Homocysteine Levels: Huh?

By Mila McManus M.D.

Do you know your homocysteine level? If not, ask your healthcare provider to order it.  Homocysteine levels can be measured with a simple blood test at most laboratories.  High homocysteine levels indicate inflammation, probable nutrient deficiencies, and or a genetic defect. Persistently high levels can suggest B vitamin deficiencies, signs of possible heart disease or stroke risk, potential Alzheimer’s risk, and other neurological concerns.

Many foods we eat have an amino acid called methionine, such as nuts, beef, lamb, cheese, turkey, pork, fish, shellfish, eggs, dairy, and beans. Methionine is converted in the body to homocysteine, which in turn is converted back to methionine, or to cysteine, another important amino acid.  This cycle requires adequate levels of  vitamin B₁₂, vitamin B₆, folate and the modified amino acid called betaine. Many people, however, often don’t, which allows homocysteine to build up, damaging  your blood vessels and brain.

Reasons for elevated homocysteine levels include:

  • Poor dietary habits
  • Smoking or drug use
  • Sedentary lifestyle
  • Nutrient deficiencies
  • Genetic variants, such as MTHFR

Natural ways to lower homocysteine levels include:

  • Improve your diet, avoiding gluten, sugar, preservatives, refined oils, and processed foods.
  • Exercise regularly.
  • Manage stress with, e.g., meditation, yoga, and energy therapies. (stress depletes B vitamins!)
  • Supplement with high quality B vitamins and antioxidants.
  • Avoid recreational drugs and reduce or eliminate alcohol.
  • Work to improve quality of sleep.

Discuss checking this important marker with your provider. In the meantime, work on ways to protect yourself.  Nutrition help is also available at TWIHW.  Be well!







By |2021-04-14T06:56:19-05:00April 15th, 2021|General|

Replacing Electrolytes: Better Options

By Nancy Mehlert, MS.

There are a couple of well known electrolyte and hydration drinks popular in the marketplace today. Everyone has seen commercials and ads for them. Common to the sports scene in our schools, colleges, and professional sports, these sweet, fruity flavored hydrators are sold by some of the largest beverage retailers in the world. In addition, many companies make cheaper knock-offs.  That makes them very affordable and easily obtained, but what about the ingredients? Should we be concerned? ABSOLUTELY!

These beverages, whether you have chosen the zero sugar options, the regular, or even the organic, have a number of concerning ingredients. Sugar content is the first concern.  Remember, the intended goal of these beverages is to return water to the body and to bring electrolytes (sodium, calcium, potassium, chloride, phosphate and magnesium) back into the body.  The need is not sugar, yet the most popular versions contribute more than 45-50 grams of sugar in each bottle. Considering our optimal blood sugar at any given moment should be about 4 grams, these drinks elevate blood sugar immediately by more than 10 times. This creates a very dysregulated blood sugar problem for the body.  Another concerning ingredient is the sweetener most commonly used in lieu of sugar.  While sucralose removes the sugar, this artificial sweetener is known for destroying the favorable bacteria in the GI tract, contributing to yeast overgrowth and leaky gut syndromes. Two additional concerning ingredients include food dyes and caramel coloring. There are a number of health concerns from these man-made chemicals, ranging from cancers to allergic reactions.  All of these concerning ingredients can be avoided with a little effort.

Perfection is difficult to find.  The recommendations below would be a significant improvement over most options offered by our largest retailers.  I’ve listed them in descending order from satisfactory to the most ideal. The  more sugar it contains, the better it is to use before and during very demanding and high activity exercise. Everyone needs less sugar, more water, and good electrolytes.

  • Nuun Rapid Instant Hydration portable packets
  • Harmless Harvest coconut water (pure coconut water, 23g naturally occurring sugar) ok for very active people
  • Ultimareplenisher.com – Hydration Powder stick packs
  • Liquid IV (11 g of sugar) ok for very active people
  • Keynutrients.com – Electrolyte Recovery Plus, Keto approved, Lemonade flavor
  • 8 ounces of water with 2 tablespoons of lemon juice and a pinch of Redmond’s Sea Salt, along with eating your vegetables (an excellent source of electrolytes and water)!

Support your health and that of your family.  Small changes add up to greater health and wellness.

Standard Gatorade, ½ a bottle is 22g or whole bottle 51 g of sugar:  


Organic Thirst Quencher, Berry Flavor by Gatorade – 30 g of sugar:


Gatorade Zero:


By |2021-04-07T09:25:47-05:00April 7th, 2021|General, NANCY’S NUTRITIONAL NUGGET|

Dijon Baked Salmon or Trout

From www.downshiftology, Lisa Bryan

Serves 4

Prep Time: 5 minutes

Cook Time: 20 minutes


1 ½ pounds wild Pacific Salmon or Steelhead Trout*

¼ cup fresh parsley finely chopped

¼ cup Dijon mustard

1 tablespoon lemon juice

3 garlic cloves finely chopped

Salt and pepper


  • Preheat oven to 375 degrees.
  • Line a baking tray with parchment paper and place the fish on it, skin down.
  • Mix together the remaining ingredients in a small bowl and generously coat the top of the fish.
  • Bake the salmon for 18-20 minutes, depending on size and thickness, then slice into individual portions and serve.

Notes: Wild pacific salmon and farmed Steelhead Trout are sustainable, high omega 3, low mercery options. 

By |2021-03-31T08:31:09-05:00March 31st, 2021|General, Recipes|

COVID and the flu will continue for now.

By Mila McManus, M.D.

COVID and the flu will continue to be with us for now, so I wanted to remind everyone to please support your immune system and overall health to avoid bad outcomes. I recommend a foundational daily minimum of vitamin D3, a multivitamin, and a quality probiotic. Preventing any illness means staying true to an integrative approach that is attentive to all of the key pillars of your health.  Those key pillars include:

  • A whole food diet and good hydration – maintaining balanced blood sugar is key (did you know that sugar immediately suppresses your immune system for up to several hours?)
  • Moderate exercise
  • Keep the gut healthy – easy on the alcohol, sugar, wheat, and pain relievers, while taking your probiotic and drinking bone broth
  • Get quality rest and sleep
  • Avoid toxins and support detoxification – see gut health above and step into the IR sauna too!
  • Manage stress – take time for quiet meditation, practice yoga and/or deep breathing exercises
  • Make use of appropriate supplementation – see below

For most, a healthy diet still cannot provide adequate nutrition for a strong immune system because of poor food quality, daily stressors, and the toxicity of our world.   For those with compromised immune systems, or who are living and working in higher exposure areas, or traveling, a selection from the following supplements would be wise protective additions.

All of these options, along with common sense measures such as thorough hand washing and avoiding crowds, will help to keep you healthy this year. If you are unsure about which supplements would be best for you, consult with our medical providers for a customized plan that’s right for you.

By |2021-03-26T08:29:48-05:00March 26th, 2021|Articles, General|

What is NAD+?

by Mila McManus MD

Nicotinamide Adenine Dinucleotide (NAD+) is the active form of a coenzyme that is an essential component of chemical reactions that occur in all of our cells. These reactions regulate nearly every bodily process. 

Be careful of other products marketing themselves as NAD.  NAD+, NADH and NR (Nicotinamide Riboside) are not the same. Although NAD+ plays a role in the same pathway as NADH and NR, there are certain NAD+ consuming reactions where only NAD+ can be utilized. In these reactions, NADH and NR are not effective. While NADH and NR are less expensive than NAD+, the positive effects are not nearly as potent as NAD+.

NAD+ is Involved in Two Major Functions:

FIRST: Energy Production. NAD+ helps to turn carbohydrates, fats, and proteins in the body into useable energy via the Citric Acid Cycle (Krebs Cycle). This important chemical reaction results in the production of ATP. ATP is the energy currency of life, powering nearly every biological activity such as muscle contraction, protein manufacturing, and cellular communication.

SECOND: Regulating the Body’s “Stress Response”. NAD+ partners with proteins involved in regulating and preserving health. This includes synthesis and repair of DNA, regulation of circadian rhythms (sleep-wake cycle), and stem cell production.

As we age, levels of NAD+ decrease in our bodies. Scientists believe that by the time we reach our 40’s, the supply of NAD+ is no longer able to meet the demand for important biological processes. Additionally, sickness and disease, as well as environmental and self-induced stressors can rapidly deplete our body of this vital nutrient.

Additionally, low levels of NAD+ may contribute to fatigue, depression, and anxiety. It hinders our body’s ability to overcome the grip of drug and alcohol addiction. Additionally, low levels of NAD+ may contribute to worsening disease states in vital organs such as the heart, liver, and brain. NAD+ depletion weakens our immune system, which affects our ability to fight infection or slow the progression of cancer.

Reasons to consider incorporating NAD+ into your regimen:

  • The aging process
  • Athletic performance
  • Anxiety, depression and PTSD
  • Drug and alcohol addiction
  • Parkinson’s disease
  • Alzheimer’s disease
  • Other forms of Dementia
  • Multiple sclerosis
  • Other neurodegenerative disorders
  • “Chemo Brain”
  • Low energy levels
  • Chronic Fatigue Syndrome
  • Sleep disturbances
  • Chronic pain syndromes
  • Migraine headaches
  • Autoimmune diseases
  • Autoinflammatory diseases
  • Chronic Traumatic Encephalopathy (CTE)

What is the Course of Treatment for NAD+?

Treatment strategies at TWIHW are tailored to your specific needs.

We currently offer treatments consisting of 4-8 hour IV infusions of NAD+. These treatment durations vary based on treatment protocol and allow for a larger amount of NAD+ to be delivered directly to the body’s tissues, allowing depleted stores to be replenished.

For those just looking for a quick “boost”, we also offer reduced dose IV infusions that take only 2 hours.

 What Can I Expect During the NAD+ Treatment?

A brief assessment will be conducted on the day of treatment. For intravenous NAD+, a small IV will be inserted. The infusion will run for approximately 4-8 hours (or 2 hours for the reduced dose treatment). Patients are able to pass the time in our relaxing environment by watching TV, reading, and listening to music. You will also have access to high-speed internet and can bring your laptop for personal use. Water, tea, and coffee are available upon request. Please plan accordingly for meals as needed if doing a longer infusion. Delivery can be made to the facility but we ask that you refrain from any fast food or pizza.

Call our office at 281-298-6742, or visit www.twihw.com

When NAD+ IV isn’t possible, consider Tru Niagen as an alternative.

By |2021-03-24T07:09:21-05:00March 24th, 2021|Articles, General|

Who Needs a Ca Score?

By Mila McManus, M.D.

medical stethoscope with red paper heart on white surface
Photo by Karolina Grabowska on Pexels.com

Almost 50% of those who suffer from a heart attack had no known risk factors

Could this be you or someone you love? It is a rather concerning fact since it means many of us could be ticking time bombs without knowing it. Cardiovascular disease remains the number one cause of death in the United States¹, so there is a good reason for all of us to be concerned.

We know that heart attacks ARE preventable. So what can be done to ensure you are not in that 50% who don’t have known risk factors but may have heart attack risk? 

The Calcium Score, also called the Agatston Score, for many experts, has come to be the best predictor of a future heart attack. Determining the Calcium Score is done through CT Scan testing lasting less than 3 minutes and requiring no dye. The test is a measure of the amount of calcium nestled in the walls of your coronary arteries that feed your heart muscle. It reflects the total amount of atherosclerotic plaque that has built up and is an indicator of how all of your risk factors interact with each other to cause heart disease.

A study of 44,000 individuals free of known coronary heart disease underwent the non-invasive CT scan of the heart for coronary calcium scoring and were followed for a median of five years to determine if any of them died of any cause (this is “all-cause mortality”, a good marker since three-fourths of all deaths are related to atherosclerosis). Those with a Calcium Score exceeding 400, but no risk factors, had substantially higher death rates compared to individuals with three risk factors and the absence of coronary calcium. In other words, the Calcium Score was more predictive of heart attack or other cardiovascular issues causing death than the conventional risk factors for heart disease – such as high blood pressure, high cholesterol, family history, pre-diabetes and diabetes, smoking, being overweight, high triglycerides, and a sedentary lifestyle. 

Generally, all men over the age of 45, and most postmenopausal women would do well to have a heart scan to determine their Calcium Score, and especially if there are other risk factors involved. Most major medical centers do CT scans for coronary calcium and the cash cost ranges from $99-399. (In the Spring, Tx area, it’s ~$150)  It’s not covered by most insurance companies yet, and therefore is not yet considered ‘standard of care’.  For this reason, you’ll find that some doctors order this test routinely, while others don’t order it at all.  This test has been invaluable in my practice, especially since I know that cholesterol levels can be VERY misleading in regards to assessing your risk.

Ask your medical provider if a Calcium Score heart scan would be right for you.

Facebook Review from one of our patients whose decision to have a heart scan was life-changing:

“Living a healthy lifestyle; staying fit is my “modus operandi”. I’m not perfect, but I do eat right and avoid a sedentary lifestyle. I’ve been very active on the racquetball court for 35 years. Reason: Both my parents died early from Heart Disease.
A few weeks ago, my Functional Medicine MD, Mila McManus recommended I get a heart scan (due to my family history) to get a baseline calcium score. I paid the $140 for a heart scan and awaited the results.
To my surprise, my score was high. I saw my cardiologist and scheduled an Angiogram. Again, to my surprise, they found 100% blockage in one heart artery, and significant blockage in two others, I need heart bypass surgery.
I was shocked. I feel great, I have no symptoms, work hard, get plenty of exercise and did I mention: I FEEL GREAT!
But the images don’t lie. So, at 62, I’ll undergo bypass surgery next week.
I share this story for one reason only: Get yourself checked out! Even though you may have no symptoms and feel like you can take on the world, you could possibly be living with a serious heart event on your horizon, especially if you have Heart Disease in your family history.
Thank you Dr. McManus, you may have saved my life!”
By |2021-03-16T21:49:39-05:00March 17th, 2021|Articles, General|

Black Lentil Salad

From www.nutritionaction.com
Photo: Kate Sherwood & Jennifer Urban/CSPI

Serves 4

Black Lentil Salad is a delightful meatless high protein, high fiber meal.


1 teaspoon lemon zest

2 tablespoons  fresh lemon juice

1 teaspoon Dijon mustard

2 tablespoons minced shallot

2 tablespoons extra-virgin olive oil

½ teaspoon sea salt

2 cups cooked black lentils

1 cup sliced celery

¼ cup chopped walnuts

¼ cup shaved Manchego or Pecorino Romano sheep cheese

Freshly ground black pepper


    • In a large bowl, whisk together the lemon zest, lemon juice, mustard, shallot, oil, and salt.
    • Toss with the lentils, celery, walnuts, and cheese. Season to taste with the pepper.
    • Refrigerate overnight to allow flavors to develop.

Per ¾ cup serving:

Calories: 280

Total fat: 14 g

Carbs: 26 g

Fiber: 12 g

Net Carbs: 14 g

Total sugar: 2 g

Protein: 13 g

By |2021-03-08T11:42:06-06:00March 10th, 2021|General, Recipes|

Sacred Cow

An excellent documentary with a compelling message!

By Mila McManus, M.D.

In a well thought out documentary, Sacred Cow focuses on the great meat debate. The documentary explores the environmental and health impacts on humans, cattle, and the ecosystem when we commercially produce beef. It also explains and demonstrates the benefits of a healthy, sustainable, conscientious food system. The first part of the documentary is fairly graphic with animal handling, but it then moves into a beautiful and outstanding demonstration of the natural life cycle of all living things and their deep connectedness, guided by a noble and responsible way of resolving issues around raising and eating meat.

To learn more about the book and the movie, Go to https://www.sacredcow.info/ .

By |2021-02-24T06:33:31-06:00March 3rd, 2021|Articles, General|

Food Gums: What matters is dosage.

by Nancy Mehlert MS

Food gums are plant sourced food additives used as thickening, stabilizing, and emulsifying agents. The most common gums are agar agar, arabic, locust bean, guar, acacia, gellan, xanthan, and carrageenan.   They are very common in dairy, nut milks, and non-dairy yogurt and cheese replacements, salad dressings, baked goods, and many gluten free foods. They do not provide any valuable nutrition.

Most people seem to be fine consuming gums, however if you have digestive issues, such as bloating, constipation, or diarrhea, you may want to closely examine how many foods you are consuming that have gums in them.  While a small amount in one food is generally recognized as safe and harmless, many people who count on pre-packaged and gluten free foods, as well as non-dairy dairy replacements, are actually consuming more than they realize. While all the gums are used in very small amounts, often times multiple gums will be used in one product, making the amount more than it seems.

Xanthan, carrageenan, and guar gums are polysaccharides, banned from the popular FODMOPS diet due to their impact on digestive issues. Guar gum feeds pesky bad bacteria in the gut and can cause significant bloating. Carrageenan gum is a possible source for monosodium glutamate (MSG), and has been known to cause stomach inflammation. It is currently being investigated more closely by the FDA.

To summarize, be aware of the sources of gums you are consuming, realizing that less is likely better, especially if you have a sensitive digestive system.


Dessey, Mira. The Pantry Principle; The Woodlands, Texas: Versadia Press, 2013.

https://chriskresser.com/harmful-or-harmless-carrageenan/, accessed on 1/23/21

By |2021-02-24T06:13:18-06:00February 24th, 2021|Articles, General, NANCY’S NUTRITIONAL NUGGET|


by Mila McManus, MD

Poly-MVA is emerging as an important nutritional therapeutic means of supporting immune health, mitochondria, and cellular repair.  It is a patented type of palladium lipoic acid complex composed of lipoic acid, the mineral palladium, and thiamin bonded in one molecule. Poly-MVA also contains other vitamins, minerals, and amino acids. There are many methods of delivery, including IV infusions, injections, oral administration, and via nebulizer. It can even be injected locally around wounds to help them heal.  

Poly-MVA works by a novel mechanism of action: poly-MVA quenches free radicals in the body and turns those damaging molecules into energy.

            Damaged molecules→→→→ENERGY

Then the electrons get donated back to the cell via the electron transport chain where they do a one-two punch. First, the energized electrons introduce cell death of abnormal cells. Second, the immune system is also strengthened as normal, healthy cells are supplied oxygen and protected from oxidative stress.



Studies are proving promising for Poly-MVA therapies suggesting:

  • Improved length and quality of life with its anti-aging properties
  • Extreme effectiveness in boosting the immune system.
  • Increased wellbeing and energy levels.
  • Non-invasive support for cancer treatment
  • Non-invasive support for stroke recovery
  • Promising help for those with other degenerative diseases such as multiple sclerosis.
  • A safe, and effective therapy with no contraindications*.  A detoxification “Herxheimer” reaction has been observed.

You can learn more about Poly-MVA here.

*If you have a severe allergy to sulfa, you should first take a small test dose orally and increase as recommended by healthcare provider

The Woodlands Institute for Health and Wellness is now offering Poly-MVA therapies. To find out if Poly-MVA is the right option for you, speak to one of our medical providers.

By |2021-02-17T09:14:56-06:00February 17th, 2021|General|
%d bloggers like this: