Functional Medicine
Back Clinic Functional Medicine Team. Functional medicine is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms.
Practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, functional medicine supports the unique expression of health and vitality for each individual.
By changing the disease-centered focus of medical practice to this patient-centered approach, our physicians are able to support the healing process by viewing health and illness as part of a cycle in which all components of the human biological system interact dynamically with the environment. This process helps to seek and identify genetic, lifestyle, and environmental factors that may shift a person’s health from illness to well-being.
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Adrenal Fatigue (AF), Gut and Intestinal Health, Natural Health, Wellness
Chronic fatigue syndrome, a baffling disorder that affects an estimated 1 million Americans, has been strongly linked to imbalances in gut bacteria in a new study from Columbia University’s Mailman School of Public Health.
The researchers found abnormal levels of specific gut bacteria are found in people with the condition — formally known as myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), according to the study published in the journal Microbiome.
The findings offer new hope for an effective new way to diagnose and treat ME/CFS, a complex, sometimes-debilitating disorder that can interfere with activities of daily living.
Symptoms include extreme fatigue after exertion, muscle and joint pain, cognitive dysfunction, sleep disturbances, and orthostatic intolerance (light-headedness, dizziness, or fainting when standing upright).
Up to 90 percent of ME/CFS patients also have irritable bowel syndrome IBS, past research has shown. But the Columbia University study is among the first to disentangle microbiome imbalances in individuals with ME/CFS and IBS.
“Individuals with ME/CFS have a distinct mix of gut bacteria and related metabolic disturbances that may influence the severity of their disease,” says co-lead investigator Dr. Dorottya Nagy-Szakal.
The findings suggest sufferers may be able to ease their symptoms by incorporating certain probiotics — healthy bacteria — in their diets, to balance their gut bacteria.
To reach their conclusions, the researchers tracked 50 ME/CFS patients and 50 others without the condition. They tested subjects’ fecal samples for bacterial species, and blood samples for immune molecules.
The study’s key findings show that:
- Levels of distinct intestinal bacterial species —Faecalibacterium, Roseburia, Dorea, Coprococcus, Clostridium, Ruminococcus, Coprobacillus — are strongly associated with ME/CFS.
- The abundance of these species appears to be predictive of a ME/CFS diagnosis.
- An abundance of Alistipes and low levels of Faecalibacterium are the top biomarkers of ME/CFS with IBS. Increased Bacteroides abundance and decreased Bacteroides vulgatus are the top biomarkers of ME/CFS without IBS.
The researchers also noted the severity of patients’ symptoms — such as pain and fatigue — correlated with the abundance of distinct bacterial types.
“Our analysis suggests that we may be able to subtype patients with ME/CFS by analyzing their fecal microbiome,” says co-lead investigator Dr. Brent L. Williams, Ph.D. “Subtyping may provide clues to understanding differences in manifestations of disease.”
The study also points toward a possible mechanism behind the development of ME/CFS.
“ME/CFS may involve a breakdown in the bidirectional communication between the brain and the gut mediated by bacteria, their metabolites, and the molecules they influence,” explains senior author Dr. W. Ian Lipkin.
“By identifying the specific bacteria involved, we are one step closer to more accurate diagnosis and targeted therapies.”
So far, researchers have not identified the cause of ME/CFS. Nor are there any standard diagnostic lab tests or federally-approved treatments for the condition. For reasons that are unclear, women are two to four more times likely than men to have ME/CFS.
Because MD/CFS is so variable, treatment focuses on individual symptom control. Conventional approaches include prescription medications to treat anxiety, depression, and insomnia; graded exercise, physical therapy, and psychological counseling including cognitive-behavioral therapy (CBT).
Adjunctive therapies to help manage pain and fatigue include:
- Acupuncture.
- Biofeedback.
- Deep breathing exercises.
- Hypnosis.
- Massage.
- Meditation.
- Muscle relaxation techniques.
- Yoga or tai chi.
- Preliminary but inconclusive research suggests that some natural remedies may be helpful for ME/CFS, according to the Mayo Clinic. These include:
- Magnesium injected into the muscles of people with low red blood cell magnesium.
- A combination supplement containing fish oil and evening primrose oil.
- Melatonin.
- Nicotinamide.
- Adenine dinucleotide hydrate (NADH).
- Coenzyme Q10.
- Propionyl-L-carnitine.
- D-ribose.
Although the new Columbia University study suggests that probiotic supplements may be helpful for ME/CFS, more research is needed, experts say.
A 2009 study of 39 ME/CFS patients, however, showed that the Lactobacillus casei strain Shirota (LcS) was associated with significantly reduced anxiety symptoms compared to placebo.
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Gastro Intestinal Health, Gut and Intestinal Health, Natural Health, Probiotics, Wellness
Breastfeeding has long been linked to a variety of health benefits in babies, and a new study suggests that bacteria transferred from mothers to their nursing infants might be at least partly responsible.
Researchers focused on what’s known as the microbiome, or all of the bacteria, viruses and fungi that live in and on the body. They tested 107 mother-baby pairs for organisms on women’s breasts and in their milk, and they also examined babies’ stool as a way of determining what types of organisms were in the infant gut microbiome.
While they found distinct types of bacteria in milk, breast tissue and infant stool, researchers also found infants’ gut microbial communities matched the bacteria in their mothers’ milk and on their mothers’ skin much more than it resembled samples from other women in the study.
That suggests each mother’s milk was a major contributor to her own infant’s gut microbiome.
“We were able to show that there are bacteria in milk and that these bacteria could be traced to bacteria in infant stools,” said senior study author Dr. Grace Aldrovandi, chief of the division of infectious diseases at Mattel Children’s Hospital at the University of California, Los Angeles.
“This supports the hypothesis that milk microbes are a mechanism by which breastfeeding provides benefit,” Aldrovandi said by email.
Pediatricians recommend that mothers exclusively breastfeed infants until at least 6 months of age because it is tied to reduced risk for babies of ear and respiratory infections, sudden infant death syndrome, allergies, childhood obesity and diabetes.
Mothers may benefit too, with longer periods of breastfeeding linked to lower risks of depression, bone deterioration and certain cancers.
Based on lab tests of bacteria found in milk, on skin and in stool in the current study, researchers estimated that babies who got at least 75 percent of their nutrition from breast milk during the first month of life received about 28 percent of their gut bacteria from their mother’s milk. These babies also got about 10 percent of their gut bacteria from mothers’ skin and 62 percent from sources researchers didn’t determine.
The more babies nursed, the more their gut bacterial community changed to resemble what was found in their mother’s milk.
And in babies who got more of their nutrition exclusively from breastfeeding, microbial communities were slightly more diverse overall and different microbes predominated compared to babies who breastfed less.
One limitation of the study is that researchers didn’t assess the origins of the breast milk bacteria or other bacterial communities from the mother that might have contributed to the infant gut microbiome, the authors note. Nor did they assess any effects on the babies’ health based on differences in their microbiomes.
Still, the results build on previous research suggesting that the infant gut microbiome is different for breast-fed and formula-fed babies, said Dr. Alexander Khoruts, a researcher at the University of Minnesota in Minneapolis who wasn’t involved in the study.
“We’ve always assumed that most of these microbes come from the mother,” Khoruts said by email. “They found that breastfeeding is the major source of microbial transfer during the early months of life, and I think the study provides supportive evidence for the current recommendations of exclusive breastfeeding for the first six months and continued breastfeeding to 12 months.”
Many factors can influence the infant gut microbiome, including breastfeeding, whether babies arrived by vaginal or surgical delivery and antibiotic use, noted Jose Clemente, a researcher in the genetics and genomic sciences at the Icahn School of Medicine at Mount Sinai in New York.
“The beneficial effects of breastfeeding are well known, and this study provides further evidence by demonstrating that probiotic bacteria found in breast milk can be transferred to the infant,” Clemente, who wasn’t involved in the study, said by email. “Every little bit helps, so even some amount of breast milk can be a source of beneficial bacteria for babies.”
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Leaky Gut
- Intense physiological stress can change the composition of our gut microbiota
- Imbalances in the gut arelinked to diabetes, obesity and some cancers
- Findings raise concerns for endurance athletes and military personnel
- The study is the first to investigate gut bateria during military training
Long periods of intense exercise can change the composition of your gut bacteria, a new study has found.
The research looked at soldiers taking part in an intensive training programme and found that pro-longed exercise caused the protective barrier in their guts to become permeable.
In other words, the prolonged exertion triggered �leaky guy syndrome� � a condition that could let harmful substances leak into the bloodstream.
With our gut health and overall health believed to be strongly linked, intense physiological stress could therefore raise the risks of many types of illnesses.
The new research is the first to investigate the response of gut microbiome � the term for the population of microbes in the intestine � during military training.
It provides a stark warning for endurance athletes and military personnel.
The study suggests physical stress can increase intestinal permeability, which can raise the risk of inflammation and illness
Most of us are aware that the bacteria in our gut play an important role in digestion. Furthermore, they are known to aid the production of certain vitamins � such as vitamins B and K � and play a key role in immune function.
But increasingly, research is emerging showing how poor gut health is linked to conditions ranging from irritable bowel syndrome, diabetes, high blood pressure, depression, obesity, childhood asthma, to colitis and colon cancer.
The study is the first to investigate the response of gut microbiome � the term for the population of microbes in the intestine � during military training.
It looked at a group of 73 Norwegian Army soldiers taking part in a military-style cross country skiing training programme.
Recent research suggests our gut bacteria holds the key to improving our health � and may be the key to tackling obesity
The group skied 31 miles (51 km) while carrying 99-pound (45 kg) packs, across four days.
Before and after the training exercise, researchers collected blood and stool samples from the soldiers.
It was found that the microbiome and metabolites � the substance formed in or necessary for metabolism � in the soldiers� blood and stool altered �significantly� by the end of the aggressive training period.
Furthermore, sucralose excretion in their urine samples rose considerably, indicating an increase in intestinal permeability (IP).
Scientists know that healthy intestines have a semi-permeable barrier, which acts as a defense to keep bacteria and other harmful substances out, while allowing healthy nutrients into the bloodstream.
It is thought that physical stress can increase IP, increasing the risk of inflammation, illness and symptoms such as diarrhoea.
The findings may spell bad news for endurance athletes and military personnel
The researchers wrote: �Intestinal microbiota appear to be one influencing factor in the gut�s response to physical stress.
�Our findings suggest that the intestinal microbiota may be one mediator of IP responses to severe physiologic stress, and that targeting the microbiota before stress exposure may be one strategy for maintaining IP.�
The study was published ahead of print in the American Journal of Physiology � Gastrointestinal and Liver Physiology.
MICROBIOME: DOES IT CONTROL EVERYTHING?
Researchers now estimate that a typical human body is made up of about 30 trillion human cells and 39 trillion bacteria.
These are key in harvesting energy from our food, regulating our immune function, and keeping the lining of our gut healthy.
Interest in, and knowledge about, the microbiota has recently exploded as we now recognise just how essential they are to our health.
A healthy, balanced microbiome helps us break down foods, protects us from infection, trains our immune system and manufactures vitamins, such as K and B12.
It also sends signals to our brain that can affect mood, anxiety and appetite.
Imbalances in the gut are increasingly being linked to a range of conditions. Last year, scientists at California Institute of Technology found the first ever link between the gut and Parkinson�s symptoms.
The composition of our gut microbiota is partly determined by our genes but can also be influenced by lifestyle factors such as our diet, alcohol intake and exercise, as well as medications.
Source: http://www.dailymail.co.uk/health/article-4484680/Intense-exercise-causes-leaky-gut-risk-illness.html
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Anti Aging, Seniors, Skin Health
Prices for generic topical steroids to treat skin conditions like eczema and psoriasis are on the rise, and many seniors may pay more for generic medications than the brand-name versions, a U.S. study finds.
Researchers compared average out-of-pocket patient costs as well as spending by Medicare, the U.S. health insurance program for people 65 and older, for several commonly prescribed topical corticosteroids that have been used for decades to treat a wide variety of inflammatory skin conditions.
Medicare Part D, the drug benefit program, spent $2.3 billion on topical steroids between 2011 and 2015, the study found. During that period, spending surged 227 percent while the number of prescriptions increased just 37 percent.
If doctors had prescribed the cheapest version when a variety of similarly effective options were available, Medicare could have saved $944.8 million, the researchers calculate.
Patients could have saved a lot too; seniors’ annual out-of-pocket spending for topical steroids grew from $41.4 million to $101.8 million, 146 percent, during the study period.
“Patients often have difficulty paying for their medications and many patients on Medicare are retired and on fixed incomes,” said senior study author Dr. Arash Mostaghimi, a dermatology researcher at Harvard Medical School and Brigham and Women’s Hospital in Boston.
“Paying extra for their medications may mean going without other medications or sometimes food,” Mostaghimi said by email.
Generics accounted for almost 98 percent of total spending on topical steroids during the study period, the researchers report in JAMA Dermatology.
In theory, generic drugs are supposed to come on the market after brand-name versions lose U.S. patent protection and help lower prices by increasing competition. The study of topical steroid costs, however, offers one look at a much more complex and confusing reality.
For the study, researchers examined costs for drugs grouped based on potency, or how much medication is blended into the ointments and creams. They sorted drugs into five classes, with one being the most potent and five being the weakest potency.
Costs grew at the slowest rate, 23 percent, for the weakest steroids, the study found. By contrast, costs rose the most, 604 percent overall, for the most potent group of steroids.
Within that group of most potent steroids, the steepest increase in average user costs was for clobetasol propionate (Temovate), which is used to treat itching and inflammation from skin issues caused by allergic reactions, eczema and psoriasis. During the study, user costs for this drug climbed by more than 605 percent.
Limitations of the study include the lack of data on certain drug manufacturer rebates that might help lower costs, the authors note. Researchers also didn’t know if doctors had certain clinical reasons for choosing specific versions of similar medicines.
Still, the study illustrates something doctors already see all the time: that these costs often take a toll on patients, said Dr. Joslyn Kirby, author of an accompanying editorial and a dermatology researcher at Penn State Hershey Medical Center.
One challenge for doctors is that they can’t always see what different steroids of similar potency cost when they prescribe the drugs, because that’s not in electronic medical records, Kirby said by email.
“I ask my patients to contact me and let me know if the medication I prescribed during the appointment is too expensive when they go to the pharmacy,” Kirby added. “I need my patients to know that it’s ok to tell me that something is too expensive, because I can work with our staff to find an alternative or a solution.”
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by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Cancer Health, Natural Health, Wellness
“Eat a healthy diet” and “exercise for at least 30 minutes three times a week” are the two top suggestions from experts on how to stay youthful and live a long, healthy life. Unfortunately, that excellent advice can often seem overwhelming to novices who are trying to improve their health.
Where do you start? Are there easy ways to boost your health and keep aging at bay? Fortunately, there are quick, dead-simple things that clinical studies show you can do in less time than it takes to eat a cheeseburger. They include:
• Drink a cup of coffee. When the Journal of the American Medical Association reviewed a series of studies, they found that regular coffee drinkers had a lower risk of developing Type 2 diabetes than those who avoided it. They found that those who drank four to six cups a day cut their risk 28 percent, and people who drank more than six cups reduced their risk by 35 percent.
The good news about coffee keeps pouring in: A European study found that drinking three cups of coffee daily slashes the risk of developing Alzheimer’s, and a study published in The Journal of Alzheimer’s Disease found that drinking three cups of coffee daily can help forestall Alzheimer’s in people who are already having memory problems.
There’s also good news on the war against cancer. A study from Harvard Medical School found that men who drank the most coffee slashed their risk of developing the fastest growing and most difficult to treat prostate cancers by more than half when compared to men who drank no coffee. Men who drank the most coffee — six or more cups daily — reduced their risk by 60 percent. Another study found that people who drank up to three cups of coffee daily slashed their risk of liver cancer by 55 percent.
The latest news, published in The American Journal of Clinical Nutrition found that people 65 years and older who drank four or more cups of coffee daily lowered their risk of heart disease by 53 percent.
• Get enough vitamin D. Multiple studies show that a deficiency of vitamin D raises the risk of cardiovascular disease, diabetes, multiple sclerosis, osteoporosis, depression, and several cancers. One study found genetic markers that indicated the difference between the highest and lowest levels of vitamin D equaled five years of aging. The government recommends 400 I.U. daily, but many experts believe much more — 1,000 I.U. to 2,000 I.U — is needed for optimal health.
• Pour a glass of red wine. A few glasses of red wine every week protect against many ailments of aging such as Alzheimer’s, cardiovascular disease, cancer, and Type 2 diabetes. It prevents heart disease by increasing levels of HDL — the good cholesterol — and guards arteries against damage. Red wine slashes the risk of some cancers, including lung and colon, by as much as two-thirds.
A recent study published in The New England Journal of Medicine found that women who drank moderately (about one drink a day) reduced their risk of mental decline by 23 percent when compared to women who were teetotalers.
Researchers believe one of the main active ingredients in red wine is resveratrol, a compound found in the skin of red grapes that acts as an antioxidant and is anti-inflammatory. Resveratrol is also available as a dietary supplement.
• Take a daily aspirin. People take a low-dose aspirin daily to ward off heart disease, but studies have shown that the 100-year-old wonder drug also helps prevent many types of cancer. A daily low-dose aspirin can cut the risk of breast cancer and deadly melanoma skin cancer by up to 30 percent, gastrointestinal cancers and colorectal cancers by 38 percent, and lung cancer by up to 62 percent.
A new study from the University of Oxford found that a daily aspirin reduced the risk of developing cancer of any kind by about 25 percent when compared to controls who didn’t take aspirin. After five years, the risk of dying in the group taking aspirin was reduced by 37 percent. Aspirin also helps keep aging brains healthy, according to Swedish research that studied women aged 70 to 92.
• Sip green tea. People who drink more than three cups of green tea each day live longer, according to a Japanese study of more than 40,000 people. Study participants who drank the most tea — five or more cups a day — were the least likely to die during the 11-year follow up. Green and white teas contain generous amounts of EGCG, a powerful antioxidant linked to a lower risk of heart disease, Alzheimer’s disease, and numerous types of cancer. Catechins, which are antioxidant compounds found in green tea, may also protect aging eyes from glaucoma.
• Eat fish. Choosing fish over beef or pork twice a week can give your health a big boost. A study published in the journal Neurology found that seniors whose diets were rich in omega-3 fatty acids had lower blood levels of beta-amyloid, a protein that’s deposited as plaques in the brains of people with Alzheimer’s disease, and another study found fish oil reduced by 26 percent the risk of brain lesions that cause dementia. Additional studies have found that eating fish lowers the risk of Type 2 diabetes, arthritis, prostate cancer, obesity, and heart disease.
• Dance. A study at Albert Einstein College of Medicine found that while reading reduced the risk of dementia in those 75 years and older, frequent dancing cut the risk by 76 percent — more than any other activity studied, mental or physical. Experts believe dancing is so effective because it combines intense mental and physical activity.
An Italian study found that people suffering from heart failure who waltzed significantly improved their breathing and quality of life when compared to those who biked or hiked. Dancing also reduces stress, depression, and obesity while it aids balance, increases energy, and helps control weight.
• Nibble on chocolate. Studies show that chocolate increases brain function and lowers blood pressure. A study at Harvard Medical School found that older people who ate chocolate every day improved their thinking skills as well as blood flow to the brain, and a German study found that small amounts of chocolate daily could reduce the risk of heart attack and stroke by almost 40 percent. Most experts recommend 1 to 1.5 ounces of dark chocolate.
by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Chronic Back Pain, Mind Body and Spirit, Wellness
Doctor of Chiropractic, Dr. Alexander Jimenez looks into Tai Chi for back pain.
Q&A with Tai Chi Specialist Dr. Paul Lam
While lots of people take a �no pain, no increase� approach to work out, that�s for handling back and neck pain not always safe or effective. That�s where tai chi comes in. This low-impact, slow moving form of exercise delivers results without the sweat and soreness. Though it�s tender and meditative tai chi promotes strength, flexibility, and balance�the trifecta to get a healthier spine.
In case you have back or neck pain�or you�re looking for methods to prevent it in the first place �tai chi may be worth investigating. To help answer common questions and shed light on lesser-known facts relating to this ancient Chinese mind and body practice, we reached out to Dr. Paul Lam, manager of the Tai Chi for Health Institute in Australia.
Tai Chi Can Help
Q: During your research, what has become the most insightful finding you�ve found about tai chi as it relates to back pain?
A: The most insightful finding in my research concerning tai chi involved the mental impact and the deep stabilizer muscles to back pain.
Ninety percent of men and women have back pain at some period in their own lives, and more than 60 percent of that is continual. I discovered that nearly all individuals with back pain, no matter what the cause, have poor stabilizer muscles. Research has shown that strong stabilizers will prevent back pain and hasten healing.
Reinforcing the stabilizer muscles that are back is quite similar to tai chi training. The main element is an erect pose, exercising the stabilizers through the pelvic floor along with the transverse abdominus muscles, and using abdominal breathing. This really is among the important reasons why tai chi works so well for back pain.
One other insight I�ve discovered involves your head. Anxiety makes pain worse. Oftentimes with the continuing and persistent back pain, the cause of the pain might have gone, but the pain continues. Like a phantom pain, the thoughts�s ingrained custom proceeds to provide pain signals to the brain. Tai chi trains body and the mind, making both integrated and more powerful. It is but one of the utmost effective tools to greatly help with the mental aspects of back pain.
Q: What�s your best advice for somebody who’s apprehensive about beginning tai chi?
A: The reason why they are apprehensive about beginning tai chi, it depends. I can guarantee them it is safe, simple to understand, and proven effective, if people believe tai chi is a martial art and might be overly hard to learn. Millions of people around the globe have learned and profited from it, although the other consideration is the fact that individuals might believe tai chi is too tough to learn.
Q: How do individuals get the most?
A: I advocate people to practice tai chi for 30�40 minutes daily (it may be performed in separate sittings) most days each week. You will gain significant improvement in your quality of life and relief from back pain.
Q: Do you have some success stories that are personal which you can share regarding the benefits of tai chi for back pain?
A: Thousands! But to pick on only one, I�ve comprised a letter below written by a woman named Amatullah from Saudi Arabia.
“In 2009, I ‘d back pain for quite a while. Nothing worked, although I attempted many types of therapy. My friend said, �Try tai chi, it’s a gentle exercise.� Because my back was sore, I refused at first, but I attempted it. It was really surprising to me how people from 35 to 80 years old could do the movements, when I couldn�t. I found to be able to steadfastly keep up their health, some of them had been practicing for up to 35 years. I understood they were much fitter and much more flexible than my parents, therefore I decided to learn it. I practiced in all weather, in the park every day. My back pain vanished and has never return.”
Q: Are there tai chi resources you can recommend?
A: Yes, the Tai Chi for Health Institute web site has many resources, including a summary of accredited educators around the planet.
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by Dr Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP | Leaky Gut
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