Uncategorized Archives - Gil Winkelman ND

How to Cope with Pandemic Anxiety using Teletherapy

March 26, 2020 by Dr. Gil Winkelman 1 Comment

In the two weeks since I sent my last newsletter about teletherapy we have all experienced many changes. Many of us are sheltered in place. We are stuck at home, balancing work and children. We are unaccustomed to the constancy of family being around, while some feel very isolated. What to do?

Before I give more information, I want to let you know that for people in Oregon and some in Hawaii, I can bill telemedicine visits to your insurance. That change is a huge step in the right direction. I do not know how long this will last. And obviously I cannot do neurofeedback. But I can help with many medical issues and provide counseling during this difficult time. One of the curious aspects of this virus is that people with underlying conditions such as diabetes, heart disease, and high blood pressure may be at greater risk to this virus. Naturopathic medicine has much to offer regarding treating these conditions.

How to Cope with the Anxiety

What can you do to help yourself and your family? Here’s a list of the main items that I have compiled from looking at several studies about this, along with my experience of working from home for many years.

Create a routine and stick to it! This is important even not in quarantine. We are creatures of habit in a lot of ways. Our bodies like consistency. I’m not suggesting that you have to do or eat the same thing every day. But going to bed and waking at the same time daily is good for our systems. It reduces stress and helps the adrenal glands be balanced. Lower stress means higher immunity.
Another aspect of a regular sleep routine is it helps our bodies produce the proper amount of melatonin. It may be related to stress and cortisol levels, but higher melatonin levels also improves immunity. There are a few studies suggesting that melatonin levels that function properly help fight off coronavirus. (There have not been studies on supplements, only looking at melatonin in the body.)
Every hour of sleep before midnight is like two hours after midnight to the body. I recommend going to bed by 10 PM. It can also help your weight too.

Reframe your situation. Instead of thinking you are stuck inside the house, do projects you have not had time to complete. Always wanted to plant a garden? Get to it! Or maybe you wanted to explore an aspect of yourself. Whatever it is, you have time to do it now. Even if you are still working, most people will save commute time. (Not to mention getting ready for work time.) Use that extra few hours to do something you have wanted to do.

Avoid the news. I know some have a morbid fascination with what’s going on. Or maybe there’s this unconscious belief that knowing what is going on will protect us. What is happening extends way beyond this outbreak. (I’ll write more about this later.) It is unlike anything we have faced in our lifetimes. But constantly going online and reading about what is going on is not good for anyone’s mental health. (I’m talking to you too, Facebook users!) The constant barrage of information is stress provoking even in good times. It’s super intense. Step away from the computer. Unless you’re watching funny cat videos.

Keep things clean and decluttered at home. I have a confession to make. In the last three weeks, I have cleaned my house more times than I think I have in the last three years. Seriously! I have become a clean freak. And I have decluttered everything too. It is calming. I can think. I feel there is space to think.

Start a quarantine ritual. This is odd I know. And it can be anything to meditating to journaling. Writing about what is happening can be super helpful for people.

Use Video Chat and the phone to connect with friends. This is super important, particularly for teens. I think the most stressful thing for adolescents is the social isolation. Younger kids often miss their peers too. But they can talk on the phone or computer. (You can limit the time if that is appropriate. And limit social media.)

Kids and Relationship Issues

Signs of Stress in Kids. Along this line, if you have children there are definite signs of stress that may require help in this situation. Here’s a partial list:

In younger children, excessive crying or irritation.
Returning to outgrown behaviors (for example, toileting accidents or bedwetting).
Excessive worry or sadness.
Unhealthy eating or sleeping habits.
Irritability and “acting out” behaviors in teens.
Poor school performance or avoiding school (For those of you with closed schools, I’ve found that most kids want something to do to feel a little productive. So if they are avoiding everything, that could be a sign).
Difficulty with attention and concentration.
Avoidance of activities enjoyed in the past.
Unexplained headaches or body pain.
Use of alcohol, tobacco, or other drugs.

Take space. There was a tiktok video showing a cat upset that the humans were always at the house. My brother related to the cat. He works at home and found his family being shuttered with him to be stressful at first. And maybe others can relate. Take space for yourself and communicate to others around you. Explain calmly that you need time to yourself. NOTE: I will do a relationship workshop in the near-term. More on this later.

Get outside if allowed by law. Being in nature is best, if you can and properly socially distance yourself. Having that time is necessary regardless. But this is a stressful time.

Teletherapy for anxiety or just to talk. Get help when you need it. It’s so important to use professional help. As I mentioned, I provide services and can bill insurance for Oregon and Hawaii. But if you are in another state, telemedicine is required coverage now. Check with your healthcare provider because there are stipulations by different companies. But overall, there is help available. You can always call 808-726-2772 to schedule or ask about coverage.

The Advantages of Telemedicine Appointments: How to Get Care During an Outbreak

March 12, 2020 by Dr. Gil Winkelman Leave a Comment

With WHO declaring the Covid-19 a pandemic, we all must take precautions. By now you have received many emails about what to do to protect yourself. Social isolation, as best as possible, is one of them. That does not mean you cannot see the doctor. The advantages of telemedicine are clear right now. For many years, I have offered telemedicine appointments. I use HIPAA compliant software to allow me to do video consults with patients. For many people, this suffices to get their medical needs met. First, a quick reminder about how to protect yourself:

The CDC and the WHO recommend several basic measures to help prevent the spread of respiratory diseases such as Covid-19.

CDC and WHO Guidelines

Wash your hands often for at least 20 seconds.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
Clean and disinfect frequently touched objects.
Stay home when you are sick.
AVOID touching your face.
DON’T travel if you have a fever and cough.

NOTE: Several surveys suggest that only 66% of Americans wash their hands regularly. This is problematic. Get in the habit of washing your hands. It could save your or someone else’s life.

The Advantage of Telemedicine Appointments While in Isolation

Second, if you are showing symptoms, isolate yourself right away. There is testing available, but they must perform the test in an outpatient setting. The test is a nasal, lung, or throat swap. Hawaii is setting up test centers for symptomatic patients. Oregon is rolling out drive through testing stations. Many clinics do not want patients to come if they are showing symptoms. My local Adventist Health outpatient clinic is asking people to stay home and call the advice line if they are sick. Why? Most offices do not have resources to handle infections disease.

And this is one of the biggest advantages of telemedicine. Most people infected with the coronavirus (or another virus) can be treated at home. While it is likely highly contagious and will be deadlier than the seasonal flu, it is self-limiting in the majority of cases. I can prescribe treatments via video (or instruct you what to do if it’s more serious.) Telemedicine appointments can help with the coronavirus (or other illness). There are many natural treatments body fight infections before needing hospitalization. And if you have other health concerns, telemedicine appointments helps avoid exposure.

If you wish to discuss your symptoms, or have any other issues that require medical help, please call my office to schedule a telemedicine appointment.

You can email me at info@askdrgil.com or call 808-726-2772.

How to Cure Hypothyroidism and Anxiety

January 24, 2020 by Dr. Gil Winkelman Leave a Comment

In medicine, hypothyroidism and anxiety aren’t typically associated. It is usually depression associated with a low thyroid function and anxiety with high. But many of my patients found their anxiety disappear with proper thyroid function. Why is this? Could low thyroid be the answer to treatment-resistant anxiety? Many patients come to me taking thyroid but are not feeling better. Others presented with subclinical hypothyroid. Why is this? Let’s explore more about these issues. I should note that hormone interactions in the body are very complex. This article does not serve as a full primer but a short introduction.

Before jumping into the complexity of hormones, I want to review the scope of the problem. Anxiety occurs in 30-40% of patients with hypothyroid. They can also have irritability, depression, learning issues, and poor concentration.

The Causes of Hypothyroidism (and Anxiety)

Most research suggests that doctors should not give medications for depression and anxiety until they check thyroid levels. While I agree with the approach in theory, it’s not as simple as testing thyroid.
To understand the paradox of this problem, I want to explain a bit about the hypothalamic-pituitary axis (HPT). This may be technical but bear with me. The hypothalamus and pituitary are in the brain, controlling hormonal function in the body through different hormones. The hypothalamus produces Thyrotropin-releasing hormone (TRH) to signal the pituitary to make thyroid-stimulating hormone (TSH). TSH signals to the thyroid to produce T4 (Thyroxine) which is stored in the thyroid gland until the body needs to use it. When the body needs energy, T4 converts to T3 (Triiodothyronine).

Because T3 is so potent, the body only converts what it needs when it needs it and mostly inside the cell. T3 then crosses into the nucleus and started turning genes on. If you have listened to my podcast about methylation and epigenetics, there may be a connection here. Remember that everything you eat, drink, breathe, and experience can change your genetic expression. Specifically, high or low methyl may affect T3 binding at specific sites, thereby producing different results. The following are required for the thyroid to work:

Hypothalamic/pituitary function
Secretion of TSH
Thyroid function (secretion of T4)
Thyroid hormone transport into the cell
Conversion of T4 to T3
Receptor binding
Downstream activation

There are a lot of steps. I want you to remember this list because it will be important in a moment.
But the doctor said my thyroid levels were normal!
Both the tests for thyroid and their interpretation are problematic. Typically, most doctors only run a TSH to see if thyroid is functioning well. But many recent research studies suggest that TSH is a poor measure of thyroid function. Several studies concluded that looking at just TSH does not show how cells are utilizing thyroid.

Some doctors know this and also measure T4 to determine thyroid function. There are problems with this approach. First, both TSH and T4 measure supply of thyroid hormone. A normal TSH means that the pituitary receives the message from the hypothalamus to tell the thyroid to produce thyroid. When these numbers are normal, most likely, your thyroid is working. But often in hypothyroidism, the problem stems from somewhere further downstream from the gland. Look at the list above. There are four more steps below the level of the thyroid that can lead to hypothyroidism.

Why am I Anxious if I’m Hypothyroid?

You may wonder how this related to anxiety. The short answer is we don’t know. My best guess is that the sympathetic nervous system kicks in to speed up processes in the body. Adrenaline rushes over long periods leads to anxiety.

If you suffer from anxiety, depression, learning issues, or brain fog, it’s time to get your thyroid checked. There are better ways to test thyroid than just doing a TSH including taking your temperature or measuring other hormone in the body such as sex hormone binding globulin. This is what I do in my practice now instead of measuring just the thyroid levels. I am certified in Wilson’s Temperature Syndrome therapy, a novel approach to correct issues with thyroid conversion. In fact many people who were previously diagnosed with Hashimoto’s or other thyroid issues, regained healthy thyroid function after this treatment approach. Schedule with me if you want to learn more. Your path to feeling better is just around the corner.

Pyroluria Supplements and Test Kits: How to Improve Your Anxiety

February 7, 2018 by Dr. Gil Winkelman 6 Comments

Jason’s parents brought him to my clinic because of violent behavior. (I am not using anyone’s real name.) Several suspensions from school alerted his parents there may be a problem. But it was his punching a hole in the wall of his bedroom that led to the call to me. Lisa’s anxiety became so debilitating that she didn’t want to leave her house. By the time she called to make an appointment, she had confined herself to only her room and the adjoining bathroom. Clark’s sudden mood swings correlated with depression and not knowing what he wanted to do with his life. Though very smart and done well in school, Clark was currently underemployed. His mom convinced him to see me. We sent pyroluria test kits to all three of these patients, and I knew the results would be positive.

While depression, anxiety, oppositional defiance disorder (ODD), and reactive attachment disorder (RAD) may arise from different causes, pyroluria should be ruled out as the cause of these and other mental health problems. Testing is easy to do at home. The lab sends a pyroluria test kit; the sample is collected and sent back to the lab. After Jason’s mom called, we had results within two weeks, and I developed a treatment plan of vitamins and minerals ready for Jason.

“He’s a different kid,” his mom reported to me after the first follow-up appointment. “Had I known that treatment was so simple, I would have called you much sooner!”

Jason is not unusual. I have treated hundreds of people with pyroluria over the last seven years with great success. A pyroluria test kit is inexpensive and easy to do. Pyrrole supplements cost little and are simple to take. If that is the only imbalance in the body, we see changes in the person within a month.

What is Pyroluria?

What exactly is pyroluria? Confusion abounds as to how to explain pyroluria or Pyrrole Disorder. Other names include Mauve Factor and Kryptopyroluria. Many doctors do not recognize the clinical significance of pyrrole disorder. Though I didn’t learn about it in medical school, I can assure you that pyroluria is real.

Kryptopyrroles seem to appear under conditions of oxidative stress in the body. The body produces an unusable form of the part of the red blood cell that holds the oxygen, called a heme-ring. This molecule, harmless in most people, will deplete the body of nutrients such as zinc, vitamin B6, and gamma-linolenic acid (GLA) in others. People who have pyroluria be in normal range for these nutrients in their blood tests but still have symptoms. What are some of the symptoms? The chart below shows the effects of pyrrole disorder. You only have to have two or three to be positive. Oddly, there isn’t always a correlation between symptoms and amount of pyrroles. I have seen patients with extremely high numbers but few signs and patients with lots of symptoms and a low kryptopyrrole result. Over the course of the next could of articles, I’ll explain why that is. Suffice to say, pyroluria can affect different parts of the body in different ways.

Why would oxidative stress lead to the creation of kryptopyrroles? The short answer is we don’t know. There are many different theories, but the one I like the best is trauma. Early childhood trauma seems to be a commonality of people with this condition. Pyrrole disorder and oxidative stress, in general, seems to be a physiologic response to emotional or physical trauma. Jason’s parents adopted him as a baby. Early childhood wounding contributed to his behavior. Pyroluria may be a clue to mind-body connections; the bridge between the trauma that one experiences when younger and the physical symptoms that occur later in life. A diagnosis doesn’t mean that psychotherapy is unnecessary, but it can make it more successful.

pyroluria supplements and symptoms

Pyrrole supplements make a huge difference in the patients who have pyroluria. Treatment plans are inexpensive and easy to follow. While the number of pills can be daunting, most people find it effortless to integrate the task into their day. And the results are extraordinary. Lisa’s anxiety abated so she could continue her life again. Jason finished high school and responded to the new counselor his parents arranged. Clark’s mood swings disappeared with pyrrole treatment, and his motivation returned. “I feel that I have my son back,” his mother said to me. “He’s calm, funny, and is starting to have direction in his life again. He’s doing great!”

You too can get help. If you or a loved one has some of the symptoms listed, call or email us today. We will be happy to send out a pyroluria test kit and consult about the results, which we can do via an online doctor consultation. Pyrrole supplements can be life-changing. We’d be happy to help facilitate moving you into a happier place.

Though the patients mentioned in this article had an easy time with treatment, not everyone does. The next article will discuss some of the pitfalls of self-treatment.

How to Benefit from Online Doctor Consultations

January 26, 2018 by Dr. Gil Winkelman 3 Comments

Online doctor consultations are becoming more popular. And why not? Patients don’t have to travel to the office, park the car, and wait for the doctor. You can stay in the comfort of your home and consult with the doctor through your computer or phone. But are online doctor appointments good for everyone? Not likely. But for many people, virtual medical visits provide a simple approach to medical care. Let’s explore what online doctor consultations look like with Dr. Gil and what sort of conditions are appropriate for treatment.

Online Doctor Consultations with Dr. Gil

Dr. Gil has been using telehealth services for mental health for many years. The process begins with either a phone call or email and determine if labs need ordering. If you have the correct labs run relatively recently, there’s no need to repeat them just yet. Sometimes Dr. Gil orders additional labs, especially if you attempted similar treatments that didn’t work or only had partial results. Labwork performed by other providers may be reviewed before your appointment. Labs aren’t required for every patient before the first appointment but can expedite the treatment process. For most patients in the US, we can arrange for the lab collection to occur near your location. Outside the US, some results are challenging but not impossible to obtain. The office staff assists as best it can to help you get what is required.

Before the appointment, you will fill out an extensive questionnaire that combined with the lab results helps Dr. Gil uncover possible causes of the ailment. The first appointment lasts up to an hour whereby Dr. Gil comes up with a treatment plan for your condition. You can merely order the vitamin and supplements from Dr. Gil’s medicinary or obtain through another source.

Conditions Treated During Online Doctor Consultations

It is difficult to say what conditions can or cannot be treated online. New technologies are making it possible to do medicine via telehealth services. Dermatology, for example, is moving to a model that allows doctors to diagnose skins conditions via online doctor consultations. Some situations require an in-person visit before telehealth services will be useful. The Walsh Protocol, a system that uncovers nutrient deficiencies causing mental health issues, can be productive using telehealth services for mental health. Some of the conditions that Dr. Gil treats using online doctor consultations include:

Oppositional Defiance Disorder
Reactive Attachment Disorder
Conduct Disorder
Anxiety
Depression
Bipolar
Schizoaffective Disorder
Autism/Asperger’s
Obsessive Compulsive Disorder
Attention Deficit Disorder (ADD/ADHD)
Migraine Headaches

Insurance may or may not cover telemedicine visits but may reimburse the lab fees. Check with us first about whether coverage is possible. Neurofeedback services typically require appointments to be in-person.

Demand for online doctor visits has increased as patients discover its advantages. Find out for yourself how easy it is to get help for you or your family member. Schedule today for a free pre-consultation.

The Colossal Mistake of Everyone Taking Methylated Folate

June 9, 2017 by Dr. Gil Winkelman 19 Comments

I get a lot of questions about the methylation cycle and taking methylated folate. In articles and podcasts, I go into great detail about undermethylation. This causes a lot of confusion amongst patients because most providers don’t understand how methylated folate works. Folate is a wonderful vitamin for many people. But for undermethylators, folate can cause problems. Why is that? To understand the issue, we have to first understand more about methylation, DNA, and why genetic tests may not be the right approach.

Undermethylators is one of the primary subtypes described by the Walsh Protocol. To understand why folate is a problem for them though, we should discuss undermethylation.

To begin, let’s discuss what methylation is. Methylation is the process where DNA gets “tagged” by a small hydrocarbon group. Methyl is one carbon and three hydrogens. Carbon can bond to four different atoms so a methyl group has one spot that allows it to attach somewhere else. The body uses methyl in many different reactions and one of them is to turn off DNA.

How does it do this?

We don’t know the exact mechanism. It appears that the methyl group stops the DNA from turning on at particular locations. Methylation seems to be responsible for turning genes off. Acetylation (a different hydrocarbon) and folate are responsible for turning genes on. In some cases, the reverse is true but for now, let’s simply the thought process.

One gene methyl turns off is the serotonin reuptake gene. Folate or folic acid appears to turn this gene on. If you have too much serotonin reuptake happening, serontonin levels will be low. If you have too little, serotonin will be too high. (Yes, you can have too much serotonin in your body and some people do.)

Undermethylators are particularly vulnerable to folates. The folates turn on the serotonin reuptake gene that is already not downregulated due to the lack of methyl. For some people, they find that a sudden intake of folic acid causes a precipitous drop in mood or exacerbation of symptoms.

NOTE: If you are a pregnant woman, take your folate even if you’re an undermethylator.

What about Methylated Folate?

What about methylated folate? Isn’t that suppose to help undermethylators? Many providers prescribe it. A good number of patients have seen other providers that believe this. And why not? It was what we were taught in medical school. I was. But Dr. Walsh has shown something different. All folates including methyl folate probably cause a net reduction in methyl in the body. Couple that fact with how folic acid turns on the serotonin reuptake gene so that serotonin levels drop and you have a recipe for problems.

That all said, many undermethylators do show temporary improvement as a result of taking methylfolate. After two to three months, the person devolves again. The methyl donation from the methylfolate gets overshadowed by the effects of folate on the body. So the person gets worse.

This is when patients call me. Fortunately, it’s not too late to feel better under this circumstance. A proper treatment plan can benefit someone at any time. Undermethylators respond slowly; some people may not get a benefit for almost a year after treatment starts.

If you think you may be an undermethylator or overmethylator, call today to schedule an appointment. Let me review your medications and supplements to ensure you are taking what is right for your healing process.

What you Need to Know About Getting Pyroluria Disorder Symptoms

August 29, 2016 by Dr. Gil Winkelman 2 Comments

Pyroluria is more common than previously though. Pyro-what? What is this disease? The word pyroluria is a combination of pyrrole and urine. It refers to a molecule that shows up in the urine in most people. There are different things that can cause pyroluria. For many people, pyroluria treatment can be life changing. And many kids with Reactive Attachment Disorder or RAD Disorder have pyroluria. Behavior problems can disappear with simple natural treatments. Pyrrole Disorder symptoms are diverse. Let’s explore what pyrrole disorder is and what the symptoms look like.

Pyroluria is a condition that leads to an incomplete breakdown of red blood cells. This causes the formation of small molecules called kryptopyrroles that bind to zinc and B6 in the body. As a result, the body registers a deficiency of both those nutrients. There are many theories about what causes pyroluria but the reality is that we don’t know. It is definitely a sign of inflammation in the body. Some of the possible causes are as follows:

Genetics. Pyroluria does seem to run in families. I have tested kids who are siblings where both have had it many times. But not all the time. If a relative suffered from depression, schizophrenia, bipolar disorder, alcholism, or another mental health condition, get tested.
Childhood Trauma. There may be an epigenetic component to the condition. Trauma may cause a rise in inflammation in the body and lead to this condition.
Chronic infection. It is difficult to know if the problem exists because of the infection or if the lack of zinc leads to poor immunity.
Alcoholism of the sufferer or parents.
Environmental toxicity. Heavy metal poisoning in particular could play a factor in the cause of pyroluria.
Processed foods. A standard American diet of processed foods and sugar can stress the body out and lead to absorption problems.

Stress may be a trigger to pyroluria or it could be a result of it. It is not clear at the moment.

What are Pyrrole Disorder Symptoms?

Pyroluria has some distinct symptoms. I have a questionnaire that helps people determine if they have the condition. Most of the symptoms that I see in my practice revolve around mental health problems. But many people experience problems with other areas of the body. Let’s start with the mental health symptoms first though.

Mentally, people feel stressed. There is a high amount of severe inner tension or anxiety. Tolerance to stress is low. For example, someone who easily stresses out with minimal traffic may have pyroluria. Social withdrawal is common as is sensitivity to crowds.

But more severe mental health symptoms exist too. There can be periods of mild to severe depression followed by hyperactivity. Episodic anger outbursts or other mood swings are common. Panica attacks or severe anxiety. They may enjoy an argument but be upset by criticism. In severe cases, pyrolurics may hallucinate or have delusion disorder.

Physical symptoms also exist though. Here’s a partial list:

Fatigue easily likely due to nervous exhaustion.
Insomnia.
Poor dream recall
Ringing in the ears.
Digestive disturbances including irritable bowel, abdominal pain, and frequent gas and bloating. (They may have tried avoiding meat as a way to deal but this actually makes the problems worse as we’ll see.)
Gluten intolerance
Blood sugar control. There may be hypoglycemia with blood sugar drops.
Allergies to food or the environment
Frequent illnesses
Morning nausea and poor appetite in the morning. They may skip breakfast.

There are some people who have few of these symptoms but may still have pyroluria. You may have done blood work for zinc for example and shown that it is normal but still have symptoms of zinc deficiency. This is typically caused by pyrrole disorder. So what can you do? My article about pyroluria gives suggestions but the short answer is get tested! I can do pyroluria testing and help develop a custom treatment plan via telemedicine services. Call today to learn more.