SIBO vs. IBS: A Physician’s Guide to the Root Cause of Your Gut Symptoms
As many as 40 million Americans live with irritable bowel syndrome, and for decades, the medical community treated it as a dead end. Patients came in with bloating, cramping, and unpredictable bowel habits. They endured test after test, and when the results came back normal, they were told to manage their symptoms and move on.
Too often, especially for the two-thirds of IBS sufferers who are women, the diagnosis came with a dismissive explanation: “You’re just anxious.”
I’ve seen this pattern play out with patients here at Banner Peak Health. They arrive frustrated, sometimes after years of symptom management that never addressed the real problem.
IBS isn’t the problem itself. It’s a label we’ve placed on a constellation of gut symptoms that almost always has a deeper, treatable cause.
About 60% of the time, that cause is SIBO, small bowel bacterial overgrowth. If you’re struggling to understand SIBO vs. IBS, you’re asking the right question.
What Is IBS (and Why Has It Been So Misunderstood)?
IBS, or irritable bowel syndrome, has long been a diagnosis of exclusion. A patient reports abdominal pain, bloating that worsens throughout the day, alternating diarrhea and constipation, and cramping with bowel movements.
The gastroenterologist runs blood work, imaging, and endoscopy. When those tests come back clean, the patient receives the IBS label.
The Rome criteria, a symptom-based framework, have been used to formally diagnose IBS through several iterations. Gastroenterologists are moving away from this framework, though, and toward a more investigative approach that searches for the condition behind the symptoms.
For too long, the standard of care was limited to treating symptoms with motility agents, anti-diarrheal medications, or antidepressants for pain. These medications addressed what a patient felt, not why they felt it. If you’ve been told your bloodwork looks normal and handed a prescription for your symptoms, you’re not alone.
What Is SIBO?
SIBO stands for “small intestinal bacterial overgrowth,” and it’s the root cause behind a majority of IBS cases.
In a healthy gut, a diverse population of bacteria lives in balance within the small intestine. This microbiome, as we call it, produces hormones, regulates inflammation, and contributes to immune function.
Certain bacterial populations even produce GLP-1, the same hormone that GLP-1 agonist medications mimic for weight loss and blood sugar control. A healthy microbiome depends on diversity and proper ratios of different bacterial species.
SIBO occurs when the diversity in the gut microbiome breaks down. Bacteria that belong in normal quantities begin to overgrow, like weeds overtaking a garden. These overgrown populations produce excess gas, create persistent inflammation, and damage the gut’s mucosal barrier. Once that barrier weakens, substances leak through the intestinal wall and trigger immune responses that worsen the cycle.
The bacteria in our gut communicate with each other through chemical messengers. When the wrong populations dominate, these signals shift toward inflammation and immune dysfunction rather than the hormonal and metabolic processes that keep us healthy.
How Food Poisoning Leads to SIBO and IBS
The connection between SIBO and IBS often traces back to food poisoning.
A patient can get gastroenteritis from a virus, a bacterial infection, or contaminated food. The bacteria (most commonly Campylobacter) release a toxin called cytolethal distending toxin B, or CdtB. The immune system mounts a response against this toxin, which is appropriate.
The problem is that CdtB’s surface looks remarkably similar to a human protein called vinculin. Vinculin controls motility and pain sensation in the gut. Once the immune system creates antibodies against CdtB, those antibodies cross-react with vinculin. The nerves that regulate normal bowel movement are now under attack from the patient’s own immune response.
This is the mechanism through which food poisoning can cause SIBO and, through SIBO, can cause IBS. A 2017 meta-analysis found that one in seven people who experience bacterial gastroenteritis go on to develop IBS.
The California Department of Public Health estimates about 200,000 Californians contract Campylobacter infections each year. It’s one of the state’s most common foodborne illnesses. Every one of those infections carries the potential to trigger this cascade.
A patient might get food poisoning on a trip to Mexico at 18 and spend the next 12 years dealing with unexplained gut symptoms and digestive issues before anyone connects the dots.
Symptoms of SIBO vs. IBS: Why They Overlap
Symptoms of SIBO vs. IBS look identical: IBS is the symptom picture, and SIBO is often the condition producing it. Bloating, gas, abdominal pain, diarrhea, constipation, and cramping appear in both diagnoses. Patients frequently report a flat stomach in the morning that becomes distended and uncomfortable by evening.
Distinguishing SIBO from IBS based on symptoms alone isn’t practical. The overlap is too complete. Instead, we test for bacterial overgrowth.
Different subtypes of SIBO produce different symptom patterns. Methanogenic SIBO, for instance, tends toward constipation, and hydrogen-dominant SIBO more commonly presents with diarrhea. Identifying the specific subtype allows us to tailor treatment to each patient based on the type of bacterial overgrowth involved.
Diagnosing SIBO vs. IBS
The overgrown bacteria in the small intestine produce byproducts that convert into measurable gases. We exhale these gases, and breath tests can detect their levels. A positive breath test confirms bacterial overgrowth and helps identify the subtype of SIBO present.
Breath testing changes how we approach gut symptoms. Instead of guessing, we can measure directly and monitor treatment progress over time. If a patient responds to therapy, repeat testing confirms the bacterial overgrowth is resolving.
When a breath test comes back negative, we move to other investigations: gastric emptying studies to evaluate motility, food sensitivity testing, and a review of the patient’s medical history. Patients who’ve had their gallbladder removed, for example, sometimes develop bile acid diarrhea that mimics IBS symptoms. A thorough evaluation of each patient helps us identify these less common causes.
Treating SIBO vs. IBS: Beyond Symptom Management
Once we identify the root cause, treatment gets specific.
For confirmed SIBO, the antibiotic rifaximin targets the bacterial overgrowth. This antibiotic works primarily within the gut, which limits systemic side effects. Depending on the SIBO subtype, the treatment protocol may differ.
Low FODMAP diets have gained recognition for IBS relief, and the reason they work often traces back to SIBO. FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) feed the overgrown bacteria. Restricting these foods starves the excess bacterial populations and reduces gas, bloating, and pain.
After a restriction period, we gradually reintroduce foods to identify which specific FODMAPs a patient tolerates.
The advantage of knowing the root cause is precision. We can combine antibiotic therapy with dietary changes, monitor bacterial levels with retesting, and adjust the approach based on the data. Compare that to the old model: take this medication for your pain, eat less fiber, and hope for the best.
At Banner Peak Health, we prefer to find and fix the cause rather than mask the symptoms.
Other IBS Causes Outside of SIBO
SIBO accounts for about 60% of IBS cases. The remaining 40% have other identifiable causes.
Bile acid diarrhea affects patients whose digestive systems produce or manage bile acids poorly, especially those who’ve had gallbladder surgery. The excess bile irritates the bowel lining and produces symptoms that look identical to IBS.
Food allergies and intolerances can produce the same bloating, cramping, and irregular bowel patterns. These are distinct from SIBO and require different testing and treatment approaches. A careful dietary evaluation can identify triggers that standard IBS protocols overlook.
The gut-brain axis and stress response play a real role in bowel function. Chronic stress alters gut motility, increases visceral sensitivity, and can shift the composition of the microbiome. Stress doesn’t cause IBS in the way patients were told for years (“It’s all in your head”), but it can contribute to the same downstream effects: slowed motility, bacterial backup, and overgrowth.
Depression and anxiety affect the parasympathetic nervous system, which controls intestinal movement. Reduced motility allows bacteria to accumulate and create the conditions for SIBO.
The relationship is bidirectional. SIBO can cause IBS symptoms through bacterial overgrowth and inflammation. And IBS can cause SIBO when dysfunctional motility patterns (slowed gut movement, stress responses, impaired clearing mechanisms) allow bacteria to accumulate.
The mental health connection is real and valid, even if previous generations of physicians used it as a dismissal rather than a starting point for investigation.
Today’s Takeaways
IBS is not a life sentence. It’s not all in your head. It’s not anxiety manifesting as stomach pain. It’s a real condition with identifiable root causes, and those causes can be found and addressed.
When patients ask about SIBO or IBS, the answer is often both: IBS symptoms almost always point to an underlying condition we can test for. Whether the answer is SIBO, bile acid dysfunction, food sensitivities, or motility issues related to the gut-brain connection, the distinction between SIBO vs. IBS matters less than finding the cause.
You deserve answers, not decades of frustration. If you’ve been told your tests are normal and handed prescriptions that mask your symptoms, consider whether anyone has actually tested you for SIBO or other treatable causes.
At Banner Peak Health, that’s where we start.
The Art of Ageless Longevity: A Physician’s Guide to Building a Resilient Body
David Bowie once said, “Aging is an extraordinary process where you become the person you always should have been.”
I love that quote. It reframes aging as an evolution rather than a decline. And it stands in stark contrast to the message most of us receive from the beauty and wellness industry, where “ageless” means looking 35 at 55, and “anti-aging” implies we’re fighting a war we’re destined to lose.
As a physician, I define agelessness differently. It’s not about face creams, peptides, or the next miracle drug. It’s about resilience: the body’s capacity to absorb a stressor and return to its natural equilibrium state, or even adapt upward from it.
What Aging Looks Like at the Cellular Level
Aging is a declining ability to return to baseline after a stressor.
In your 20s, you stayed up late, ate junk food, drank too much without consequence, exercised on and off, caught colds, and bounced back within a day or two. Your body handled neurologic stressors (poor sleep, alcohol), metabolic stressors (junk food), cardiovascular stressors (weekend warrior sprints), and immune stressors (infections) with speed, precision, and proportionality.
We’ve all felt the change: “I used to be able to do this and feel fine the next day!” That’s aging: the loss of adaptability, not the number on your birthday card.
At the cellular level, researchers such as Carlos Lopez-Otin have cataloged the hallmarks of this process: genomic instability, telomere attrition, mitochondrial dysfunction, cellular senescence, and chronic inflammation. Every one of these hallmarks traces back to the cell’s declining ability to respond, repair, and restore.
Senescent cells (cells the body needs to clear out) aren’t “old.” They’re stress-damaged cells locked in a permanent damage signal polluting the surrounding tissue.
This is how chronic inflammation begins.
The Fire Pit: How Inflammation Becomes Chronic
I picture it like a campfire.
Your immune system mounts a fire to burn off damaged or diseased cells, the same way you’d burn a pile of dead leaves. That fire is inflammation, and it’s a normal, healthy response. The problem arises when the fire isn’t contained.
The rocks around the fire pit are the behaviors keeping inflammation in check: Zone 2 cardio training, resistance training for longevity, quality sleep and recovery, glucose stability and monitoring, mitochondrial health, community and social connection, and real, unprocessed food.
When gaps appear between those rocks, bits of the fire escape. Small embers of inflammation travel to other parts of the body and ignite low-grade, chronic fires. Over time, those fires spread and cause disease in tissues and organs never part of the original immune response.
A resilient body adapts. And the way we build adaptability is by maintaining every rock around that fire pit.
Measuring Resilience: VO2 Max, HRV, and Glucose Regulation
If resilience is the goal, we need ways to measure it. Three biomarkers give us the clearest picture of how well your body bounces back from stress.
VO2 max and recovery time measure oxygen delivery at peak effort and, more to the point, how long it takes to recover. It’s the single strongest predictor of longevity we have.
Heart rate variability by age reflects your autonomic nervous system’s ability to oscillate between states. A high HRV means your nervous system responds and recovers with speed. A low HRV signals a rigid, non-adaptive system.
Glucose regulation tracks how well your body processes fuel. After a meal, blood sugar spikes are normal. The question is how long it takes to return to baseline: hours or minutes?
That recovery speed tells us a lot about metabolic resilience. These aren’t vanity metrics; they’re direct measurements of your body’s ability to absorb a stressor and snap back.
Parasympathetic Rehab: Training Your Nervous System With Controlled Stress
A concept I discuss with patients is “parasympathetic rehab,” which ties back to vagus nerve stimulation techniques and what’s called hormesis: the application of controlled, recoverable stress as training.
Your sympathetic nervous system (fight or flight) mobilizes the body under stress. Your parasympathetic nervous system (rest and restore) applies the brakes and initiates recovery. The goal is to create a better, more dynamic balance between the two.
As we age, sympathetic tone increases and parasympathetic tone decreases. Chronic stress, poor sleep, and sedentary behavior amplify the imbalance.
Hormetic stressors like cold plunging and cold exposure, heat exposure, belly breathing and breath work, and fasting can help retrain the parasympathetic system. You apply a controlled stressor, then recover from it. Over time, your nervous system becomes more adaptable, more responsive, and more resilient.
But these hormetic tools aren’t replacements for the fundamentals. Don’t skip straight to cold plunges if you’re sleeping five hours a night and haven’t picked up a weight in years.
The Foundations: Exercise, Nutrition, and Sleep
Exercise is the most potent longevity drug we have. No pill, supplement, or therapy comes close.
Zone 2 cardio (sustained effort at a conversational pace) trains your mitochondria to be more efficient in both heart and skeletal muscle. This is the aerobic base every other form of fitness depends on.
Resistance training preserves muscle mass across your lifespan and is our primary defense against the metabolic fragility of aging. Lean mass protects us from falls, fractures, metabolic syndrome, and loss of independence.
Nutrition goes beyond calorie counting. Every macronutrient, phytochemical, and meal timing pattern sends signals to the pathways governing repair and stress response. Real, unprocessed whole food is the foundation.
Sleep and athletic recovery recalibrate us. Growth hormone secretion, cortisol regulation, and the glymphatic system (the brain’s waste-clearing mechanism) all depend on adequate sleep architecture. It’s the single most undervalued recovery tool in medicine.
Healthspan Over Lifespan: Compressing Morbidity
Modern medicine excels at managing crises and acute disease.
We can prevent death from cancer, heart disease, and infection. But our current system doesn’t account for the slow erosion of resilience, leaving people spending their final decades with declining function, stacks of medication, and diminished independence.
The goal of longevity medicine is to compress morbidity: to make your last decade look more like your sixth decade than a slow decline from your eighth.
The metrics that matter aren’t cholesterol and blood pressure alone. They’re VO2 max, grip strength, muscle mass and body composition, sleep architecture, and HRV.
The conversation starts with a simple question: What do you want to be able to do when you’re 75? Hike with your grandchildren? Travel on your own? What would you like your life to look like when you are in your eighth or ninth decade?
That answer shapes the strategy. At Banner Peak Health, we work backward from those goals to build a plan that protects your healthspan, not just your lifespan.
Longevity Science: Separating Signal From Noise
A lot of misinformation circulates in the longevity space, driven by a massive emotional investment. Everyone wants to live longer and better. That desire creates commercial incentives, and those incentives can distort the science.
Be skeptical and curious. Develop a relationship with evidence, not conclusions.
When a product or protocol claims to be “research-backed,” look at the actual research. A small trial in mice doesn’t validate a $200 supplement marketed to humans.
The gap between non-human trials, small pilot studies, and large-scale human evidence is enormous. Yet many claims leap across that gap without hesitation.
It comes down to signal versus noise. The signal (the part of longevity science supported by decades of consistent evidence) is exercise, sleep, nutrition, stress management, and social connection.
These aren’t glamorous. They don’t come in a bottle. But they work.
Today’s Takeaways
Build a body that recovers from stress quickly and precisely.
Start with the foundations: Zone 2 cardio, resistance training, real food, and quality sleep. Measure your resilience through VO2 max, heart rate variability, and glucose regulation. Once those foundations are solid, explore hormetic stressors to train your nervous system for greater adaptability.
Question every claim. Invest in the long game. A resilient body adapts.
At Banner Peak Health, we help our patients build resilience through data-driven, personalized health strategies. Contact our team today to learn more about optimizing your healthspan.
The Fasting-Mimicking Diet: Get the Benefits of Fasting Without the Hunger
About Our Guest Expert: Angela Stanford, MBA, RDN, is a registered dietitian, integrative nutritionist, and board-certified health and wellness coach. As the owner of Vital Nutrition and Wellness, Angela educates and empowers her clients with the tools to adopt healthier eating and lifestyle habits. Whether working with individuals or groups through coaching programs and worksite wellness programs, Angela inspires people to eat with confidence and take charge of their health.
Many of our patients want the benefits of fasting but find it too difficult to sustain. A traditional water-only fast (three or more days with no food) can trigger powerful cellular repair, but the hunger, fatigue, and disruption to daily life make it impractical for most people.
This has led to growing interest in the fasting-mimicking diet, a protocol designed to deliver the same cellular benefits with less restriction and discomfort.
What Is the Fasting-Mimicking Diet?
The USC Longevity Institute’s Valter Longo, PhD, developed the fasting-mimicking diet (FMD). Longo’s research focuses on cellular repair and longevity, and his research’s central question was, “Can we trigger the body’s fasting response without eliminating all food?”
The answer, based on his research, is yes. By controlling the composition and quantity of calories over a five-day period once a month (low protein, low carbohydrate, high in healthy fats), the FMD tricks the body into activating the same cellular repair pathways as a true water fast.
To understand why this works, it helps to understand what happens at the cellular level during fasting.
How the Fasting-Mimicking Diet Works: Catabolism, mTOR, and Autophagy
Our bodies shift between two states at all times:
- Anabolism is the building state: muscles grow, cells multiply, mitochondria generate energy, and fuel gets stored. Growth hormone, exercise, protein intake, and a protein called mTOR all drive anabolism.
- Catabolism is the opposite: conserving energy, cleaning up cellular waste, and building stress resistance. For the body to do its deepest repair work, it needs to shift into this catabolic state.
Fasting is one of the most effective ways to flip that switch. When calorie intake drops low enough for long enough, the body downregulates mTOR and activates a process called autophagy.
Think of your cell as a factory. Supplies come in, products go out, mitochondria generate power, and DNA directs operations. But if no one ever takes out the trash, the factory floor fills with debris: worn-out organelles, damaged proteins, and cellular waste.
The machinery can’t function at full capacity. Autophagy is the cleanup crew. During fasting, the cell redirects energy toward clearing accumulated waste, a process associated with slower aging, reduced inflammation, and protection against neurodegenerative disease.
A second benefit: During the refeeding phase after a fast, cells appear to use incoming nutrients with greater efficiency, which may stimulate immune renewal through stem cells. The science here is still emerging, but the early data look promising.
The third benefit, and the one with the strongest research behind it, is metabolic reset: reduced insulin resistance, less visceral fat and belly fat (shrinks the waistline), and improved metabolic markers across the board.
What Does the Research Say About the Fasting-Mimicking Diet?
The most notable FMD study appeared in 2017 in Science Translational Medicine. Longo conducted his earlier work in mice, but this study enrolled 100 human participants and tracked outcomes over three monthly cycles of the FMD protocol.
After three months, participants showed reduced fasting glucose, reduced insulin, lower IGF-1 (a growth factor linked to cellular proliferation and cancer risk), reduced visceral fat with preserved lean mass, and lower inflammatory markers like CRP.
The fasting-mimicking diet delivered its clearest results for participants who entered the study with existing metabolic risk factors, a pattern consistent with what we see in clinical practice. Ongoing trials are now exploring potential benefits for cardiovascular disease, autoimmune disease, and cancer therapy. These areas are still early-stage, but the metabolic evidence is solid.
The Fasting-Mimicking Diet Is a Tool, Not a Hack
Angela Stanford, our collaborating dietitian, puts it well: “For long-term change, there’s no hack. There’s science, and there’s protocol.”
The fasting-mimicking diet is a tool within a broader lifestyle strategy, not a five-day fix that lets you eat cheeseburgers the rest of the month. The protocol includes those five days of structured eating, and it’s designed to influence your habits over the other 25 days, too.
Angela sees this play out with patients at Banner Peak Health. After completing a round of FMD, people feel better, see improved lab results, and carry that momentum forward.
They start walking for their daily steps. They move their bedtime up. They sign up for a yoga class. The FMD becomes an entry point that triggers a cascade of positive changes.
This is one area where the fasting-mimicking diet differs from both intermittent fasting and extreme water fasts. True intermittent fasting, the alternate-day version (eat Monday, fast Tuesday, eat Wednesday, fast Thursday), is difficult to maintain alongside a modern work and family schedule. Long-term extreme caloric restriction tends to create a pendulum effect: severe restriction followed by overcorrection.
The fasting-mimicking diet sits in a more practical middle ground.
A deeper distinction between the fasting-mimicking diet and time-restricted eating: The cellular benefits of fasting (autophagy, in specific) don’t kick in until day two or three of sustained caloric restriction. A 16-hour daily fast may not reach that threshold. By eating again the next morning, you interrupt the catabolic shift before the cell’s cleanup mechanisms engage.
It’s like cleaning your house: You can tidy up every day (time-restricted eating), but a deep clean (the five-day FMD) clears out the accumulated mess in a way daily maintenance can’t. And once the house is clean, most people are more motivated to keep it that way.
The Fasting-Mimicking Diet Food List and Protocol Structure
The fasting-mimicking diet protocol calls for whole, plant-based foods eaten within a 12-hour window. The macronutrient breakdown targets low carbohydrates, around 10% protein, and a high proportion of high-quality fats. Hydration is a priority throughout.
The calorie structure breaks down like this: about 1,100 calories on day one, then 700 to 800 calories on days two through five. These numbers are starting points.
Angela emphasizes the need for individual fine-tuning, which is why working with a dietitian matters. A six-foot-two active man and a five-foot-one woman recovering from an injury need different calorie targets to hit the metabolic sweet spot.
A typical fasting-mimicking diet food list includes vegetable broths, nuts, avocado, low-glycemic fruits like berries, and salads with simple dressings (lemon juice, olive oil). The menu is limited, but most patients tolerate it well.
What about hunger? Angela reports most patients don’t complain. During the first cycle, some notice mild cold sensitivity and lower energy.
By the second and third cycles, patients are walking outdoors during their fast days and returning to yoga and other regular exercise. The body adapts.
The standard protocol is once a month for three consecutive months. After that, the frequency depends on individual goals and health status.
A healthy person might continue two to three times a year. Someone working to lower their hemoglobin A1C and blood sugar or reduce visceral fat around the belly might continue monthly under medical supervision.
One note on supplements and medications: The FMD alters your metabolic state. Consult your physician or dietitian before starting, as dosing for certain medications and supplements may need adjustment during the five-day window.
Who Is the Ideal Candidate for a Fasting-Mimicking Diet?
The fasting-mimicking diet is best suited for:
- People with metabolic syndrome, pre-diabetes, insulin resistance, or high triglycerides.
- People who are overweight, carry excess visceral fat, or have elevated cardiovascular risk markers like high CRP or blood pressure.
- Healthy adults pursuing longevity and healthspan optimization.
- Select individuals with autoimmune conditions (pilot data on MS, lupus, and inflammatory bowel disease are intriguing, though still preliminary).
The fasting-mimicking diet isn’t appropriate for:
- Pregnant or nursing women.
- Anyone with a history of eating disorders.
- Type 1 diabetics.
- Children or underweight individuals.
- Frail or elderly patients, type 2 diabetics on insulin or sulfonylureas, patients on warfarin, or those with severe kidney or liver disease.
- Cancer patients undergoing active treatment (emerging protocols may change this, but the evidence isn’t there yet).
Note: One population worth mentioning: patients considering GLP-1 medications like Ozempic for metabolic improvement. For people on the fence, the FMD offers a comparable tool with added lifestyle benefits, lower cost, and greater sustainability. It’s worth a conversation with your physician before committing to a medication when a dietary approach may accomplish similar goals.
Today’s Takeaways
The fasting-mimicking diet bridges the gap between the cellular benefits of a traditional fast and the practicality of a protocol most people can follow. It’s a five-day, physician- and dietitian-guided intervention that can improve metabolic markers, reduce inflammation, and serve as a catalyst for lasting lifestyle change.
But it isn’t a stand-alone fix. The FMD works best as part of a broader exercise and health strategy that includes:
- Sleep quality and architecture
- Zone 2 and resistance training
- Whole, unprocessed foods and mindful eating
- Stress management
If you’re interested in exploring whether the fasting-mimicking diet is right for you, don’t go at it alone. Get baseline labs and measurements first. Work with a physician and dietitian who can tailor the protocol to your body, track your progress, and adjust the plan based on real data.
The before-and-after numbers do more than measure outcomes; they build motivation for sustainable change.
At Banner Peak Health, we partner with registered dietitians like Angela Stanford to offer the FMD as part of our personalized preventive care. Contact us today to learn more.
How to “Prevent” Cancer: A Physician’s Guide to Reducing Your Cancer Risk
Can you prevent cancer? Not exactly.
I can’t promise you won’t get cancer. We all know someone who did everything right and still got the diagnosis.
But 40–50% of all cancers are preventable through lifestyle and environmental modifications. For certain cancers, that number climbs even higher. Quitting smoking can prevent 80% to 90% of lung cancers. Avoiding UV radiation can prevent 70% of skin cancers.
Learning how to prevent cancer means shifting the odds in your favor, not chasing guarantees.
You can’t change your genetics or early life exposures, but you can control what you do today. Focus on what’s within your power and let go of the rest.
Understanding Germline vs. Somatic Mutations
People often say, “Cancer doesn’t run in my family, so I’m safe.” That isn’t how cancer develops.
Germline mutations are the ones you’re born with. Having a germline mutation doesn’t mean you’ll inevitably develop cancer; it means you’re at higher risk for certain cancers. Only 5–10% of cancers come from these inherited mutations.
Somatic mutations occur after birth due to environmental exposures and lifestyle factors. UV light hits your skin a million times, damages the DNA in a cell, and that cell starts multiplying abnormally. That’s a somatic mutation, and that’s how most cancers develop.
This is why lifestyle and environmental factors matter for cancer prevention. Your genes are only one part of the story.
The Truth About “Cancer-Fighting” Foods and Supplements
The internet is full of silver bullets: cancer-fighting superfoods, miracle supplements, exotic plants from distant lands, etc. We’re all looking for an easy answer.
Can you prevent cancer with a single food, supplement, or detox? No. Preventing what you can requires sustained effort: don’t smoke, move your body, maintain a healthy weight, eat whole foods, limit alcohol, and see your doctor.
If you want to take supplements, focus on ones that support mitochondrial health: a B-complex vitamin with methylated folate, a quality fish oil, and possibly magnesium. That’s about it.
Why Cellular Health Is Central to Cancer Prevention
Let me explain the why behind these cancer-preventing recommendations. I’ve included some excerpts from my 11-year-old son’s biology project as a visual aid.
Your cells are tiny factories. The mitochondria generate energy. Your DNA contains the blueprint. When the blueprint gets damaged, cells can produce abnormal copies, and that’s how cancer begins.
As I stated above, only 5–10% of cancers are purely genetic. The rest come from environmental factors and lifestyle choices that damage your DNA over time.
The culprit is oxidative stress. Your body constantly produces reactive oxygen species (free radicals) that can interact directly with your DNA and cause mutations. Your cells have repair mechanisms, enzymes like superoxide dismutase and catalase, that clean up this damage. But when the damage overwhelms your cells’ capacity to repair, mutations accumulate.
Everything I’m about to recommend comes back to this principle: protect your DNA by reducing oxidative stress and supporting your cells’ natural repair mechanisms.
The Number One Way to Prevent Cancer
Don’t smoke. Or, if you smoke, quit.
This is probably the single most impactful action you can take to reduce your cancer risk.
How to Prevent Cancer Through Diet
Ultra-processed foods (classified as NOVA stage four) damage mitochondrial health. When your mitochondria can’t function properly, they can’t help your cells clear reactive oxygen species. The damage accumulates.
Here’s what works:
- Whole foods, whole grains, fruits, and vegetables form the foundation of a cancer-preventive diet.
- A good color spectrum on your plate provides a diverse array of phytonutrients.
- Fish provides omega-3 fatty acids, which help reduce inflammation.
- Green tea may stabilize ATP synthesis at the mitochondrial level.
- The Mediterranean diet has strong evidence supporting its role in cancer prevention.
Avoid burning your food. Charred meat and overheated oils create volatile organic compounds that increase oxidative stress. When frying, use oils with higher flash points, like peanut oil rather than olive oil.
Environmental Exposures That Increase Cancer Risk
Understanding how to prevent cancer means knowing which environmental factors damage your cells. Minimize exposure to these three categories.
Ionizing Radiation
Limit unnecessary X-rays and CAT scans. If you have a choice between a CAT scan and an MRI, choose the MRI when appropriate. Ionizing radiation directly disrupts DNA.
Endocrine Disruptors
Microplastics, PFAs, pesticides, and Teflon all cause oxidative stress and inflammation. These endocrine disruptors generate reactive oxygen species that damage DNA and cause mutations.
The plastics are already in our environment. We can’t undo that. But to stop certain preventable cancers, we can stop drinking from plastic water bottles and reduce our exposure where possible.
Air Pollution
California banned indoor wood-burning stoves for a good reason. Pay attention to spare-the-air days. Keep plants indoors that filter volatile organic compounds. Use a HEPA filter in your home, and monitor your indoor air quality.
How to Prevent Cancer With a Vaccine
The HPV vaccine prevents cervical cancer. The hepatitis B vaccine prevents liver cancer. These vaccines protect against viruses that cause cancer, so they’re a direct form of cancer prevention.
How to Prevent Skin Cancer
Wear sunscreen. But here’s the catch: many non-mineral sunscreens contain chemicals that get absorbed into your skin, potentially causing oxidative stress in other ways.
A compound called bemotrizinol is approved for use in sunscreen in other countries but not yet in the US. It doesn’t get absorbed into your skin. If you can find sunscreen with this ingredient, you’ll protect yourself from the sun without absorbing potentially cancer-causing chemicals.
How to Stop Cancer: Cut Down on Alcohol
Alcohol is an underappreciated cancer risk factor. Even moderate drinking increases the risk of breast, colorectal, and esophageal cancer. The relationship is dose-dependent: less is better than more, and none is better than some.
How to Prevent Cancer Through Physical Activity
Exercise has protective effects outside of weight control. It decreases insulin resistance, boosts your natural killer cells (which help remove abnormal cells that might become cancerous), and reduces inflammatory cytokines.
Maintain a Healthy Weight to Prevent Cancer
Excess fat causes hormonal abnormalities that can compromise your mitochondrial health. Much of this relates to cortisol, the stress hormone. Chronic stress has the same effect, elevating cortisol and damaging cellular function, potentially leading to cancer.
How to Know When a Cancer Symptom Warrants Concern
Social media and “Doctor Google” have created an epidemic of health anxiety. Type in “headache,” and you’ll find brain tumor listed as a possibility. This fear itself is harmful, as the anxiety elevates cortisol and damages the very mitochondria you’re trying to protect.
When you hear hoofbeats, look for horses, not zebras. Social media amplifies rare conditions far beyond their actual prevalence.
Use the four Ps to evaluate your symptoms:
- Persistent: A headache that comes and goes is different from one that never leaves and gets worse.
- Progressive: Is the symptom getting worse over time?
- Pattern-breaking: Is this different from what you’ve normally experienced in your body?
- Plus (red flags): Are there associated symptoms like unexplained weight loss, a new lump, or unexplained fevers?
Context matters. Feeling tired after a stressful week with poor sleep is different from feeling exhausted after a vacation when you’ve been resting well.
Don’t go down the rabbit hole at 2 a.m. If you’re worried about a symptom that may be indicative of cancer, write it down, schedule an appointment with your doctor, and go to bed. Staying up late researching rare diseases will only further damage your mitochondrial health.
Cancer Screenings: Early Detection Matters
Participate in standard cancer screenings based on your age and risk factors:
- Breast cancer screening begins at age 40
- Colorectal cancer screening begins at age 45, possibly earlier based on risk factors
- Cervical cancer screening frequency may decrease with HPV vaccination and improved testing
- Skin checks are especially important if you have many pigmented moles or a family history of melanoma
- Lung cancer screening applies to those with a smoking history
Consider genetic testing if you have a family history of cancer. And ask about cell-free DNA testing, which we offer at Banner Peak Health for cancers that are difficult to detect early.
How Not to Get Cancer: Focus on the Basics
Information overload is harmful. One day, coffee is good for you; the next day, it’s bad. This constant churn of conflicting advice adds stress, raises cortisol, and compromises your mitochondrial health.
When it comes to stopping preventable cancers, stick with the basics:
- Don’t smoke
- Move your body
- Maintain a healthy weight
- Eat more plants and whole foods
- Avoid ultra-processed foods
- Cut down on alcohol
- Get your screenings
- Build a strong relationship with your doctor
Think long term. Be kind to yourself when you slip up. One bad meal won’t cause cancer; sustained patterns over years will.
Set specific, achievable goals. Instead of “be more active,” try “walk for 10 minutes before lunch every day.” Small habits compound into big rewards.
Today’s Takeaways
You can’t guarantee you’ll stop cancer. But you can do everything within your power to prevent it.
Remember, your DNA is your body’s blueprint. If the blueprint gets damaged, the factory starts making defective products. Diet, exercise, and avoiding environmental toxins all protect that blueprint.
At Banner Peak Health, we help patients develop personalized strategies for how to prevent cancer. We offer genetic testing, cell-free DNA screening, and comprehensive guidance on lifestyle modifications. Schedule an appointment to discuss cancer prevention based on your individual risk factors and health history.
A Patient’s Guide to Statins for Cholesterol Treatment
High cholesterol is common — as is the question, “Do I need to take a statin?”
Despite their efficacy, statins get a bad rap. Cardiovascular disease remains the number one killer of Americans, even though it’s preventable. And still, my patients resist taking statins. I just don’t understand.
When we assess your risk for cardiovascular disease, we explore family history and other confounders, including smoking, high blood pressure, and diabetes. We can also perform a screening test to determine your coronary calcium score. This tells us whether you have calcified plaque in your arteries, indicating that cardiovascular disease is already present.
Beyond that, a MESA score can help us determine whether you’ll have a major heart event in the next 10 years.
Primary and Secondary Prevention
There are seven different statins available:
- Atorvastatin
- Fluvastatin
- Lovastatin
- Pitavastatin
- Pravastatin
- Rosuvastatin
- Simvastatin
Two (pravastatin and rosuvastatin) are more specific to the liver (hydrophilic), whereas the others are lipophilic and may cause more muscle-related side effects.
Statins work by blocking the enzyme that creates cholesterol. As the statins reduce the amount of LDL (low-density lipoproteins) in the blood, cholesterol and the amount of inflammation and plaque in the arteries also decrease.
Possible Challenges and Side Effects of Statins
The following are side effects or challenges patients may experience when taking statins:
- Muscle aches and pains: These occur in 5–20% of patients.
- Rhabdomyolysis: This rare muscle breakdown can increase the risk of kidney failure.
- Transient elevation in liver enzymes: Similar to an allergic reaction, this occurs in 10–15% of patients but is completely reversible upon stopping the medication. A doctor monitors the patients’ liver enzymes for signs of elevation during the initial course.
- Increased glucose intolerance or insulin resistance: This can be problematic for diabetics.
- Drug interactions: Patients must avoid certain medications while taking statins, especially atorvastatin and simvastatin.
Not All Symptoms Are Side Effects
Aches and pains are a side effect of statins, but they’re also a normal symptom of aging. Don’t blame the aging process on your medicine.
A patient of mine recently stopped taking a statin due to minor aches and pains, only to experience a major cardiac event a few days later and wind up hospitalized. Don’t make the same mistake.
If You Need a Change, What Can You Do?
If you’re convinced you need to stop taking statins, you have options. First, talk to your doctor.
Alternative Statins
If you react badly to a certain statin, you can probably try a different one. Most side effects are not class effects; you could take another statin and experience none of the same issues.
It’s just a matter of finding the one that’s right for you.
Alternative Medications
Of course, if statins just aren’t right for you, some alternatives to statins don’t have the same side effects. Consider:
- Ezetimibe: Tablets that reduce the amount of cholesterol absorbed from the food you eat
- PCSK9 inhibitors: Two FDA-approved injectables administered every two to four weeks
- Bempedoic acid: Targets the liver, so patients experience fewer muscle aches
Today’s Takeaways
Medications like statins are another reason to have a close, conversational relationship with your doctor. A health advocate who understands your disease risks supports you and keeps you accountable.
If you’re at risk for the poor health outcomes associated with high cholesterol, you should take some kind of medication. Cholesterol is nearly impossible to control with diet alone. Genetics influences about 75% of your cholesterol, while food only influences about 25%.
The good news is that medication is extremely effective, and your doctor is available to help you. The sooner you start, the better.
The ABCs of Dementia and Alzheimer’s Prevention
Many people still believe dementia and Alzheimer’s are genetic diseases beyond our control. That’s not the case anymore. We can do more to prevent these issues than we ever thought possible.
More than six million Americans have Alzheimer’s, and we expect that number to double by the year 2050. Additionally, an estimated 47 million Americans are in the pre-clinical stages of Alzheimer’s disease but have yet to experience any noticeable symptoms.
These pre-clinical stages involve changes in the brain that occur 20–30 years before signs of mild cognitive impairment (like saying “I can’t find my keys” and then finding them in the fridge, etc.).
Currently, researchers are trying to define stage one of Alzheimer’s, which is challenging because it’s subclinical (meaning people who don’t have symptoms are at risk). Stage two is mild cognitive impairment, and stage three is dementia/Alzheimer’s.
Published dementia/Alzheimer’s research focuses on stage three, but we’ve seen very few benefits from the billions of dollars spent. Although Big Pharma would love to make a mint from selling a “silver bullet” for Alzheimer’s, success remains elusive. The drugs on the market offer little relief to patients.
As in most things, we at Banner Peak Health take the road less traveled and prefer an approach focused on how to prevent dementia and Alzheimer’s pre-onset. Fortunately, science is catching up.
How to Prevent (or Delay) Dementia and Alzheimer’s
One-third of Alzheimer’s cases are preventable. We can delay the onset of, or improve, the remaining two-thirds, which we hope to do until we find a “silver bullet.” Unfortunately, a minority group will be diagnosed with Alzheimer’s regardless of their efforts.
Doctors like Richard Isaacson lead the way, but prevention isn’t as attractive as finding a cure. Because prevention relies mainly on lifestyle changes, there’s no product to sell and no money to make (unlike with a miracle pill).
Lifestyle changes are also difficult to track and isolate. However, through precision medicine, we’ve noticed certain impactful markers. Let’s review the ABCs of how to prevent dementia and Alzheimer’s.
A: Anthropometrics (Body Composition/Body Fat)
We’ve found that the waistline is inversely related to the size of the hippocampus (the part of the brain related to memory). So, as your belly grows, your hippocampus shrinks, damaging your memory.
To optimize your capacity for memory as you age, engage in more cardiovascular and fat-burning exercise. HIIT (high-intensity interval training) burns fat, and studies have demonstrated a relationship between HIIT and memory.
B: Biomarkers
Biological markers, or biomarkers, serve as early warning signs of poor health. These include:
- Cholesterol
- Nutritional markers
- Homocysteine — high levels are injurious to the brain
- B vitamins — cofactors to reactions that help the brain
- Metabolic syndrome
- Blood sugar
- Blood pressure — the SPRINT study demonstrated that patients with lower BP have less cognitive decline
- Lipids/ApoB — should be as low as possible to make sure there are no vascular issues
- Insulin resistance in brain cells — it’s suspected that brain insulin resistance may cause or contribute to Alzheimer’s, unofficially termed “type 3 diabetes”
All these factors are within your control. Discuss each with your doctor and decide which are of most concern for you and how to best optimize your health.
The APOE Gene
You get one copy of the APOE gene from each parent. This gene has different types: APOE e2, APOE e3, and APOE e4.
- APOE e2 may protect against Alzheimer’s disease, and about 5–10% of the population has it.
- APOE e3, the most common variety of this gene, doesn’t affect Alzheimer’s disease.
- APOE e4 increases the risk of Alzheimer’s disease and is associated with early onset. If you have two of these genes, one from each parent, your risk for Alzheimer’s increases 8x–12x (2–5% of the population).
Knowing your risk is essential; you can find out through genetic testing. The more you know, the more intentional you can be about specific strategies on how to prevent dementia and Alzheimer’s.
C: Cognitive Assessments and Activities
Neuro-psych tests take about three hours to complete and cover short-term memory, long-term memory, spatial abilities, language ability, and fluency. Each subset of the test examines different parts of the brain for dysfunction.
After the test, you may be asked to take it again to gauge whether you can improve or reverse some cognitive impairment. You may receive some cognitive exercises to practice beforehand.
Activities like learning a new language, learning a new instrument, or learning how to ride a bike can have tremendous cognitive benefits. Regularly challenge yourself with puzzles or games, and engage in new activities.
How to Prevent Dementia and Alzheimer’s: Your Plan
Each person’s prevention plan is different, but tracking the anthropometrics listed above is essential for everyone. Monitor them and work with your doctor to outline a strategy that works for you. Proactively working to prevent dementia and Alzheimer’s is reliant on precision medicine and open, honest communication.
We All Self-Medicate for Stress — What Are YOU Reaching For?
Fill in the blank: “Today was a hard day. I need ___.”
What do you reach for? Exercise? Family time? Comfort food? A glass of wine? Pills?
Stress affects us all. I see it hurting my patients, my family members, and myself. We shouldn’t be ashamed to reach for something that helps us cope, but we must know when we’re reaching for the wrong thing — when the coping mechanism makes matters worse.
Healthy Coping
Healthy coping mechanisms keep you in control of yourself and leave you prepared to address your source of stress.
Here are some excellent coping methods you can try:
Box Breathing
This breathing technique activates your parasympathetic nervous system and curbs your vagal response.
Breathe in four-second increments. Inhale, hold your breath, exhale, hold your breath, and repeat.
5-4-3-2-1 (Grounding)
This technique uses your senses to return you to the present.
Name five things you see, four things you feel, three things you hear, two things you smell, and one thing you taste.
This technique’s simplicity makes it a great option for kids.
Exercise
Use moderate exercise to release the excess adrenaline that stress generates.
Journaling
Journaling can help reduce stress, among other benefits. You can even use your journaling session to plan a way to address the source of your stress.
Take a Break From Technology and Lean on Others
Practice being present (i.e., not distracted) by focusing on your immediate surroundings and connecting with other people. It’s easier to be present when you’re with another person.
It can feel challenging to admit you’re struggling, but you’ll almost always feel better when you open up to someone else. If you don’t want to talk about it, it’s still beneficial to simply spend time with others.
Practice Gratitude and Perform Acts of Kindness
Instead of dwelling on your stress, develop a list of five things going well in your life.
Performing acts of kindness also makes you feel good. There is a chemical component here (endorphin release), but this particular chemical makes you feel better and puts you in a healthy frame of mind.
Unhealthy Coping
It’s perfectly normal to reach for unhealthy coping methods because they work... for a while. Unfortunately, the relief is temporary.
Young, healthy, driven professionals are especially prone to unhealthy coping mechanisms. They don’t notice the damage of unhealthy coping like an older, less healthy person would.
Alcohol and Other Substances
Alcohol and other substances often dull the pain of stress. Many people reach for these “solutions” because they work — but only for a short time. Then, they lead to larger problems, like addiction.
Overeating or Undereating
Eating too much or too little harms our bodies and doesn’t resolve stress. In fact, it creates more problems and additional stress.
Avoidance
Avoiding the root of your stress by burying yourself in something else (e.g., work, social media, television, etc.) is escapism. It’s not helpful, and it’s becoming a massive trend.
Social Withdrawal
Interacting with others almost always relieves our stress, and isolation almost always makes it worse.
Aggression or Aggravation Toward Others
Hurting the people closest to you won’t eliminate your stress. It’ll only make you feel worse.
Turning your frustration toward loved ones creates cycles of retaliation and dysfunction. It’s confusing to the people who care about you. For example, your kids may not understand your anger and blame themselves. This can perpetuate dysfunction for generations.
Do You Need Help?
If your unhealthy coping mechanisms lead to depression, addiction, or physical or emotional harm (for yourself or others), rest assured that there are healthier options. Don’t be ashamed to talk to your doctor. This is part of being human.
This is one of the reasons I love practicing medicine in a concierge model. I have the time to explore these topics with my patients without feeling rushed. Together, we can devise a plan for healthy coping.
How to Treat the Winter Blues (SAD)
Around 15 million adults in the U.S. suffer from seasonal affective disorder (SAD), or “the winter blues,” every year. According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders — Fifth Edition), SAD isn’t its own entity. It’s a subset of depression or mania with a seasonal pattern.
If you meet five of the criteria for major depression and your symptoms present when days are short and nights are long and then improve when spring arrives, you probably have SAD.
Major depressive episodes are characterized by at least five of the following symptoms (over two weeks):
- Depressed mood; gloom; despair
- Loss of enjoyment of hobbies
- Sluggishness; fatigue
- Reduced appetite or increased food cravings and weight gain
- Insomnia or excessive sleep
- Lack of focus; brain fog
- Psychomotor changes (walking slower)
- Feelings of worthlessness or guilt
- Suicidal thoughts or ideation
Symptoms of seasonal depression subside every spring and recur in the fall. This pattern must repeat for at least two years to result in a diagnosis.
The Biology Behind SAD
Culturally, we’ve evolved to associate light with happiness and darkness with fear. However, biologically, our genetically-influenced circadian clocks determine how we respond to light and darkness.
Physiologically, it works the same way for all of us. The rods in our eyes detect sunlight and activate the retinal ganglion cells (RGCs). That signals the suprachiasmic nucleus, which tells the pineal gland to stop producing melatonin.
When we’re exposed to less light (such as during daylight savings time or the longer nights of winter), our bodies continue to produce melatonin, which encourages sleep. SAD is the biological consequence of hormonal dysregulation precipitated by less daylight.
How Common Is SAD?
Half the population may be vulnerable to SAD, but that doesn’t mean one in every two people suffers from it. One in 20 people, or around 5% of the population, is a more accurate estimate.
The incidence of SAD depends on geography. The closer you are to the equator, the longer the daylight hours, and the less likely you are to suffer from seasonal depression.
How to Identify SAD in Yourself
Mood disorders cause dysfunction in people’s lives, including excess stress, insomnia, increased blood pressure, and other metabolic parameters, though symptoms vary from person to person. Such changes can affect your job, relationships, and sleep.
Many people realize they’re affected by depression or some form of seasonal issue. However, many also explain their feelings away, dismissing them as:
- Holiday-related stress (seeing or not seeing relatives)
- Needing a vacation
- School-related stress (final exams, etc.)
- Cold weather/feeling “cooped up”
Don’t invalidate or minimize your feelings. Your biology causes them, and they deserve attention.
What to Do if You Think You Have SAD
First, talk to your doctor. They’ll ask questions and determine a diagnosis.
If you receive a SAD diagnosis, you may need to consider medication with your doctor. Light box therapy is also extremely effective and recommended to treat seasonal and non-seasonal depression, since it has no side effects.
A light box should have a minimum exposure of 10,000 LUX and should NOT emit UV light, which can cause skin damage.
Use a light box in the morning for 20–30 minutes within the first hour of waking. Keep the light box 16–24 inches from your face. Keep your eyes open, but don’t stare at it.
Typically, you’ll feel a difference within the first few days. Be aware of the other lights you’re exposed to in your home at night. It’s best to mimic a natural light cycle as much as possible — sunset, then starlight and moonlight.
This may sound gimmicky, but it works! Ask your doctor whether a light box is a good choice for you this winter season.
Sleep Apnea: More Than a Nighttime Annoyance
Sleep apnea is extremely common. Around a billion adults suffer from obstructive sleep apnea (OSA), and 80–90% of those cases remain undiagnosed.
OSA is a tip-of-the-iceberg illness, meaning many symptoms don’t seem noteworthy until they lead to more serious, dangerous conditions.
Today, I’m discussing what OSA is, what it looks like, and how to diagnose and treat it.
What Is Obstructive Sleep Apnea?
Everyone knows sleep is important for our health.
In deeper sleep stages, the muscles relax, including those in the back of the throat. Sometimes, the soft tissue there is floppy, either through heredity or because of excess weight. When the muscles relax, that floppy tissue briefly obstructs the airway.
When this happens, oxygen levels drop, and the brain signals the body to wake up. Although you may not wake up entirely, this cycle prevents you from remaining in deeper sleep stages.
Over time, this cycle of lost deep sleep causes hemodynamic changes that put you at greater risk for:
- High blood pressure
- Stroke
- Cardiovascular disease
- Memory loss
How Do You Know You Have Sleep Apnea?
A sleeping partner will become aware of a patient’s sleep apnea if they hear loud snoring and breathing pauses followed by gasping for breath. Other times, the patient experiences excessive fatigue, mental fog, and headaches, or feels unrefreshed upon waking.
In the long term, the lack of oxygen can also cause memory issues.
OSA Is the Tip of the Iceberg
On the surface, obstructive sleep apnea manifests as snoring or fatigue, which is nothing more than an inconvenience.
In reality, OSA can lead to more dangerous issues, including:
- High blood pressure
- Stroke
- Heart attack
- Cardiovascular disease
- Memory loss
- Increased risk of motor vehicle accidents due to fatigue
- An angry, sleep-deprived spouse
Never ignore the symptoms of sleep apnea.
Risk Factors of OSA
Risk factors for sleep apnea include:
- Being overweight
- Certain anatomy, like jaw structure, having a thicker neck, or having larger tonsils and adenoids
Although you can’t prevent heredity, losing 10% of your body weight can significantly improve sleep apnea symptoms if you’re overweight.
Some doctors recommend tonsillectomies, but surgery isn’t often the best solution for sleep apnea. It’s painful and tends not to be very successful.
Available Treatments
Don’t wait until you’re exhausted and experiencing severe symptoms to pursue help. If your partner notices apneic episodes, talk to your doctor. They’ll schedule a sleep study to confirm.
Once you’re diagnosed, your doctor will likely recommend you lose some weight.
A continuous positive airway pressure (CPAP) machine is another standard treatment for sleep apnea. Many people can find a mask that works for them and feel much better once they do. For those who can’t tolerate it, there are other options.
Dentists have created oral appliances that adjust your lower jaw forward just enough that when you relax into sleep, your airway isn’t obstructed. These appliances are effective for some patients.
Another option is a hypoglossal nerve stimulation implant. This is an excellent option for patients with sleep apnea who aren’t overweight. Two of my patients have them and are very happy with them.
Sleep apnea-correcting pillows are a solution for people who only suffer from sleep apnea when lying on their backs. The pillows keep the patient from rolling onto their back during sleep, preventing the position that causes OSA.
Finally, playing the didgeridoo (an aboriginal wind instrument that uses circular breathing) can effectively treat OSA, according to a study conducted in 2006. You can pick up a new hobby and treat your sleep apnea simultaneously.
Today’s Takeaways
Don’t be the Titanic. When you see the tip of the iceberg, don’t wait to take action. Talk to your doctor and schedule a sleep study. Sleep (and your health) is too important to risk.
We’re here when you need us. Just give us a call.
Why Is My Hair Falling Out So Much? (Hair Loss in Men and Women)
One in three women asks her doctor about hair loss at some point.
Although hair loss is often considered more acceptable in men, women are almost as susceptible and often more emotionally impacted. They ask, “Why is my hair falling out so much?” “Will I need a wig?” “Am I going bald?”
The physical causes of hair loss range, and while hair loss can indicate a serious condition, it often doesn’t. Still, it’s essential that your doctor address all your questions and concerns.
I’ll try to answer the most common questions about hair loss in this blog post.
Types of Hair Loss
We generally divide hair loss into two categories: patchy and diffuse.
Patchy Hair Loss
Patchy hair loss occurs only in specific areas. It has two causes:
- Scarring: A rash (usually caused by a fungal infection), psoriasis, or discoid lupus leaves scarring, which inhibits hair growth.
- Non-Scarring: Also called alopecia areata, this kind of patchy hair loss is believed to be autoimmune and is fairly simple to diagnose.
Diffuse Hair Loss
Diffuse hair loss occurs over the entire scalp but begins on the crown and front. People refer to this as “thinning hair” or to their scalp getting “wider.” Causes of diffuse hair loss include:
- Androgenic Alopecia: This is classic “male-pattern baldness,” though it can also occur in women and commonly does (especially in women with a family history).
- Telogen Effluvium: This is the most common form of hair loss in women. All hair follicles synchronize, and most or all hair falls out simultaneously. Hormonal changes from pregnancy, thyroid disease, iron deficiency, and other physical or psychological stressors trigger telogen effluvium.
- Anagen Effluvium: Unlike telogen effluvium, anagen effluvium isn’t natural. Chemical damage like chemotherapy or exposure to heavy metals (mercury, arsenic, etc.) causes this condition.
- Topical Chemical, Heat, or Traction-Related Damage: Tying long hair back into braids or ponytails that are too tight, excessive heat from hairdryers and flat irons, and chemical damage from dyes cause this type of hair loss.
Identifying the Cause
The first step in treating hair loss is to determine the cause. When a patient asks, Why is my hair falling out so much?, I first consider their personal history, their family history, and the timeline and pattern of their hair loss.
Beyond that, the following tests can help in certain situations:
- A biopsy can determine the cause of patchy hair loss.
- Blood tests will identify hormonal changes (e.g., thyroid disease) and vitamin or mineral deficiencies (e.g., iron).
- A hair pull test determines the severity and, therefore, the type of hair loss.
- Using a folliscope, a doctor examines a hair’s structure to help determine the cause of the loss.
Traditional Treatments
Once the cause of your hair loss is determined, your doctor can begin treatment. The following treatments have been used for several years to treat hair loss in both men and women:
Iron Supplementation
If the cause of your hair loss is iron deficiency, we treat it with iron supplementation.
Thyroid Hormone Replacement
We treat thyroid disease with thyroid hormone replacement, which enables hair to regrow.
Hair Transplants
Hair transplants have been used to offset hair loss for many years but are costly, painful, and questionable in efficacy.
Treatments Exclusive to Androgenic Alopecia
Many women have polycystic ovarian syndrome (PCOS), which causes excessive testosterone that metabolizes into dihydrotestosterone (DHT). DHT harms hair follicles and leads to hair loss. Androgen blockers for PCOS help reduce DHT-related damage to hair follicles.
Oral spironolactone has effectively treated both men and women, especially when combined with minoxidil.
Women who won’t become pregnant and men may use the following treatments to treat androgenic alopecia:
- A low dose of oral finasteride can effectively prevent hair from falling out but doesn’t regrow hair.
- Minoxidil, the primary ingredient in Rogaine, has been used as a hair loss treatment for decades but is perhaps only 40% effective. It’s also inconvenient; most patients stop using it before seeing results.
New Treatment Options
Oral Minoxidil
Oral minoxidil, not to be confused with topical minoxidil, is an old blood pressure medication. It’s now used orally in low doses to prevent androgenic alopecia in males and females. Its efficacy in regrowing hair is impressive.
PRP (Platelet-Rich Plasma) Injections in the Scalp
PRP injections have shown promise as a treatment for hair loss, but their use is currently off-label. They’re also painful and short-acting.
Today’s Takeaways
- If you’re losing hair, pay attention to it. Know your history.
- Most of the time, we can diagnose hair loss by knowing its timeline and pattern and by doing bloodwork.
- Most of the time, especially for women, it’s telogen effluvium.
- Talk to your doctor. Don’t be afraid to ask, “Why is my hair falling out so much?”