P: 281-298-6742 | F: 281-419-1373|info@TWIHW.com

Processed Foods: Odds Are Against Us

by Nancy Weyrauch Mehlert, MS

More than 75% of the food in our grocery store is ultra-processed food, while only 25% is real, whole, non-MAN-ufactured food. 

The most common nutrition questions we get in our practice are whether or not a particular packaged product is “good” or not.  The questions come in about supplements, protein powders, other superfood powders, and all kinds of chips, protein bars, cereals, pastas, and seemingly better peanut butter cups and gummy bears. When it comes to food questions, 99% revolve around wanting the convenience of ready-made and packaged foods. Many of the packages look pretty impressive. Grocery stores and food producers bend over backwards to create convenience, all-the-while convincing you of its nutritional value, healthiness, or goodness. Many of the catch words marketers are hoping will speak to your common sense in the healthy food arena, such as non-GMO, Organic, No Sugar Added, Gluten Free, Keto, Paleo, All Natural, Nothing Artificial, are usually present. But do all those words really make it good for you?

Some words are popular right now that confuse even the best label readers, such as ultra-pasteurized or grass-fed, cage-free, pasture-raised, and natural flavors. “Ultra” is a great example of a word or prefix that can be misleading. Most people think of ultra as an improvement, a finer, better feature. But in the food industry, with rare exception, ultra-filtered or ultra pasteurized simply means another step was taken to further refine and process that food. And what about cellulose powder?  Sounds harmless enough, right? Did you know that it is refined wood pulp? When did man ever eat wood?

So here’s the thing. There is plenty of data now demonstrating that more than 75% of the food in our grocery store is ultra-processed food, while only 25% is real, whole, non-MAN-ufactured food.  In other words, odds are against you when you are shopping that you will find the good 25%. Meanwhile, the other 75% are being highly marketed, end-capped, taste sampled, specially signed, and stunningly packaged with all the titillating sensory words and colors that attract and draw you to the 75%. And a lot of it looks really healthy.

The point here is to remind you, if it’s in a package, man put it in the package. If you pick it up in a drive-thru, it is ultra-processed. If it is not in the original state from which it comes out of nature (a whole fruit, vegetable, nut, meat from the bone), we should all be asking ourselves just how much had to be done to make this product. This is especially true of powders, flours, pressed bars, baked goods, dressings and sauces, chips, and other snack and convenience choices. Even if all of the ingredients are whole food, many are still heavily processed, void of fiber and precious nutrients. Aiming to swap these percentages in our favor rather than against us is a good goal.  Seek to make 75% of your food whole from the store periphery and farmers’ markets.  One challenge may be to find all of the packaged food in your house that has a Nutrition Facts and Ingredient label and put it on your kitchen counter. Then ask yourself how much of that makes up your daily diet.

Diets rich in ultra-processed foods cause an increased risk for cognitive decline, dementia, stroke, cancer, and all cause mortality.  Consistently, data also shows that people in general today also suffer from significant nutritional deficiencies. Ultra-processed foods fail to provide adequate nutrition.  Compared to the historical past, prior to the explosion of the processed food industry, people ate mostly local foods, and whole, real food.  And during that time we did not experience the explosion of lifestyle disease and nutrient deficiencies we see today. 

No doubt, this is a tough challenge. We all have busy lives, careers, and family responsibilities, and all of the stresses that are common to us all. Changing how we eat and what we eat takes time and effort. It is not easy, especially at first. New habits can nevertheless be developed that, once practiced, are also convenient and easy. If we reorganize our priorities, we might find that we are able to endure the challenges of life as well as pursue our dreams more easily than ever before.  


Mila McManus MD. Highway To Health: A Nutritional Roadmap.(2019)

https://www.medscape.com/viewarticle/994958 [Diet and the Brain: From Ultra processed Foods to the Farmers Market]

Joseph Mercola MD. Kids Intentionally Poisoned by Artificial School Lunches. (September 6, 2023)


By |2023-09-21T06:40:06-06:00September 21st, 2023|Articles, General|

Twelve Weight Loss Hacks

by Mila McManus, MD

Weight loss never seems to be as simple as just changing diet or increasing exercise. 

Weight loss never seems to be as simple as just changing diet or increasing exercise.  Often, it is more of a multi-faceted approach that stimulates the body to burn fat. For example, we know that diet, exercise, proper hydration, stress reduction, and quality sleep work well together to stimulate weight loss.  Also, within each of these lies many nuanced hacks to help you make even more progress. Check out these hacks and start practicing them for improved weight loss and overall health.

  • Dress up your carbohydrates. Keep carbohydrates (vegetables, fruit, grains, sugar) in context with fat, protein, and fiber. Naked carbohydrates, eaten by themselves, get to the intestines very quickly. This usually causes hunger, carb cravings, weight gain, fatigue, elevated insulin levels, brain fog, inflammation, and ill health.  Mix your carbs with fat, protein, and/or fiber. All three inhibit and slow down carb digestion.
  • Drink some vinegar before a meal. More than a dozen research teams around the world have repeatedly discovered that vinegar has a favorable impact on fat loss. Adding vinegar right before meals for three months, subjects lost 2-4 pounds and reduced visceral fat, waist and hip measurements, triglyceride levels, and blood glucose levels. Blood glucose levels were reduced from 8 to 30 percent. Vinegar contains acetic acid and, when absorbed through the GI tract, it moves from the bloodstream to the muscles which then increases uptake of glucose from the blood. Before a meal, vinegar helps to release glucose more slowly from your food into the bloodstream, while also encouraging the muscles to take up glucose from the blood more quickly. One tablespoon of any kind of vinegar added to eight ounces of water is the recipe. But don’t use this hack expecting it to slow down your hamburger, fries, and milkshake! Pair it with a healthy, whole food meal.
  • Pick dessert rather than a sweet snack. It is better to eat dessert than a sweet snack. For example, if you want to indulge in a brownie, it is better to consume it after eating a meal with fat, fiber, and protein, than to isolate it at 3pm or 9pm by itself away from a meal.
  • Start with your rabbit food (raw or cooked vegetables) first. At mealtime, eat your veggies first, followed by protein and healthy fats. Then place higher carb foods, such as potato, grains (rice, corn, wheat, etc.), fruit, or dessert at the end of the meal. Fiber expands and creates a barrier while protein and fats are slower to digest.  This lines up the fast carbohydrates at the end of the line and are stalled by everything before it.
  • Eat, then get moving. Moving immediately after a meal uses up available blood sugar rather than storing it in fat.  The more carbohydrates you can burn, the better!
  • Stop eating at least 3 hours before bed. Sleeping with food in the stomach causes fat storage and interrupts sleep quality. During sleep, we detoxify, reset hormones, calm the adrenal stress response system, and heal.  If you are digesting food instead, none of this occurs.
  • Stop counting calories. Instead, eat quality. 100 calories in a Donut is NOT the same as 100 calories of nuts. Calories are not nearly as important as quality, real whole food! RUN from ultra-processed foods. If you count anything, count carbohydrate grams. Lower them until weight loss begins. Your carb gram number will be unique to you, and is best advised by a qualified healthcare professional.
  • Go savory for breakfast. If you are going to start the day with breakfast, start with protein, fat, and fiber – limit grains and fruit, especially tropical fruits, such as banana, pineapple, or mango, as well as dried fruits like raisins, prunes, or apricots. Avoid putting two carbohydrates together (e.g., oatmeal with raisins or blueberries and brown sugar, jam and toast, fruit juice and a muffin).
  • Limiting sugar is the hack, not using one kind over another. Sugar is sugar. At a molecular level, they all spike blood sugar. In other words, whatever it is called, and there are more than 60 kinds of sugar found in our foods, (e.g., table sugar, honey, coconut, date palm, maple syrup, corn syrup, brown sugar, glucose syrup, naming just a few), all of them will spike your blood sugar, which is what you want to avoid.
  • Flee from fructose. It is more harmful than glucose or sucrose. Fructose is overwhelming to the liver, turns to fat, precipitates insulin resistance, and makes us gain more weight than will glucose. It also makes us hungrier rather than satiated.  Agave syrup is 90% fructose and honey is 40%. The highest fructose-containing fresh fruits include grapes, bananas, jackfruit, and papaya, and all dried fruit and fruit juices. Sweet tea, coconut water, soft drinks, fast food hamburgers, and ketchup are other considerable sources of fructose.
  • Savory snacks are ideal. Eating in between meals is best done with savory, salty, fatty foods such as nuts and nut butters, guacamole, hummus, olives, and bean chips, to name a few. When we eat fruit or any type of sugary food by itself without fat, fiber, and protein, we are setting ourselves up for fat storage, sugar spikes and dumps, and fatigue.
  • Intermittent fast to turn on your fat burning mechanism. While intermittent fasting (IF) and an extremely low carbohydrate (ketogenic) diet are not a suggested daily lifestyle, they are an excellent strategy for breaking a weight gaining streak and resetting the body’s ability and willingness to burn fat. Chronic high carbohydrate consumption and snacking prevents the body from needing to burn fat and the body gets very lazy about doing so. Instead, your body demands more carbohydrates for fuel rather than accessing fat stores.  Intermittent fasting (IF) with a more ketogenic diet reminds your body to access fat stores. One word of caution, intermittent fasting should not be done suddenly, and it might be wisest to ask your medical provider and our nutritionist if IF is a good option for you and how best to implement this strategy. Moreover, some people don’t do well cutting out carbs cold turkey.  If you are going to attempt a keto diet, decrease carb intake gradually and be sure to supplement with minerals (e.g. salt, potassium, magnesium).

Best wishes and be Well!



Inchausepe, Jessie. The Glucose Revolution. (London: Short Books, 2022).


By |2023-09-13T13:26:27-06:00September 14th, 2023|General|

Sodium Part II:  15 True, New, and Surprising Factoids!

by Mila McManus, MD

In our August newsletter , we questioned if sodium, or salt, is really bad for you and answered a resounding NO. Salt is important! First, the body requires sodium. Second, sodium must be understood in the context of potassium levels. And finally, not all salts are the same. Purchasing quality salt matters [e.g., Redmond’s Real Salt™, Himalayan Pink Salt from Pakistan].

This week, we continue with true, new, and surprising factoids about sodium[i] that you need to know!

Salt cravings are biologically normal, just like our thirst for water. We should pay attention to our salt cravings and respond by increasing our salt intake.

  • Sugar cravings are not biologically normal, causing fat accumulation, insulin resistance, chronic inflammation, oxidative stress, and mitochondrial damage.
  • A high sugar diet increases your need for salt, and satisfying your salt cravings may be a key to kicking your sugar cravings. 
  • Salt restriction/depletion increases LDL and total cholesterol levels.
  • Salt restriction/depletion causes insulin resistance and sugar cravings.
  • Sodium is required for vitamin C absorption.
  • Salt is essential for vitamins and minerals to be pushed into the bones, making them strong.
  • Low sodium level results in sodium being pulled from the bones, and brings calcium and magnesium with it!  This results in bone loss.
  • Early humans, well before refrigeration, used salt to preserve most foods and consumed as much as 100 grams of salt without issues of cardiovascular disease and hypertension.
    • [The DASH diet for hypertension recommends only 1500-2300 mg per day[ii]].
  • The rise in hypertension in the early 1900’s actually parallels a reduction in salt intake.
  • The salt “thermostat” regulates intake and prevents addiction to salt. However, introduction of sugar results in a definitive thirty-fold escalation in intake, with evidence of bingeing, tolerance, and structural changes in the brain in response to consuming sugar, all three criteria for addiction.
  • Sugar, unlike salt, is the real villain, along with harmful industrially processed seed oils.
  • When we sweat [e.g., exercising, using a sauna, working in hot weather], we lose about ½-1 teaspoon of salt per hour, on average.
  • Pre-loading salt before excessive sweating will provide greater endurance by dilating vessels for better heat dissipation and slowing of the heart rate.
  • When fasting or lowering carbohydrates below 50 grams per day [ketogenic diet], it is important to increase salt intake. This is because lowering sugar intake will lower insulin, and this leads to more salt wasting [excretion].

Eat Salt!

[i] DiNicolantonio, James. The Salt Fix. (New York: Harmony Books, 2017).

[ii] https://www.nhlbi.nih.gov/education/dash-eating-plan

By |2023-09-07T10:53:04-06:00September 7th, 2023|General|

CGM’s – Continuous Glucose Monitors

A Weight Management Option For Understanding Yourself Better 

by Mila McManus, MD

Continuous Glucose Monitors, or CGM’s, are a breakthrough in biomedical technology. They help individuals to track blood sugar in real time.

Continuous Glucose Monitors [CGM’s] are a more recent breakthrough in biomedical technology. In a minimally invasive way, CGM’s help individuals to track blood sugar in real time.  While the only perfectly accurate glucose reading is by getting a blood glucose tests from a lab, wearers of a CGM can gain meaningful information regarding how their unique metabolism responds to food combinations, as well as to stress, sleep, and exercise.

These devices are helping people to understand the unique aspects of their metabolism,  which is directly influenced by genetic make-up, eating habits, and overall health (e.g., thyroid function, hormone balance, muscle mass, chronic stress, poor sleep, disease, toxins, and inflammation). Research is showing that there are significant differences in how each of our bodies manages glucose. 

When you wear a CGM, it informs you in real time of what food combinations elevate your blood glucose excessively and which combinations keep it stable. Data patterns can be sent to an app on your phone for evaluation and to increase understanding of your own biochemical response to food, stress, exercise, and sleep. As a result, you are able to make lifestyle changes that directly impact your weight, healing journey, and wellness.

If you are interested in finding our more about a CGM, ask your medical provider if this is a good option for you.  

If you missed last week’s newsletter article about blood sugar, click here.

Know you, Be you, Be Well.



By |2023-08-30T12:49:02-06:00August 31st, 2023|General|

Blood Sugar:

Our Need For Glucose is a Slow Drip, Not a Flood!              

Nancy Mehlert, MS, Nutrition Expert at The Woodlands Institute for Health and Wellness

When early humans hunted, gathered, and raised their own food sources, the diet was naturally balanced with healthy fats, protein, fiber, and carbohydrates. Stable blood sugar was almost a given and is our ideal state. When your blood sugar is stable, you are alert, focused, and able to function optimally. Normally it would also mean you are maintaining a normal weight. Blood sugar stability means that the body is getting adequate resources of glucose from the diet or back-up storage in the liver, and is sustaining a balance of glucose to total blood volume.   Stability means your sugar is not too high (hyperglycemia) or too low (hypoglycemia). 

Glucose primarily comes from the carbohydrates we eat. Carbohydrates include all grains, sugars, fruits, and vegetables. The more fiber a carbohydrate has, the slower it digests.  The less fiber it has, the faster it digests. Nuts and seeds, meat, eggs, and animal fats are not significant sources of carbohydrate.  Any pulverized (made into flour) grain or bean, all natural sugars, and the lowest fiber fruits, eaten independently of fat or protein, will digest VERY rapidly, dumping glucose into the blood all at once.  Glucose makes its way to the blood stream BOTH through the intestines as well as sublingually, under the tongue. Our approximate one gallon of blood in the human body is optimally balanced with glucose when there are about 4 grams of glucose mixed in our blood.  Therefore, when we eat predominantly carbohydrate foods such as wheat, rice, or corn based breads and pastas, or drink any liquid with carbohydrate content (soft drinks, energy drinks, fruit juices) especially with no sources of significant fat, fiber, or protein, we destabilize blood sugar by 5, 10, or even 20 times more than our optimal state.

Our body stabilizes elevated blood glucose levels by releasing insulin. Insulin is a hormone that ushers glucose from the blood stream first into the liver. The liver, however, has a limited capacity for glucose, so once that capacity is reached, excess glucose is usually stored as fat. Thus when we consistently consume excess glucose (i.e. carbohydrates), we gain weight. Moreover, inflammation occurs which results in other diseases such as a fatty liver, diabetes, bone deterioration, heart disease, cancer, or poor brain function.  Insulin usually is an overachiever when removing glucose from the blood, taking blood sugar a bit below normal.  The result is a desire or craving for more carbohydrates to level out blood sugar, but usually results in our consumption of too much again. This vicious sugar craving cycle of spiking and dumping blood sugar ultimately leads to metabolic disfunction, damage, and disease.

The goal in developing a healthy nutritional lifestyle is to determine the methods that effectively deliver a slow and low glucose drip into the bloodstream, rather than flooding it with more glucose than it can use at that moment. Next week, we will offer a new approach to doing just that. Stay tuned.

By |2023-08-24T06:24:54-06:00August 24th, 2023|General|

Sodium: Is it Really A Villain?

by Mila McManus MD

Your body requires sodium to function and getting too little actually increases your risk of heart problems, not lower it.

Reduction of dietary sodium is the conventional wisdom offered to solve a number of health problems including high blood pressure. This wisdom is grossly oversimplified and is often a problematic approach to any number of health concerns.

Of the 118 building blocks of life identified in the periodic table, 25 are essential to life, and 95% of the body is made up of carbon (C), oxygen (O), hydrogen (H) and nitrogen (N).  The next seven most essential elements for life on the periodic table are calcium, phosphorus, potassium, sulfur, sodium, chlorine, and magnesium. Sodium is in the top 11 essential elements needed for life.

Three Key Salt Facts

First, your body requires sodium to function.  According to James DiNicolantonio, PharmD, author of The Salt Fix, inadequate consumption may actually increase your risk of heart problems!

Second, sodium MUST be understood in the context of its balance to potassium, as well as other key elements in the body.  This balance is FAR more important to maintain than lowering salt intake alone. Failing to address increasing dietary sources of potassium while decreasing sodium results in an imbalance that’s harmful to health. In addition, the body strives to maintain an optimal level of sodium regardless of your intake. Magnesium and calcium levels are used to control sodium levels. If sodium levels drop too low, sodium will be pulled from your bones, along with magnesium and calcium.  This is one reason why low salt diets are likely to be implicated in osteoporosis.

Third, not all dietary salts are the same. Salt has two essential elements – sodium and chloride. The vast supply of salt in the American diet is found in processed foods. Processed salt is about 39% sodium, 58% chloride, and the remainder is chemical additives such as moisture absorbents, anticaking gents, and often iodine.  Unprocessed, natural salt, such as Himalayan or sea salt, contains slightly lower amounts of sodium and chloride and valuable remaining trace minerals such as silicon, phosphorus, and vanadium. Natural salt is also higher in potassium than processed salt. White iodized table salt has 151 mg/kg of potassium, while pink Himalayan salt contains 2,085 mg/kg. So, switching the kind of salt you use can improve your sodium to potassium ratios and improve health. Natural varieties include pink Himalayan (beware of knock-off’s!) and salt from ancient salt beds. Both sources are free from the pollutants and plastics now found in our oceans.  

Finally, it is essential and smart to increase dietary sources of potassium to keep sodium balance in check. Needless to say, processed foods are a poor dietary choice from every direction. Your body needs five times more potassium than sodium, but most people get the exact opposite ratio, i.e. five times more salt than potassium. The most potassium dense food sources are found in the foods humans are best wired to eat – fruits and vegetables. Potassium is also found in small amounts in meats, dairy, nuts, and grains.  The most potassium rich food sources include fruits such as avocadoes, tomatoes, oranges, bananas, cantaloupe, honeydew, apricots, and grapefruit. Potassium rich vegetable sources include cooked spinach and broccoli, red boiled potato, sweet potato, mushrooms, peas, cucumbers, zucchini, pumpkin, and leafy greens. The best strategy is to eat 3 to 5 servings of a wide variety of fruits and vegetables every day, along with other whole, unprocessed, natural foods.  Moreover, according to DiNicolantonio, most people should salt their food “to taste”, taking it as a sign that the body needs as much as the body’s craving.

Be well!


New England Journal of Medicine, August 14, 2014; 371:612-623

American Heart Association, Primer on Potassium

Science Direct, Table Salt, Different salts in snacks

The Salt Fix by James DiNicolantonio, PharmD

The Ultimate Age-Defying Plan by Mark Reinfeld and Ashley Boudet, ND. 2019

Foods. 2020 Oct; 9(10):1490., Table 2

BitChute, Mercola October 26, 2021, 00:19

Mo Med. 2018 May-Jun; 115 (3): 247-252

Harvard T.H.  Chan School of Public Health, Potassium


By |2023-08-17T08:45:52-06:00August 17th, 2023|General|

Whole Fat Dairy: From No-Low to Yes Whole!

by Mila McManus, MD

food categories that were found to be most protective against cardiovascular disease...is the addition of whole fat dairy.

PURE,  the international Prospective Urban and Rural Epidemiological study collected data from five international trials encompassing more than 240,000 people to determine the food categories that were found to be most protective against cardiovascular disease. As you might expect, fruits, vegetables, nuts, legumes, and fish were all regarded as protective. The final food category associated with cardiovascular protection was whole fat dairy.

The scoring system was derived from dietary patterns and clinical events observed in the PURE study and was applied to populations internationally. Greater consumption of these six categories (fruits, vegetables, nuts, legumes, fish, and whole fat dairy) resulted in significantly reduced risks for death, myocardial infarction, and stroke.

This further confirms our strong belief that the best food for the human body is the food found in nature. Too many food options available are edited by man and genetically altered due to environmental forces (e.g., remove cattle from a calm, fresh pasture, and put them in a crowded, stressful feedlot, and feed them grains to which their digestive systems are not designed to handle).

Our commercial grain and dairy industries use a lot of the UNnatural man-made processes such as confinement, pesticides, genetic modification, antibiotics, hormones, and feeding animals something other than their natural diet.  Dairy and wheat continue to be two of the top 5 food sensitivities and food allergies in our country. This adulteration of our food likely contributes to the develop of allergies and sensitivities.  In addition, dairy and grains are ubiquitous in the diet, and this also contributes to the development of food allergies and sensitivities.  In other words, over-exposing the body to a particular food on a constant or continual basis makes you more likely to develop an allergy or sensitivity to it.

It is also noteworthy that many people who struggle with wheat and dairy allergies/sensitivities can tolerate dairy from European A2 cows, and can tolerate wheat from countries that do not allow genetic modification or excessive pesticides and herbicides.

Please note several considerations regarding dairy consumption:

First, be sure you have carefully tested yourself, by oral food challenges, allergy testing, and/or food sensitivity testing, to determine how dairy effects your body and inflammatory processes. Food allergies and food sensitivities are not the same and both should be evaluated. Many do not do well on any kind of dairy; others don’t do well with milk, but can tolerate cheese, or vice versa. Frequency of consumption also varies greatly. Many people find that using dairy on a daily basis is very congesting and causes inflammatory responses, but that occasional consumption of goat or sheep products can be enjoyed.

Second, if you are going to consume dairy, choose products in full fat form, organic, and 100% pasture-fed, as any cow, goat, or sheep would voluntarily choose. Also, products marked “A2” may be a better choice. 

Third, all dairy has many components, each of which can create sensitivities or allergies. Milk dairy is made up of at least two key proteins: Casein and Whey.  Both are common problems digestively. Dairy also includes a problematic sugar called Lactose.  Milk dairy also contains fat. Food sensitivities and allergies are to proteins, not FAT.  Cheeses are made by intensifying casein and reducing the whey.  The watery aspects of milk, yogurt, and cottage cheese are the whey.  Dense casein is hard cheese.  Dense whey is milk. Butter is 95% or more of the butter fat, minus lactose, casein, and most of the whey.

Fourth, milk from any living human or animal is designed to feed babies and help them grow.  Once growth is underway, weaning has been the long held historical tradition of humans and animals. We tend to see adult milk drinkers struggle with weight, elevated triglycerides, sugar addiction, hormonal imbalance, or allergies and sensitivities, especially to commercially produced milk. Non-fat and low-fat milk have been contributors to increased sugar in the diet, leading to obesity and diabetes. Fat helps to slow down the digestion of sugar, demonstrating the truth that food in its natural state is best for our health and wellness.  

Dairy is not for everyone and most likely not an ideal daily “go to”. So please focus more on vegetables, fruits, nuts, legumes, and meat!

Choose well, be well!

Medscape.com/viewarticle/994218  Heart-Protective Diet in PURE Study Allows Whole-Fat Dairy





By |2023-08-09T12:18:17-06:00August 10th, 2023|Articles, General|

Sleep Apnea – Don’t Be Fooled – It’s Sneaky

by Mila McManus, MD

in my experience, it is just as possible for a thin, physically fit, non-snorer female to have sleep apnea too, and not know it.

It’s a common assumption that sleep apnea is frequently associated with middle aged, overweight, thick-necked males who snore. While there is truth in this assumption, it’s important to know that many thin, non-snoring men and women have sleep apnea too. My patients will often say, “I sleep great!,” not knowing that they are suffering with sleep apnea as a root cause of some of their ailments, such as fatigue and high blood pressure.

Sleep apnea is a serious sleep disorder that most frequently remains undiagnosed, and left untreated, can lead to a greater risk for high blood pressure, cardiac arrhythmias, stroke, and erectile dysfunction. Other signs and symptoms that can accompany sleep apnea include morning headaches, unrefreshing sleep, poor sleep quality, needing to urinate in the night, and daytime fatigue and sleepiness.

Sleep apnea often remains undiagnosed. If you don’t fit the typical profile (middle aged, overweight, thick-necked, snorer, male), your doctor isn’t likely to send you for a sleep study.  

With obstructive sleep apnea, the muscles in the throat and the jaw relax during sleep. As this happens, the tongue also falls back into the throat creating partial blockage of the airway, either fully or partially. This causes decreased airflow, causing oxygen levels in the blood to drop and carbon dioxide blood levels to increase. Eventually the oxygen-starved brain signals the body to wake up and clear the blockage so that oxygen levels improve once again. This cycle repeats itself throughout the night, sometimes hundreds of times, but at a subconscious level.  This means that you don’t know this is happening and think you’re getting a great night’s sleep.

Aging and increased weight are risk factors. Interestingly, when we gain weight, our tongue increases in size, as does the tissue around the neck, and this narrows the airway. Aging also results in throat muscles becoming less stiff and more likely to narrow and collapse. Furthermore, airway architecture might be problematic for a much broader range of people.

  • Family predispositions for certain anatomical features can put you at risk. Families may have narrower airways, enlarged adenoids or tonsils, or adjusting the tongue or jaw in a posterior position (pulling the tongue to the back of the mouth or pulling the lower jaw backward toward the neck).
  • Certain ethnicities have tendencies for sleep apnea. The most common are African Americans, Hispanics, and Pacific Islanders, due to architectural features making the airway environment during sleep more susceptible to obstruction.
  • Highly fit individuals can be more susceptible to sleep apnea. Due to a thicker and more muscular neck, the muscles and fat pads can compress and narrow the airway.
  • Medical conditions such as hypothyroidism, growth hormone irregularities, food and environmental allergies, and other medical conditions causing congestion in the upper airways such as a deviated septum, and mold or yeast issues, are also causes of increased risk for sleep apnea.

And let’s not forget about CENTRAL sleep apnea.  This is another explanation why thin, non-snoring people can have sleep apnea.  Rather than an airway obstruction causing OBSTRUCTIVE sleep apnea, the other type of apnea called ‘central’ sleep apnea occurs due to the brain not signaling the need to breathe consistently while asleep.  Risk factors for this include heart issues such as atrial fibrillation or congestive heart failure, and stroke or other brain injury, certain medications such as narcotic pain medications, age, and toxic burden in the body that’s affecting the brain and central nervous system.

Main takeaway: If you don’t fit the profile of a typical apnea patient, but exhibit symptoms such as morning headaches, unrefreshing sleep, poor sleep quality or daytime sleepiness, it is best to seek a medical evaluation and request a sleep study.

 Breathe Well, Sleep Well, Be Well!



Mayo clinic






By |2023-07-31T14:47:21-06:00August 2nd, 2023|General|

Myopia, Dry Eyes, and Mac D, Oh My!

by Mila McManus, MD

Increased usage of electronic screens results in significantly increased risk for myopia, or nearsightedness.

You may not realize it, but increased usage of electronic screens results in significantly increased risk for myopia, aka nearsightedness. Nearsightedness is when close objects appear clear but distant objects are blurry. Excessive use of computer monitors, smartphones, and tablets also causes the glands that keep your eyes moist to atrophy, resulting in dry, sometimes painful eyes. This is caused by the fact that we blink less frequently when staring at a screen.

When the eye is forced to stare at something too close, the brain and eye adjust or accommodate to increase close up vison.  Over time, the squeezing of muscles used to make that adjustment can elongate the eyeball, causing myopia. This is especially concerning for children and youth whose eyes are still developing. Dr. Vivian Hill, a Calgary-based pediatric ophthalmologist and surgeon, emphatically tells parents with children less than one year old that they should not be exposed at all to electronic screens! She recommends all children reduce screen time and increase outdoor activity. She has observed an alarming rate of progression of myopia in children under 12 years old.

Hill stresses that daily exposure to natural sunlight, which releases dopamine in the retina, possibly slows the elongation of the eye and changes to visual acuity. Research published in June 2022 found that the rate of myopia in children aged 5-17 who live in urban areas is 41%.  Children who live in rural areas and tend to spend more time engaged in outdoor activities have a myopia rate of just 15.7%! Additionally, adequate sleep is essential for protection and proper development of the eyes for both adults and children.

Lutein is an essential nutrient for the eyes. It is very efficient at filtering out blue light- the type that comes from cellphones, computers, tablets, and LED lights. Moreover, blue light induces oxidative stress, increasing risk for macular diseases. The body does not produce lutein. It must come from diet or supplementation. Particularly rich sources of lutein include dark leafy greens, broccoli, red and yellow peppers, avocados, cherries, carrots, egg yolks, raspberries and paprika. Our eye health is another good reason to eat 5 or more servings of vegetables and fruits every day.

Other than sunlight and a healthy diet, another interesting approach to prevent or reverse nearsightedness is call the Bates Method. Dr. William H. Bates identified this method over 100 years ago. It was so effective that optometrists in New York lobbied local politicians to have it banned because it cut into their optometry business!  Today this method is still taught by Bates Method International. The method is simple. First, sit while leaning forward with your elbows on a table or a stack of pillows and relax the shoulders and body. Second, place the center of your palms over your eyes and relax like this for at least two minutes. Third, remove your hands, open your eyes, and notice whether anything looks clearer. Usually, it will.

Bates was also a proponent of sun exposure to the eyes to help correct vision problems, and recent research suggests he was right on track 100 years ago! 

Get some sunshine, extra sleep, and extra veggies. See Well. Be Well.



CBC News April 23, 2023

Nature March 18, 2015; 519(7543): 276-278

J Ophthalmic Vis Res October-December 2021; 16(4): 531-537

Review of Myopia Management February 1, 2023

Investigative Ophthalmology & Visual Science June 2022; 63: 244 – A0098

Seeing.org Bates Method International

Healingtheeye.com, Bates Was Right


By |2023-07-13T06:56:34-06:00July 13th, 2023|Articles, General|

BMI Loses Primary Status

by Mila McManus, MD

It has been clearly proven to me that the Body Mass Index, or BMI, was an inadequate way to define all people.

Over the last two decades of my practice, it has been clearly proven to me that the Body Mass Index, or BMI, is an inadequate way to define all people as underweight, normal weight, overweight, obese, or morbidly obese. This has been the American Medical Association’s standard gauge for healthy weight, until now.

Thankfully, in recent weeks, the American Medical Association has agreed to advise doctors to pay less attention to BMI as the only standard.  Body composition, belly fat, waist circumference, and genetic factors will also now be taken into account. The action came as a result of mounting evidence that it is an inaccurate predictor of individual health risk.  The BMI scale is based primarily on data from white people, so the issue here is that body shape and composition vary among racial and ethnic groups, genders, and age groups. 

The AMA’s statement further added that “overemphasis of bodily thinness is as deleterious to one’s physical and mental health as obesity.” The organization asks doctors to help patients “avoid obsessions with diet and to develop balanced, individualized approaches to finding the body weight that is best for each of them.”

At last! Promotion of the idea of individualized medicine! 

Be you. Be well. Be here at TWIHW where personalized medicine is the standard.



By |2023-07-06T05:54:56-06:00July 6th, 2023|General|