Functional Medicine honors the innate healing processes within each of us and is based on the most current science including the concepts of genetic individuality, biochemical individuality, and the web-like interconnections of all processes within the body. Functional Medicine recognizes that every biological process affects every other biological process. There is absolutely no separation between inflammation, digestive processes, neurotransmitter balance, structural balance, immune function, detoxification, or mental/emotional experiences. Everything is related and everything is interconnected. In order to understand the causes of illness, one must understand the individual’s history and the interactions among their biological systems.

My practice of medicine is organized through the precepts of Functional Medicine. Using this framework, I am able to practice conventional medicine in a comprehensive manner utilizing the most natural interventions possible. Functional Medicine uses your entire story from conception to the present moment to understand key processes that are dysfunctional, when they began to be dysfunctional, and how these dysfunctions triggered imbalances in other processes. Hence, I can create a timeline that explains how everything that has happened to you has brought you to this place and time. This framework, in turn, can lead us to create a program of interventions that can enhance your health and/or work to reverse chronic disease.

The beautiful thing about Functional Medicine is that it incorporates all of the natural and traditional healing modalities including acupuncture, mind-body therapies, herbs, vitamins, supplements, and most importantly nutrition in addition to pharmaceuticals and, as a last resort, surgery.

A key example of the functional medicine approach would be an individual who had a history of ear infections as a young child, later allergies, asthma and sinus problems as an older child, and then gastrointestinal issues as an adult. In this case, I would look to gut dysfunction and food sensitivities as the underlying biological processes that will need to be brought into balance. These issues will be made worse by stress, by deficiencies in nutrients reduce inflammation, and by the presence of toxic elements.

Fatigue can touch almost all of life and can be caused by many varied circumstances.

The Functional Medicine approach to fatigue looks at the whole person and sees the complex interrelationships among many diverse variables:

Step 1: Understand the problem through a complete history and targeted benchmark laboratory data.

Step 2: Replenish the identified nutritional deficiencies using food wherever possible and supplements as necessary. While few of us have a deficit of calories in our diet, many of us have significant micronutrient deficiencies. Some potential nutritional deficiencies that can cause fatigue are folate, B12, B3, B6, magnesium, zinc, and iron.

Step 3: Understand and optimize how the gastrointestinal tract functions. If nutrition can’t be properly ingested and assimilated, or if molecules that are not supposed to be able to enter actually do (food sensitivities), fatigue can occur.

Step 4: Understand inflammation and reduce it. Whether by foreign food-based molecules, infectious disease (Lyme, hepatitis, Epstein Barr for example), sugar dysregulation, smoking or other causes, uncontrolled inflammation, mediated through numerous different molecules, can trigger fatigue.

Step 5: Understand and optimize hormone function. Whether through imbalanced thyroid hormone, low adrenal function (low cortisol), low estrogen or testosterone, or by high insulin (causing first high blood sugar levels then low blood sugar levels), imbalanced hormones can lead to fatigue directly or through their combined effects on the body (obesity contributing to sleep apnea).

Step 6: Understand and balance mood. Depression can cause fatigue. In turn, depression can be caused by imbalances in a number of neurotransmitters. Optimizing neurotransmitter balance through food and supplements can alleviate fatigue. Stress contributes to fatigue through this mechanism.

Step 7: Remove toxic exposures and toxic burden. Heavy metals such as mercury and lead can directly create fatigue by poisoning our energy-generating mechanisms, or mitochondria.

Step 8: Understand a person’s genetic makeup. Genetic inefficiencies can cause fatigue even if all other findings appear normal.

In short, everything that has ever happened to you collectively brings you to the place of feeling fatigued. Usually, fatigue results from a complex set of interacting factors rather than a single cause. For each of us, the source of fatigue may be different because our specific genetics are different and our specific exposures are different.

The GOOD NEWS: by looking at the whole person over the course of his or her lifetime, it is possible to not only alleviate fatigue, but to reverse it.

Every year, for International Integrative Medicine Day, Integrative Medicine physicians and programs within academic health centers join together to educate and inspire individuals in their quest for optimal health.

If you pay for your healthcare out-of-pocket, pay co-pays, deductibles and premiums, or are an employer who provides healthcare for your employees, this talk is for you.

Dr. Roca presents this talk in recognition of Greenwich Hospital Volunteers who provide caring and personal attention to patients. These volunteers help to make the hospital a healing place.

The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, reports that 38 percent of U.S. adults who were surveyed have used a form of Complementary and Alternative Medicine in the previous 12 months, with the highest rates among people aged 50–59.

These simple steps may be helpful in encouraging your individual health:

1. Ask the following question regarding every behavior: DOES THIS CHOICE BENEFIT AND ENHANCE MY HEALTH? If the answer is yes, then increase, refine and duplicate that behavior. If the answer is no, then ask if there is a different option that may enhance your health.
2. Identify activities that enhance your health and that you enjoy, that you find easy, that occur almost without thinking. Work to add these behaviors at more times during the week. Celebrate them.
3. Invite friends to participate in these enjoyable activities with you. Behaviors practiced by a community become contagious and are more easily maintained.
4. Create an affirmation or a collage that reinforces the ultimate outcome and the enjoyment you have along the way. Be sure all affirmations are positive and in the present tense.
5. Link the affirmation or collage with strong positive feelings. Literally breathe in positive feelings from previous experiences (related to the behavior or not) and link them with the affirmations and images.
6. Replace non-health-enhancing behaviors with enjoyable healthy behaviors through a series of small subtle steps. Implement one simple step a week. Invite a friend to help you both stay on track.
7. Remove temptation from your environment; avoid triggers for unhealthy behavior. This is especially important during health behavior change. For example, remove all simple carbohydrates and sweets from the house or turn off the television.
8. If health change is difficult or if you aren’t comfortable asking your friends for help, consider retaining a health coach.
9. Change requires time and attention. Recognize the need to devote time to enhance your health. Even 20 minutes a day can make a significant difference.
10. Recognize that the biggest challenges to health behavior change are stress, anxiety, addiction and depression. Hone your stress management skills and address any mood disorders

The goal this year – and every winter season – is to enhance health and ward off symptoms. We must plan that most of us will be exposed to the flu. Our goal is to enhance immunity so that there will be few to no symptoms even if there is exposure.

The items below should be in your Health and Healing Cabinet. Remember that our primary care patients have access to our after-hours call service. If you have these products on hand, we can easily direct you as to how they should be used under your specific circumstance.

The Golden Ten:

• Immunity Take Care or Elderberry Syrup
• Kold Care
• Flu Plus
• Vitamin C (ester)
• Vitamin D
• Bovine Colostrum
• D-Hist and/or D-Hist Jr
• Jade Windscreen
• Gan Mao Ling
• Yin Qiao

(All orders to Louisiana, MIssissippi, and Arkansas are shipped free of charge. Shipping charges requested by the website will be reversed at the source.)

In addition there will be other homeopathic preparations specific to the flu virus. However, this repertorization is not yet complete.

While there is no guarantee that the above will absolutely prevent illness this winter, they constitute the best tools available to help enhance our health.

Summary of Symptoms of Allergy, Colds, Flu & Bacterial Infections

Answer by Integrative Clinical Pharmacist Scott Berliner, RPh, and Medical Director Henri Roca, MD:
Seasonal allergies can surely put a damper on energy and vitality. Allergies are a series of symptoms caused by irritation from outside triggers. These symptoms may range from simple eye irritation to skin problems, intestinal issues, sinus congestion and infection, respiratory issues, and even asthma. The effects of allergies can reach every part of a person’s “being.”

To help control allergies:

• Control the triggers
• Reduce the overall allergen load
• Evaluate and reduce food allergens and sensitivities
• Flush, flush, flush your nasal passages
• Support the body with anti-inflammatory botanicals, supplements and homeopathic remedies
• Use acupuncture
• Use conventional medications as necessary

For truly effective allergy control you need to remove as many causative agents as possible. Consider the carpet in your house that holds onto dust and dust mites, the small leak in the attic where fungus may be growing in the closet, even what you eat as it may contain chemicals or other substances that act as triggers for the allergic response.

The goal is to reduce or eliminate the allergic response. That allergic response may be partially due to stomach dysfunction, immune system dysregulation, food sensitivities, toxic metals or persistent infections. These issues should be evaluated by a medical professional knowledgeable in functional medicine. Assessing the role these factors may play in allergies is a proactive way of preventing and treating allergies. Holistic practitioners always take this into consideration.

It is important to realize that our bodies work as a whole and not individual parts. What we eat and drink can affect our entire body. This is particularly true when it comes to allergies. Eating a healthy diet low in allergenic foods can reduce allergy symptoms from environmental and other factors. The immunoglobulins that mediate allergic reactions are produced in the stomach, so eating well reduces the production of histamine.

Since many allergic symptoms are caused by the release of histamine in response to the activation of the immune system by a trigger, you have another wonderful opportunity for prevention. It usually takes about 30 minutes for these triggers to create an immune response. So, within the first half-hour of exposure, flushing your nose with nasal saline can stop or reduce that immune activation. You can flush your nose as frequently as necessary up to six times a day. Use an over-the-counter nasal saline flush or make your own and use with a neti pot.

For sinus sufferers, there are new and effective treatments that span the gamut from homeopathic to herbal, leaving no area untouched. Our Radiant Health Apothecary offers numerous products and can provide guidance and finding the right product for your needs.

Sinusin Nasal Spray from the German homeopathic company Heel has proven effective during the heating season, when chronic rhinitis is common. This condition is commonly caused by dry air, which dries and inflames the sinus passages. With plants, trees and grass blooming, allergies have taken the place of these winter problems. A number of homeopathic combinations can ease allergies. BHI’s Allergy formula is a broad homeopathic remedy that stimulates the body to produce its own antihistamine in a timely manner. There is also a nasal spray called Lufteel that works in a similar manner when applied to the nasal membranes as a spray. The key to success in the homeopathic treatment of allergies is getting the most appropriate formula for your individual issues. There are homeopathic eye drops, eardrops, nose drops, etc.

In the herbal world there are thousands of formulas promoted for treating allergies. D-Hist and D-Hist Jr (chewable for children) are combinations of standardized extracts from quercetin and stinging nettles leaf that act as natural antihistamines to relieve runny nose and watery eye symptoms. They also contain bromelain and n-acetylcysteine to boost the immune system and reduce some of the inflammatory response that accompanies allergies. Unlike pharmaceutical antihistamines, these are chemical-free, not sedating and have been used for years in herbal medicine. Beware of using nettles if you are taking testosterone or estrogen therapies.

Kold Kare contains an adaptogenic herb, Andrographis Paniculata, which is often used at the first signs of a cold or sinusitis and can open clogged sinus passages like pharmaceutical decongestants, but without the jitters and “speedy” feeling that these allopathic agents can cause.

Some supplements that are generally safe to use and have been shown to be effective in reducing allergy symptoms include omega-3 fatty acids (fish oil) and probiotics.

Acupuncture for Allergies

Acupuncture can help enhance the body’s resistance to triggers, open clogged nasal passages, and resolve symptoms related to allergies. Imbalances in the lung and large intestine meridians and their associated meridians – the spleen and stomach – are often the targets for therapy. These treatments should be done prior to allergy season and once a week during allergy season. Often the treatment is done in areas over and around the sinuses as well as on the arms and legs. This intervention is especially useful for those whose allergies tend to produce systemic symptoms, life-interrupting symptoms, and can lead to infections.

If all else fails, medications may be necessary for comfort. Cromyln sodium comes as a nasal spray and helps to prevent allergies from even being triggered. At times nasal steroids may be useful. For some, the newer antihistamines work well. For others they seem to not work at all. Anxiety and stress can make any allergy symptoms worse. Now is the time to create your allergy prevention plan. The best strategy is to intervene early and often. Please don’t wait until the symptoms are in full bloom.

The cocktails are typically filled with B vitamins (especially those who have autoimmune gastritis), magnesium or calcium and can also be used to balanced nutrition for someone who is unable to eat.

A recent study at Yale’s Prevention Research Center on fibromyalgia patients, showed that eight weeks after treatment stopped, the group receiving IV vitamin and mineral therapy experienced significantly improved tender points, pain relief and quality of life.

The process requires evaluation by a physician at the Center, at which time a series of routine blood tests will be ordered. If therapy is determined to be appropriate, based on test results and medical history, a specific formulation will be tailored. Treatment is typically once a week for 6 weeks to be followed by repeat blood tests and re-evaluation. Each treatment lasts about 30 minutes.

ANSWER: Depression often begins as a dysfunctional stress response. First we would evaluate you to see if you need the medication. There might be natural ways to address your depression. If you need the medication, here are some things we would explore to minimize your side effects.

When a patient appears depressed, there is too often a knee-jerk reaction to prescribe medication, typically classified as SSRI (affects serotonin the brain) or SNRI (affects serotonin and norepinephrine in the brain). We work to enhance a person’s stress resiliency and stress management tools. This type of therapy or some kind of cognitive behavioral therapy is ESSENTIAL whenever a person is on a medication or on a supplement/botanical program for depression. Both the medications and the supplements can make the brain more plastic thus allowing you to more easily change the way you think and perceive the world. (Plasticity, or neuroplasticity, is the lifelong ability of the brain to reorganize neural pathways based on new experiences. The ability of the brain to change with learning is what is known as neuroplasticity.) This will allow the stress resiliency work to “settle in” more easily and be more easily retrieved.

Interestingly, diseases that cause inflammation have a direct effect on the functioning of the brain and can contribute to depression. Therefore inflammation, whether caused by food sensitivity, long standing infection (such as Lyme disease or autoimmune disease, needs to be addressed.

Nutritional deficiencies combined with genetic inefficiencies in key enzymes can prevent the body from replenishing neurotransmitters. These values can be tested and should be tested on ALL vegetarians. Amino acids, from which serotonin is created, come from meat products primarily. Often nutritional change and supplementation are required

Botanicals can be very useful but should not be self-prescribed. Many people know of St John’s Wort, but few may be aware of the significant negative interactions it has with most medications. Please use this and other botanicals under the supervision of a knowledgeable practitioner. It’s very important that you develop a relationship with your physician to monitor progress and tweak your treatment as you progress.

Please note: This question has been republished from the Ask the Practitioner section of the Center for Integrative Medicine website.

The psychoemotional component of libido and performance is demonstrated in the power of fantasy. Fantasy stimulates arousal. Depression and stress affect this component most strongly. So as a baseline, stress and depression must be evaluated. The effect is even worse when the stress or depression results from issues within the relationship.

Physiologically, libido and performance are the result of a delicate balance between the sympathetic nervous system and the parasympathetic nervous system. Of course both depression and stress contribute to imbalance here as well. However, so do deficiencies in key neurotransmitters and nutrients. If norepinephrine levels are too high, serotonin and dopamine levels too low, or the GABA levels too high, libido and performance will suffer.

Deficiencies in arginine can affect performance by decreasing vasodilation in the penis, thus reducing erectile strength. Taking arginine can induce a flare up of herpes, so only take it under the supervision of medical professional who specializes in men’s health.

Structural changes in the arteries and nerves supplying the genitalia can also contribute to poor performance. These changes are most often due to high blood pressure, diabetes, neuropathy, and atherosclerosis (high cholesterol).

Unfortunately medications designed to help the above diseases as well as those designed to help stress and depression may also diminish libido and performance.

Perhaps most importantly, low testosterone or high estradiol levels in men can contribute to low libido and performance. No amount of medication, supplements, or botanicals can shift libido and performance in the presence of low hormone levels.

The infections that occur with the Lyme bacteria (Borrellia burgdorfii) are Babesia and Erlichia (now called Anaplasma). Another bacteria, Bartonella, can occasionally co-occur.

The Lyme bacteria is insidious because it exists in at least three forms in our bodies: the free flowing bacteria in the bloodstream, the bacterial form that hides inside cells and evades identification and basic antibiotic therapy, and the encysted form which also evades diagnosis and treatment. For this reason a Lyme test, either the titer test or the Western Blot test, may be negative even though the bacterium is present in the body. In other words, a negative test cannot definitely tell you that you do not have Lyme. It can only say that at this time, in this sample, the Lyme organism has not been identified. Some people need many Lyme tests before the bacterium is finally identified.

When a Lyme infection is recent, a bull’s-eye rash often occurs. This will require immediate treatment for Lyme in all of its forms. Treatment for the co-infections may be necessary at this time as well. However the rash can show up in as few as 30 percent of the cases of Lyme. Most people never know they have been bitten. If the tick is removed within 6 hours in a way that does not force the tick’s content through the mouthpart into your body, then the likelihood of Lyme transmission is quite low. Be sure to do regular tick checks – even if just walking across the yard – especially if you have pets.

When a person has unusual or unexplained fatigue, muscle aches, joint aches, weird electric-like feelings, brain fog, unusual troubles with sleeping, or mood instability, a Lyme test is often required. At the Center for Integrative Medicine, under these circumstances, we run a very detailed test that must be sent out. In addition to checking for the basic Lyme titer and Western Blot test, this test also looks for the DNA of the Lyme organism. The testing may be expanded to look for the co-infections as well.

Treatment for acute Lyme begins as soon as a person has been bitten by a tick and changes according to the results of tick testing. If the tick tests negative, treatment is stopped. If the tick tests positive, treatment continues for up to three weeks. At the Center we give people an initial course of antibiotics if they have been bitten by a deer tick but do not have the tick to submit for testing.

If a person has been identified with Lyme disease at a time remote from the potential exposure, treatment for Lyme and co-infections are begun and last at least two months. This treatment may include several antibiotics to address all forms of Lyme disease as well as supplements and medications that support the liver and the intestines. Other antibiotics may be added to cover the likely co-infections as well. Control of yeast overgrowth in the gut is an important component of the treatment. This treatment protocol is based on the work of Richard Horowitz, MD. Our goal is to manage the Lyme so that the body’s immune system can keep it in check. There is no evidence that chronic Lyme disease can be eradicated from a person. Ongoing management and maintenance with the fewest courses of antibiotics is the goal of therapy.

In addition, the treating physician must discern between the effects of Lyme and co-infections and the consequences of long-term antibiotic therapy. Unfortunately some of the same symptoms of Lyme disease may be caused by the consequences of long-term antibiotic therapy. In addition, for therapy to be successful, the person’s liver and detoxification system, gut and digestive system, and anti-inflammatory systems must all be in good working order. Stress can also get in the way of therapy and may need to be addressed