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

Inflammation: Fighting the Elephant in the Room

By Mila McManus, MD

Inflammation[1] lies at the root of most disease pathways, pain, and other symptoms.  Reducing inflammation is mission critical to feeling better and avoiding many lifestyle diseases of our day.

The biggest contributor to inflammation is your diet![2]  All foods fall on a sliding scale from wonderfully anti-inflammatory to painfully inflammatory. While the goal is to eat a balanced diet, some of which will be slightly inflammatory, most of what we eat should focus on anti-inflammatory and neutral foods.

Ranked for their extraordinarily powerful anti-inflammatory effects, nutrient density, antioxidant-richness, detoxifying ability, and gut-health promoting effects, here are the top 15 of the most anti-inflammatory foods.[3] 

First – Berries – Blueberries, Strawberries, Blackberries, and Raspberries

Second – Tomatoes

Third – Mushrooms

Fourth – Broccoli

Fifth – Bell Peppers

Sixth – Sweet Potatoes

Seventh – Onions

Eighth – Apples, Cherries, Oranges

Ninth- Avocado

Tenth – Dark Leafy Greens (the best are collards and spinach, but anything dark green is great)

Eleventh – Black Beans

Twelfth – Lentils

Thirteenth – Chickpeas

Fourteenth – Gluten Free Oats, Millet, Buckwheat

Fifteenth – Macadamia Nuts, Walnuts, Pecans, Almonds, Brazil Nuts, Hemp, and Pumpkin Seeds

Seventy five to eight five percent of our diet is best chosen from the anti-inflammatory and neutral categories. While some meats, dairy, eggs, and alcohol are generally inflammatory, eaten in moderation with anti-inflammatory choices provides a well-balanced, healthy diet.

Need more help? Call our office to schedule an appointment with our nutritionist, Nancy Mehlert, MS.

[1] Inflammation displays in the body as anything that is painful, swollen, red, raw, bloody, or irritated. It applies to all aches and pains, digestive discomfort, painful joints, headaches, skin irritations and rashes, mucous membranes that are chronically producing mucus in the stool or nasal passages.

[2] On the scale, nothing is worse than deep fried combinations of wheat flour, damaged oil, and sugar. This translates directly into donuts and French fries. All fast food falls to this extreme because of the sugar, gluten, and trans-fatty acids in them. Also included in the extremely inflammatory list are candy, cookies, ice cream, and sugary beverages. And lastly, most people are unaware that bread is one of the most highly processed fake foods.

[3] Goodness Lover Pty Ltd. The Inflammation Solution: Top 29 gut Healing & Inflammation – Fighting Foods, 2022.

By |2022-07-12T07:39:47-06:00July 13th, 2022|Articles, General|

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 |2021-04-14T06:56:19-06:00April 15th, 2021|General|

Autoimmunity Explained

By Mila McManus, MD

According to the American Autoimmune Related Diseases Association, there are more than 150 different diseases on the autoimmune spectrum[i].  In America, almost one in six people have an autoimmune disease.  To understand autoimmunity, it is necessary to start with discussing foreign invaders and inflammation.

Inflammation is designed to be a necessary process. It is a natural response when the body identifies a foreign invader or threat.  Examples of threats include:

  • Injury
  • Microbes, such as bacteria, viruses, molds or parasites
  • Chemicals and heavy metals
  • Undigested food particles that have made their way into the body through a leaky gut

When a threat is detected, the body creates antibodies to find and mark the invaders. Antibodies attach to, and highlight, the foreign invader so that the immune system can see it and attack it.  Inflammation is the result of the battle within.  Under healthy circumstances, once the threat is removed, the battle is won, and the inflammation dissipates.

Antibodies find the foreign invader by identifying the unique protein molecules of the invader. This can be complicated, much like trying to distinguish poison ivy from another green, leafy plant.  You have to know what distinguishes poison ivy from other plants that look very similar.

Problems arise when foreign threats multiply and/or become persistent.  As small battles turn into full blown war, inflammation, stress and confusion increases. The immune system is now hyper sensitive and operating in high alert.  Antibodies begin to make mistakes and fail to distinguish the nuanced differences between the proteins in healthy, human tissue and the proteins of the foreign invader.  Mistakenly, antibodies attach to human tissues (for example, thyroid tissues or joint tissues), marking them for attack, and causing the immune system to attack its own. This is autoimmunity.

Autoimmunity develops over time, in a sequence, from chronic, on-going exposure and inflammation. As tissue damage accumulates, degenerative processes escalate, and symptoms are increasingly manifesting. The autoimmune process moves from unnoticeable to an organized disease pathology.

Autoimmune diseases can strike many parts of the body, making symptoms vary widely, and making diagnosis sometimes difficult.  Interestingly, the same foreign threat can manifest differently in different people. For example, a gluten sensitivity may result in compromised brain function for one person.  In the next person, it may manifest as constipation, while yet another person, as liver disease and neuropathy. For yet another, it may affect the thyroid. Some suggest that the place of attack is simply your weakest link in overall health, caused by genetics, lifestyle factors or environmental factors.

Conventional Medicine will tell you it is genetic, and nothing can be done except to minimize the severity of symptoms. You will be directed to a specialist who treats the specific damaged tissue.  Standard treatment protocols involve reducing inflammation with steroids, biologics, and even cancer drugs such as methotrexate.

Functional Medicine will seek to stop the cascade of events which lead to autoimmunity.  The root of the problem lies first with the foreign invasion and resulting inflammation. A Functional physician will address the entire chain of events rather than one tissue that has been attacked.  For example, important interventions include:

  • Addressing gut health
  • Identifying and reducing toxic burden
  • Uncovering and addressing food sensitivities and allergies
  • Supporting and strengthening immune function
  • Identifying if pathogenic microbes are involved and address them
  • Improving diet and nutrition in general
  • Obtaining a genetic profile to address mutations that affect how the body functions

Other supportive modalities include:

If you want to read  more about autoimmunity, we recommend the following books:

Brain Maker by David Perlmutter, MD

Plant Paradox by Steven Gundry, MD

Wahls Protocol by Terry Wahls, MD

The Autoimmune Fix, by Tom O’Bryan, DC, CCN,DACBN

[i] American Autoimmune Related Diseases Association, “list of Diseases: Autoimmune and Autoimmune-Related Diseases,” http://www.aarda.org/autoimmune-information/list-of-dieases/.

By |2019-07-29T13:47:24-06:00July 25th, 2019|Articles, General|

Could this help you?

by Mila McManus MD

If you are familiar with my practice and know that we work hard to heal and restore health in everyway possible without using prescription drugs, you may be wondering why I am excited to tell you about Low Dose Naltrexone (aka LDN).  For three reasons, I believe this is a great example of a very useful drug. LDN does not mask symptoms.  It addresses the issues of dysregulation of the immune system (and regulates it) and issues of inflammation (by reducing it).  And finally, LDN has no known side effects other than transient effect on sleep and vivid dreams.

Since inflammation and immune dysregulation are at the root of many diseases, especially autoimmunity, clinicians are using it for a whole range of conditions involving inflammation and immune dysregulation including Hashimoto’s, Grave’s, rheumatoid arthritis, lupus, psoriasis, MS, ALS, alopecia, chronic fatigue syndrome, and neurogenerative disorders such as Parkinson’s and Alzheimer’s.  LDN is also used as a complementary medicine by functional specialists for cancers, HIV/AIDS, as well as for post radiation salivary gland destruction, chronic allergic rhinitis, nerve damage, autism, shingles, weight management, infertility and migraines.

The original commercial prescription use of Naltrexone was approved by the FDA in 1984 in a 50mg dose and used for helping opiate addicts get off illegal and prescription drugs by blocking opiate receptors.  It’s also used to reverse opiate overdose (e.g., heroin, morphine).

Since that time, many doctors have pioneered the use of Naltrexone at very low doses, thus the name, Low Dose Naltrexone, or LDN.  One of the first was Bernard Bihari, MD, a physician in New York City who was interested in treating cancer and AIDS patients.  He discovered that low doses between 3 and 4.5 mg had very beneficial effects on the immune system.

Over the last 25 years or so, there have been increasingly more clinical trials with very favorable results. Additionally, clinical and anecdotal experience is showing improvements for a wide variety of conditions. So far, two main mechanisms of LDN have been identified.

First, LDN modulates the immune system by helping the T regulatory cells balance immune function without suppressing the body’s ability to regenerate and repair.  T regulatory cells are responsible for turning inflammation on and off in the body.  Patients with overactive immune systems (such as asthma, allergies, and autoimmune conditions) have immune systems that get “stuck in overdrive”.  LDN helps to get the system balanced again.

Second, LDN reduces inflammation in the Central Nervous System which is thought to play a significant role in fibromyalgia, other forms of chronic pain, and depression.  In the Central Nervous System there are receptors found on certain brain cells called microglia.  These cells can become chronically activated, resulting in neurotoxicity, which causes a cascade of symptoms that are associated with chronic pain, fatigue, mood disorders, and cognitive problems.  LDN reduces inflammation and quiets the microglia, which slows or stops the cascade of symptoms.

Another important advantage is that LDN is safe for almost everyone. People who regularly use opioid drugs or medication should not take LDN (however, there is a new FDA approved morphine that has a VERY low dose of LDN combined with it).  LDN is not addictive and can be stopped abruptly without harm or withdrawal.

While most conventional healthcare practitioners are not familiar with LDN, it’s gaining popularity in the functional medicine realm. At TWIHW, we’ve been prescribing LDN for several years for all sorts of health issues.  Because it’s specially compounded, it’s not covered by insurance.  Dosing is very personalized for each patient. In our practice, dose varies from 0.5mg per day, up to 4.5mg twice daily.  It can be formulated into capsules, sublingual drops, topical cream, nasal spray, and eye drops, depending on the purpose or need.

Studies with LDN have been especially encouraging for treating Crohn’s with over a 70% remission rate, and even complete mucosal healing as evidenced by colonoscopy in some cases.

Because naltrexone has been without patent protection for many years, no pharmaceutical company will bear the expense of the large clinical trials necessary for FDA approval of LDN’s new special uses.  There are at least 2 new FDA-approved and patented combination drugs (one mentioned above, and a new weight management drug called CONTRAVE®) which include LDN.  They always find a way!!







By |2018-06-11T08:37:08-06:00May 5th, 2018|Articles, General|

Got Pain?

Some Causes of Pain That You May Not Know Aboutgot-pain

by Mila McManus MD

I’m going to make this short and to the point.  I want to make this topic concise yet meaty. Some of the items below have links if you wish to delve deeper.

Here are some causes of pain that you may not know about:

  • Certain foods due to their nature, such as grains and sugar (read more here)
  • Food sensitivities and intolerance
  • Dysbiosis (aka microbial imbalance in the gut)
  • Adrenal fatigue  (test yourself here)
  • Low thyroid function (test yourself here)
  • Chronic infection(s), whether obvious or in disguise, such as a tooth abscess, infection in the gastrointestinal tract, or chronic lyme disease (the existence of chronic lyme disease is still very controversial in the medical field).
  • Alcohol
  • Poor posture
  • Certain Medications (prescription as well as over-the-counter) e.g., statin drugs used to lower cholesterol
  • Being overweight which causes inflammation throughout the body
  • Healing process that stalls out (read about how PEMF can help with this)
  • Nutrient deficiencies (e.g., vitamin D, B vitamins)

As you can see, there are many ways you can address chronic pain other than with pain medications. Call (281) 298-6742 today for more information on how we can help you address your chronic pain, and forward this newsletter to someone you care about who suffers with chronic pain!





By |2016-11-01T07:09:25-06:00October 31st, 2016|General|

Eating Should be Painless

by Nancy Mehlert MSfood-should-be-painless

When I first met Dr. McManus, she made a remark to me that I’ll never forget. Never because I did not want to believe what she said, and never because she proved to be right.  You see, I came to her with significant body pain.  My wrists, hands, knees, and lower back were chronically painful. I had joint and muscle pain. So what did she say that I’ve never forgotten?  She told me that she believed more than 50% of my issues, especially around pain, were a result of the foods I was eating.  That was hard for me to swallow (pardon the pun) because I love food and I loved the foods she was suggesting I eliminate.  However, several weeks later, after cleaning up my diet (specifically removing wheat and sugar), my body pain was gone and I realized that she was right!  When anyone tells me they have joint, muscle and nerve pain, a first priority is to clean up the diet.  Specifically, below are the foods you would be wise to eliminate to see if you experience significant reductions in pain.

Sugar in all forms.  Look closely at your diet. Be aware of the collective sugar.  It is surprising to see that several somewhat innocent choices can add up to considerable sugar in a day.  For example, one cup of organic brown rice pasta, one ounce of dried cranberries and a cup of watermelon is digestively over 60 grams of sugar. Sugar sources include fruit juices and smoothies (no matter how fresh pressed or organic they are!) and even some fruits such as grapes, watermelon and ripe bananas which have little to no fiber. The more obvious forms of sugar are included such as agave, maple syrup, honey, coconut sugar, and corn and rice syrups.  Less obvious are the carbohydrates that digest rapidly to glucose (i.e. sugar) such as wheat, rice, corn, and potato as well as gluten free grains. Remember, your approximate one gallon of blood only needs about 1 teaspoon, or 4 grams of sugar in it at any given moment for optimal function.  Anything more than that is suboptimal and harmful, i.e. inflammatory! Inflammation is PAIN.  We would all do best if we kept added sugar to zero, and grain intake to very little or none.  Whole fruits with good fiber content are fine but the low to no fiber fruits are best kept to a minimum or avoided all together.  Most of your healthy carbohydrates should come from the vegetable world and all others should be kept as low as possible and certainly should not exceed 15-25 grams a day.

Processed Foods of every kind. This is where all breads, cereals and pastas fall, especially the glutinous wheat products.  Also included here are the additives, preservatives and food chemicals that are so harmful to the nervous system, organ systems and digestive tract. Monosodium glutamate, nitrates and nitrites, artificial sweeteners, especially aspartame, are all potential pain creators by stimulating pain receptors.  This makes the receptors more sensitive, irritating muscle tissues, disrupting sleep and compromising the immune system.  Dairy is another culprit due to pasteurization and often times added sugars where the end product is highly processed food.  Casein, one of the proteins found in dairy can be very difficult to digest and causes pain for many.

Allergy Foods, those foods to which you are allergic often manifest as pain.  It is wise to test for food allergies and eliminate those foods to quiet the immune system and reduce pain and inflammation.

Foods that Reduce Pain and Inflammation

Thankfully there are many foods that help to reduce inflammation and pain. Here are some of the best: ginger, olive oil, green leafy vegetables, walnuts and almonds, turmeric, salmon, celery, blackberries, raspberries, blueberries, strawberries, and cayenne pepper. It’s no surprise that these are all real, whole, natural foods and spices from the earth that naturally do the work of pain relief.

By |2016-10-31T10:42:06-06:00October 31st, 2016|General, NANCY’S NUTRITIONAL NUGGET|



MSM is short for methylsulfonylmethane which is a substance that’s naturally occurring in msmthe body.  MSM has been extensively studied in humans and animals.  It is a ‘methyl donor’ and a ‘sulfur donor’ which help reduce inflammation and support detoxification.  It can also boost energy!

Here are some of the common uses of MSM:

  • pain
  • muscle recovery after exercise
  • osteoporosis
  • hair loss
  • skin disorders
  • allergies and asthma
  • high blood pressure
  • fatigue
  • dental and gum disease
  • leaky gut syndrome

Talk to your functional medicine specialist about whether MSM is right for you and about appropriate doses for your specific needs.


By |2016-10-06T13:32:24-06:00October 6th, 2016|Articles, General|

Proteolytic Enzymes (Protease)


by Mila McManus MD

Proteolytic Enzymes, or Protease, is a supplement which serves multiple purposes that support the immune system and all inflammatory processes.  They are extremely useful as part of a holistic regimen in the treatment of cancers, chronic infections, digestive issues, cardiovascular disease, and auto immune diseases, just to name a few.

Proteolytic enzymes, or proteases, are produced in our stomach and pancreas and used in the digestive process to break proteins down into amino acids.  Many people have heard of protease as a component of digestive enzymes taken as a supplement at meals to support healthy digestion; however, proteases have many systemic (i.e., full body) uses and are essential to good health.  When taken between meals, protease is absorbed through the gut lining and into the blood stream where they begin to distribute throughout the body to serve many critical functions, including:

  • Improving blood flow.  Under a microscope, healthy blood cells are dispersed and fluid, while unhealthy ones are clumped and crowded, or sticky.   UNclumped cells have more surface area to accept nutrients, oxygenate, and rid themselves of debris.
  • Improving circulation of blood which helps to repair and heal.  Blood and its components deliver nutrients to cells, removes waste from cells, delivers oxygen to the brain, muscles and tissues, and transports immune cells to sites of infection, inflammation and damage.
  • Stimulating the immune system by pairing up with white blood cells, working to make the immune system more precise and efficient.  This results in fewer colds, allergies, and infections.  Improved detoxification frees up the immune system to focus on real threats and also helps to manage the inflammatory response, thereby reducing  allergies, inflammation and pain, and overreaction to minor triggers.
  • Improving detoxification through removal of metabolic waste, environmental toxins and helping to maintain a clean and healthy internal environment.  Proteases help to break down and eliminate damaging, allergenic, or compromised proteins and thus reduce inflammatory responses. Proteases also break down defensive biofilms created by pathogens (e.g., bacteria). These pathogens create the biofilms in the body to hide themselves from the immune system.  Once revealed again, the immune system can attack those pathogens and eliminate them. Breaking down biofilm also allows medications, such as antibiotics, to reach their targets.

I like to think of proteases as a great cleaning crew that goes all over the body to scavenge for waste, cleaning up debris and removing the sticky film on surfaces that make it hard to tell what is underneath. Dirty=irritated and inflamed.  Clean=calm and peaceful.

Talk to your healthcare provider about proteolytic enzymes, or proteases.  Whether you are well and want to be preventative or if you suffer from any kind of inflammation, pain, organ or system dysfunction, compromised immune function, metabolic or genetic disorders, cardiovascular or circulatory concerns, you should consider proteases. We carry Transformation Enzyme formulas and can recommend the best one for you.

And if you really want to ‘nerd out’, you can read a Scientific Brief.

By |2021-11-03T14:06:06-06:00July 22nd, 2016|Articles, General|