ChronoBiology - Understanding Chronotype Circadian Rhythms

Understanding Chronotype May Address Underlying Causes of Chronic Conditions

When you think about how to achieve optimal health, it’s most likely you think about what nutrients to eat and what foods you might avoid, how many hours of sleep to get each night, how much water to drink and how much exercise you should try to achieve in a week. All extremely important lifestyle factors to consider in our quest for a healthy body.

However, there is an emerging field of functional medicine research that specifically addresses, not the what or how much, but the when – the timing of when to sleep, when to eat and when to exercise, to name a few – on the impact of human disease to help inform and improve medical treatment.

Chronobiology

Chronobiology is a study of biologic rhythms that follow a daily or ~24 hour cycle. Most of us are familiar with the circadian rhythm, our internal biological clock, responsible for sleeping at night and being awake during the day. These biological rhythms influence our sleep-wake cycles, eating habits and digestion, body temperature, and other metabolic processes.

Studies suggest that disruptions in the circadian-system (like watching a movie late at night, working late) have been linked to sleep disorders, seasonal affective disorder and various chronic health conditions like cardiovascular disease, neurodegenerative disorders, obesity, diabetes, and mood disorders.

Researchers are taking a closer look at other rhythms of the human body as it impacts health outcomes: timing of eating and meal schedules, when to exercise, and even when we should be taking our medications.

For example, “results from a 2019 study regarding eating times and mood disorders indicated that of the 1,304 study participants, those who reported skipped or delayed breakfasts were more likely to experience a mood disorder compared to those with a regular schedule of eating breakfast, lunch, and dinner.”

And “Human and animal-based studies suggest circadian rhythms influence cardiovascular function and diseases, and may also offer an avenue for disease prevention and treatment. In 2019, a study of over 19,000 patients with hypertension found that those who took their medication at bedtime rather than upon awakening had better ambulatory blood pressure and lower risk of developing cardiovascular disease (CVD).”

Considering the developing research of medical chronobiology and circadian rhythms, offer additional root cause reasons and tools to glean insights into achieving individualized optimal health and wellness. Understanding your own personal chronotype may help address the underlying causes of chronic conditions and assist in the optimization of treatments and lifestyle interventions. Considering the developing research of medical chronobiology and circadian rhythms, offer additional root cause reasons and tools to gleam insights into achieving individualized optimal health and wellness. Understanding your own personal chronotype may help address underlying causes of chronic conditions and assist in the optimization of treatments and lifestyle interventions.

Credits:

Erin D’Elia Assenza, Health Coach at Healthy, Wealthy & Wise Medical Practice

 

 

Stress Anxiety and Insomnia during the COVID-19

Webinar: Stress, Anxiety, and Insomnia during the COVID-19

Join Dr. Elena Klimenko, a functional and integrative medicine doctor, for a discussion on psychological issues during this current health crisis in our country and around the globe.

The outbreak of coronavirus disease 2019 (COVID-19) may be stressful for people. Fear and anxiety about the disease can be overwhelming and cause strong emotions in both adults and children.

Because of the big wave of questions regarding anxiety, stress control, and insomnia, we decided to guide you on how to manage your anxiety, stress, and insomnia during this unprecedented time.

Watch free webinar
“Stress, Anxiety, and Insomnia
during the COVID-19″
presented by Dr. Elena Klimenko, MD, IFMCP

 

LIVE MEDITATION
led by Erin Assenza
Integrative Nutrition Health Coach

https://youtu.be/8evTbq3eUkA

Immune Support for Lungs Health webinar

Webinar “Immune Support for Your Lungs Health”

Join Dr. Elena Klimenko, a functional medicine doctor, for a discussion on respiratory health, diving deep into the details of respiratory infections, especially in the time of COVID-19.

Learn the ways our respiratory system is affected (i.e. seasonal allergies, home pollutants, diet, environment, etc.), along with what we can do to support our respiratory health overall.

Watch free webinar

“Immune Support for Your Lungs Health”
By Dr. Klimenko

Password: Wellness2020

“Immune Support for Your Lungs Health” webinar
boost your immune system to fight coronavirus

4 Tips To Boost Your Immunity So You Can Reduce The Chances Of Getting The Coronavirus Infection

Don’t Panic! Our very own Dr. Elena Klimenko did a Facebook Live video at the Well, answering questions about the Novel Coronavirus and how to reduce the chances of getting the infection.

You can watch the full video here:

The Coronavirus is a family of viruses that most Americans have been exposed to in the past.

However, this Novel Coronavirus, Covid-19, is more virulent than what we are used to and spreads pretty quickly. Symptoms of Covid-19 are fever, body aches, runny nose and in worse cases, an upper respiratory infection.

Generally, only cases that go deeper into the respiratory tract will be seen by professionals.

To keep yourself from getting to that point, you must boost your immunity, keep your immune barriers strong and take the following necessary steps for general prevention.

By taking the necessary steps listed below, the likelihood of getting the virus (or any virus for that matter!) is low:

  1. Wash Your Hands. For at least 20 seconds at a time, several times a day, especially after touching anything that might have been exposed (doorknobs, shopping carts, subway poles, etc). Make sure to get under your fingernails as well.
  2. Wash out your nasal orifices. You can also use a normal saline nasal spray to flush mucus membranes 2-3 times/day to reduce exposure to the virus.
  3. Get good sleep! To keep your immune system strong, you must prioritize 7-8 hours of uninterrupted deep sleep.
  4. Take these supplements to support your immune system.
    If you are running low, you can order them from our office at 212-696-4325.

a. Vitamin D – Your Vitamin D levels should be between 50-80.
b. Vitamin A
c. Herbs like Echinacea, Andrographis and Elderberry
d. Homeopathic Silver and Homeopathic Oscillococcinum

If you are feeling sick, we recommend you stay at home to help stop the spread of any virus.
If you must leave your house for any reason, using a surgical mask can prevent you from spreading germs and keep your community safe.

Hydrogen Sulfide SIBO Small intestinal overgrowth

Hydrogen Sulfide SIBO

Small intestinal overgrowth (SIBO) is a common gut health issue characterized by bacterial overgrowth in the small intestine. It is normally diagnosed through a breath test identifying hydrogen or methane produced by the overgrown bacteria. The problem is that this breath test is unable to detect a less talked about form of small intestinal overgrowth, hydrogen sulfide SIBO.

The good news is that working with a functional medicine practitioner, you can find out if your symptoms are due to hydrogen sulfide SIBO and if so, treat it naturally through a low-sulfate diet.

In this article, you will learn what SIBO and hydrogen SIBO are. You will learn how they are different, what are their symptoms, and how to diagnose them. I will explain why a low-sulfur diet is the best solution for hydrogen sulfide SIBO and how to follow a low-sulfur food plan.

You will also understand how working with a functional medicine doctor, like myself, can help you overcome hydrogen sulfide SIBO.

What Is SIBO

Small intestinal bacterial overgrowth (SIBO) is a gut health condition that affects the small intestine. It happens when certain bacteria, normally grown in other areas of your gut, start growing in your small intestine leading to overgrowth.

Symptoms of SIBO

If you have SIBO, there are a variety of symptoms you may experience. These SIBO symptoms may include:

  • Stomach pain
  • Indigestion
  • Gas
  • Bloating
  • Diarrhea
  • Constipation
  • Cramps
  • Feeling of fullness and quick satiety
  • Weight loss

What Is Hydrogen Sulfide SIBO

If your doctor is suspecting SIBO after going through your symptoms, health history and performing a physical exam, she or he will use a breath test that can detect hydrogen and methane in your breath. Since excess bacteria in your small intestine can lead to the release of these gases, this certainly makes sense and helps to identify most forms of SIBO. However, it doesn’t take hydrogen sulfide SIBO into account.

Hydrogen sulfide is a third form of gas that is commonly present among patients with SIBO. The problem is that hydrogen sulfide cannot be measured with a SIBO breath test. Hydrogen sulfide is produced by a very specific type of bacteria that can overgrow in your small intestine.

The interesting thing about hydrogen sulfide is that in small amounts, it can be beneficial and anti-inflammatory. However, when it occurs in high amounts due to a bacteria overgrowth in your small intestine, it becomes very problematic. High amounts of it in your large intestine can also result in health problems. Therefore to handle this overgrowth and to resolve your symptoms, we have to bring the healthy balance back to your small intestine, your whole gut, and body.

Diagnosing Hydrogen Sulfide SIBO

Since SIBO breath tests are not looking for hydrogen sulfide, you may wonder how can you know if you have hydrogen sulfide SIBO. That’s a great question. Let’s see how functional medicine doctors, such as myself, can help to diagnose hydrogen sulfide SIBO.

As you’ve already learned, breath tests only look for hydrogen and methane, not hydrogen sulfide, and can only diagnose traditional SIBO, not hydrogen sulfide SIBO. One study has found that people with traditional SIBO also have a higher risk of hydrogen sulfide SIBO.

However, another study has found that people who test negative for the SIBO breath test have a higher likelihood of having hydrogen sulfide SIBO. This is why it is important that you are working with a doctor who is familiar with hydrogen sulfide SIBO and is willing to dig deep to find the root causes of your symptoms and gut health issues. Working with a functional medicine doctor, like myself, is a great option.

First, your doctor will go through your symptoms. Symptoms of hydrogen sulfide SIBO may be different than the symptoms of SIBO. Sulfur-like, rotten egg smelly gas or belching are generally a good indication that you are dealing with hydrogen sulfide SIBO. You may also be more likely to experience diarrhea and nausea. You may also have other symptoms as well, such as rashes and pain. Once your doctor understands your symptoms, they can run some more complex GI tests other than the breath test to look for bacteria overgrowth and other gut imbalances. Lastly, if going on a low-sulfur food plan helps to relieve your symptoms, it is a good indication that hydrogen sulfide SIBO was the culprit behind them.

Low-Sulfur Food Plan for Hydrogen Sulfide SIBO

Traditionally, people with SIBO are often recommended to follow the low-FODMAP diet.

However, research has found that low-FODMAP is actually not beneficial for hydrogen sulfide overproduction. If you have hydrogen sulfide SIBO, a low-sulfur diet is a much better idea.

When you eat sulfur-containing food, they go through a process to naturally occurring sulfate in your body. While in a small amount, sulfate is good for you, too much becomes a problem. If you are dealing with hydrogen sulfide SIBO, following a low sulfur food plan can help your body regain its balance and get rid of your symptoms.

What to Eat and What Not to Eat on a Low Sulfur Food Plan

Vegetables to avoid:

  • Arugula
  • Asparagus
  • Bok choy
  • Brussels sprouts
  • Broccoli
  • Cauliflower
  • Cabbage
  • Daikon radish
  • Collard greens
  • Garlic
  • Kale
  • Horseradish
  • Onion
  • Leek
  • Radish
  • Peas
  • Scallion
  • Swiss chard
  • Sauerkaut
  • Spinach
  • Split peas
  • Turnip
  • Soybeans
  • Watercress

Fruits to avoid:

  • Dried fruits
  • Dried coconut
  • Grapes
  • Papaya
  • Pineapple

Dairy and dairy alternatives to avoid:

  • Cow, sheep, and goat milk
  • All cheese
  • Cottage cheese
  • Yogurt
  • Whey
  • Eggs
  • Coconut milk from a carton
  • Soy products
  • Animal protein to avoid:
  • Red meat
  • Fish
  • Poultry white meat

Legumes to avoid:

  • All legumes, including beans, lentils, bean sprouts, soy, etc.

Herbs to avoid:

  • Chives
  • Curry
  • Ginger
  • Horseradish
  • Turmeric

Other things to avoid:

  • Amaranth
  • Buckwheat
  • Lemon and lime juice
  • Frozen potatoes and french fries
  • Peanuts
  • Quinoa
  • Tamarind
  • Vinegar
  • Wine
  • Tamarind
  • Wheat germ

Supplements to avoid:

  • ALA
  • Bromelain and papain
  • Chlorella
  • NAC
  • MSM
  • Milk thistle
  • Turmeric
  • DMSO
  • Dairy source acidophilus
  • Cysteine

Vegetables allowed:

  • All squash
  • Artichokes
  • Avocado
  • Beets
  • Bell pepper
  • Carrot
  • Celery
  • Cucumber
  • Corn
  • Eggplant
  • Lettuce
  • Mushrooms
  • Olives
  • Potatoes
  • Pumpkin
  • Tomato
  • Water chestnut

Fruits allowed (up to ½ cup a day):

  • Bananas
  • Berries
  • Cantaloupes
  • Dates
  • Figs
  • Grapefruit
  • Melons
  • Kiwi
  • Lemon
  • Lime
  • Mango
  • Pear
  • Pomegranate

Herbs allowed:

  • Anise
  • Bay leaves
  • Basil
  • Caraway
  • Cilantro
  • Cinnamon
  • Cumin
  • Dill
  • Lemongrass
  • Lavender
  • Nutmeg
  • Oregano
  • Parsley
  • Pepper
  • Thyme
  • Rosemary
  • Thyme

Other foods allowed:

  • Almond, rice, and hemp milk
  • Nuts, including almonds, cashews, and macadamia
  • Seeds, including pumpkin seeds, sesame seeds
  • Gluten-free bread
  • Beet, corn, or parsnip chips
  • Basmati and jasmine vinegar

Final Thoughts

Hydrogen sulfide is the third most common gas in those with SIBO, yet, there is less research on it making diagnosis and treatment more difficult. If you have hydrogen sulfide SIBO, I recommend that you try a low-sulfur food plan, and notice a reduction in symptoms within a couple of weeks.

If you suspect that you have SIBO or hydrogen sulfide SIBO, I recommend that you contact a functional medicine doctor, like myself, for diagnosis and treatment. I can help you to address the underlying causes of your hydrogen sulfide and other types of SIBO, as well as other gut health issues using a system-oriented approach and engaging both patient and practitioner in a therapeutic partnership. As an experienced functional medicine doctor with integrated expertise of both Western medicine and traditional Eastern practice, I can assess all the factors, including diet, lifestyle, stress, toxicity, allergies, sleep habits, and medication, that may affect your gut health. Then I will prescribe a personalized and effective plan to improve your gut health condition, repair your body, and regain your health and well-being.

If you would like to get more information about hydrogen sulfide SIBO and gut health treatment or to schedule a functional medicine consultation, please call my office at 212-696-4325.

Sources:

https://www.ncbi.nlm.nih.gov/pubmed/15747080

https://www.ncbi.nlm.nih.gov/pubmed/9448181

https://www.ncbi.nlm.nih.gov/pubmed/19709217

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5023273/

https://onlinelibrary.wiley.com/doi/pdf/10.1016/S0378-1097%2803%2900748-1

https://www.fasebj.org/doi/abs/10.1096/fasebj.29.1_supplement.598.10

https://www.ncbi.nlm.nih.gov/pubmed/23898195

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5023273/https://www.ncbi.nlm.nih.gov/pubmed/23898195

Testing of Lyme Disease and photo of Tick

Testing of Lyme Disease and Problems with It

Lyme disease is an infectious disease spread by ticks. It is a growing problem with hundreds of thousands being diagnosed each year. However, Lyme disease is possibly the most misunderstood and controversial health issue. Many people go misdiagnosed and silently suffer from chronic and serious symptoms of chronic Lyme disease without receiving proper treatment. Unfortunately, current testing for Lyme disease is highly unreliable, and many doctors are not versed enough in Lyme disease to provide an accurate diagnosis and treatment.
In this article, you will learn what Lyme disease is, the difference between acute and chronic Lyme disease, and their symptoms. You will learn about current testing methods for Lyme and the problems with these tests. You will learn what tests may further help accurate diagnosis, and why you need a Lyme-literate health practitioner for proper diagnosis and successful treatment.

What Is Lyme Disease?

Lyme disease is an infectious disease. It is caused by the Borrelia burgdorferi bacteria found in ticks.
Lyme is more common in wooded areas or in nature. It is transmitted to the human body by the bite of an infected black-legged or deer tick. Based on the old standards, in order to transmit the disease, the tick usually has to stay in the body for 24 to 48 hours or longer. However, the new studies show that even 15 min from tick attachment it may transmit the variety of microbes into the victim.

Acute vs Chronic Lyme Disease

Acute Lyme disease refers to a short-term or recent infection, whereas chronic Lyme refers to a long-term infection with ongoing health problems. After getting infected with Borrelia burgdorferi, you may develop symptoms of acute Lyme disease. When caught early, within the first few days to weeks, acute Lyme disease is usually treated with a course of 1-2 antibiotics.
However, chronic Lyme disease is increasingly prevalent as well. Some people, unfortunately, are simply resistant to treatment. In other cases, Borrelia burgdorferi simply lingers in the body even after adequate treatment. While in other situations, acute Lyme disease symptoms may be too mild to take seriously, and the infection becomes chronic. In other cases, acute Lyme gets misdiagnosed and confused with the summer flu or another short-term illness and patients never get adequate treatment. Unfortunately, when the bacteria has fully integrated itself into your system, it leads to chronic health issues, and it is much harder to identify and shift.

symptoms from lyme disease include rash

Symptoms of Acute Lyme Disease:

  • Flat, circular rash with a bull’s eye
  • Joint pain, including neck and back pain
  • Fatigue
  • Muscle pains
  • Headaches
  • Sleep issues
  • Fever
  • Swollen lymph nodes
  • Concentration problems

Not all people with acute Lyme have a bull’s eye rash, actually, those who do are minority. Many people miss the tick bite altogether. Not all people with acute Lyme disease experience severe symptoms. Some may not visit the doctor. In some cases it may be confused with the flu or due to inaccurate Lyme testing, may get tested for autoimmune or other health conditions instead of Lymes. In some cases, symptoms may be written up as symptoms of stress, fatigue, or psychosomatic symptoms.

Symptoms of Chronic Lyme Disease:

  • Fatigue
  • Pain
  • Migrating and intermittent joints and muscle pains
  • Migrating pains or swelling in elbows, knees, and shoulders
  • Sleep troubles
  • Memory and concentration problems
  • Speech problems
  • Neurological issues — migrating numbness, tingling or burning pains
  • Fibromyalgia-like pain
  • Other chronic health issues

Chronic Lyme disease is often confused with fibromyalgia, autoimmune conditions, mental health issues, and psychosomatic illness. Without proper diagnosis and treatment, people with chronic Lyme disease may get worse over time and never recover.

Lyme Disease from Ticks

Conventional Testing for Lyme Disease

Conventional testing for acute Lyme disease usually starts with a health story. Your doctor will look for tick bites and rashes. They will perform a physical exam looking for symptoms of Lyme disease.
If your doctor believes that you have Lyme disease, they may order the following “standard-of-care” tests:

  • Enzyme-linked immunosorbent assay (ELISA) may be ordered to detect antibodies against B. burgdorferi.
  • Western blot may be used to confirm a positive ELISA test result. It is only used if your ELISA test is positive and checks for the presence of antibodies specific to B. burgdorferi proteins.
  • Polymerase chain reaction (PCR) may be used to evaluate people with Lyme arthritis or nervous system symptoms. This test is not routinely used as it has a very low sensitivity.

If a patient tests positive for both ELISA and Western blot tests the conventional diagnosis of Lyme disease can be established.

Problems with Testing for Lyme Disease

The problem is that Lyme disease is critically misunderstood by many people in the medical profession. Most doctors are not very well-versed in Lyme disease. Testing is not reliable. Many medical professionals are simply not educated about chronic Lyme disease to recognize and treat it. Conventional doctors often have a difficult time diagnosing, understanding, or treating something that they cannot see or isolate. Hence, Lyme disease diagnosis and treatment may be one of the most controversial and difficult issues in medicine. There are a lot of grey areas, a lot of misunderstandings, and unreliable testing, so going to a Lyme-literate practitioner is critical.

Lyme Testing Is Not Designed to Detect the Lyme-Causing Bacteria

It is important to know that there are many types of Borrelia, not just B. burgdorferi, that also cause Lyme-like illnesses. Despite of the variety of bacterias, the conventional tests only look for one species of Borrelia, B. burgdorferi. There are actually 16 known strains of Borrelia. Another example of Lyme-related infection, for example, is caused by B. mayonii. If it is not that you are infected with B. burgdorferi, conventional testing may not pick up on your Lyme diagnosis and may be misdiagnosed and left without treatment.

Inaccurate Results and False Negative Due to Lower Test Sensitivity

Most non-Lyme literate doctors and labs stick to the two-step test for Lyme that is recommended by the CDC and approved by the FDA. These tests include the ELISA followed by a Western blot test. Both tests are only designed to detect B. burgdorferi and no other Lyme-related bacteria or co-infection.

One of the problems with testing for Lyme disease is that the ELISA tests are not always accurate. False negatives may occur. For example, if you get tested too soon after getting bitten and infected, it’s possible that your body hasn’t developed enough antibodies for the test to detect the bacteria. If your ELISA test is negative, many labs will not move onto the Western blot. Many doctors don’t retest, even if your symptoms persist and are in correspondence with the symptoms of Lyme disease. Research has shown that the two-step testing of ELISA and Western blot may miss up to 60 percent of Lyme cases.

The ELISA and Western blot are also not accurate when it comes to chronic Lyme disease, and are more helpful when it comes to acute Lyme disease.

False-Negatives May Also Occur

While false negatives may occur, false positives also commonly occur. After getting infected with B. burgdorferi, your immune system may not show a positive response with positive IgM (young antibodies), however, neither convert or mount an immune response with IgG (old antibodies). One study, for example, has found that over 50 percent of test participants showed false positive for Lyme disease. This may happen because of early antibiotic use or because the B. burgdorferi destroys the specific part of your lymph nodes that are responsible for IgG antibodies.

Some patients simply will not ‘convert’ to a classic immune response that most conventional healthcare professionals and testing are looking for. If you are working with a health practitioner who is not Lyme-literate, they may have a false-positive interpretation as positive for Lyme disease, when you don’t have Lyme disease.

Indirect vs Direct Testing: More False-Negatives

The two-step testing process used by most doctors is indirect diagnostic methods that do not look for or detect the bacteria that are causing the infection but measuring your body’s immune system response when the bacteria is present. There are several problems with this method:

  • Timing: During the early stages of the disease, your body may not have created enough antibodies yet to show up on the ELISA test. Most doctors don’t retest even if symptoms persist.
  • Immune suppression: Tick bites are tricky. The saliva of Lyme-causing ticks has an immune-suppressing component that may prevent or delay your body’s immune response, hence, your body won’t respond to the two-step test.
  • Antibiotics: Taking antibiotics around the time of the infection may also prevent your body from making enough antibodies to show up on your test.
  • Modified form of Borrelia: In some cases, the bacteria will turn into a cyst and prevent the production of antibodies.
  • Weakened immune system: If you have a weak or compromised immune system due to an illness, co-infection, or poor diet, false negatives may occur.
  • Seronegative patients: Some patients’ bodies simply do not produce antibodies at all.

More Reliable Diagnosis

In order to get the right diagnosis and the right treatment, you need to find a Lyme-literate functional or integrative medicine practitioner who understands Lyme disease.

Direct Testing

Direct testing methods are better than indirect testing. They don’t simply rely on your body’s response to bacteria. Instead, they are looking for specific disease-causing bacteria. This can help to determine if you have Lyme, what exact bacteria is causing it and what co-infections you may have.

More Lab Testing

Lab testing only provides a glimpse of what’s going on in your body. There is certainly more needed than simple Lyme blood testing. Other blood tests, besides the standard Lyme tests, may help to evaluate the state of your health and get a better understanding of what is going on in your body. It is crucial that you find a Lyme-literate functional doctor who listens to your symptoms and is able to make an accurate Lyme diagnosis based on your symptoms, health history, and other tests.

Some further blood tests that may help accurate diagnosis include:

  • Complete blood count (CBC): white blood cells count (WBC), differential (diff), hemoglobin (HB)
  • Blood chemistries: electrolytes, liver function, kidney function
  • Glucose metabolism: fasting blood glucose, fasting insulin hemoglobin A1c (HbA1c)
  • Minerals: magnesium and calcium
  • Thyroid function: complete thyroid
  • Lipid panel
  • Autoimmune testing rheumatoid factor, ANA titer
  • C-reactive protein (CRP)
  • Vitamins: vitamin D and B12
  • Iron: ferritin
  • Urinalysis: pH, WBCs, nitrites, protein, bilirubin
  • Mold and mycotoxins
  • Food sensitivities
  • Omega-3/omega-6 ratio
  • Cytokine testing (Th1/Th2)
  • Adrenal hormone testing
  • Reproductive hormone testing: estrogen, progesterone, testosterone
  • Testing for toxins
  • Comprehensive stool analysis: yeast, parasites, viruses, and bacteria
  • Microbes testing
  • Genetic testing, like methylation ( MTHFR gene mutation)
  • Testing for neurological, cardiac, and GI symptoms
  • Testing for Lyme co-infections

Find a Lyme-Literate Integrative or Functional Health Practitioner

If you know or suspect that you have a Lyme disease (acute or chronic), it is important that you find a Lyme-literate functional medicine practitioner to help you received the right diagnosis, identify the root cause of your condition, and prescribe a personalized treatment.

As a Lyme-literate functional and integrative doctor, I can help you to receive the right diagnosis, address the underlying causes of all your health issues, and get the right treatment using a system-oriented approach, engaging both patient and practitioner in a therapeutic partnership. As an experienced functional medicine doctor with an integrated expertise of both Western medicine and traditional Eastern practice, I can assess all the factors, including diet, lifestyle, stress, toxicity, allergies, sleep habits and medication that may affect your immune system in order to accurately diagnose Lyme disease and/or other health issues or co-infections and provide a personalized and effective plan to improve other organs function like the thyroid condition, repair your body and regain your health and well-being.

If you would like to get more information about Lyme disease and other tick-borne illnesses or to schedule a functional medicine consultation, please call my office at 212-696-4325.

References:

  1. Wormser GP, Nowakowski J, Nadelman RB, Visinainer P, Levin A, Aguero-Rosenfld ME Impact of clinical variables on Borrelia burgdorferi-specific antibody seropositivity in acute-phase sera from patients in North America with culture-confirmed early Lyme disease.Clin Vaccine Immunol 2008 Oct;15(10):1519-22.
  2. Engstrom SM, Shoop E, Johnson RC Immunoblot interpretation criteria for serodiagnosis of early Lyme disease. J Clin Microbiol 1995 Feb;33(2):419-27.
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  5. Bakken LL, Callister SM, Wand PJ, Schell RF Interlaboratory comparison of test results for detection of Lyme disease by 516 participants in the Wisconsin State Laboratory of Hygiene/College of American Pathologists Proficiency Testing Program. J Clin Microbiol 1997 Mar;35(3):537-43.
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  8. Wojciechowska-Koszko I et al Seroidiagnosis of Borreliosis: Indirect Immunofluorescence Assay, Enzyme-Linked Immunosorbent Assay and Immunoblotting Arch. Immunol. Ther. Exp. (2011) 59:69– 77
  9. Chmielewska-Badora J, Cisak E, Wo´jcik-Fatla A et al Correlation of tests for detection of Borrelia burgdorferi sensu lato infection in patients with diagnosed borreliosis. Ann Agric Environ Med (2006) 13:307–311
  10. Coulter P et al Two-Year Evaluation of Borrelia burgdorferi Culture and Supplemental Tests for Definitive Diagnosis of Lyme Disease Journal of Clinical Microbiology Oct 2005 Vol 43, No. 10 5080- 5084
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  12. Hilton E, Tramontano A, DeVoti J, and Sood SK. (1997) Temporal study of immunoglobulin M seroreactivity to Borrelia burgdorferi in patients treated for Lyme borreliosis. J Clin Microbiol 35(3), 774-776.Kalish RA, McHugh G, Granquist J, Shea B, Ruthazer R, Steere AC (2001) Persistence of IgM or IgG antibody responses to Borrelia burgdorferi 10 to 20 years after active Lyme disease. Clin Infect Dis 33, 780-5. Abstract/FREE Full Text
  13. http://cid.oxfordjournals.org/content/33/6/780.full
  14. Racine R., McLaughlin M. Jonesa DD. et al. (2011) IgM Production by Bone Marrow Plasmablasts Contributes to Long-Term Protection against Intracellular Bacterial Infection. J Immunol 186, 1011-1021 Prepublished online 8 http://www.jimmunol.org/content/186/2/1011
  15. Seriburi V, Ndukwe N, Chang Z, Cox ME, Wormser GP (2012) High frequency of false positive IgM immunoblots for Borrelia burgdorferi in clinical practice. Clin. Microbiol. Infect 18, 1236-1240.
  16. Elsner RA, Hastey CJ, Baumgarth N (2014) CD4+ T cells promote antibody production but not sustained affinity maturation during Borrelia burgdorferi infection. doi:10.1128/IAI. http://iai.asm.org/content/early/2014/10/08/IAI.02471- 14.abstract
  17. https://www.healthline.com/health/lyme-disease#symptoms
  18. https://www.webmd.com/rheumatoid-arthritis/arthritis-lyme-disease
  19. https://www.cdc.gov/lyme/index.html
  20. https://www.healthline.com/health/lyme-disease-chronic-persistent
  21. https://www.healthline.com/health/lyme-disease
  22. https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.2008.20.1.iv
  23. https://www.ncbi.nlm.nih.gov/probe/docs/techpcr/
  24. https://www.sciencedaily.com/releases/2014/04/140402110029.htm
  25. https://www.health.harvard.edu/blog/lyme-disease-resolving-the-lyme-wars-2018061814071
  26. https://danielcameronmd.com/relying-on-a-negative-lyme-disease-test-can-prove-deadly/
  27. https://danielcameronmd.com/lyme-diagnosis-tests/
  28. https://www.tiredoflyme.com/4-reasons-a-lyme-test-will-come-back-negative-even-if-a-person-truly-has-lyme-disease.html
  29. https://www.lymedisease.org/lyme-sci-testing/
  30. https://www.cdc.gov
  31. https://www.mayoclinic.org/diseases-conditions/lyme-disease/diagnosis-treatment/drc-20374655
5 Simple and Smart Ways to Stay Hydrated in Winter

Five Simple and Smart Ways to Stay Hydrated in Winter

“Every aspect of our being fully alive relies on the precious resource of water. It’s the most important thing we consume, as the primary building block for our cells; it’s integral to many human faiths and spiritualities, and since ancient times, diverse hydrotherapies have been used to manage pain and stress and boost energy, sleep and immunity.”

Global Wellness Institute

Harsh winter weather can wreak havoc on your system, leaving your skin parched and body dehydrated. Even though your thirst response diminishes because of low temperature, staying well-hydrated during winter is as crucial as it is during the summer season. “In cold climates, body fluid losses can be as high as those in hot climates because of high rates of energy expenditure, use of heavy clothing and increased losses in urine,” the European Hydration Institute points out. The average man needs roughly 125 ounces of water daily (91 ounces for women) from both food and beverages. Inadequate water intake can cause fatigue, muscle cramps, headaches, even dizziness.

Keep winter dehydration at bay with these five smart strategies to up your water intake:

1. Set a drinking water goal

Being attentive to the amount of water you drink each day is important for optimal health. Establishing a daily drinking water goal is one of the easiest ways to keep track of your water consumption. You can use apps like Waterlogged, Hydrate Daily and Plant Nanny to set and achieve these water goals. Also, make a habit of carrying a water bottle everywhere you go, including at work, as it acts as a physical reminder to stay hydrated.

2. Warm it up

Hydrate With Room-Temperature Beverages. Instead of forcing yourself to gulp down glasses of cold water, drink warm water (plain or infused), homemade smoothies and healthy hot beverages like green tea, cinnamon tea or ginger tea.

3. Eat hydrating foods

Consuming fluid-filled foods like orange, oatmeal, cantaloupe, celery, strawberries and yogurt is a great way to sneak in more water into your daily diet. Eating homemade soups made with seasonal vegetables and herbs can also help you stay hydrated while providing warmth and nourishment to your body.

4. Layer your clothing

Wear layers of breathable fabrics instead of heavy-duty woolens to minimize water loss caused by perspiration.

5. Consider your workout water needs

It’s recommended to take half a cup of water for every fifteen minutes of exercise to rehydrate your body. To replenish lost fluid post-workout, “aim to drink one and a half times the fluid you lost while exercising”, suggests Better Health Channel. Instead of drinking it all in one go, “spread it over the next two to six hours after the session”, it adds.

And last but not least, if you want skin that looks and feel hydrated this winter, start growing indoor plants like peace lily, English ivy, snake plant and Boston fern that can naturally humidify a room.

Stay hydrated, stay healthy!


References:

https://www.health.harvard.edu/staying-healthy/the-importance-of-staying-hydrated

Autoimmune Thyroid Disease - Functional Medicine Approach

Functional Medicine Approach to Autoimmune Thyroid Disease

Autoimmune diseases affect nearly 24 million Americans, and thyroid diseases affect about 20 million. Many Americans are dealing with autoimmune thyroid disease. In fact, Hashimoto’s disease, an autoimmune thyroid condition, is one of the most common causes of hypothyroidism.

The scary part is that a high percentage of those with autoimmune thyroid disease are completely unaware of their condition. If you have autoimmune thyroid disease, you don’t want to leave it untreated. Read on to learn more about autoimmune thyroid disease and how functional medicine can help you to treat your condition naturally.

What Is Autoimmune Thyroid Disease?

Your thyroid is shaped just like a butterfly. It’s a small gland located at the base of your neck. It plays an important part in your endocrine system, which produces hormones that are responsible for your metabolism, temperature regulation, heart rate, breathing, and mood.

Autoimmune conditions occur when your immune system attacks your own body, in the case of autoimmune thyroid disease, your thyroid. The most common autoimmune thyroid disease is Hashimoto’s disease, a form of autoimmune hypothyroidism. You may also develop autoimmune hyperthyroidism, such as Graves’ disease.

Hashimoto’s Disease

Hashimoto’s Disease is an autoimmune condition characterized by an underactive thyroid.

Symptoms of Hashimoto’s disease include:

  • Fatigue
  • Muscle aches, stiffness, tenderness, or weakness
  • Joint pain and stiffness
  • Unexplained or unexpected weight gain
  • Constipation
  • Pale, dry skin
  • Hair loss
  • Brittle nails
  • Puffy face
  • Enlarged tongue
  • Increased sensitivity to cold
  • Memory issues
  • Depression
  • Prolonged menstrual bleeding

Early diagnosis and treatment of Hashimoto’s disease are crucial. Untreated Hashimoto’s disease may lead to a variety of health complications including goiters, heart problems, mental health issues, myxedema, and birth defects.

Graves’ Disease

Graves’ disease is an autoimmune condition characterized by an overactive thyroid.

Symptoms of Graves’ disease include:

  • Anxiety and irritability
  • Tremor
  • Fatigue 
  • Unexplained or unexpected weight loss, despite eating enough
  • Enlargement of the thyroid gland (goiter)
  • Heart sensitivity
  • Increase in perspiration
  • Warm or moist skin and increased body temperature 
  • Frequent bowel movement
  • Bulging eyes (Graves’ ophthalmopathy)
  • Thick, red skin on the top of the feet or shins (Graves’ dermopathy)
  • Rapid or irregular heartbeat
  • Thinning or brittle hair
  • Difficulty sleeping

It is important to diagnose and treat Graves’ disease early on. Untreated Graves’ disease may lead to a variety of health complications including heart problems; increased risk of heart disease, stroke, and congestive heart failure; eye problems; brittle bones; red and swollen skin and thyrotoxic shock.

Diagnosis of Autoimmune Thyroid Disease

Conventional, functional, and integrative doctors use similar tools for autoimmune thyroid disease diagnosis. You can expect a physical exam, a complete medical history and an analysis of your symptoms. Your doctor will also order some blood tests.

Many conventional doctors only check for your thyroid-stimulating hormone (TSH) level and inactive thyroid hormone (T4) level. However, in order to gain a full understanding of your thyroid health, most integrative medicine and functional medicine doctors find it important to get a complete panel. They check your TSH, free T4, free T3, and reverse T3 levels, as well as certain antibodies to understand the full picture.

What Conventional Doctors Don’t Understand About Autoimmune Thyroid Disease Treatment

Conventional doctors tend to look at your symptoms only, instead of looking at you from a holistic perspective, as a person affected by their diet, lifestyle, and environment. They miss digging deeper for the root cause of your issue and risk factors that may lead to autoimmune thyroid disease. The question of “WHY?” you developed autoimmune thyroid conditions most often remains unanswered.

Risk Factors of Thyroid Disease:

  • Stress: Cortisol, the stress hormone, may also interfere with thyroid hormone production leading to all kinds of imbalance in your body.
  • Leaky Gut: If you have increased intestinal permeability or “leaky gut syndrome”, your gut wall allows undigested food particles to escape into your bloodstream leading to chronic inflammation, a compromised immune system, and potential autoimmune disease.
  • Toxins: An exposure to harmful chemicals—in particular, the ones used in plastic may cause thyroid issues. Heavy metals is another big risk factor. 
  • Infections: Mononucleosis (Epstein-Barr virus), mumps and the flu virus have all been linked to thyroid problems. These viruses can stay dormant in your body for years then flare up when you are under great stress.
  • Food sensitivities and inflammatory foods: Inflammatory foods and foods that you are sensitive to may lead to further inflammation and disease in your body. Gluten sensitivity, for example, may lead to the overproduction of antibodies, which may end up attacking your own body, including your thyroid gland.
  • Autoimmune conditions: If you already have another autoimmune condition, then you are 10 times more likely to develop another one, including autoimmune thyroid disease.

Understanding these risk factors is incredibly important when it comes to autoimmune thyroid treatment. Unlike functional medicine doctors and integrative medicine doctors, conventional practitioners don’t take dietary and lifestyle factors into account when it comes to autoimmune thyroid disease treatment.

The conventional treatment of autoimmune thyroid diseases, such as Hashimoto’s disease and Graves’ disease, usually involves surgery and/or medication. Thyroid medications with synthetic thyroid hormones are one of the top sellers that patients usually stay on for life.

The problem is that these drugs don’t address the root cause of the problem and may lead to side effects and other health problems in the long run. Functional medicine doctors, on the other hand, have a different approach. Your functional medicine doctor will spend time with you to listen and understand why you may have developed an autoimmune thyroid condition. Instead of simply relying on thyroid medication or surgery, they look for the root cause of your autoimmune thyroid disease and offer natural treatment.

Functional Medicine Approach to Autoimmune Thyroid Disease

You will be happy to learn that you may be able to treat autoimmune thyroid disease naturally by following a functional medicine approach. This means addressing the root cause of your issues and following some dietary and lifestyle strategies.

Experiencing a lot of stress, sleeping very little, and eating junk food seems to be the norm in today’s fast-paced world. The problem is that such a lifestyle leads to inflammation and health issues, including autoimmune thyroid disease.

The functional medicine approach to autoimmune thyroid treatment requires dietary changes, adopting some lifestyle strategies, and appropriate supplementation to support your body. Visiting a functional medicine doctor is the first step for identifying the root cause of your autoimmune thyroid disease. Your functional medicine doctor can create an autoimmune thyroid treatment protocol that’s right for you.

Functional Medicine Strategies for Improving Your Thyroid Function

Take a look at some of the main functional medicine strategies for improving your thyroid function.

Repair Your Gut

Support your gut with a fiber-rich and nutrient-dense diet. Eat plenty of probiotic-rich foods, and take probiotic supplements to support your gut flora. Visit a functional medicine doctor to identify problems that may be compromising your gut health.

Clean Up Your Diet

Remove inflammatory foods, such as refined sugar, refined vegetable oils, processed foods, unhealthy fats, gluten, conventional dairy, and any foods to which you may be sensitive. Instead, eat plenty of anti-inflammatory foods, such as greens, vegetables, fruits, healthy fats and clean protein.

Lower Toxicity

Our modern world is full of toxins that create inflammation and disease in your body. Minimize toxic exposure by using organic and natural cleaning and body products, reducing the use of plastics, avoiding smoking and second-hand smoke and spending time in nature.

Identify Infections

There may be infections lying dormant in your body ready to activate an autoimmune thyroid condition under stressful circumstances. It is important that you work with a functional medicine doctor to identify your hidden infections and develop a plan to fight them naturally.

Exercise Regularly

Regular exercise supports your immune system and overall well-being. Aim to exercise 20 to 30 minutes five times a week and to move your body regularly. Get up and stretch at work. Go for a walk during lunch. Play outdoors with your kids or pets.

Relieve Stress

Managing your stress levels is absolutely essential for a healthy immune system. Avoid stress as much as possible. Learn skills that help you to react to stressful situations more effectively. Engage in relaxing activities, including yoga, meditation, journaling, breathwork, and nature walks.

Sleep Plenty

Getting regular quality sleep is essential for your overall well-being. Make sure to sleep 7 to 9 hours a night. Support your sleep cycle by having a regular bedtime. Develop a relaxing night-time routine that works for you to calm your mind and ease your body before bed. Meditation, journaling, light stretching, and a calming cup of tea are great ideas.

Find a Functional Medicine Doctor for Autoimmune Thyroid Treatment

If you suspect or already know that you have autoimmune thyroid disease, it is important that you find a functional medicine practitioner to help you identify the root cause of your condition and prescribe a personalized autoimmune thyroid treatment.

I can help you to address the underlying causes of your autoimmune thyroid condition using a system-oriented approach, engaging both patient and practitioner in a therapeutic partnership. As an experienced functional medicine doctor with an integrated expertise of both Western medicine and traditional Eastern practice, I can assess all the factors, including diet, lifestyle, stress, toxicity, allergies, sleep habits and medication that may affect your immune system in order to uncover the root cause of your autoimmune thyroid disease and prescribe a personalized and effective plan to improve your thyroid condition, repair your body and regain your health and well-being.


If you would like to get more information about autoimmune thyroid treatment or to schedule a functional medicine consultation, please call my office at 212-696-4325.

Functional Medicine Doctor NYC

References:

https://www.aarda.org/news-information/statistics/
https://www.thyroid.org/hypothyroidism/
https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855
https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855
https://www.niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism
https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659
https://www.thyroid.org/thyroid-function-tests/
https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease
https://www.endocrineweb.com/conditions/thyroid/how-stress-affects-your-thyroid
https://www.webmd.com/women/news/20100121/chemical-may-be-linked-to-thyroid-disease#1
https://www.ncbi.nlm.nih.gov/pubmed/24574735
https://www.ncbi.nlm.nih.gov/pubmed/26230132
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5099387/
https://www.ncbi.nlm.nih.gov/pubmed/30213697
https://www.uclahealth.org/endocrine-center/subacute-thyroiditis
https://pubs.acs.org/doi/abs/10.1021/acschemneuro.5b00148
https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease
https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/diagnosis-treatment/drc-20373665
https://www.sciencedirect.com/science/article/abs/pii/0024320589901793

How to Get Better Night Sleep

How To Get Better Night Sleep (According To Functional Medicine)

JUST ONE MORE click along your episodic TV show on Netflix, that means one less hour of sleep, but that’s nothing a cup of coffee won’t fix tomorrow, right? Not quite. Over time, a deficit of deep sleep could mean way more than just a bit of daze—think weight gain, mood disorders, fatigue, increased stress levels, reduced attention span, and declined cognitive performance.

With the hectic pace of day-to-day life, many people don’t get the recommended amount of sleep each night. According to the National Sleep Foundation, adults typically need between seven and nine hours of sleep per night in order to function at their best. Getting fewer hours for even a couple of nights in a row can have the same effect as staying awake for 24 hours straight. And, over time, the chronic sleep debt can even contribute to illness.

I want to get real with you about the importance of sleep and share

12 simple tips from functional medicine on

How to Get Better Night Sleep:

  1. Set the right temp. Make the room a comfortable temperature for sleep (not too hot or cold). In general, the suggested bedroom temperature should be between 60 and 67 degrees Fahrenheit for optimal sleep.
  2. Soak the day away. Take a hot bath at night for 20 minutes. You might want to add 2 cups of Epsom salt and 10 drops of lavender essential oil to the bathwater.
  3. Calm your system. Take a daily dose of Magnesium Lactate before bed, which relaxes the nervous system and muscles. Magnesium supports ion signaling across cell membranes; it supports the body’s natural ongoing activities of bone formation and resorption; it helps facilitate muscle contraction and body’s energy production, which is used by the central nervous, neuromuscular, and cardiovascular systems. Raise your hand if you feel you don’t need it tonight!
  4. Supplement thoughtfully. Other supplements and herbs to get sufficient shuteye include calcium, L-theanine (an amino acid from green tea), Kava Forte by MediHerb and Min–Tran.
  5. Ditch the coffee addiction. Avoid or minimize substances that affect sleep, like caffeine, sugar, and alcohol.
  6. Unplug. Avoid any stimulating activities for two hours before bed such as watching TV, using the Internet and answering emails.
  7. Set a bedtime (and a rise time). Go to bed (preferably before 10 or 11 p.m.) and wake up at the same time every day.
  8. Sweat it out. Exercise daily for 30 minutes (but not three hours before bed, which can affect sleep).
  9. Designate a role. Keep computers, TVs and work materials out of the room to strengthen the mental association between your bedroom and sleep.
  10. Cut the lights. Keep your bedroom very dark or use eyeshades.
  11. REST. Keep it quiet. Block out sound if you have a noisy environment by using earplugs.
  12. Daytime Napping. “No day is so bad it can’t be fixed with a nap.”—Carrie Snow.
12 Tips on how to get a better night sleep

One way to combat the effects of sleep deprivation—and repay some sleep debt—is to incorporate daytime napping into your schedule. The length of the nap and type of sleep you get during that nap help determine its potential health benefits. The table below identifies these benefits.

Health Benefits of Nap

If you need extra support with sleep issues, feel free to call our office at (212) 696-4325 and schedule a consultation. We provide a full-spectrum functional medicine evaluation by a Certified Functional Medicine practitioner.


References:

The Institute For Functional Medicine

Inflammatory Bowel Diseases (IBD)

Functional Medicine Approach to Inflammatory Bowel Diseases (IBD)

Inflammatory bowel diseases (IBD), which include Crohn’s disease and ulcerative colitis, affect as many as three million Americans, most of whom are diagnosed before age 35. These chronic, life-long conditions can be treated but not cured, so as a result IBD can significantly affect a patient’s quality of life and may have a high financial load. Up until now, traditional medicine has taken a linear view of treatment options by focusing only on addressing and commonly suppressing symptoms, ignoring the impact of the whole person; their mind, body or lifestyle, causing many patients continuing the struggle.

In contrast, the Functional Medicine approach to Inflammatory Bowel Diseases (IBD) is the most healing road to optimal health. It focuses on addressing the root cause of the imbalance that is generating the symptoms. To do this, functional medicine doctors rely on many tools and methods, including but not limited to: food plan and balanced nutrition, lifestyle modifications, acupuncture, homeopathy and mindfulness therapy.

Gas, bloating, constipation, diarrhea, urgency, and painful cramping—these are just some of the many difficult symptoms that come along with inflammatory bowel disease. Inflammation in the gastrointestinal tract can become debilitating if left untreated, but an integrated functional medical approach can help restore the natural balance to a patient’s digestive system. The digestive system is one of the most important and sensitive biological systems in the body, critical to overall health and well-being. Also, we now know that the immune system is very reactive to the environment, so when we look at Crohn’s and ulcerative colitis, there is a genetic component in some but the escalation of these diseases worldwide in the last twenty years is not genetically founded, so something about the environment (such as what we are exposed to or consume) plays a fundamental role.

Functional medicine’s approach is like building a house, starting by building a foundation which is a healthy lifestyle, a healthy environment, and a personalized food plan. We need to return to the roots and start to cultivate a healthy inner environment – a strong microbiome that supports the rest of the body. Treating inflammatory diseases of the bowel can be challenging: genes, food, gut microbes and disrupted immune function – all contribute. Functional medicine is really a paradigm shift, progressing from the medications that suppress symptoms or a reactive immune system to addressing the underlying cause of the problem.

Inflammatory Bowel Diseases IBD

In our functional medicine of Healthy Wealthy & Wise Medical PC along with Dr.Elena Klimenko, we address the underlying causes of IBD disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It’s really all about approaching these diseases by looking at the wholeness of the patients and identifying the root causes, which may vary for each patient.

There is so much we can do for patients with IBD, which can be done in parallel with conventional medicine. Healing takes time, but the functional medicine approach is the most certain road for optimal health. It is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century.


As an experienced functional medicine expert with an integrated combination of Western medicine and traditional Eastern practice, Dr. Elena Klimeko can assess the numerous factors of you that can affect your immune system – potential environmental toxins, lifestyle, stress, diet, medication, allergies, and sleep habits – to uncover the root cause of your IBD diseases. If you would like to get more information or to schedule a consultation, please call her office at 212-696-4325.


References:

https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf