 1 mmol/L in male and female rats, respectively) in comparison to control ( mmol/L and mmol/L in males and females, respectively) and rats treated by D-glucose combined with apple vinegar ( mmol/L and mmol/L for male and female rats, respectively). Similar findings for lipid profiles (although there is some mixed data on ldl)

4) Hospitalized patients. They were given something called gutsy gum. For gerd. Calcium carb, Acv, licorice extract (which I use) Papaine

Gerd sx resoved this was measured by a Mean acid reflux score was significantly lower in GutsyGum^tm than in placebo treatment (0.72 ± 0.19 vs. 1.46 ± 0.19 cm; p = 0.013). There were no significant differences for any of the secondary outcomes. However, pain approached significance with less pain reported in GutsyGum^tm versus placebo treatment (0.4 ± 0.2 vs. 0.9 ± 0.2 cm; p = 0.081).

Teach children (IDM) start with a shot diluted in

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SUPPLEMENTS

MAGNESIUM

Magnesium Glycinate Supplementation

Add Epsom Salts in Soil of Food

Epsom Salt Baths

Curate Magnesium Rich - Food Lists

Food Sources Rich in Magnesium

Green Leafy Vegetables| Wholegrains | Nuts | Seeds | Legumes

EPSOM SALT

4 LB BAG

$3.29

TARGET

Volpe SL. Magnesium in disease prevention and overall health. Advances in Nutrition. 2013 May 1;4(3):378S-83S.

DiNicolantonio JJ, O'Keefe JH, Wilson W. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open Heart. 2018 Jan 13;5(1)

Gröber U, Werner T, Vormann J, Kisters K. Myth or Reality-Transdermal Magnesium? Nutrients. 2017 Jul 28;9(8):813

THE LOW HANGING FRUIT�GUT HEALTH

Dis-eases associated with

Magnesium Deficiency:

Hypertension

Heart Disease

Diabetes Mellitus

Osteoporosis

ALL

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

Magnesium Deficincy

Magnesium has been recognized as a cofactor for more than 300 enzymatic reactions, where it is crucial for adenosine triphosphate (ATP) metabolism. Magnesium is required for DNA and RNA synthesis, reproduction, and protein synthesis. Moreover, magnesium is essential for the regulation of muscular contraction, blood pressure, insulin metabolism, cardiac excitability, vasomotor tone, nerve transmission and neuromuscular conduction. Imbalances in magnesium status—primarily hypomagnesaemia as it is seen more often than hypermagnesemia—might result in unwanted neuromuscular, cardiac or nervous disorders.

TRANSDERMAL MAGNESUM

Magnesium might be able to get into the lymphatic system beneath the dermis and enter the circulatory system, bypassing the regulation through the GI tract and hereby increasing serum magnesium

where 19 subjects underwent a full body bath (temperatures 50–55 °C) for 7 days in a solution of magnesium sulphate (Epsom salt) for 12 min. Blood samples were taken before the first bath, at 2 h after the first bath and at 2 h after the seventh consecutive bath. Baths were taken daily at the same time for 7 days for the experiment. Urine samples were collected before the first bath and then 2 h after the first bath and at all subsequent baths. Urine samples were also taken 24 h after the last bath. All urine samples were corrected for creatinine content. Of the 19 subjects, all except three showed a rise in magnesium concentrations in plasma, though this was small in some cases.

The most plentiful source of biologically available magnesium, however, is the hydrosphere (i.e., oceans and rivers). The Dead Sea, the deepest and most saline lake on earth, has been known from biblical times for its healing properties and the effectiveness of bathing in the Dead Sea is well known

In the sea, the concentration of magnesium is about 55 mmol/L and in the Dead Sea as an extreme example, the concentration of magnesium is reported to be 198 mmol/L and has steadily increased over time. In comparison, the typical human serum magnesium concentration is only ~0.8 mmol/L.

Thus, there is a substantial gradient into the human body.Near-drowning in the Dead Sea is expected to result in severe electrolyte abnormalities and respiratory failure. This suggests that magnesium does not pertain to the topic of dermal absorption

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Original Publication:

O’Hare J.P., Heywood A., Summerhayes C., Lunn G., Evans J.M., Walters G., Corrall R.J., Dieppe P.A. Observations on the effect of immersion in Bath spa water. Br. Med. J. (Clin. Res. Ed.) 1985;291:1747–1751.

�Later Publication:

Gröber U, Werner T, Vormann J, Kisters K. Myth or Reality-Transdermal Magnesium? Nutrients. 2017 Jul 28;9(8):813

EPSOM SALT

4 LB BAG

$3.29

TARGET

THE LOW HANGING FRUIT�18^th CENTURY BATH CARD

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

Magnesium Deficiency

Magnesium has been recognized as a cofactor for more than 300 enzymatic reactions, where it is crucial for adenosine triphosphate (ATP) metabolism. Magnesium is required for DNA and RNA synthesis, reproduction, and protein synthesis. Moreover, magnesium is essential for the regulation of muscular contraction, blood pressure, insulin metabolism, cardiac excitability, vasomotor tone, nerve transmission and neuromuscular conduction. Imbalances in magnesium status—primarily hypomagnesaemia as it is seen more often than hypermagnesemia—might result in unwanted neuromuscular, cardiac or nervous disorders.

TRANSDERMAL MAGNESUM

Magnesium might be able to get into the lymphatic system beneath the dermis and enter the circulatory system, bypassing the regulation through the GI tract and hereby increasing serum magnesium

where 19 subjects underwent a full body bath (temperatures 50–55 °C) for 7 days in a solution of magnesium sulphate (Epsom salt) for 12 min. Blood samples were taken before the first bath, at 2 h after the first bath and at 2 h after the seventh consecutive bath. Baths were taken daily at the same time for 7 days for the experiment. Urine samples were collected before the first bath and then 2 h after the first bath and at all subsequent baths. Urine samples were also taken 24 h after the last bath. All urine samples were corrected for creatinine content. Of the 19 subjects, all except three showed a rise in magnesium concentrations in plasma, though this was small in some cases.

The most plentiful source of biologically available magnesium, however, is the hydrosphere (i.e., oceans and rivers). The Dead Sea, the deepest and most saline lake on earth, has been known from biblical times for its healing properties and the effectiveness of bathing in the Dead Sea is well known

In the sea, the concentration of magnesium is about 55 mmol/L and in the Dead Sea as an extreme example, the concentration of magnesium is reported to be 198 mmol/L and has steadily increased over time. In comparison, the typical human serum magnesium concentration is only ~0.8 mmol/L.

Thus, there is a substantial gradient into the human body.Near-drowning in the Dead Sea is expected to result in severe electrolyte abnormalities and respiratory failure. This suggests that magnesium does not pertain to the topic of dermal absorption

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THE LOW HANGING FRUIT�GUT HEALTH

Vitamin D Foods

Support Daily Sunlight

Vitamin D3 w/ K2 Supplementation

Sources of Vitamin D

Fatty Fish | Egg Yolk | Sardines | Cod Liver

RHNP HOLISTIC TOOLS

Support Vitamin D

Dis-eases associated with

Vitamin D Deficiency:

All !!!!!!

Wang H, Chen W, Li D, Yin X, Zhang X, Olsen N, Zheng SG. Vitamin D and Chronic Diseases.

Aging Dis. 2017 May 2;8(3):346-353.

Umar M, Sastry KS, Chouchane AI. Role of Vitamin D Beyond the Skeletal Function: A Review of the Molecular and Clinical Studies. Int J Mol Sci. 2018 May 30;19(6):1618. doi: 10.3390/ijms19061618. PMID: 29849001; PMCID: PMC6032242.

Alfredsson L, Armstrong BK, Butterfield DA, Chowdhury R, de Gruijl FR, Feelisch M, Garland CF, Hart PH, Hoel DG, Jacobsen R, Lindqvist PG, Llewellyn DJ, Tiemeier H, Weller RB, Young AR. Insufficient Sun Exposure Has Become a Real Public Health Problem. Int J Environ Res Public Health. 2020 Jul 13;17(14):5014.

SUPPLEMENTS

VITAMIN D

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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THE LOW HANGING FRUIT�MICROBIOME HEALTH

NON-GMO

PERSONAL

HYGEINE

Purchase a Tongue Scraper $2.99

Change to a Toothpaste Brand without: ❌ Flouride

Flouride is associate with:

Brain Fog

Fatigue

Hypertension

Clean Brands

Risewell
Karex
Boka

$5.00 - $20.00 / tube & up

Amazon Tongue Scraper

2.99

Trader Joes Toothpaste

$2.99 / Tube

RHNP HOLISTIC TOOLS

�Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019 Mar 4;3(3):CD007868.

Umar M, Sastry KS, Chouchane AI. Role of Vitamin D Beyond the Skeletal Function: A Review of the Molecular and Clinical Studies. Int J Mol Sci. 2018 May 30;19(6):1618.

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

Studies

As early as 2006, flouride was being looked at as a #neurotoxin

�

flouridation of water has been linked to major adverse health outcomes

�

Since 2016, the #epa Environmental Protective Agency has been in a legal battle with Health Advocacy Groups over water fluoridation

�

The healthadvocate groups want a judge to rule that fluoride in drinking water poses an unreasonable risk

�

The EPA is fighting this…because it would change everything in their regulation of fluoridated water. And would open up a discussion about fluoride in our oral care products 😏

�

This ruling is due in June 2022

�

Fluoride is not the only ingredient in our #toothpaste that is harmful to our health #childrenshealth

�

Others harmful ingredients are:

❌Sodium Laural Sulfate

❌Titanium Dioxide

❌#Tricosan

❌Glycerine

�

Getting these #ingredients out of your mouth is critical to your overall health

�

❗️My family’s oral care routine includes:

�

#TongueScraper: stainless steel (copper can be useful in some cases) $2-3

��

#Oilpulling: you don’t need to buy a fancy oil on the market. Make your own. #Purecoconutoil or #oliveoil can be used. All you need is 2 tablespoons worth

�

👉this disgusted my kids at first, but they got over it👍

�

Toothpaste: #bakingsoda preparations are great, because they provide #alkalinity by balancing your oral pH

�

👉this change was no biggie to make, kids didn’t care or notice

�

My 3️⃣ favorite toothpaste brands of holistic toothpaste:

��

#nursemom #nursemomlife #functionalmedicine #functionalmedicinenp #microbiome #oralmicrobiome #oralhealth #holisticnurse #holisticnursepractitioner #oralhygiene #oralcare #microbiomehealth #environmentalprotection #environment #toxins #beholistic #holostichealth #autoimmunemom #holisticmom #detoxyourmouth #autoimmunedisease #juvenilediabetes #diabetes

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THE LOW COST - LOW HANGING FRUIT

Source

ZRT LABS

TEST CORTISOL AWAKENING RESPONSE

SYMPTOMOLOGY

Peirson SN, Brown LA, Pothecary CA, Benson LA, Fisk AS. Light and the laboratory mouse. J Neurosci Methods. 2018 Apr 15;300:26-36.

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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CIRCADIAN-DIURNAL RHYTHM TESTING

OPTIMIZING NATURAL LIGHT

THE LOW HANGING FRUIT�BRAIN HEALTH

Our circadian rhythm is controlled by light

being absorbed by photoreceptors in the eye

resulting in a decrease in melatonin production

Natural light therapy for 30 min. (in the morning) can help suppress melatonin production in the pineal gland, thereby relieving many of the symptoms associated with Seasonal Affective Disorder

FREE

Lewy A, et al The phase shift hypothesis for the circadian component of winter depression. Dialogues in Clinical Neuroscience 9: 3, 2007

Holick et alBiological Effects of Sunlight, Ultraviolet Radiation, Visible Light, Infrared Radiation and Vitamin D for Health Anticancer Research March 2016, 36 (3) 1345-1356

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

early fruit fly studies 1984

A 6-week study of 18 patients with chronic kidney disease aged 26-66 years who were exposed to either UVB or UVA radiation reported that those exposed to UVA radiation had no change in their blood pressure, whereas those exposed to UVB radiation had a statistically significant decrease in both their systolic and diastolic blood pressure

�Shift workers this is important work (I teach this to nurses as much as possible)

Optimizing the Brain

Can decrease Cortisol and Balance Melatonin

Example of day or night shift workers in

The earliest connection linking insufficient daylight/sunlight to a recognised clinical pathology (the bone disease known as rickets) was made in 1861–1862.

This same beta endorphin is noted in runners

Sunlight deprivation has been implicated in worsened cardiovascular disease and autoimmune diseases (with and without appropriate vitamin d levels) some mechanisms are not udnesrtood

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THE LOW COST - LOW HANGING FRUIT

5-6:00 am

Optimize Light Exposure

Bright Natural Light

(12 Hours Later)

5-6:00 pm

Dim Lights

Blue Blockers

Start Reducing Artificial Light

11:00 pm to 4:00 am

No Light of Any Color

5-6:00 pm

Optimize Light Exposure

Bright Natural Light

(12 Hours Later)

5-6:00 am

Dim Lights

Blue Blockers

Start Reducing Artificial Light

11:00 am to 4:00 pm

No Light of Any Color

DAY SHIFT

NIGHT SHIFT

7am to 7pm

Schedule

Dopamine-Mediated Circadian and Light/Dark-Adaptive Modulation of Chemical and Electrical Synapses in the Outer Retina

Front. Cell. Neurosci., 05 May 2021�Sec. Cellular Neurophysiology

As we age, our internal clock becomes more sensitive

FREE

CIRCADIAN-DIURNAL RHYTHM TESTING

OPTIMIZING NATURAL LIGHT

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

Well published light and the brain

There is a lot known about the effects of serotonin but more is being learned on the postiive effects of light on the brain and specificailly dopamine

But now

Optimize Light Exposure: studies are showing that correcting the arcadian rhythm and adding gut heath can impact mental health outcomes

Distinct extrinsic and intrinsic modulatory processes in this synaptic layer are mediated by long-range feedback of the neuromodulator dopamine. Dopamine is released by dopaminergic cells, interneurons whose cell bodies are located in the second synaptic layer of the retina. Distinct actions of dopamine modulate chemical and electrical synapses in day and night. The retinal circadian clock increases dopamine release in the day compared to night, activating high-affinity dopamine D4 receptors on cones. This clock effect controls electrical synapses between rods and cones so that rod-cone electrical coupling is minimal in the day and robust at night

Within first 30 minutes of waking

The early morning transition from dim to bright light suppressed melatonin secretion, induced an immediate, greater than 50% elevation of cortisol levels, and limited the deterioration of alertness normally associated with overnight sleep deprivation.

Light inhibits melatonin through a well established pathway in the pineal Gland

Social Jet Lag

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THE LOW COST - LOW HANGING FRUIT

HIGH-COST EMF DISRUPTORS

DEVICE DETOX

Non-Ionizing:

Microwave ovens

Computers

House energy smart meters

Wireless (wifi) networks

Cell Phones

Bluetooth devices

Power lines

MRIs

Ionizing:

Sunlight

X-Rays

Some Gamma Rays

Kıvrak EG, Yurt KK, Kaplan AA, Alkan I, Altun G. Effects of electromagnetic fields exposure on the antioxidant defense system. J Microsc Ultrastruct. 2017 Oct-Dec;5(4):167-176.

Exposure to EMFs can damage biological tissues by inducing changes, which can be explained in terms of thermal or non-thermal mechanisms.

Thermal effects can occur with the conversion and absorption of heat by the body's electromagnetic energy.

Rita Wadhwani, Holistic Nurse Practitioner

RHNP.net

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RITARHNP@GMAIL.COM

@Rita_holisticnp

RHNP.net

FOR ADDITIONAL REFERENCES

PLEASE CONTACT ME DIRECTLY

THANK YOU SO MUCH FOR HAVING ME.

IM4US 12^th Annual Conference | Virtual, October 6–8, 2022 | www.im4us.org

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Thank you!

@www.im4us.org

IM4US-Integrative Medicine for the Underserved

@IM4USorg

@im4usorg