The Importance of Vitamin D In my practice treating infections, chronic illness, COVID, and weight-related conditions, the topic of vitamin D deficiency comes up often. Vitamin D plays over 200 roles in the body and is essential for immunity, energy metabolism, cellular growth, and more. More than half of our human cells have receptors for vitamin D, highlighting its importance in overall health. Understanding Vitamin D Levels In 2010, the Institute of Medicine (now the National Academy of Medicine) defined vitamin D deficiency, insufficiency, and sufficiency based on serum 25-hydroxyvitamin D [25 (OH)D] levels: Deficient: < 12 ng/ml Insufficient: 12-20 ng/ml Sufficient: 20-30 ng/ml However, these values were based on bone health, not immunity or chronic illness. In 2011, the Endocrine Society recommended levels above 30 ng/ml, but emerging research suggests that levels between 50-90 ng/ml are necessary for functional health and 80+ ng/ml for optimal health . Factors Influencing Vitamin D Your vitamin D levels are influenced by: Geography: Latitude, season, time of day Biology: Genetics, skin pigmentation, age Metabolism: Vitamin D3 is processed in the liver into its active form (calcitriol), which has a longer half-life in the body Since vitamin D3 has a short half-life (1-2 days), but its metabolized form lasts 2-3 weeks, testing the 25-OH hydroxy vitamin D is the best way to assess your levels. Click here to order your test. Supplementing Vitamin D If you’re deficient, it can take months to achieve optimal levels with 5,000 IU daily. However, prescription-strength 50,000 IU vitamin D is highly absorbable, low-cost (~$3 for a 3-month supply), and often covered by insurance. Vitamin D3 vs. D2: Vitamin D3 is 30% more bioavailable than D2. Combining Supplements: If taking >8,000 IU/day , add: Vitamin K2 (100 mcg/day or 800 mcg/week) Magnesium (250-500 mg/day) Both vitamin K2 and vitamin D have anti-cancer properties. Click here to request a prescription-strength vitamin D supplement. Vitamin D and Weight Weight Loss Studies suggest vitamin D can help with weight loss by: Regulating appetite: Vitamin D receptors in the hypothalamus reduce food intake. Reducing fat storage: Vitamin D promotes apoptosis (cell death) in fat cells. Improving metabolism: Clinical trials show vitamin D supplementation supports weight loss better than a placebo. Weight Gain Conversely, low vitamin D levels contribute to weight gain by: Disrupting glucose regulation Promoting fat accumulation Interfering with insulin signaling in muscles My Perspective on Vitamin D Testing Given the obesity epidemic and rising cases of long COVID and frequent infections, I find it concerning that the Endocrine Society (July 2024) recommended against routine vitamin D testing for the general population. Their rationale is that only specific groups—such as older adults, pregnant individuals, and children—need supplementation without testing. However, I believe most people are not in optimal health . Of those I test, only 10-15% have levels at or above 70 ng/ml. What About Your Vitamin D Levels? I am offering vitamin D testing at no extra cost during your next visit. I can submit this through insurance, or you can use Ulta Labs , which offers discounted testing through Quest Labs. Lab costs are: With a visit (provider order): $24.12 Without a visit (self-order): $49.95 Click here to schedule your visit and test your vitamin D levels. If your levels are low, treatment may be as simple as adjusting your daily dose. If prescription vitamin D is needed, you can request it here . For a full supplementation guide, check out the IMA Health Protocol here . Sincerely, Anna Yoder, DNP, APRN, ANP/GNP-BC References: Sisley SR, Arble DM, Chambers AP, et al. Hypothalamic Vitamin D Improves Glucose Homeostasis and Reduces Weight. Diabetes . 2016;65(9):2732-41. doi:10.2337/db16-0309. Sergeev IN. Vitamin D Status and Vitamin D-Dependent Apoptosis in Obesity. Nutrients . 2020;12(5):E1392. doi:10.3390/nu12051392. Lotfi-Dizaji L, Mahboob S, Aliashrafi S, et al. Effect of Vitamin D Supplementation Along With Weight Loss Diet. Clinical Endocrinology . 2019;90(1):94-101. doi:10.1111/cen.13861. Xenos K, Papasavva M, Raptis A, et al. Vitamin D Supplementation and Genetic Polymorphisms Impact on Weight Loss Diet Outcomes. Frontiers in Medicine . 2022;9:811326. doi:10.3389/fmed.2022.811326. Abboud M, Liu X, Fayet-Moore F, et al. Effects of Vitamin D Status and Supplements on Anthropometric and Biochemical Indices. Nutrients . 2019;11(12):E3032. doi:10.3390/nu11123032. Benetti E, Mastrocola R, Chiazza F, et al. Effects of Vitamin D on Insulin Resistance and Myosteatosis. PloS One . 2018;13(1):e0189707. doi:10.1371/journal.pone.0189707. Bouillon R, Carmeliet G, Lieben L, et al. Vitamin D and Energy Homeostasis: Of Mice and Men. Independent Medical Alliance (IMA). Retrieved March 20, 2025, from: IMA Health Protocol .

The Biden administration has proposed expanding Medicare and Medicaid to cover popular weight-loss medications like Wegovy and Zepbound, recognizing obesity as a treatable disease. These medications help reduce weight by 15-25%, potentially lowering risks for heart disease and diabetes. If approved, this change could cut the cost of these pricey drugs (often over $1,000/month) by 95% for 7.4 million beneficiaries, but it’s projected to cost taxpayers $35 billion over a decade. The rule isn’t final yet and could face changes under the incoming Trump administration, as HHS nominee Robert F. Kennedy Jr. has voiced skepticism about drugmakers and favors focusing on access to healthy nutrition. "I do not share this to express support or opposition to the proposal. My considerations include improved and equitable access to medical treatments, use of taxpayer dollars, prioritizing systemic solutions for obesity over medication, and ensuring patient suitability. In my practice, I’ve observed that Medicare and Medicaid patients often have more complex medical needs and take multiple medications. These weight-loss drugs can affect how other medications work, necessitating frequent monitoring and dosage adjustments. Additionally, some geriatric patients tolerate GLP-1 and GIP weight-loss drugs poorly and experience more side effects. These are important factors to consider." https://www.cnbc.com/2024/11/26/biden-proposes-medicare-and-medicaid-cover-weight-loss-drugs.html

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As a nurse practitioner, I often come across valuable resources from my patients. Recently, one patient shared their experience with Galleri®, a multi-cancer early detection test. This blood test screens for many of the deadliest cancers before they become symptomatic, including some cancers that currently lack routine screening options. Cancers growing in the body shed DNA into the bloodstream, and these DNA fragments carry a unique "fingerprint" of cancer. The Galleri test analyzes this DNA, potentially detecting cancer signals and identifying where in the body the signal originated—even before clinical diagnosis through conventional methods. The Galleri test is designed for adults with an elevated risk for cancer, such as those aged 50 or older, obese (BMI >30), or former and current smokers. It is not designed for individuals who are pregnant, under 21 years of age, or undergoing active cancer treatment. And, although it detects over 50 cancers, it does not detect all cancers and is not a substitute for regular cancer screening. As with any medical test, good judgement is needed when deciding to proceed. Every test has risks considering, such as cost, the potential for unnecessary worry, or false positives/negatives. Nonetheless, for individuals seeking a highly sensitive cancer screening option, the Galleri test may provide valuable insights. To learn more about Galleri®, visit their official site: https://www.galleri.com/what-is-galleri Sharing this information is intended to inform and empower, but any medical decision should be made in consultation with your healthcare provider.

I recently read an excellent book: “ Trust: Knowing When to Give It, When to Withhold It, How to Earn It, and How to Fix It ” by Dr. Henry Cloud. I found its principles deeply relevant to my work as a nurse practitioner. Trust is the foundation of all meaningful relationships, including that of patient and provider. Dr. Cloud asserts that "trust impacts everything and is essential for life" and is indispensable for "doing life well"—with ourselves, family, friends, businesses, and even matters of faith. Think about it: we rarely choose to engage with a person, institution, service, or product unless we have some level of trust in the person or product’s ability to deliver on its promise. In healthcare, the best outcomes occur when a patient and provider establish a trusting relationship. So, if trust is important, how do you know when to give it or how to fix it when it is broken? And when it comes to your health, how do you determine which healthcare provider is worthy of your trust? Using Dr. Cloud’s five essentials of trust —understanding, motive, ability, character, and track record—let’s explore how to find a provider suited to your unique health needs. 1. Understanding A trustworthy provider listens to you. They need to understand your concerns, goals, and values. Do you feel heard during appointments? Does your provider take the time to grasp what’s important to you about your health? If you feel understood, you’re more likely to engage in the care process fully, leading to better health outcomes. 2. Motive Is your provider motivated to improve your well-being, or are they more focused on external factors like profits, schedules, or credentials? A provider’s "Why" matters. When a provider is genuinely in healthcare for the good of others, it’s evident. You’ll feel like a partner in your care, rather than a number on their schedule. 3. Ability Understanding and caring are essential, but they’re not enough without ability. Does your provider have the expertise and skills necessary to address your specific health concerns? A cardiologist might be excellent at treating heart conditions but would not be the right choice for managing seizures or joint issues. Trust isn’t transferable across areas of expertise. Always verify that a provider has the qualifications and experience to address your concerns. 4. Character Character is the backbone of trust. Even the most skilled and caring provider can be untrustworthy if they lack integrity. Are they honest, reliable, and ethical? Do they follow through on promises? Trustworthy character ensures that the person you’re entrusting with your health will act with your best interests at heart, even when challenges arise. 5. Track Record Finally, consider a provider’s track record. What has their past performance been like? Have they successfully handled similar cases to yours? A proven history of reliability and success is one of the best indicators of future behavior. That said, if a provider is actively working on improving a skill or knowledge set, their actions are also worth noting. Putting It All Together Trust is not simply given; it is earned. Understanding, motive, ability, character, and track record form the framework for assessing whether a person is trustworthy. Importantly, no one is perfect—no provider excels in every area—but finding someone who demonstrates these qualities in their lane of expertise is critical. As a nurse practitioner, I’ve seen firsthand how trust transforms patient care. Patients who trust their providers are more open, more engaged, and more likely to follow through on treatment plans. Conversely, misplaced trust can lead to disappointment or even harm. Takeaways for Patients Trust isn’t blind. It requires discernment and due diligence. Look for a provider who: Actively listens to you and seeks to understand your concerns. Centers their care on your well-being rather than rigid protocols. Demonstrates competence in the specific area of care you need. Maintains integrity and ethical standards. Has a proven track record of reliability and success in their field. Healthcare is deeply personal, and trust is the bridge that connects providers and patients. By carefully assessing potential providers through Dr. Cloud’s framework, you can build a relationship that fosters both health and peace of mind.

As Thanksgiving approaches, we are reminded of the profound importance of gratitude—a simple yet transformative act that fosters connection, kindness, and resilience.

 Your heart, the tireless engine powering your every move, deserves your utmost care. Yet, navigating the complexities of cardiovascular health can feel overwhelming. Fear not, knowledge is your strongest ally! This blog, brought to you by Telehealth NP, aims to demystify this vital topic, answer your burning questions, and equip you with actionable insights to keep your heart humming. Understanding the Threat: A Glimpse into Cardiovascular Disease (CVD) CVD, encompassing a spectrum of heart and blood vessel conditions, remains the leading cause of death globally. From high blood pressure and cholesterol lurking silently to the more dramatic heart attacks and strokes, CVD paints a diverse picture. But don't let that scare you! Early detection and management can significantly improve outcomes, making knowledge your first line of defense. Burning Questions Answered: Unraveling the Mysteries What are the risk factors for CVD? Genetics, age, lifestyle choices like smoking and unhealthy diet, and even stress play a role. Understanding your individual risk profile empowers you to take preventive measures. What are the warning signs of CVD? Chest pain, shortness of breath, fatigue, and even seemingly unrelated symptoms like leg pain or jaw pain can be red flags. Don't ignore them! How can I prevent CVD? The good news is, you have the power to significantly reduce your risk! Embrace healthy eating, regular exercise, stress management, and regular checkups. Every small step counts! Beyond Awareness: Actionable Insights for a Healthier Heart Fueling Your Engine: Ditch processed junk and embrace a diet rich in fruits, vegetables, whole grains, and (take out lean) and proteins (lean meat is old scientific data). Remember, you need all fats, saturated, poly unsaturated and monounsaturated. Saturated fat comes from meats and poly unsaturated and monounsaturated fats come from vegetables and seeds! Moving Your Body: Aim for at least 150 minutes of moderate-intensity exercise weekly. Find activities you enjoy, from brisk walks to dancing, and make movement a joyful habit. Taming the Stress Monster: Chronic stress hurts your heart. Practice deep breathing, meditation, yoga, or simply spend time in nature to find your zen and keep stress at bay. Talk to a friend, shed the emotions. Know Your Numbers: Regularly monitor your blood pressure, cholesterol, and blood sugar levels. Early detection of abnormalities allows for timely intervention and management. Telehealth NP: Your Partner in Cardiovascular Health Telehealth NP brings experienced nurse practitioners directly to you, by phone or video (virtually). Schedule consultations, discuss concerns, and receive personalized guidance – all from the comfort of your own home. We believe convenience shouldn't compromise quality, and our platform empowers you to take charge of your heart health proactively. Remember, your heart's health is a lifelong journey. This reading is just the beginning! We invite you to explore our resources, ask questions, and join us in creating a community dedicated to empowered health. Let's keep the beat going, together!

JN.1, the new SARS-CoV-2 variant of interest, has caught the attention of the CDC and the WHO. Although it is not classified as a variant of concern, it is still being closely monitored. JN.1 is a descendant of the BA.2.86 variant from Omicron, which was prevalent in the summer of 2023. BA.2.86 had 30 mutations on its spike protein, but never gained prevalence globally. It’s global prevalence peak waS 8.9% in the summer of 2023. What sets JN.1 apart is its transmissibility despite only 1 spike protein mutation It is evading neutralizing antibodies. Neutralizing antibodies are those antibodies your body makes after a natural infection rather than a vaccination. As of January 2024, JN.1 has become the dominant variant, making up 61.6% of circulating variants in the US. And in January of 2024, Covid infections and positive tests are higher than January of 2023. Thankfully, hospitalizations and deaths are lower. One specific mutation in JN.1, L455S, allows it to enhance its binding capability to the ACE2 receptor site on the spike protein, increasing its transmissibility. Therefore, even if a test comes back negative, if you are sick, please consider yourself to have COVID unless proven otherwise. If you do choose to test, understand your test will likely be negative the 1st few days as the viral load will not be high enough to measure. This is the best time to see treatment- when your efforts will have the greatest positive effect. Like previous COVID-19 infections, symptoms include: • high fevers, • body aches, • muscle and joint pains, • cough, and • extreme fatigue. JN.1: A New Variant of Interest in the COVID-19 Landscape The Journal of the American Medical Association and the CDC are still recommending the latest COVID-19 vaccine, despite some interesting factors to consider. The vaccine, released in September 2023, targets XBB1.5, which is no longer in circulation. By the time the vaccine was released, the circulation of XBB1.5 had already reduced by 3%. It's important to note that XBB1.5 belongs to a different branch of the Omicron variant than BA.2.86, which JN1 is a descendant of. And, JN! is three to five times LESS susceptible to the most recent vaccine released. Given these circumstances, here are some recommendations if you find yourself sick. First, I advise you to stay home to prevent the spread of the virus. Additionally, you can take certain supplements to support your immune system. Increase your • zinc intake to 100 milligrams a day, • consume 1000 milligrams of vitamin C twice a day, • take 500 milligrams of quercetin daily, • consume 500 milligrams of curcumin twice a day, • take 5000 units of vitamin D daily. • Consider taking 325 milligrams of aspirin daily unless it is contraindicated for you. • Finally, taking melatonin extended release at night can help regulate your immune system. • Add an antiviral drug to your regimen, such as hydroxychloroquine or ivermectin, which prevents the virus from replicating in your body.

Exercise is often referred to as medicine, and for good reason. It has been widely recognized that regular physical activity can have a profound impact on our health. In this blog post, I will delve into the mechanisms behind how exercise affects insulin sensitivity and provide practical tips on how to increase insulin sensitivity through exercise and other lifestyle changes. Insulin sensitivity refers to the body's ability to effectively respond to insulin and regulate blood sugar levels. When we are insulin sensitive, our cells are able to efficiently take up glucose from the bloodstream with the help of insulin. This is particularly important for skeletal muscle cells, as they are the primary site for glucose uptake. Exercise plays a crucial role in improving insulin sensitivity. When we engage in physical activity, blood flow to the skeletal muscles increases, leading to enhanced glucose delivery through insulin stimulation. Additionally, exercise activates a protein called GLUT-4, found in muscle and adipose tissue, which is responsible for transporting glucose into skeletal tissue. By promoting these mechanisms, exercise helps to combat insulin resistance, which is a key factor in the development of cardiometabolic diseases, including type 2 diabetes. The effects of exercise on insulin sensitivity can be both acute and chronic. The acute effect, known as prolonged acute effect (PAE), can last up to 72 hours after a single exercise session. During this time, insulin sensitivity remains heightened, allowing for efficient glucose uptake by the muscles. Chronic exercise, on the other hand, leads to long-term adaptations in the body. One such adaptation is the widening of the capillary basement membrane, which improves capillary blood flow and glucose transport. These structural changes contribute to increased insulin sensitivity over time. Maintaining insulin sensitivity is crucial for overall health and weight management. When we become inactive or sedentary, our insulin sensitivity decreases, making it harder for our cells to respond to insulin. This can lead to weight gain and further exacerbate insulin resistance. Furthermore, body fat distribution plays a role in insulin sensitivity. Excess fat, especially in the abdominal region, can contribute to insulin resistance. However, exercise alters body composition and reduces centrally located adipose tissue, positively impacting insulin sensitivity. It is worth noting that insulin sensitivity is not a permanent state. Even individuals who are regularly active can experience a decline in insulin sensitivity after just 10 days of no training. However, the good news is that for chronic exercisers, it can be regained with as little as one exercise session. When discussing the impact of exercise on insulin sensitivity, it is important to understand the difference between physical activity and exercise. Physical activity refers to any bodily movement that results in energy expenditure, while exercise is a subset of physical activity that is planned, structured, and repetitive, with the goal of improving or maintaining physical fitness. While the specifics of exercise, such as duration, frequency, and intensity, are beyond the scope of this blog, it is crucial to emphasize the importance of regular physical activity for maintaining optimal health. By raising awareness about the relationship between activity and insulin sensitivity, I hope to inspire individuals to prioritize exercise and take steps towards improving their overall health. In conclusion, exercise has a profound impact on insulin sensitivity. By understanding the mechanisms behind this relationship and implementing regular exercise into our lives, we can improve insulin sensitivity and reduce the risk of developing cardiometabolic diseases. So let's lace up our sneakers and get moving! Fitness Tips for a Healthy Lifestyle 💪 Tip 1: Every movement counts! Whether it's taking the stairs, walking to the mailbox, parking far from the store entrance, hitting the gym for a workout, or training as an athlete, your body is always in motion. This activates circulation, glucose and insulin use, and energy metabolism in your muscles. 🏋️ Tip 2: Intermittent exercise is a game-changer for your insulin sensitivity. Even just one session can improve your insulin sensitivity for 72 hours! 🔥 Tip 3: Regular exercise not only transforms your body composition, but also reduces insulin resistance and improves glucose uptake in your muscles. This powerful combo helps protect against cardiovascular disease, weight gain, and type 2 diabetes.