Woman holding her hair.


By: Grace Greenwald 

Aesthetic Nurse Injector & Owner of Refine with Grace Aesthetics

There is a belief held by many skincare enthusiasts that you must pause your skincare regimen during the summer. Even though you may be shelving retinols, avoiding chemical peels and other more aggressive treatments for the season, that doesn’t mean you still can’t attain visible results. What is changing is your environment and those changes bring new challenges to our skin. 

Think about the summer season. You experience increased sun exposure as well as heat and humidity. These things can cause skin concerns such as excess pigmentation, sun damage, dryness and sensitivity. Living an active lifestyle and enjoying all that Lake Oconee has to offer means more time in the sun. Some patients complain of freckles, sunburn, dehydrated skin, oily skin, rosacea outbreaks, and/or acne flare-ups. These are all natural skin responses to being exposed to natural elements. Fortunately, there are numerous methods available to treat these conditions safely and effectively during the warmest months.

Protect your skin this spring and summer with these tips from Grace Greenwald (Owner of Refine with Grace) \


No matter the time of year, always make sure to cleanse, exfoliate, and tone. Not only do these steps help maintain your skin health, but following a daily regimen can restore skin barrier function, reduce excess surface pigment, and minimize surface oils and debris. If you don’t already have a regimen of your own, you can schedule a consultation at Refine with Grace to begin a medical-grade regimen tailored specifically to your concerns and goals.


The most essential skincare product for any skin type is sunscreen. Our skin is our largest organ and deserves a lot of love! SPF protects your skin from harmful rays from the sun. When selecting an SPF product, make sure it has broad-spectrum protection from different types of light and radiation. All of the sunscreens we offer are formulated with Triple-Spectrum Protection®, and include an exclusive antioxidant blend to protect skin from free radical damage and IR-A rays. That also includes blue light from electronics, too, making sunscreen an even more important player in your regimen beyond the summer months.

Having trouble knowing which sunscreen is best? Anything is ALWAYS better than nothing! However, Grace recommends the ZO Skin Health line because of the variety of coverage and the options available to tailor to your lifestyle and preferences. For beach trips or for perspiration-heavy days, Daily Sheer Broad-Spectrum SPF 50 is a great, water-resistant option, offering a non-greasy formula with a sheer matte finish. Looking for something to add into your makeup routine or provide on-the-go coverage? Sunscreen + Powder Broad-Spectrum SPF 40 provides buildable coverage with color-enhancing pigments + light reflecting minerals for a gorgeous, luminous glow.


If dealing with pesky dark spots is one of your skin health goals, products that are clinically proven to increase luminosity, visibly improve skin clarity and fade the appearance of dark spots for a brighter, more even complexion are a great option to get results even when sun exposure is increasing with spring and summer activities!

For more moderate cases of excess pigmentation, pair your skincare regimen with 10% Vitamin C (not all are created equal so consult is key!). This potent dose of Vitamin C helps brighten the complexion while also providing protection from environmental triggers. Combining the antioxidant, hydration and anti-aging benefits of photosensitivity-safe products will keep your complexion radiant all summer long without causing sun sensitivity.


Beat the heat by storing skincare products in the refrigerator, or purchase a mini cosmetics fridge to keep at your vanity for a convenient, cooling, calming experience! Hydration is also key for maintaining healthy, beautiful skin so don’t forget to ask about our IV Hydration Therapy options to get ahead of dehydration as the temperatures rise. No matter your skin type or skin concern, Refine with Grace has your skin health, aesthetic appearance, and wellness covered this summer and beyond.

Still curious about how to maximize your summer skin routine? 

Give Grace a call or text to set up a consultation at (706) 338-0433.

Refine with Grace is conveniently located within Lake Country Medical Group and Lake Country Medical Concierge in Harmony Crossing.


Lake Country Medical Group Employee Spotlight: Rannie McCannon


Lake Country Medical Group and Concierge would like to welcome Rannie McCannon to our practice. She brings with her a tremendous amount of experience working within the community as well as a keen understanding of medication regimen and working with pharmaceutical companies. Rannie graduated from Greene County High School and was a cheerleader there for four years. She worked for Jay and Melinda Spivey at Lake Oconee Family Pharmacy here in The Harbor Club until it closed. In 2003, she was hired as a full-time Pharmacy Technician at Publix Pharmacy. Rannie stated, “I really enjoyed working at Publix and I’m very proud to say that I worked there for 18 1/2 years! I enjoyed working and building relationships with all of the Patients, Pharmacists and Technicians over the years.” 

At Lake Country Medical Group Rannie is taking on the roles of Chronic Care Management Coordinator and Medical Reconciliation Specialist. According to Dr. Nicolas Chronos, “Rannie is friendly, efficient, and effective. Since hiring Rannie we have seen a dramatic improvement in our ability to reconcile medications, check patients are on the correct medications, and save money for patients on their prescriptions. I am amazed by Rannie’s desire and ability to make sure patients are able to take the medications they need by finding grants and coupons to make their medications more affordable.”

What Is Medical Reconciliation? 

Medication reconciliation is the process by which a healthcare professional creates a comprehensive list of all the medications a patient is currently taking, including information such as the proper route of administration, dose, time, and frequency of the medication. This sounds simple but it is actually a process that oftentimes gets disregarded in the business of a medical practice or hospital.

In fact, according to the NIH, 

“The average hospitalized patient is subject to at least one medication error per day. This confirms previous research findings that medication errors represent the most common patient safety error. More than 40 percent of medication errors are believed to result from inadequate reconciliation in handoffs during admission, transfer, and discharge of patients. Of these errors, about 20 percent are believed to result in harm. Many of these errors would be averted if medication reconciliation processes were in place.” 

Why is medication reconciliation important? 

Medication reconciliation is important because it reduces the medication errors made in regards to the patient. With more than 7 million Americans impacted by medication errors every year, this process is integral to the healthcare system. When medication lists are inaccurate, a patient may be receiving too much or too little of a certain medication. Healthcare professionals will also be checking to make sure that there are no duplicates on the list. A second healthcare professional who monitors the medication reconciliation process, ensures that a double-check is being done so that all medications are being prescribed within safe levels, none are being duplicated, and that the patient is safe from harm caused by medication errors. 

At Lake Country Medical Group and Concierge we believe it is vital to be diligent about medical reconciliation. We have had new patients come to their first visit with a list of medications which have not been properly managed by previous providers. In just two months Rannie has helped our patients understand their medications and ensure that the medications they are taking are serving their purpose and not causing harm. 

In addition, Rannie has been able to help many of our patients save money on their prescriptions. In several cases she has saved them thousands of dollars! When asked to share an example Rannie explained, “the other day a patient stated to me that he couldn’t afford his Eliquis medication and that he was spending over $200 per month for the medication. I reached out to the Eliquis Foundation that helps fund certain Medicare patients. Once all of the correct documents were sent in, the patient was approved. Because of their annual income, they were able to receive Eliquis free of charge for the remainder of the year! That saved them a total of $2,400 for the year which is amazing!!”

All About Rannie McCannon 

  1. How long have you worked for Dr. Chronos? 

I have worked with the Lake Country Medical Group for almost two months and it thrills me to come to work everyday to be of support to the team. 

  1. What do you enjoy most about working at the practice? 

I really enjoy working with the patients. I know most of them already which is also exciting! 

  1. How long have you lived in Georgia’s Lake Country and where are you originally from? 

I have lived here in Greensboro, Ga. all of my life. I love this community as it is where I was raised and where I have raised my family. 

  1. Can you tell us a little bit about your family? 

I’m very honored to say that I’m happily married to my wonderful husband, Robby McCannon, who is a Greene County Deputy Sheriff. He is also very well known in the community. We share a total of 21 years together and have 2 beautiful children (Rj and Jaxon) whom we adore so much!


Resources – 




Don’t Put Away Your Mask Yet


Written by: Ofek Laks, Public Health Intern at Lake Country Medical Concierge


With the new COVID-19 Variant known as Omicron sweeping all over the United States, it is important we continue taking precautions. The Georgia Department of Health has reported as of January 18th, 2022 that there are “1,679,773 confirmed cases” in the State of Georgia. With the number of cases continually increasing, it is crucial to be prepared when leaving the house. As well as, continue practicing social distancing and wearing a mask when possible.


How Masks Work

Covid-19 is transmitted through respiratory droplets when the people around you cough, sneeze, talk, and breath. In order to protect yourself and others around you the CDC recommends the continued  usage of masks due to the increase in Omicron cases. The effectiveness of masks depend on how they fit one’s face and if there are filters or respirators inside to block the respiratory droplets.

Types of Masks

There are 3 types of masks that help with the prevention of contraction for COVID-19 and each have their own statistics on how effective they are. The CDC has come out with recommendations on which they believe is the best for protection.

The most common type of masks are the cloth masks. The benefits of these masks are that they have no nose wire so it allows for more flexibility, and it is a breathable fabric that can be customized to whatever designs people want to wear. Unfortunately, cloth masks are the least effective and are recommended only if you do not have another option. The EPA reports that these masks are only about “80%” effective for the prevention of spreading the virus. Another downside is that there are gaps arounds the side of the face and they are not as effective if they become wet or dirty, so there needs to be constant maintenance with their cleanliness.

The next best masks that are recommended are procedure or medical masks. These are disposable masks with a nose wire that allows for a proper fit around the nose, mouth and chin for protection. A benefit of these masks is that they have been known to be easier to breathe in compared to cloth masks and KN95 masks. They are also disposable so if they happen to get dirty you can throw them away and get a new one with no issue. The EPA reports that they provide up to “90%” of protection from respiratory droplets.  A downfall is that they can sometimes not fit properly around the face since it has a wider fit. The CDC recommends that if you wear a disposable mask, to pair it with a cloth mask on top to provide the most protection while still being able to breath properly.

The masks that provide the most protection when it comes to the spreading of COVID-19 are the KN95 masks. These masks include respirators that provide surgical protection against not only respiratory droplets, but other hazards that can occur. The benefits of these masks are that they can be sealed tightly to your face if fitted and the EPA reports that it provides more than “95%” of protection from the virus. These masks have also been approved by the National Institute for Occupational Safety & Health (NIOSH) for having a specific quality requirement on the amount of protection.

Lake Country COVID accessibility

Feel like you are experiencing symptoms or want to get your COVID-19 vaccine? Lake Country Medical Group has resources and accessibility for all of their patients needs via appointment. We are able to offer PCR and antibody testing to those who desire it through our front desk via email for appointments. Vaccinations are also available at Lake Country Medical Group through appointments for the Moderna Vaccine and Booster. The contact information for joining the waitlist for the vaccine clinic is frontoffice@cardiologycareclinics.com. If you do not want to wait on the list for an appointment here at Lake Country Medical Group, we can also give recommendations to locations where they offer both rapid and PCR tests. Call the front desk for more information. Lake Country Medical Group has also started the infusion of REGEN-COV antibodies for current patients who are post-exposure to COVID-19 and need preventative measures if not fully vaccinated. In order to make an appointment join the same waitlist as the ones above.


Information from:






Oily Fish, Fish Oil Supplements Linked to Lower Diabetes Risk

In the largest study of its kind to date, regularly eating oily fish such as salmon, sardines, lake trout and albacore tuna reduced the risk of type 2 diabetes.[1]

The observational study, which was published in Diabetes Care, analyzed the health and diet of nearly 400,000 middle aged and older UK residents across roughly 10 years.[2] The study found people who eat one or more servings weekly of oily fish have a 22% lower risk of type 2 diabetes compared with those who never eat oily fish. Even people who eat less than one serving of oily fish weekly have a 16% lower risk of type 2 diabetes. Non-oily fish, on the other hand, has no link to type 2 diabetes risk reduction, according to the study.  While the study may lead to future dietary guidelines for prevention of type 2 diabetes, clinical trials are needed before any formal recommendations are made.

Other Potential Benefits of Oily Fish

Fish oil contains high amounts of omega-3 fatty acids called eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).[3] Omega-3 acids support essential functions throughout the human body, from maintaining cell membranes to promoting hormone production.

Some research indicates omega-3 acids may reduce the risk of heart attack or stroke, according to the American Heart Association.[4] Other research suggests omega-3 acids can help reduce inflammation and even fight depression, according to studies published by the National Institutes of Health (NIH).[5][6]

Staying Safe with Fish

Oily fish is an attractive option for good health — not only for its rich omega-3 content and potential type 2 diabetes risk reduction, but also for its high amounts of protein, vitamin B12, vitamin D, iron, and numerous other nutrients. [5] However, it’s important to remember fish contain mercury. The Food and Drug Administration (FDA) provides detailed guidelines for safely eating fish, including which fish contain more mercury than others. As always, remember to talk with your doctor before making changes to your diet.

Though regularly eating oily fish was linked to the greatest type 2 diabetes risk reduction, the study found those who consistently took fish oil supplements had a 9% reduction in risk.[1] It’s important to remember not all fish oil supplements are equal. Make sure you choose high-quality, highly concentrated supplements  such as OmegaGenics EPA-DHA 1000 from Metagenics and follow the recommended dosage.


  1. https://care.diabetesjournals.org/content/early/2021/01/05/dc20-2328
  2. https://www.medscape.com/viewarticle/945007
  3. https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/types-of-fat/omega-3-fats/
  4. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids
  5. https://pubmed.ncbi.nlm.nih.gov/21784145/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976923/
  7. https://www.fda.gov/food/consumers/advice-about-eating-fish

Not Taking a Multivitamin? Here Are 5 Reasons to Reconsider

Modified from an Original Post by Metagenics Institute

You try to eat well to feel good and stay healthy. While it’s optimal to get your daily nutritional needs from the foods you eat, it’s just plain difficult. There is conflicting information out there on the benefits of supplements, but the Dietary Guidelines for Americans 2020-2025 say that supplements may be useful for providing the nutrients you may be lacking from diet alone.

Still on the fence? Consider these top five reasons to add a multivitamin to your daily regimen.

1. Healthy aging. As we get older, our bodies have a harder time absorbing nutrients from food. The National Institute on Aging notes that starting around age 50, people begin to require increased amounts of certain vitamins and minerals.1,2 In fact, according to a study published in the American Journal of Clinical Nutrition, researchers found that taking a daily multivitamin & mineral supplement may help improve micronutrient deficiencies associated with aging.3

2. Making up for eliminated food groups. While some people have to cut certain foods like nuts or gluten out of their diets due to allergies, many eliminate particular foods or food groups from their diet voluntarily. This can cause vitamin insufficiencies and deficiencies that would be helped with a multivitamin. Trying a paleo diet? You might risk a shortage of calcium or vitamin D by eliminating dairy or grains. Cutting back on red meat? A multivitamin will replace the iron and B12 you would normally get from diet.

3. Getting the RDAs you’re not getting from food. You’ve probably heard that the typical Western diet doesn’t include nearly enough fruits, vegetables, whole grains, legumes, or lean protein. Because of that, you don’t always reap the vitamin and mineral benefits that those foods naturally supply. Consequently, nationally US adults are routinely failing to meet their daily requirements for vitamin A, C, D, E, and K, as well as for calcium, magnesium and potassium from diet alone, and this is including fortified sources!4 Supplementing with a multivitamin is therefore a prudent way to strategically fill those gaps on a daily basis. After all, the goal should not simply be to avoid blatant vitamin deficiencies, like scurvy with vitamin C deficiency. Borderline vitamin and mineral insufficiencies are just as important to avoid and address. Even the most health-conscious eater will benefit from multivitamin support to achieve micronutrient sufficiency across the board.

4. Getting that extra energy to get through the day. In today’s “go-go-go” society, one of the top complaints is a general lack of energy. Instead of reaching for that third cup of coffee, remember that your cells require certain vitamins and minerals to power your busy life; especially if you’re not getting a full eight hours of sleep or eating a balanced diet, a multivitamin can help provide the nutrients you need to feel energetic throughout the day.5

5. Managing stress. Daily life stressing you out? You’re not alone. But vitamins and minerals play significant biochemical roles in supporting and preserving your brain’s cognitive processes, and studies have shown that a daily multivitamin—particularly one with high doses of B vitamins—can help to reduce stress and support a healthy mood.6

Ready to add a daily multivitamin to your diet? Be sure to check with your healthcare practitioner to see if he or she has personalized recommendations for you and to ensure that any medications you’re currently on won’t interfere with their effectiveness or the effectiveness of the multivitamin ingredients.

You can order multivitamins through Metagenics, our trusted supplier of nutraceuticals and supplements.


  1. Department of Health and Human Services and U.S. Department of Agriculture. 2020–2025 Dietary Guidelines for Americans. 9th Edition. December 2020. Available at https://www.dietaryguidelines.gov
  2. National Institute on Aging. Dietary Supplements. Available at https://www.nia.nih.gov/health/dietary-supplements
  3. Xu Q, Parks CG. Multivitamin use and telomere length in women. Am J Clin Nutr. 2009; 89(6):1857–1863.
  4. Fulgoni VL, Keast DR. Foods, fortificants, and supplements: where do Americans get their nutrients? J Nutr. 2011;141(10):1847-1854.
  5. Bailey RL, Gahche JJ. Why US adults use dietary supplements. JAMA Intern Med. 2013; 173(5):355-361.
  6. Stough C, Simpson T, Lomas J, et al. Reducing occupational stress with a B-vitamin focused intervention: a randomized clinical trial: study protocol. Nutrition J.2014;13(1):122.
Woman With a Headache

COVID’s Lingering Symptoms

Two new studies are adding to a growing body of evidence suggesting COVID-19 causes chronic, debilitating symptoms long past infection and illness. There are now more than 50 symptoms tied to COVID in mild, moderate and severe cases. Fatigue, headaches, brain fog, hair loss, and loss of smell are the most common lingering effects while more worrying symptoms such as lung problems, chest pain, heart problems, sleep disorders and neurological issues have also been reported.

The first investigation is a large meta-analysis that included data from 15 studies in the US, Britain and Europe and involved nearly 48-thousand patients. It found eight out of 10 COVID-19 patients had lingering symptoms or signs 14 or more days after acute infection. At Houston Methodist Research Institute, one site where the data was collected, clinicians found fatigue was the most common symptom of both long and acute COVID-19, and remained present 100 days after onset.

The meta-analysis revealed that during follow up appointments, more than a third of patients had an abnormal chest x-ray or CT scan. Tests also showed elevated biomarkers for inflammation, such as D-dimer and C-reactive protein (CPR). Other symptoms included persistent cough, chest discomfort and pulmonary fibrosis, as well as cardiac arrhythmias, inflammation of the heart muscle (myocarditis), depression, anxiety and sleep issues.

Last month, the prestigious medical journal, The Lancet, reported findings from another study that followed hospitalized patients in Wuhan, China. It showed 76% of those patients were still struggling with the after-effects of COVID-19 six months later. The study cited fatigue and muscle weakness as the most common symptoms. However, some patients experience lasting impacts such as long-term cardiac damage, lung damage and kidney damage.

Because COVID-19 is a new disease, it’s not known how long many of the symptoms will last. Even patients with a mild case of COVID-19 report lasting symptoms for months after infection, such as breathlessness while walking. Adding further to the mystery, researchers are still trying to determine why some people experience these persistent problems — especially when the virus is no longer detected. In many cases, chest x-rays, scans and other tests mysteriously come back normal or negative.

There’s no specific diagnosis for post-COVID symptoms. The syndrome has been described as “long COVID” and those suffering with it as “long haulers.” While at first, some experts dismissed the idea of long haulers due to the lack of medical evidence and inconsistent test results, the medical community is now paying close attention. Dr. Anthony Komaroff, editor-in-chief of the Harvard Health Letter, believes post-COVID-19 symptoms can affect a wide range of people from young to old — those who were healthy, those who have been hospitalized, and those with mild cases. As he states, it’s not unthinkable that 50 million Americans could ultimately become infected. If just 5% of COVID patients develop lingering symptoms, post-COVID treatment will become even more critical.

The head of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, has suggested “long COVID” resembles a condition called myalgic encephalomyelitis/chronic fatigue syndrome or ME/CFS. More commonly known as chronic fatigue syndrome, ME/CFS has symptoms including extreme fatigue, sleep dysfunction, and brain fog — similar to symptoms reported by long-COVID sufferers — and is known to develop following viral infection. A recent study at the Stanford University School of Medicine indicates inflammation is a powerful driver behind chronic fatigue syndrome. Similarly, some scientists believe inflammation could be an underlying factor in the lingering effects of COVID-19. More studies with standardized testing are needed to determine whether COVID-19 directly causes long-term symptoms or if these symptoms are caused by a preexisting disease or condition.

If you’ve had COVID and are still dealing with lingering symptoms that impact the quality of your life, contact your doctor or healthcare provider.


Alopecia: Genes, Hormones, and More Causes of Hair Loss

By Bianca Garilli, ND

From Metagenics Institute

Hair loss, or alopecia, is a common complaint by patients, male and female alike. It can affect localized regions (like the temples and crown of the head seen in male-pattern baldness), the entire scalp, and sometimes can even extend to other areas of the body. Typical hair loss is approximately 50-100 hairs per day, but those suffering from more extensive hair loss frequently notice increased hair loss after brushing or styling their locks or even when cleaning the sinks and sweeping their floors.1 Hair loss can have a significant emotional and social impact on individuals. Understanding the underlying causes can be extremely helpful in creating an effective set of recommendations to mitigate hair loss.

Although hair loss or balding has a genetic component in many cases, there are also non-genetic, modifiable factors that may lead to hair loss. Let’s explore a few of the most common causes, including your genes, that underlie hair loss as well as targeted recommendations to reduce the loss.1,2 Woman getting a haircut.

Heredity (genetic): 

Many people are convinced that their hair loss is hereditary and runs in the family. For cases of male-pattern baldness or female-pattern baldness (both also known as “androgenetic alopecia”), this would be correct. This form of balding typically occurs gradually as the person ages, often following specific patterns such as a receding hairline in males and thinning of hair in specific areas or over the whole scalp in women.3

The genetics of hair loss is complex. For example, over 200 independent, novel genetic correlates of male pattern baldness were identified in a recent genome-wide association study (GWAS), with a majority of those being autosomal related, while others were found to be X chromosome variants.4 Another well-studied gene, the androgen receptor (AR) gene, is associated with hormonally-related balding and may contribute to androgenetic alopecia.5

Androgenetic alopecia is the most prevalent hair loss disorder globally.6 This hereditary baldness affects over 80 million people in the US alone, creating a demand for effective treatments.7 Hereditary balding may be caused in some part by excess androgens, when testosterone is converted into dihydrotestosterone (DHT) by 5-alpha reductase (5AR) at higher-than-normal rates.8 Approaches to slow the rate of balding include reducing DHT levels or giving 5AR inhibitors.8

Beyond the conventional medicine prescription approach, non-Rx options on the market are numerous, including: L-cystine, caffeine-based lotions and shampoos, capsaicin, marine protein supplements, melatonin, procyanidins (a phytonutrient class of anti-inflammatory flavonoids found mainly in plants, including apples, barley, cocoa, cinnamon, grapes, and tea), pumpkin seed and rosemary oils, saw palmetto, zinc, and various others.9


Hormonal changes associated with various life stages including pregnancy, childbirth, and menopause or fluctuation in thyroid function and thyroid hormone levels can also lead to temporary and sometimes permanent hair loss. Partnering with a healthcare provider who practices personalized lifestyle medicine is key to balancing hormone levels through individualized lifestyle changes and sometimes targeted nutritional supplementation or medications, such as hormone replacement therapy (HRT).1

Medical conditions and medications: 

Medical conditions may also be the culprit for some individuals’ hair loss; these conditions may include infections such as ringworm, conditions with mental health underpinnings (e.g., trichotillomania, a disorder involving recurrent, irresistible urges to pull out body hair), and a relatively common condition called alopecia areata.1,7 The latter has a lifetime incidence of 2% globally and is an immune-mediated condition that creates smooth, round patches of hair loss on the scalp or body; characterized by unpredictability, spontaneous regrowth as well as possible relapse periods.6

Identifying and treating the root causes of the medical condition can lead to hair regrowth, so it is prudent to seek out clinician experts who know how to utilize a Functional Medicine lens. In some cases, medications used to treat other health issues can induce hair loss as a side effect; these might include medications used for the treatment of cancer, arthritis, depression, heart problems, gout, and high blood pressure.1


The physiologic effects of stress are not limited to specific organs like the brain or heart. No, stress impacts whole body health, including increasing the risk of hair loss through various mechanisms, one of those being the pro-inflammatory milieu (i.e., hormones, cytokines, etc.) of stress in the body.10 In recent years, the concept of a “brain-skin” connection has taken hold as a way to understand how stress may influence difficult-to-treat skin disorders such as psoriasis, atopic dermatitis, and urticaria, as well as its effect on hair loss.11

In particular, it is thought that, “neurohormones, neurotransmitters, and cytokines, released during a stress response may also significantly influence the hair cycle.”11 The growth of hair, the hair shaft production, and hair pigmentation, along with various other hair characteristics, may be impacted by the production of these stress-related molecules.12 If hair loss is considered to be stress-related (which may be a possible underlying factor in Telogen effluvium, alopecia areata, trichotillomania, and hormone-related hair loss), a wide range of mind-body, naturopathic, and Functional Medicine approaches may be useful.13

Nutritional deficits: 

In some situations, sudden weight loss or protein deficiency can lead to hair loss.2 Additionally, certain nutritional deficiencies can also exacerbate hair thinning and loss. These include: iron, niacin, fatty acids, selenium, and zinc; conversely, excess intake of vitamins E and A may increase risk of hair loss.2 Although biotin (vitamin B7) is anecdotally thought to be useful for combating hair loss, available published research indicates that biotin supplementation may only yield helpful hair effects if a gross biotin deficiency (relatively rare) or hair syndrome (e.g., uncombable hair syndrome) exist.14-15 Healthcare practitioners should use lab testing and physical exams to assess for nutritional insufficiencies or deficiencies, so a dietary plan and supplementation recommendations can be individualized and effective.

Beyond the above common reasons for hair loss, the following are also potential causes: radiation treatments, excessive hair styling, and certain types of hair treatments.

In summary, hair loss, although common, does not have to be permanent in all cases. Working with a Functional Medicine provider to determine the root causes of the hair loss is the first and best step in understanding the “why” of a patient’s hair concern and the “how” of the personalized treatment.


  1. Mayo Clinic. Hair Loss. https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926. Accessed January 11, 2019.
  2. Guo EL et al. Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatol Pract Concept. 2017;7(1): 1–10.
  3. NIH. Androgenetic alopecia. https://ghr.nlm.nih.gov/condition/androgenetic-alopecia. Accessed January 14, 2019.
  4. Hagenaars S et al. Genetic predication of male pattern baldness. PLoS Genet 2017;13(2):e1006594.
  5. NIH Genetics Home Reference. AR gene. https://ghr.nlm.nih.gov/gene/AR. Accessed January 16, 2019.
  6. Villasante Fricke AC et al. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol. 2015;8:397-403.
  7. American Academy of Dermatology. Hair loss. https://www.aad.org/public/diseases/hair-and-scalp-problems/hair-loss. Accessed January 14, 2019.
  8. US Pharmacists. Treatment options for androgenetic alopecia. https://www.uspharmacist.com/article/treatment-options-for-androgenetic-alopecia. Accessed January 14, 2019.
  9. Hosking AM et al. Complementary and alternative treatments for alopecia: a comprehensive review. Skin Appendage Disord. 2018. doi: 10.1159/00049203.5
  10. Hadshiew IM et al. Burden of hair loss: stress and the underestimated psychosocial impact of telogen effluvium and androgenetic alopecia. J Invest Dermatol. 2004;123(3):455-457.
  11. Botchkarev V. Stress and the hair follicle: exploring the connections. Am J Pathol. 2003;162(3):709–712.
  12. Paus R. Exploring the “brain-skin connection”: leads and lessons from the hair follicle. Curr Res Transl Med. 2016;64(4):207-214.
  13. Mayo Clinic. Stress management. https://www.mayoclinic.org/healthy-lifestyle/stress-management/expert-answers/stress-and-hair-loss/faq-20057820. Accessed January 16, 2019.
  14. Trüeb RM. Serum biotin levels in women complaining of hair loss. Int J Trichology. 2016;8(2):73-77.
  15. NIH. Biotin fact sheet for health professionals. https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/. Accessed January 16, 2019.

Your Mom Was Right – Eat Your Beets, They’re Good for Your Heart

By Bianca Garilli, ND

From Metagenics Institute

I have a patient who doesn’t like vegetables. In fact, this person is also not a fan of water (sans flavoring), exercise, nor high fiber foods such as legumes. This scenario is, in many ways, a perfect setup for a number of lifestyle-related chronic diseases, including hypertension. This patient has been on a cocktail of medications for many years but expressed to me that they’d like reduce the list. So, it was with great excitement that I recently shared emerging research on a natural, food-based approach for reducing blood pressure with this individual.

But, first, a little science background. Nitric oxide or NO, is an important signaling molecule in humans and is required for a large number of reactions and biochemical pathways in the body. NO can be made by the body (endogenously) through various, intricate enzymatic pathways and also through non-enzymatic pathways which require precursor nitrates and nitrites.1 One of the best sources of nitrates is the diet; beetroot and leafy greens such as arugula and spinach being some of the highest sources of dietary nitrates.1 After consumption, the dietary nitrate molecules are metabolized by oral bacteria into nitrites which are then endogenously transformed into the cardioprotective NO molecule.2-3

As noted above, NO plays a critical role in cardiovascular health. For example, low levels of NO in the body can lead to various pathologies, most notably endothelial dysfunction which contributes to hypertension and atherosclerosis; low NO has also been found to play a role in diabetes and hypercholesterolemia.1

In contrast, healthy levels of NO in the body support vascular tone, healthy blood flow, leukocyte adhesion, and platelet aggregation.Consuming food-based nitrates on a routine basis, then, would seem to be a logical next step for those desiring to prevent or treat NO deficiency-related disease processes. And, in fact, that logic is backed by science, which is the exciting new research I was hoping to share with the unnamed individual mentioned earlier.

A recent study published in Nutrition Reviews presents a systematic review and meta-analysis including 23 studies that measured blood pressure, endothelial function, arterial stiffness, platelet aggregation, and/or blood lipid outcomes in response to oral inorganic nitrate/nitrite intake.4 The analyses demonstrated that inorganic nitrate intake significantly reduced resting blood pressure, improved endothelial function (measured as flow-mediated dilatation), arterial stiffness, and platelet aggregation.4

Many of the studies in this review, utilized beets and beetroot juice as their sources for nitrates in their research. I don’t know about you, but my mother always made sure I ate my beets. These colorful root vegetables have leaves that are also edible and are classified in the Amaranthaceae family, the same family as quinoa, spinach, and lamb’s quarters (AKA wild spinach).5

One of the beetroot studies was a double-blind, placebo-controlled clinical trial that randomized 68 hypertensive individuals 18-85 years of age to one of two groups: 250 mL/day of beetroot juice or the “placebo”250 mL/day of nitrate-free beetroot juice for 4 weeks.6 Participants consumed their respective drinks daily for 4 weeks; this was preceded by a 2-week run-in period followed by a 2-week wash-out period. The trial found that daily supplementation with dietary nitrate from beetroot juice was associated with a reduction in blood pressure: systolic ↓7.7-8.1mmHg; diastolic ↓2.4-5.2mmHg.6 Additionally, endothelial function improved by approximately 20% and there was a reduction in arterial stiffness by 0.59m/s.6

These clinical trial findings are in agreement with a review and meta-analysis7 that analyzed results from multiple studies investigating the therapeutic benefits of beetroot juice supplementation on blood pressure. This review found an overall reduction in systolic and diastolic blood pressure of 3.55 mmHg and 1.32 mmHg, respectively, and these reductions were significantly greater in the beetroot juice supplemented groups vs. control groups.7 This same publication also noted greater improvements in blood pressure with higher (500 mL/day) vs. lower (70-140 mL/day) beetroot juice doses or with longer periods of consumption (≥2 weeks vs. <2 weeks).7

So, as in every good story, there is a moral. First and foremost – listen to your parents. Next, make your plate colorful and eat your vegetables, every day and lots of them. Finally, incorporate beets and other high-nitrate foods such as spinach and arugula into your healthful diet.


  1. Luiking YC et al. Regulation of nitric oxide production in health and disease. Curr Opin Clin Nutr Metab Care. 2010; 13(1): 97–104.
  2. Hobbs DA et al. Blood pressure-lowering effects of beetroot juice and novel beetroot-enriched bread products in normotensive male subjects. Br J Nutr. 2012;108(11):2066-74.
  3. Khatri J et al. It is rocket science – why dietary nitrate is hard to “beet”! Part I: twists and turns in the realization of the nitrate-nitrite-NO pathway. Br J Clin Pharmacol. 2017;83(1):129–139.
  4. Jackson JK et al. The role of inorganic nitrate and nitrite in cardiovascular disease risk factors: a systematic review and meta-analysis of human evidence. Nutr Rev. 2018;76(5):348-371.
  5. Encyclopedia Brittanica. Amaranthaceae. https://www.britannica.com/plant/Amaranthaceae. Accessed July 26, 2018.
  6. Vikas K et al. Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study. Hypertension. 2015;65(2):320–327.
  7. Bahadoran Z et al. The nitrate-independent blood pressure-lowering effect of beetroot juice: a systematic review and meta-analysis. Adv Nutr. 2017;8(6):830-838.

3 Reasons Lack of Sleep May Cause Weight Gain

From Metagenics Institute

If you’re trying to maintain a healthy weight, counting sheep may be as important as counting the carbs on your plate or weight repetitions at the gym. Because, while physical activity and a balanced diet are key factors, sleep may be the most overlooked aspect of your weight management plan.

Can you sleep your way to your dream body? Perhaps not. But if you are sleep deprived, more sleep may help you reach your weight goals. Here’s what you need to know about the sleep-weight connection.

Are you sleep deprived?

The National Sleep Foundation recommends seven to nine hours of sleep per night for adults 24-64, slightly more for younger adults and a bit less for those older.1 But due to electronic gadget lights, chronic stress, habitual caffeine, shift-work, and many other reasons, few folks get their target rack time. In fact, according to the Centers for Disease Control and Prevention (CDC), insufficient sleep is a public health problem2 with serious concerns for our productivity, safety, and health—including your waistline.

It’s not just you

If you’re sleep deprived and find yourself battling the bulge, you’re in good company. Studies have found consistency in the sleep-weight connection; sleep deficiency is linked to weight gain. The largest study of its kind involved over 200 participants and simulated a sleep-restricted workweek. It compared the effects of restricting sleep to only four hours per night compared to unrestricted sleep, up to ten hours per night.3 After only five days, the sleep-restricted subjects had gained about 2 pounds. In contrast, the control group, allowed to sleep for up to 10 hours a night, gained virtually no weight.

If sleep restriction can cause you to gain two pounds in just five days, what can happen on the scale long-term?

A lot, according to women tracked for 16 years in The Nurses’ Health Study. Women reporting six hours of sleep per night were 12% more likely to gain at least 30 pounds during the study compared to the women who slept seven hours per night. But those women who were even more sleep deprived, reporting no more than five hours per night, were 28% more likely to gain at least 30 pounds during that same period!Apparently, with the sleep-weight connection, every hour counts.

How does less sleep = less svelte?

There are several underlying factors behind the sleep-weight connection. But a common thread is our own chemistry, which almost seems to revolt when restorative sleep is intentionally or unintentionally withheld. It’s you against them—and it’s not a fair fight.

Getting to know your hunger chemistry

There’s more than your sensation of fullness and stomach-brain communication involved. Rather, when it comes to hunger regulation and sleep, we have several chemical messengers at play. And when it gets complicated between you and the sandman, those messengers are not on your side. So get to know them:

  • Ghrelin: When ghrelin, known as the “hunger hormone,” is released from the stomach, it sends your brain a “feed me” signal. It signals not only when to eat, but also when to switch from burning calories to storing them as fat. Ghrelin naturally decreases after a meal and remains lower while you sleep, when caloric needs are less. But less sleep means more ghrelin.
  • Leptin: The opposite of ghrelin, leptin, is known as the “satiety hormone,” as it plays a crucial role in appetite and weight control. Released from fat cells, leptin crosses the blood-brain barrier and signals, ‘‘We’re good here. Put the fork down.” It also stimulates fat burning to create energy. Leptin levels naturally increase after a meal and remain elevated while you sleep, until you awaken and your metabolism increases. But less sleep means less leptin. Making things even trickier, sometimes leptin is secreted, but the brain’s not getting its signals. Think boy who cried wolf. This situation, known as “leptin resistance” can mean there is an underlying insulin resistance, a sign of disordered blood sugar metabolism, which puts you at risk for obesity and metabolic syndrome. While research on how to reverse leptin resistance is limited, animal studies show that an unbalanced diet can cause leptin resistance.5 So a dietary approach to reducing the underlying insulin resistance is a logical start.

As you can see, proper balance of ghrelin and leptin is very sleep-dependent. And for the caveman, perhaps these hormones were key to survival during the shorter, sleep-heavy but food-poor days of winter. They also played a part in the ability to capitalize on the longer, lighter sleep and more food-abundant days the rest of the year.

Today, our sleep-deprived bodies are prone to having too much ghrelin and not enough leptin. The result is that the body doesn’t feel satiated, thinks it’s hungry, and needs more calories—and squirrels away those calories for the long winter. In short, ghrelin and leptin kept the caveman alive, but they may be making you heavy.

  • Endocannabinoids: “It’s 1 AM, and I’m craving a salad,” said no one ever. If you’ve ever experienced sleepiness munchies, blame it on endocannabinoids. Sound vaguely familiar? Endocannanbinoids are the endogenous version of the cannabinoids in marijuana—our bodies can generate a very close facsimile of the previously illegal (in some states) substance. Endocannabinoids bind to the same receptors in the brain, fat cells, muscles, and elsewhere, causing a similar appetite-inducing effect as cannabis.6 Further, the endocannabinoid system interacts with your dopamine and opioid pathways, driving not just hunger, but according to some studies cravings for high-carb and high-fat.7 You want cookies. Now. Resistance is pretty much futile.

What to do?

That depends. There are two main reasons behind sleep deprivation. Either you have a sleep hygiene issue (trouble falling asleep or staying asleep), or you have a scheduling issue, in that your lifestyle is interfering with adequate sleep.

For sleep hygiene issues, the typical recommendations always merit consideration: limiting caffeine, avoiding blue light before bed, creating a cool and dark environment, etc. But, when you have a scheduling challenge, getting adequate sleep requires some lifestyle restructuring. It’s worth the time to re-engineer your schedule to slowly go to bed earlier or rise later to increase your sleep time. But in the meantime, can you catch up on sleep on the weekends?

Weekend catch-up sleep: is it a real thing?

Of course, you can get extra sleep on the weekend. But can it potentially reverse your Monday-Friday sleep deprivation? Perhaps. In a study of over 2,000 people participants, those who slept longer on the weekends, nearly two hours longer on average, had a significantly lower body mass index (BMI) than those who didn’t. Further, it appears that the sleep: BMI relationship was dose-dependent in that every extra hour of weekend catch-up sleep was associated with a significantly lower body mass.8 So catch-up sleep can indeed be a good strategy. That is, if your overall average sleep for the week puts you out of the red and into the black, as in you’ve paid back your sleep debt.

Sleep more. Weigh less. Not convinced? Sleep on it…


  1. National Sleep Foundation. National Sleep Foundation Recommends New Sleep Time. https://sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times. Accessed July 19, 2017.
  2. CDC. Insufficient sleep is a public health problem. https://www.cdc.gov/features/dssleep/index.html#References. Accessed July 19, 2017.
  3. Spaeth AM et al. Effects of experimental sleep restriction on weight gain, caloric intake, and meal timing in healthy adults. Sleep. 2013;36(7):981-990.
  4. Patel SR et al. Association between reduced sleep and weight gain in women. Am J Epidemiol. 2006;164(10):947-954.
  5. Vasselli JR et al. Dietary components in the development of leptin resistance. Adv Nutr. 2013;4(2): 164-175.
  6. Hanlon EC et al. Sleep restriction enhances the daily rhythm of circulating levels of endocannabinoid 2-arachidonoylglycerol. Sleep. 2016;39(3):653–664.
  7. De Luca MA et al. Cannabinoid facilitation of behavioral and biochemical hedonic taste responses. Neuropharmacology. 2011;63(1):161–8.
  8. Im HJ et al. Association between weekend catch-up sleep and lower body mass: population-based study. Sleep. 2017;40(7):zsx089.

Vitamin D: More Important than Ever

Vitamin D has always been integral to a healthy diet, but recent evidence suggests it may have a critical role in fighting COVID-19. According to new research, people with low vitamin D levels upon hospital admission for COVID-19 have an almost quadrupled chance of dying.[1]

Vitamin D’s role in fighting COVID-19 is only beginning to be explored, but this vitamin already boasts a host of health benefits. It promotes healthy bone growth and can, according to medical research cited by Harvard University, even reduce cancer cell growth, help fight infections and reduce inflammation.[2]

Do You Get Enough Vitamin D?

So, how can you get enough vitamin D in your diet? Let’s explore options that provide good amounts of this important nutrient.

Fish contain more vitamin D than any other food type, according to the U.S. Food and Drug Administration (FDA).[3] That’s not all, though — fish also are a stellar source of protein, omega-3 fats and multiple minerals. Be careful, however, to follow FDA advisories about fish with high amounts of mercury.

Eggs are another source of vitamin D, according to the Centers for Disease Control and Prevention (CDC).[4] Although they contain less vitamin D than fish, egg yolks nonetheless have a small amount of vitamin D, according to the National Institutes of Health (NIH).[5] Eggs also are a good source of phosphorous, calcium and potassium.[5]

Although fish are among the few foods with a naturally high vitamin D content, other foods and drinks can be enhanced — or, fortified — to contain more vitamin D. Milk, for example, can be fortified with vitamin D. [4] For those avoiding animal products, fortified cereals and juices can provide a good alternative.

While food can provide varying amounts of vitamin D, it’s ultimately difficult to get enough from food alone. In fact, most people should take vitamin D supplements to get enough in their diet, according to Harvard University.[2] Supplements come in many shapes and sizes, so choose wisely!

So, do you get enough vitamin D in your diet? With the rise of COVID-19, it might be more important than ever. Consult with your doctor, maintain a healthy diet and experience the wonders of vitamin D for yourself!

You can order vitamin D through Metagenics, our trusted supplier of nutraceuticals and supplements.


  1. https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa252/6000689
  2. https://www.hsph.harvard.edu/nutritionsource/vitamin-d/
  3. https://www.fda.gov/food/consumers/advice-about-eating-fish
  4. https://www.cdc.gov/nutrition/infantandtoddlernutrition/vitamins-minerals/vitamin-d.html
  5. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/