Anxiety and depression are common problems that can be medicated with anti-depressants, anxiolytics and mood stabilizers. Although these approaches can be helpful in the short term, the rates of treatment response and long-term improvement are relatively low. We investigate your genetics, hormone function, nutritional status, and microbiome to uncover factors that may contribute to mood disorders. We take the view that these problems are not “psychological” but based on brain dysfunction, which is a byproduct of physiological and functional imbalances.
Autoimmune Disease and Inflammatory Disorders
Over the past few decades, our medical knowledge has evolved to understand that inflammation is the underlying cause of virtually all chronic illness.
Inflammation, the product of our immune systems, is what protects us from foreign substances that may be harmful. Its operation should be limited to handling the attack by resolving its activity. The problem in today’s world is that we are exposed to an ever-growing list of environmental toxins, genetically modified foods, allergens, and infectious agents that trigger uncontrolled and persisting inflammation.
This chronic immune system up-regulation causes damage to organs and tissues, resulting in autoimmune diseases, cardiovascular disease, and brain disorders. Through a process known as molecular mimicry, the immune system attacks normal tissues because of similarities in their composition to foreign substances. In other circumstances, persistent production of these inflammatory substances may cause fatigue, pain, mood disorders, and weight gain.
The world is experiencing an epidemic of autoimmune disease. There are now more than 100 diseases that have been identified as autoimmune in origin. Autoimmune diseases can affect any organ or body system and cause anything from mild to life-threatening illness. The underlying causes of autoimmune disease include infections, toxins, allergens, an imbalanced microbiome, nutritional deficiencies, and stress.
Some of the more common autoimmune disorders include thyroid disease, inflammatory bowel disease, rheumatologic disorders, cardiovascular disease, and chronic fatigue syndromes.
Conventional medicine has successfully treated some of these conditions with powerful immune-modulating drugs. This approach may be necessary when a condition is having a severe impact on your health, but these treatments come at a price. The drugs used include NSAIDs like Aleve and Advil, steroids, folate antagonists like methotrexate, and more recently TNF suppressors of TNF alpha, a powerful inflammatory molecule. These drugs can suppress the immune system and may halt the inflammatory process, but they can cause severe side effects such as infections, ulcers, liver damage, fatigue, allergic reactions, increased risk of cancer, and other tissue damage.
Autoimmune Thyroid Disease
Autoimmune thyroid disease is the most common cause of hypothyroidism, which is an underactive thyroid. The thyroid gland plays a central role in our metabolism and directly affects many processes at a biochemical, cellular and organ level. We view the immune dysfunction as the underlying cause, and we focus on identifying the cause of dysregulation to suppress the autoimmune process in order to prevent progression of early disease.
It can take ten years from the first development of thyroid antibodies to the onset of clinical illness, which gives us ample opportunity to intervene. We also optimize thyroid function with thyroid-specific nutrient supplements, the use of compounded thyroid preparations, and finely tuned dosing. We prescribe doses that reach the target level and follow up regularly until the system is properly “tuned”.
Bio-identical Hormone Replacement for Women
Bio-identical Hormone Replacement for Women is prescribed by using the DUTCH test from Precision Analytical to assess urinary metabolites of sex hormones and salivary measurement of adrenal function. These test results give us uniquely informative and actionable insights into your hormonal function.
Included in this program are exercise counseling, stress management, and psychotherapy when appropriate. Individualized hormone replacement prescriptions are determined by various biomarkers and targeted to correct the metabolic imbalances that cause your pattern of symptoms. We can individualize treatment programs that suit your lifestyle and preferences, and we provide a clear explanation of risks and benefits to help you in decision-making.
Biotoxin Illness is a common cause of chronic, complex illness. Our approach is guided by the work of Dr. Ritchie Shoemaker and Dr. Andrew Heyman. Dr. Shoemaker has been studying and treating mold illness for nearly 20 years and now trains other physicians in his protocols through the Shoemaker certification program. Dr. Shoemaker is the Program Director of Integrative Medicine at George Washington University in Washington DC, where he developed the first integrative medicine program offered at a four-year university.
Our Biotoxin Illness Program provide a customized lifestyle protocol that involves reduced exposure to toxins, modulation of an overactive immune response, and the repair of damaged tissue. Our approach begins with testing for specific genetic markers, abnormalities in signaling pathways, immune “hyperactivity,” and structural assessment of the brain when cognitive systems are impaired.
Detoxification and Biotransformation
Like any process involving construction and demolition, our bodies build and remove substances constantly. The removal process is called biotransformation or detoxification. The liver is the primary organ of biotransformation, which has two distinct processes: Phase 1 by way of the actions of the Cytochrome P450 system... and Phase 2, which involves the alteration of these intermediary products to water soluble substances. These are excreted by the kidneys and the other organs of elimination: the colon and sweat glands.
The circumstances of modern life have tremendous impact on our detoxification systems. For starters, there is the overload of toxic substances we acquire from the environment. Thousands of novel chemicals have been introduced into the environment with inadequate safety testing, forcing us to try to detoxify substances that our systems were not designed to process.
Adding even more stress to our already overburdened detox systems, our modern food supply does not provide the proper nutrients in sufficient quantities to support detoxification, while overwhelming our bodies with preservatives, genetically modified foods, and antibiotics. Other activities such as excessive exercise, inadequate sleep, and alcohol consumption add to the burden. Supporting biotransformation can alleviate symptoms such as fatigue, headaches, malaise, and depression.
Our digestive system is required to perform a complex set of tasks. First, we must digest the food we have consumed and break it down effectively into its basic components: simple carbohydrates, fatty acids, and amino acids. Then these nutrients need to be absorbed in a highly selective fashion to ensure that only the good stuff gets through and the bad stuff is rejected or destroyed. This process happens at the surface layer of the intestinal tract, where the interaction of pancreatic and brush border enzymes, hydrochloric acid, bile salts, and the microbiome direct this critical operation.
The introduction of processed and genetically modified foods has caused radical changes in our food supply. These changes, when coupled with toxins, stress, and the widespread use of antibiotics, have created the perfect storm for digestive dysfunctions. Studies of the intestinal microbiome show a progressive loss of biodiversity. Scientists have found that a strain of bacteria called Bacillus infantis, which had been the dominant bacterium in the infant gut for all of human history, is disappearing from the Western World.
In the world of functional medicine, digestive issues are at the root of many illnesses – including maldigestion, malabsorption, malnutrition, increased intestinal permeability, and immune system activation.
Irritable Bowel Syndrome is a commonly diagnosed condition with many causes. The gut, by virtue of its size and function, is our frontline immune defense system. It is also the entry point for many inflammatory substances. Our program utilizes state-of-the-art testing to identify imbalances in the intestinal microbiome and markers for increased intestinal permeability (“leaky gut”).
We identify the specific causes and underlying imbalances for each patient using an approach developed and refined by Institute for Functional Medicine practitioners, which emphasizes the basic concept that food is medicine. This systematic process is known as the 5R Approach.
REPLACE deficient enzymes, essential nutrients, and lifestyle behaviors that affect digestive disorders with proper eating habits.
REINOCULATE the intestinal tract with a diverse supply of beneficial bacteria by creating a receptive GI environment with of prebiotic foods and nutrient supplements. Gut health depends on a diverse population of beneficial bacteria which affect immune function and digestion.
REPAIR the gut lining so that its selective barrier functions properly with prebiotics, short chain fatty acids, and specific nutrients that soothe and heal the gut.
REBALANCE the autonomic and enteric nervous systems to improve intestinal motility and intrinsic secretion of digestive enzymes through stress management, sleep hygiene, and exercise.
Fatigue Syndromes and Fibromyalgia
Fatigue syndromes usually involve dysfunction in multiple areas of physiology. Fatigue disorders are generally considered to be a chronic, complex illness. Detecting the underlying cause of fatigue requires an all-inclusive, sequential search for causes that may include anemia, nutritional deficiency, hormone imbalance, biotoxin illness, mitochondrial dysfunction, sleep disorders, neurological and psychological problems, heart disease, or metabolic disorders. The underlying causes usually include dysbiosis. small intestinal bacterial overgrowth, intestinal permeability, mitochondrial dysfunction, and immune dysfunction. By this approach, we can treat the underlying causes, reverse the imbalances, and spare patients the “medical detention” of long-term analgesic use.
These disorders are among the most challenging cases we see in functional medicine. Although “cure” is elusive, nearly everyone improves to some degree. This program requires discipline, perseverance, and careful self-observation.
Functional Medicine: A Different Perspective
Functional medicine approaches these disorders from a different perspective. Recognizing the early changes in health, identifying the underlying causes, and intervening early in the process can prevent the progression to more serious illness. Even more encouraging is the fact that these treatments are primarily diet and lifestyle changes. By removing the factors that contribute to illness and providing some unmet needs, this approach supports our natural impulse toward healing. In this approach it is the patient, not the disease, that is the target of treatment.
Hormones are the chemical messengers that tell the cells in our bodies to function properly in the production of enzymes and structural proteins. These pathways produce energy, govern gene expression, and build and repair our physical structures. This communications system includes hypothalamic and pituitary hormones... thyroid, adrenal, and sex hormones... and neurotransmitters. Functionality is based on a messenger molecule traveling to a specific cell surface receptor and activating that receptor, which instructs the genetic structures within that cell to manufacture the appropriate substances.
Infections, Lyme Disease, Tick-Borne Infections
You’re probably familiar with the common infections that afflict humans – including strep throat, sinus infections, pneumonia, urinary tract infections, and gastroenteritis. Modern medicine has provided us with a wide array of antibiotics to successfully treat these illnesses.
However, there is another dimension to the problem of infectious diseases: “stealth infections.” All of us harbor pathogenic bacteria and viruses that remain dormant in us even after the symptoms of the infection have resolved. In the case of shingles, for example, the Herpes Zoster virus, acquired with chicken pox, becomes reactivated and causes inflammation along the course of a nerve. There are other infections that can be reactivated by the loss of immune system surveillance. Stress, lack of sleep, allergens, infections, and toxins all can suppress or overwhelm the immune system, which allows reactivation of these dormant microbes and can result in illness whose root cause may be difficult to identify.
Lyme Disease treatment varies depending on whether the condition is acute or chronic. In acute situations, timely and comprehensive treatment minimizes the risk of long-term illness. Chronic tick-borne illness requires an accurate diagnosis after careful history-taking and symptoms assessment. Often, this is a clinical diagnosis. Laboratory data may support the clinical suspicion but antibody testing is unreliable, with many false negative results. Laboratory confirmation more difficult because of immune suppression by tick-borne pathogens. As a result, many individuals are misdiagnosed, have a delayed diagnosis or are inappropriately or incompletely treated.
Our unique program is a synthesis of protocols in use by some of the most experienced specialists in the field of Lyme disease. Mary-Beth Charno, one of our Nurse Practitioners, has worked with these leading clinicians and integrates their approaches. She combines her clinical experience and methodical history-taking with in-depth testing to determine a treatment plan. This includes various rotations of pulsed antibiotics, often with botanical therapies.
We support your treatment with anti-oxidant IV nutrients, sauna, and an immune-strengthening lifestyle. With our experience in all of these treatment modalities, we can design a customized program that addresses symptoms, specific pathogens, duration of your illness, responses to prior treatments, and contributory lifestyle factors.
Mind Body Connection
As study and knowledge of neurobiology has advanced, we have refined and expanded the approach to mental illness by a better understanding of biochemistry, immune function, and the inflammatory process.
The causes of emotional and brain problems like anxiety, depression, ADD, memory loss, and organization and self-regulation are varied and in addition to various forms of psychotherapy, managing imbalances that occur in these areas offers new hope to those with these conditions.
Assimilation/ Nutritional Issues
Sensitivity to dietary proteins; especially dairy and gluten
Limbic system injury and emotional hyperreactivity (PTSD)
Dysbiosis, gut inflammation (The Second Brain)
Probiotics Prebiotics- what do they do
Endotoxemia from Lipopolysaccharides (LPS) and their metabolic consequences
Chronic inflammatory response syndrome
Role of chronic inflammation in altering critical protein signaling molecules
Leaky gut (increased intestinal permeability)
Leaky brain (defects in the blood brain barrier) > neuroinflammation
Our Preventive Cardiology program starts with a noninvasive assessment of cardiac endothelial function, carotid intimal thickness, vascular imaging, and an advanced lipid profile. The lipid profiling takes an in-depth look at risk factors for cardiovascular disease — including genetics, lipid particle size, fatty acid composition, inflammatory markers, and blood sugar metabolism. By evaluating and addressing all risk factors we expand the options available for management.
There is a strong association between sex hormone metabolism and the risk of heart disease, which is why we include hormonal profiling in your assessment. We also work closely with our cardiology colleagues when additional testing is appropriate. In some cases, a coronary artery calcium score may provide additional data.
Testosterone Replacement Therapy
As the population ages and environmental toxins act as endocrine disrupters, Testosterone Replacement Therapy has become a popular and much needed treatment. Symptoms of low testosterone include low sex drive, weight gain, poor energy, loss of muscle mass, depression, difficulty concentrating, and irritability. The condition may also increase the risk of heart disease.
Hormone deficiency can be managed in a variety of ways. Our approach starts with lifestyle improvement and nutritional support. We use injections, topical creams, and testosterone patches in older men when replacement is appropriate. For younger men, we emphasize finding the underlying cause that is typically a lifestyle factor.
After testosterone treatment, many men report improved energy levels, sex drive, and mood.