What's New in Consumer Natural Health Products?

 By Dr. Iva Lloyd, ND

Every year the Canadian Health Food Association (CHFA) holds a large conference and tradeshow providing manufacturers and distributors the opportunity to highlight their products.  It is one of the main venues for health care practitioners and owners of grocery stores and health food stores to stay up-to-date on new product offerings and changes in the industry.  

Here is an update on the new products that you may find in your local health food store or grocery store.  Most of the new offerings are focused on improving health and decrease the environmental impact, a few changes are concerning.

Decrease in Packaging of Personal Care Products and Cleaning Products

Over the next little while you will find more personal care products with a focus on decreasing the amount the packaging that is used and a move to recyclable packaging.  With this in mind, many manufacturers are finding new and improved ways to offer their products. For example, I encourage you to try:

• shampoo that comes a bar (similar to a bar of soap)
• laundry sheets versus laundry soap
• paper towels that are machine washable
• makeup pads that are machine washable
• beeswax sheets for wrapping up food versus plastic-based wraps

New Milk Offerings

There are a number of new milks (or mylks) that will soon be available on the market.  Look for milks such as flax seed milk, wider range of nut-based milks and pea-based milks to join the non-dairy offers such as almond, soya, oat, rice, coconut and others. This will be helpful for those that need to avoid dairy. When choosing non-dairy milk options please keep in mind:

• It is important to have at least three milks that you alternate.  Food intolerances are influenced by genetics and how often you consume a product.  Many people are becoming intolerance to foods such as oats and almonds as they are consuming them too often.
• When choosing non-dairy milks, choose those that have as few ingredients as possible as many people react to the fillers and emulsifiers that are used.

Dairy-free Cheese Offerings

If you are looking for dairy-free cheeses the main offering has been cashew-based soft cheeses and sauces - many which taste great.  There are a number of new plant-based offerings that will be coming to market.  Stay tuned.

New Wheat/Gluten-Free Offerings

The world of wheat-free and gluten-free products has come a long way over the last 10 years. There are a number of not only healthy, but great-tasting wheat/gluten-free options especially as it relates to pasta-based products and crackers.  There are also more wheat/gluten-free bread and wrap options available. When choosing wheat/gluten-free offerings please keep in mind:

• Choose products with whole grains (millet, buckwheat, quinoa, rice, teff, etc) and avoid a lot of starches (corn-starch, potato-starch, etc.)
• There are a lot of non-wheat/grain wraps made from coconut and/or vegetables. Great options for those avoiding wheat/gluten.
• I encourage you to try legume-based pastas, such as green-lentil pasta, as they have a much higher protein level that wheat-based products. 

Less Sugar in Processed Foods, especially Protein Bars

It was great to see that many of the manufacturers are focused on decreasing not only the amount of sugar, but the types of sugar in their products. Expect to see less artificial sweeteners and more products made with honey, stevia, monk fruit sugar and other healthy sugar alternatives.  Although I am not a big fan of protein bars, they are getting healthier.  Here are some things to keep in mind:

• If you want to learn more about sugar: http://www.ndhealthfacts.org/wiki/Sugar 
• The aim is to decrease sugar in the diet as much as possible. Some sugars, such as fruit-based sugars and honey, do have health benefits, but it is still important to limit the amount that you consume. A general rule of thumb is to have one serving of fruit for every four servings of vegetables. 
• When choosing protein bars remember that the grams of protein and the fat should be higher than the amount of sugar and the amount of sugar is best to be less than 10 grams. 
• Expect to see more protein or health-based bars for kids, especially for breakfast.  This can be beneficial as long as the focus is whole foods and the protein and fat is adequate. 

Plant-based Meats

For many reasons, both health and environment, there is a focus on plant-based meats. Expect to find legume and grain-based options to take the place of chicken, steak, ribs and other meats including cold-cuts.  I encourage you to take the opportunity to try out these options and decide for yourself.

"Health Shots"

Expect to see a number of small-serving drinks being offered at your local health-food store or grocery store. They now have health-shots that promote everything from immune-boosting, energy or focus-enhancing, workout recovery, detoxing, weight-loss, digestive aids, sleep and relaxing, etc.  There are a number of things to keep in mind if you choose to use "health" shots:

• They are often marketed as a food, yet it is best to consider them as a supplement and as such to recognize that they may contain ingredients that may not be ideal for your health.  For example, it is not always safe for people to detox. 
• Blog: The Do's and Don'ts of Detoxification
• Health shots generally promise a "quick fix" which is not always the best way to approach your health.  The naturopathic approach emphasizes the importance of identifying and treating the root cause of your symptoms or concerns.
• I encourage you to let you naturopathic doctor or health professional know what "health shots" you are consuming to ensure that they are beneficial for you.  I am not against "health shots", I am just concerned that they are marketed as foods and hence consumers need to be careful with how they use them.

Carbonated Drinks

The biggest concern that the CHFA this year was the tremendous increase in carbonated drinks.  Quite concerning actually.  I encourage you to check out my "Notes from the Field - May 2022" for a better understanding as to why this may not be a good thing for health. I personally hope the focus on carbonated drinks is a very short-lived fad. If you choose to enjoy carbonated drinks, I encourage you to do the following:

• Limit them to meal time and only when have a larger meal.
• Don't consumer carbonated drinks in place of water.  The body needs still water in order to perform the numerous functions that it needs to do in the body.
• If you have been consuming a high amount (more than twice a day) of carbonated drinks for awhile than I encourage you to have blood work done to see if there are any changes in key metabolic markers.

A lot of new offerings.  I do encourage you to stay informed.  If you have any questions as to the health benefits of any of these offerings for you or your family, ask you naturopathic doctor.

Notes from the Field - May 2022

 by Dr. Iva Lloyd, ND

Although there is tremendous variability in people and how their body "talks to them", there are times in practice when specific symptoms or conditions seem to be more prevalent.  Part of this is a reflection of the season or the focus of media, but sometimes it is a reflection of a change in the environment or other external factors that are at play.

Here is a snapshot of a few of the common symptoms and health issues over the last few months:

Vertigo and Dizziness

More patients have complained of vertigo and dizziness in the last few months than in the last twenty-years of practice. That to me is both interesting and concerning.  When someone presents with vertigo or dizziness the general factors to consider are:

• dehydration
• low blood pressure or high blood pressure
• low blood sugar or high blood sugar
• coldness in the abdomen
• head trauma, injury or structural misalignment
• recent infection
• extreme stress

When a number of people end up with vertigo and dizziness at the same time we would also consider other factors such as:

• increase in wifi and wireless technology (check out our blog)
• post-COVID syndrome

Generally vertigo lasts for a couple of days. If it comes on suddenly, is extreme or is lasting longer than a few days, it would be beneficial to have a naturopathic doctor or medical doctor do a more thorough assessment.

Carbonated Water

There has been an increase focus in carbonated water and drinks. Soda-stream, non-alcoholic beer, and other carbonated drinks are a new fad. Drinking carbonated water can have some benefit when consumed with a meal, especially a larger or heavy meal, but, drinking carbonated water frequently and throughout the day is not a good idea. Here are some pros and cons of carbonated water:

Pros

• increased sense of feeling full
• may decrease overall appetite
• because carbonated drinks are acidic they don't decrease the acidity of the stomach acid as much as plain water and may be more beneficial when consumed during a meal, especially for those individuals with low stomach acid 

Cons

• carbonated drinks are acidic and when consumed frequently can disrupt the acid-alkaline balance of the body
• there is a concern that carbonated drinks, especially those that have added flavoring, may cause dental erosion
• frequent consumption of carbonated water can actually add to dehydration 
• carbonated drinks are high in phosphates which are known to decrease overall bone density as they leach calcium from the bones - especially when consumed often by children and younger adults
• the increased consumption may contribute to other changes in blood markers - such as high ferritin levels.

Bottom line - carbonated water is fine if consumed infrequently and with a meal. Carbonated water is NOT a replacement for water.  

Vitamin D

We have gone from a point-in-time when the focus and concern was that most people were deficient in Vitamin D, to one where the concern is that people have taken so much vitamin D- sometimes 5,000 to 10,000 iu for an extended period of time - that they now have high levels or toxic levels of vitamin D.  Here is a quick look at the benefits and cautions of Vitamin D.

Benefits of Vitamin D

Some of the symptoms and conditions associated with Vitamin D deficiency include:

• Rickets
• Osteomalacia
• GERD
• Hypertension
• Rheumatoid Arthritis
• Multiple Sclerosis (MS)
• Cancer

Concerns with Excess Vitamin D

Excess intake over an extended period of time can contribute to:

• headaches
• kidney stones
• atherosclerosis
• diarrhea
• increased thirst and urination
• irritability
• and others.

Yes, Vitamin D is important, but if you have been taking high doses of Vitamin D for more than three months, I encourage you to have your Vitamin D level checked by your naturopathic doctor or medical doctor.

• Check out the blog on Vitamin D

Nutrient Deficiencies Due To Special Diets

At no point in time has there been such a concern with nutrient deficiencies due to special diets. Too often, there is a lack of understanding that all food groups are essential. The body needs good fats, adequate protein, lots of vegetables, fruit and grains.  A number of health issues arise when diets are deficient in grains, or when vegetables are lacking in the diet or when there isn't adequate fat or protein. Here are some resources that help explain why a balanced diet is essential:

• Nutrition - Top 5 Things to Remember
• But What Can I Eat
• Reading Labels - A Necessity for Health
• Is Your Diet Causing Your Annoying Symptoms
• Fasting - Is It Right For You
• Tweaking The Rules
• Bloating - Why Is It So Rampant

The impact of the pandemic on health will be covered in next month's blog.  Stay tuned.

Are You Focusing on What You Want to Achieve?

 by Dr. Iva Lloyd, ND

It is always a good idea to check in every now and then to determine if your focus and actions are aligned with goals and desires. Many people desire to be healthy, for example, but they actually spend very little time on activities that support health.  

One thing is true, everyone has the same amount of time - 24-hours in a day, 7-days in a week. Being able to see the connection between what you do and where you are in life is a worthwhile exercise and can help you live more consciously.

Step 1: List of Roles and Activities

The first thing to do is make a list of all the things that you do and the roles that you have in life. Most people are surprised at the number of activities and roles that they do on a daily or weekly basis.  Some examples are:

Roles:

• mother or father
• sister or brother
• aunt, uncle or cousin
• friend
• student or co-worker
• volunteer
• community work
• etc. etc.

Activities:

• self-care
• exercising
• food preparation and eating
• working
• sleeping
• mindfulness and meditation
• social media
• web searching or watching television / movies
• spending time in nature
• healthcare
• reading
• hobby or project
• spending or saving money
• etc. etc.

Step 2: Current Satisfaction Level

The 2nd step is to take some time and assess how satisfied you are with your life. How much joy and happiness do you experience.  Are you healthy and fit?  How are you handling the ups and downs of life?  What are your goals and your plans?  Do you have health concerns that you need to address?  Where are you financially?  How is the external stress of life affecting you?  Are there external factors that may impact your life and are you ready for them?

Spending time to reflect is an important aspect of life.  As we all know, there are aspects of life that are not within our control and it is important to reflect on how they have impacted us and in what ways have they affected our life and our choices. If your aim is to live life more consciously, than it is important to spend time reflecting on what you do and whether it matches with who you want to be.  Living consciously also helps to adjust and accommodate the stressors of life that cross our path.

Step 3: Mapping of Activities and Goals

Once you have an idea of what aspects of your life are working for you and which aren't, the third step is to look at how much time you are spending in each aspect and to determine what needs to change.  The aim is to decide what activities you need to increase and which ones you need to decrease. For some activities, it may be about changing how you are doing them. For example, you might find that you still want to make exercise an important aspect of your life, but you are going to spend more time exercising outside and focusing on cardiovascular versus doing weight training in a gym.  

We change and our life changes when we make conscious choices to do something differently.  It can help to:

• Keep in mind that you only have 24 hours in a day; 7 days in a week.
• Recognize that if you are overwhelmed then you likely have too many things on your plate and it would be helpful to look at those activities you can decrease or remove.
• Whatever you focus on increases in intensity and importance. Living consciously is about being more aware of your choices and choosing more intentionally.

Step 4: Make Strategic Changes

Once you have decided what needs to change, start making the changes one at a time.  Generally, it is not about changing everything at once.  It is about starting slowly and moving forward in the direction you want. It is always helpful to check in on a weekly or monthly basis with your plans to ensure that you stay on track. If you struggle with staying true to your goals, it may help to work with someone else - a naturopathic doctor, nutritionist, personal trainer, etc. - to support the specific changes that you desire.

Other blogs that you may find helpful:

• The SMART way to achieve your health goals.
• What is your word for 2021?
• It is not about work-life balance; it is about prioritization and coherence

Finding Your Anchor

by Dr. Iva Lloyd, ND

In times of chaos and change is it always helpful to have an anchor, something that keeps you steady during the storm. Anchors allow us to move forward through times of change by helping us stay grounded and limiting the chance that decisions that we make are based on fear.

The following are some tips on finding an anchor that works for you and supports your health during times of chaotic change.

Analogies

The mind likes analogies as they assist in making sense of chaotic times. They provide a perspective that helps us understand the complexity of new situations that threaten our sense of safety. They assist in providing a sense of order or process during difficult situations. At times, they can also provide a sense of meaning to things that we don't yet understand. For me, the analogies where there is extreme destruction and chaos which result in a "new normal" such as a hurricane, a forest fire, a home renovation or even war, may help explain this current pandemic.

We want to keep in mind that infections that threaten health are not a new thing. Learning from the past can help navigate the current situation. For example, an article in the European Journal of Cultural Studies has compared the current pandemic to the AIDS crisis 30 years ago in a paper titled, "Pandemic and its metaphors: Sontag revisited in the COVID-19 era.  This article highlights the overwhelming sense of fear that was originally associated with AIDS that has now significantly subsided even though AIDs has not gone away.

Change is Inevitable

Many people handle acute crises quite well. Acute crises, such as accidents, injuries, losing one's job, death of a loved one, the diagnosis of a serious condition and other life events, are seldom welcomed but there is the awareness that "things happen" and you get through them. There is generally a structured process that walks someone through the change. For example, there is a process that you follow once a loved one has passed or if there is a flood in your home - we know what needs to happen and in what order. The sense of structure and process helps us get through significant life events.

Yet, for everyone there is a cap or ceiling on the degree of change that they are comfortable with and that they are able to integrate into their lives and still maintain a sense of being okay. The pandemic is a new type of change for many of us as we are being asked to change because of an invisible external threat. Not to say that there isn't a virus, but the change that has happened as a result has affected people in many different ways.  

For some, this pandemic has resulted in the loss of loved ones. For others, it has resulted in concern for their children or their aging relatives or neighbors, the inability to spend time with family and friends and/or the realization of the tremendous mental strain the pandemic has had on people of all ages. For others, it has resulted in the loss of a job or business and/or other financial concerns. And for many, the major impact has been the loss of personal freedoms and civil rights and the impact that this will have on our future. 

The factors that have made change difficult for some people to navigate during this pandemic  include:

• External Forces: The change has been initiated by external forces in ways that we could never (and still don't) believe were possible.
• Lack of Debate: There has been a lack of consultation, debate and understanding of the broader perspective and breadth of the impact on so many.  As Canadians, we are used to filtering out the truth or at least what we believe to be true, through listening to experts debate. During this pandemic there has been pretty much no debate which has intensified the chaos and sense of fear - on all sides.

Acceptance 

When there is a significant change that has affected a person's life, it is always helpful to accept the reality of the situation - maybe not initially if there is a chance that things may change back, but eventually. Acceptance is not always about agreement. It is about recognizing that some changes alter the future forever. 

With over twenty years in healthcare, I have found that the greatest impact to health is when a person's energy is split - that is, they are living one life yet desiring something else. When your energy is split it drains you, frustrates you and/or it makes you angry. In can also show up in physical symptoms such as pain, inflammation and conditions like autoimmune and others.

This split in energy shows in many different ways. From little things such as eating "clean", but really desiring the junk food you are avoiding. It shows up as choosing a certain job or relationship because they make the most sense, but really desiring something or someone else. There can be a split in energy after an accident or injury when a person doesn't accept that something "bad" happened. At this point in the pandemic, there is a good chance that there will be a split in energy for those that still believe that there is a chance that we will go back to the "old normal".  

The aim of acceptance is to make decisions from a point of knowing, not from fear. It is about deciding to move forward within the reality of the new situation versus waiting or wanting things to go back to a previous reality. Knowingness comes from both knowledge and from instinct. For some, knowledge is the most important, while for others it is instinct. Having and trusting both is important.

Avoid Getting Overwhelmed

A little bit of stress and change can be motivating and can help facilitate change. Being overwhelmed, on the other hand, can become paralyzing.  It can actually be detrimental to acceptance and can be demotivating. When overwhelmed, the ability to make rationale decisions based on what it best for you is hampered. There is a greater likelihood for people to abdicate their own thinking processes and make decisions out of fear.

Steps to take to avoid being overwhelmed include:

• Decrease the time you spend listening to or engaged in whatever is overwhelming you.
• Engage in grounding exercises such as going for a walk (ideally in nature or in the forest), gardening, stretching exercises, breathing exercises, etc.
• Choose whole foods and limit sugar, caffeine and processed foods.
• Stay hydrated and active.
• Spend time doing things that you truly enjoy, like listening to music or reading a good book.
• Reach out to others. You may find that a phone call is more nurturing and grounding than text messages (or maybe I'm just showing my age!).
• Remember it is important to have your opinion and beliefs, but it is also important to recognize that others may have a different perspective that warrants consideration.

Truth Versus Relevance

Each person has their own truth, their belief and their position on any specific issue. Linking back to the section on change, we are reminded that the impact of a crisis may vary for different individuals. There is "truth" in many different perspectives - what matters to people is what is relevant to them. We have tended to lose sight of the difference between "truth" and "relevance".  For example, the following statements are all "true" (to someone):

• People are dying of infections.
• More people are suffering with mental health issues - young and old.
• The elderly have been more isolated which has had a significant impact on their quality of life and their health.
• The impact on children is immense and may affect them mentally, academically and socially for years to come.
• Our rights and freedoms have been significantly impacted in the last few years.
• Financially we are in trouble in Canada (and many other parts of the world).
• Businesses have closed and are closing all around us.
• Climate change is getting significantly worse and it is being ignored, for the most part.
• Environmental pollutants are likely going to be the next big crisis.

And on and on.  Each person has their own "truth" and their sense of "relevance".  When in fear, there is a tendency to jump to conclusions based on the truth that is in front of us. When grounded, there is a greater chance on making a decision based on relevance. Relevance takes the "truth" into consideration but it also weighs the short-term against the long-term and weighs a broad range of impacts for individuals and the greater community.

Find Your Lane

An analogy that I use with patients is that life is a paved highway with multiple lanes. When you are in sync with your life you are on the pavement. When you're not, it feels like you are riding on the shoulder and at times it can feel like you are going through life in the ditch. There is choice in life (the different paved lanes), but there is also the need to make choices that are best for you and that keep you on the pavement and not on the shoulder or in the ditch.

"Your lane" refers to what you should be doing. It is about your choices and your role in any situation. For example, as a naturopathic doctor, my "lane" during this pandemic is to provide primary health care by staying current on the research related to post-COVID infections and vaccine-related injuries so that I can support patients in their journey through this chaos. 

Each person has the ability to decide what lane they want to choose. An important point to remember is that there are various lanes and a lane is only the "right" lane, when it is aligned with your truth. For some, this pandemic has not changed very much in their life and they are comfortable with the lane they are in. For others, it has felt that they are moving through life in a fog and they aren't sure of their way. They may have lost their business or job and need to find a new way to support their family. Or they may be uncertain of the future for various reasons. Keep in mind, even in war there were those that were fighting the war, those that were building products to support the war, those that were fighting to end the war and those that were just trying to survive the war.

For some, their lane keeps them in the middle of the chaos - and that's okay - if that's their choice. For others, their lane simply involves taking care of a loved one or checking in on neighbors that are alone. Others may be focused on their own personal health, a family crisis or on keeping their job so that they can support themselves and their family. You will know when you are in the right lane as it is easier to move forward, despite the chaos.

Finding Your Anchor

Either at the beginning of the process, or at the end, it is helpful to find an anchor -- or a few anchors. Anchors are things that you can hang onto that pull you through a crisis. Your anchor can be anything that you know to be true - to you.  For some, that anchor is family and the desire to spend time with those they love. For others it is astrology and the belief that there is a higher purpose driving this change. For some, it will be the desire to graduate from University and make a difference in the world. Faith or spirituality has been the anchor for some during these uncertain times.  For others, it may include another person or practitioner that helps you navigate the change. 

An anchor is something outside of the chaos that you know to be true and to be beneficial for you. Your anchor should help provide a perspective that ensures that the decisions that you make are best for you, not only in the present moment, but in the future.  Anchors help ensure that we can keep an open mind and make decisions based on relevance to ourselves and others.

Master Your Mind

Is your mind supporting your health and your decision making or is it fighting you?  I truly believe that mastering the mind is the key to health in chaotic times and as you get older. The following are some tips on mastering the mind:

• Spend time eavesdropping on your mind. Get a sense for the mind chatter that occupies it.
• The mind generally settles more when it looks at a situation from a number of perspectives. Be open to seeing any chaotic situation from the perspective of you, others, community and global.
• If anxiety, fear, frustration or other emotions are driving your life, then look at ways of quelling these first. Check out books on the topic; talk to friends and family; seek help from your naturopathic doctor or healthcare provider.  Reach out.

For further information on the mind, check out the following:

• blog: Power of the Mind: Top 5 Things to Remember

If the chaos in your life is overwhelming you, I recommend that you talk to your naturopathic doctor or other healthcare provider for guidance. You can also call our clinic at 905-940-2727 to book an appointment with Dr. Iva Lloyd, ND.

What to Eat in Autumn

 by Parisa Wong, Nutritionist

The climate changes rapidly in autumn and changing your eating pattern to match the season is the key to health. In autumn, due to the rapid changes in temperature and climate, many people find that their physical ailments are aggravated. Changing your diet so that it is more suited to the changes in temperature can help to prevent many symptoms..

According to Chinese medicine, Yang foods should be eaten in spring and summer and Yin foods in autumn and winter. Autumn is actually a very good time to nurture the body when you are in sync with the season.

Nourishing your arteries and decreasing dryness

The air is dry in autumn, and people are more easily irritable. At this time of the year, choose foods that cleanse your arteries and moisturize dryness to balance the autumn dryness. Good choices include: pears, kiwi, pomegranates, sweet potatoes, carrots, walnuts, lotus root, chrysanthemum, duck, duck eggs, etc.

• Lotus root is a powerful plant that has been used in East and Southeast Asian traditional medicine and cuisine for centuries. Lotus root contains both fiber and complex carbohydrates. These two components work together to help manage your body’s cholesterol and blood sugar. Fiber and complex carbohydrates also help steady the digestive process and nourish dryness.

Nourishing your lungs

Autumn is the best time to nourish and replenish the lungs. Foods that nourish the lungs include: almonds, apples, broccoli, kale, pumpkin, squash, molasses, lily and water chestnut. The best of the season is almonds. There are two types of almonds: sweet almonds and bitter almonds. Sweet almonds have a stronger effect of nourishing the lungs.

Almonds contain lots of healthy fats, fiber, protein, magnesium and vitamin E. From a western perspective,  almonds lower blood sugar levels, reduce blood pressure and lower cholesterol levels. They can also reduce hunger and promote weight loss. From a Chinese perspective, almonds moisturize the lungs, relieve cough, smooth the intestines, have a relieving effect on a dry cough and address lung deficiency and chronic cough.

• In Chinese medicine a common food used in cooking to nourish the lungs is white fungus. White fungus (Tremella fuciformis) is a wild edible mushroom that grows on tree bark and branches, especially on broad-leaved trees. It has been used as one of Chinese herbs because of its medicinal benefits for centuries. It tastes sweet and goes to the lung channel. It is commonly used for healing dry coughs, dry skin, clearing heat in the lungs, nourishing the bodies.

Nourishing the blood

One of the most important principles of Chinese nutrition in the autumn diet is to eat less spicy and more foods that are sour, such as oranges and green apples.  Other foods that are beneficial include:

• Grapes nourish blood, promote body fluids and quench thirst. They invigorate the spleen and have diuretic properties. Eating grapes in early autumn can also help the body detoxify and relieve internal heat. Red grapes can soften blood vessels, invigorate blood and remove stasis.
• White grapes have the added  effect of moisturizing the lungs and are suitable for people with a cough and poor respiratory system. Green grapes focus on clearing away heat and detoxification. Purple grapes are rich in anthocyanins which can beautify and fight aging. Black grapes nourish yin and nourish the kidney more prominently.

Other Recommendations

The autumn diet regimen should avoid cold foods such as raw salad, cold drinks and food directly from the fridge.  It is also important to avoid a lot of dry food and fried foods. Warm foods, like soup or porridge, are the better choice in the fall.

In addition, people's vitamin A reserves in the body are likely to decrease in autumn. This can result in problems such as decreased night vision, dry eyes and respiratory tract infections. Choosing more orange and yellow vegetables, such as pumpkins, carrots and tomatoes, can help ensure that your vitamin A stays adequate.

Personalized Nutritional Support

A balanced diet is the foundation to health. What is optimum varies from person to person and is dependent on your underlying conditions, your age and health status. 

If you have questions about what type of foods or nutritional plan is best for you, I would welcome the opportunity to work with you. For more information on my approach to nutrition, check out my blog on Yin Yang theory and detoxification or check out my bio on the Naturopathic Foundations website.

To book an appointment, please contact Naturopathic Foundations Health Clinic at 905-940-2727.

 

 

COVID Long-Haulers: There is Hope

 by Dr. Iva Lloyd, ND

For too many individuals the long-term effects of COVID have been more distressing than the acute phase. Like all diseases and discussions about health, it is imperative to remember that health and disease are complex. It is appreciating the complexity and the context that each individual finds themselves in that helps to understand what is relevant for them and how best to deal with the situation. Here is an overview of what we know about long-haulers also referred to as post-acute-sequelae of COVID (PASC).

PASC Symptoms

Most people with PASC will experience a range of symptoms. The symptoms depend on a person's underlying susceptibilities and where the virus "sits" in their body.  The symptoms can include:

• chronic fatigue 
• low grade fever that may be consistent or intermittent
• shortness of breath, especially on exertion with  or without a cough
• compromised lung and/or heart function
• joint and/or muscle pain or muscle atrophy
• mental health concerns especially as it relates to worsening anxiety and/or depression
• cognitive changes and brain fog
• skin rashes
• gastrointestinal upset
• headaches and sense of dizziness or instability
• decrease or change in smell and/or taste
• changes in sleep
• changes in menstrual cycle and flow

·       Risk of PASC

There does not seem to be a relationship between the severity of the initial infection and the risk of developing post-COVID symptoms. Research does tend to indicate that there may be an increased risk of developing PASC if a person had multiple symptoms (eg. >5) during the first week of illness. The symptoms associated with PASC tend to wax and wane, as well as shift, between physiological systems. The following outlines other risk factors.

• Comorbidities that may increase risk:  Underlying conditions that may increase a person's risk of post-COVID symptoms include significant cardiovascular disease, unstable diabetes, chronic lung disease, lowered renal function, obesity, progressive asthma, and significant mental health problems.
• Other characteristics that might increase an individual's risk: older age, female, blood type A, nutritional deficiencies, environmental factors (such as increased exposure to environmental pollutants, exposure to high levels EMF), chronic stress, lower socioeconomic status, and medications such as proton-pump inhibitors
• High risk blood indicators:  There are some blood tests that may be correlated with an increased risk of PASC.  High D-Dimer, high ferritin, high LDH, progressive decrease in lymphocytes, high neutrophil/lymphocyte ratio.  Your naturopathic or medical doctor can assess these for you and determine if they are relevant indicators for you.
• Nutrient deficiencies that may be worthwhile assessing: Vitamin A, Vitamin D, B12, Vitamin C, Vitamin K, Magnesium, Zinc, Omega 3 fatty acids, glutathione and melatonin.  Assessment of  gut health / microbiome.
• Home care: moderate exercise, clean diet (anti-inflammatory, avoid food intolerances, sugar and limiting dampness forming foods (wheat, yeast, dairy), decrease stress, ensure adequate sleep and hydration.

There are four main manifestations of PASC - neurological, heart and lung, kidney and liver, and skin.  Likely, a person's underlying suspectibilitites will influence the symptoms that they experience.

Post CV-19 Neurological Syndrome

Brain / Neurological	1st degree	2nd degree	3rd degree
Symptoms	Loss of smell, â cognition â short-term memory Brain fog, dysphagia, dysarthria, headache, Trouble sleeping, depression, anxiety	â â cognition / memory Confusion, delirium Dizzy spells, lightheadedness, Hair loss, HA	Cerebrovascular disease and/or changes in cognition and memory

Post CV-19 Heart / Lung Conditions

Heart / Blood vessels	1st degree	2nd degree	3rd degree
Symptoms Impaired endothelial function	Fatigue, exercise intolerance, easy bruising, dry cough, body aches, sore throat	Dyspnea, extreme SOB and fatigue, áá exercise intolerance, bulging veins, Erratic HT beat, arrythmia, worsening dry cough, tightness in chest, body aches, silent hypoxia, low affect, “lung burn”	Cerebrovascular disease

Post CV-19 Kidney / Liver Conditions

Kidney / Liver	1st degree	2nd degree	3rd degree
Symptoms	Fatigue, itchy skin, body aches	Ascites, itchy skin, áá fatigue	Liver and / or Kidney dysfunctions

 

Post COVID-19 Skin Conditions

Skin Conditions	1st degree	2nd degree	3rd degree
Symptoms	Fever, persistent cough, fatigue, chills and sweats, Urticaria	Pernio (persistent pain, discolouration of toes, cold) Chilbains, urticaria Morbilliform rash Macular erythema Vesicular eruptions Papulosquamous eruptions Retiform purpura	Organ dysfunction

 Naturopathic Approach to Post-COVID Symptoms

Naturopathic doctors treat the whole person. They assess an individual's underlying susceptibilities and healing potential, their current health status, lifestyle, as well the impact prior diseases have had from a mental-emotional and physical perspective. Naturopathic approach to PASC would likely involve:

• A detailed intake to fully understand an individual's susceptibilities, their current symptoms and how those symptoms have impacted their life.
• A physical exam, as needed.
• The requisitioning of blood work to verify the physical impact on the body. The specific laboratory tests would depend on each person's health history and PASC symptoms. 
• Some symptoms will warrant the need for chest X-ray, scans or other testing.

The treatment of PASC needs to be individualized based on each person's unique constitution, susceptibilities and manifestation of symptoms. PASC is a new condition. There is very little research specific to this condition and naturopathic treatments. Based on uses of specific modalities Naturopathic doctors are likely to consider approaches that include one or more of the following:

• Individualized dietary recommendations and other lifestyle recommendations to assist with healing.
• Naturopathic modalities and therapies that might be indicated include:
• Nutraceuticals such as N-Acetyl-Cysteine (NAC), Glutathione (nebulizer, oral), EGCG, Vitamin B12, Serropeptidase, Modified Citrus Pectin, Quercetin,     Lutein, Zexanthin, Astaxanthin, Vitamin A, C, D, E and Selenium and Zinc.

• Herbal medicines to address the specific symptoms such as St. John’s Wort (Hypericum perforatum), Ginkgo (Ginkgo biloba), Bromelain, Turmeic (Curcuma longa), Cordyceps, Hawthorn (Crataegus monogyna), Astragalus (Astragalus membranous), Andrographis (Andrographis paniculate), Milk Thistle (Silybum marianum), Buplerum falciparum, Taraxacum officinalis (Dandelion), Nettle (Urtica dioica), Burdock (Arctium lappa)

• Gemmotherapies such as Alnus glutinosa, Vaccinium vitis idea, Rosmarinus officinalis, Vinca minor, Lonicera nigra, Populus nigra, Prunus amygdalus, Corylus avelliana, Crataegus oxycacanta, Viscum album, Rosa canina, Gingko biloba, Juniperus communis, Ribes nigra, Fraxinus excelsior, Betula pubescens, Cedrus libani, Ulmus campestris

• Homeopathic remedies and tissue salts.

• Other naturopathic approaches as indicated such as acupuncture, hydrotherapy, Intravenous therapies, lifestyle counselling and others.

If you are someone you know is dealing with PASC, it might be worthwhile to work with a naturopathic doctor to discuss how they can support you on your journey back to health. To book an appointment with one of our naturopathic doctors, contact us at 905-940-2727 or email us at info@naturopathicfoundations.ca. 

References

Another article on COVID co-authored by Dr. Lloyd, ND:

 Lloyd I, Saunders P. Assessing for the co-morbidities and factors that may affect a patient's risk and response to COVID-19. CAND Vital Link. 2020;2:19-26.

The following is an overview of research on PASC.

 

Area of Study	References
Fatigue	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. ·       Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep 2020;69:993-998. ·       Tolba M, Abo Omirah M, Hussein A, Saeed H. Assessment and Characterization of Post-COVID-19 manifestations. Int J Clin Pract. 2020 Sep 29:e13746 ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       https://www.thephysician.uk/editorial-after-the-pandemic (accessed Oct. 23, 2020) ·       Long COVID: let patients help define long-lasting COVID symptoms. Nature. 2020 Oct;586(7828):170 ·       Townsend L, Dyer AH et al. Persistent fatigue following SARS-CoV2-infection is common and independent of severity of initial infection. medRxiv https://www.medrxiv.org/content/10.1101/2020.07.29.20164293v1 (accessed Oct. 23, 2020)
Dyspnea/ breathlessness	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       Long COVID: let patients help define long-lasting COVID symptoms. Nature. 2020 Oct;586(7828):170
Cough	·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605.
Chest pain/ heaviness	·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026 ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       Long COVID: let patients help define long-lasting COVID symptoms. Nature. 2020 Oct;586(7828):170
Joint pain/ muscle pain	·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. ·       Long COVID: let patients help define long-lasting COVID symptoms. Nature. 2020 Oct;586(7828):170
Chemosensory disturbances (persistent loss of sense of smell and taste)	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605
Cognitive blunting (“brain fog”)/ loss of concentration	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026.      ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605
Emotional health and well-being: ·	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun. 2020 Oct;89:531-542. ·       Vittori A, Lerman J, Cascella M, Gomez-Morad AD, Marchetti G, Marinangeli F, Picardo SG. COVID-19 Pandemic Acute Respiratory Distress Syndrome Survivors: Pain After the Storm? Anesth Analg. 2020 Jul;131(1):117-119 ·       Leung TYM, Chan AYL, Chan EW, Chan VKY, Chui CSL, Cowling BJ, Gao L, Ge MQ, Hung IFN, Ip MSM, Ip P, Lau KK, Lau CS, Lau LKW, Leung WK, Li X, Luo H, Man KKC, Ng VWS, Siu CW, Wan EYF, Wing YK, Wong CSM, Wong KHT, Wong ICK. Short- and potential long-term adverse health outcomes of COVID-19: a rapid review. Emerg Microbes Infect. 2020 Dec;9(1):2190-2199
Skin rashes:	·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026 ·       Skin rash should be considered a 4th key sign of COVID-19 https://covid.joinzoe.com/us-post/skin-rash-covid (accessed Oct. 23, 2020)
Other:	·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605
Mitochrondia Support	·       Burtscher J, Cappellano G, Omori A, Koshiba T, Millet GP. Mitochondria: In the Cross Fire of SARS-CoV-2 and Immunity. iScience. 2020 Oct 23;23(10):101631 ·       Saleh J, Peyssonnaux C, Singh KK, Edeas M. Mitochondria and microbiota dysfunction in COVID-19 pathogenesis. Mitochondrion. 2020 Sep;54:1-7. ·       Singh KK, Chaubey G, Chen JY, Suravajhala P. Decoding SARS-CoV-2 hijacking of host mitochondria in COVID-19 pathogenesis. Am J Physiol Cell Physiol. 2020 Aug 1;319(2):C258-C267. ·       Kloc M, Ghobrial RM, Kubiak JZ. The Role of Genetic Sex and Mitochondria in Response to COVID-19 Infection. Int Arch Allergy Immunol. 2020;181(8):629-634 ·       Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, Walshaw C, Kemp S, Corrado J, Singh R, Collins T, O'Connor RJ, Sivan M. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2020 Jul 30. doi: 10.1002/jmv.26368. ·       European Respiratory Journal 2020; 56: Suppl. 64, 4143. https://erj.ersjournals.com/content/56/suppl_64/4143.abstract (accessed Niv 6, 2020) ·       Ojo AS, Balogun SA, Williams OT, Ojo OS. Pulmonary Fibrosis in COVID-19 Survivors: Predictive Factors and Risk Reduction Strategies. Pulm Med. 2020 Aug 10;2020:6175964 ·       Li G, Hu R, Gu X. A close-up on COVID-19 and cardiovascular diseases. Nutr Metab Cardiovasc Dis. 2020 Jun 25;30(7):1057-1060 ·       Boukhris M, Hillani A, Moroni F, Annabi MS, Addad F, Ribeiro MH, Mansour S, Zhao X, Ybarra LF, Abbate A, Vilca LM, Azzalini L. Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective. Can J Cardiol. 2020 Jul;36(7):1068-1080
Specific organ dysfunction (heart): ·	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026 ·       Tolba M, Abo Omirah M, Hussein A, Saeed H. Assessment and Characterization of Post-COVID-19 manifestations. Int J Clin Pract. 2020 Sep 29:e13746 ·       Leung TYM, Chan AYL, Chan EW, Chan VKY, Chui CSL, Cowling BJ, Gao L, Ge MQ, Hung IFN, Ip MSM, Ip P, Lau KK, Lau CS, Lau LKW, Leung WK, Li X, Luo H, Man KKC, Ng VWS, Siu CW, Wan EYF, Wing YK, Wong CSM, Wong KHT, Wong ICK. Short- and potential long-term adverse health outcomes of COVID-19: a rapid review. Emerg Microbes Infect. 2020 Dec;9(1):2190-2199 ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       https://www.thephysician.uk/editorial-after-the-pandemic (accessed Oct. 23, 2020) ·       Long COVID and inflammation: a cardiologists point of view https://www.medscape.com/viewarticle/935488#vp_2 (accessed Oct 23, 2020) ·       Note: the reduction in heart pumping after recovering from COVID-19 may be more common in men according to preliminary results from the COVERSCAN study https://www.itv.com/news/2020-08-12/long-covid-what-is-it-what-are-the-symptoms-and-what-help-is-there-for-sufferers (accessed OCT 23, 2020)
Specific organ dysfunction (lung): ·	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026 ·       Tolba M, Abo Omirah M, Hussein A, Saeed H. Assessment and Characterization of Post-COVID-19 manifestations. Int J Clin Pract. 2020 Sep 29:e13746 ·       Leung TYM, Chan AYL, Chan EW, Chan VKY, Chui CSL, Cowling BJ, Gao L, Ge MQ, Hung IFN, Ip MSM, Ip P, Lau KK, Lau CS, Lau LKW, Leung WK, Li X, Luo H, Man KKC, Ng VWS, Siu CW, Wan EYF, Wing YK, Wong CSM, Wong KHT, Wong ICK. Short- and potential long-term adverse health outcomes of COVID-19: a rapid review. Emerg Microbes Infect. 2020 Dec;9(1):2190-2199 ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       https://www.thephysician.uk/editorial-after-the-pandemic (accessed Oct. 23, 2020)
Specific organ dysfunction (brain): ·	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026.
Specific organ dysfunction (kidney):	·       https://www.thephysician.uk/editorial-after-the-pandemic (accessed Oct. 23, 2020) ·       Tolba M, Abo Omirah M, Hussein A, Saeed H. Assessment and Characterization of Post-COVID-19 manifestations. Int J Clin Pract. 2020 Sep 29:e13746 ·       Prelimary results from the COVERSCAN study in Oxford https://www.itv.com/news/2020-09-29/long-covid-long-term-effects-of-coronavirus-include-damage-to-heart-liver-kidneys-oxford-study-reveals (accessed Oct. 23, 2020)
Other Research	·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 P ost-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. ·         Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep 2020;69:993-998.  ·         Zhou H, Lu S, Chen J, Wei N, Wang D, Lyu H, Shi C, Hu S. The landscape of cognitive function in recovered COVID-19 patients. J Psychiatr Res. 2020 Oct;129:98-102 ·         Hascup ER, Hascup KN. Does SARS-CoV-2 infection cause chronic neurological complications? Geroscience. 2020 Aug;42(4):1083-1087. ·         Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 2020 Jul;87:34-39. ·         Steardo L Jr, Steardo L, Verkhratsky A. Psychiatric face of COVID-19. Transl Psychiatry. 2020 Jul 30;10(1):261. ·         Alam SB, Willows S, Kulka M, Sandhu JK. Severe acute respiratory syndrome coronavirus 2 may be an underappreciated pathogen of the central nervous system. Eur J Neurol. 2020 Jul 15:10.1111/ene.14442. ·         Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther. 2020 Jun 4;12(1):69. ·         Salimi S, Hamlyn JM. COVID-19 and Crosstalk With the Hallmarks of Aging. J Gerontol A Biol Sci Med Sci. 2020 Sep 16;75(9):e34-. ·         Disser NP, De Micheli AJ, Schonk MM, Konnaris MA, Piacentini AN, Edon DL, Toresdahl BG, Rodeo SA, Casey EK, Mendias CL. Musculoskeletal Consequences of COVID-19. J Bone Joint Surg Am. 2020 Jul 15;102(14):1197-1204. ·         Azim D, Nasim S, Kumar S, Hussain A, Patel S. Neurological Consequences of 2019-nCoV Infection: A Comprehensive Literature Review. Cureus. 2020 Jun 24;12(6):e8790. ·         Kaniusas E, Szeles JC, Kampusch S, Alfageme-Lopez N, Yucuma-Conde D, Li X, Mayol J, Neumayer C, Papa M, Panetsos F. Non-invasive Auricular Vagus Nerve Stimulation as a Potential Treatment for Covid19-Originated Acute Respiratory Distress Syndrome. Front Physiol. 2020 Jul 28;11:890. ·         Kempuraj D, Selvakumar GP, Ahmed ME, Raikwar SP, Thangavel R, Khan A, Zaheer SA, Iyer SS, Burton C, James D, Zaheer A. COVID-19, Mast Cells, Cytokine Storm, Psychological Stress, and Neuroinflammation. Neuroscientist. 2020 Oct-Dec;26(5-6):402-414. ·         Conti P, Caraffa A, Tetè G, Gallenga CE, Ross R, Kritas SK, Frydas I, Younes A, Di Emidio P, Ronconi G. Mast cells activated by SARS-CoV-2 release histamine which increases IL-1 levels causing cytokine storm and inflammatory reaction in COVID-19. J Biol Regul Homeost Agents. 2020 Sep-Oct,;34(5):1629-1632. ·         Shaik Y, caraffa A, Ronconi G, Lessiani G, Conti P. Impact of polyphenols on mast cells with special emphasis on the effect of quercetin and luteolin. Cent Eur J. Immunol. 2018;43(4):476-481) ·         Akour A. Probiotics and COVID-19: is there any link? Lett Appl Microbiol. 2020 Sep;71(3):229-234. ·         Saleh J, Peyssonnaux C, Singh KK, Edeas M. Mitochondria and microbiota dysfunction in COVID-19 pathogenesis. Mitochondrion. 2020 Sep;54:1-7. ·         Dhar D, Mohanty A. Gut microbiota and Covid-19- possible link and implications. Virus Res. 2020 Aug;285:198018. ·         Baghbani T, Nikzad H, Azadbakht J, Izadpanah F, Haddad Kashani H. Dual and mutual interaction between microbiota and viral infections: a possible treat for COVID-19. Microb Cell Fact. 2020 Nov 26;19(1):217. ·         Baumann A, Gönnenwein S, Bischoff SC, Sherman H, Chapnik N, Froy O, Lorentz A. The circadian clock is functional in eosinophils and mast cells. Immunology. 2013 Dec;140(4):465-74