Acne and Mental Health

by Daniella Epstein, CHC and Elena Klimenko, MD, IFMCP

Imagine a woman. A beautiful woman with deep, soulful eyes and a sparkling smile. Over some time, you notice her shoulders start to slump, her eyes seem to have a sadness inside them, and her smile doesn’t seem as bright. She still is the beautiful person you know and love, but she doesn’t look like she believes that. Her skin is red, and she has a significant amount of acne on her face. Her hair is dull and thin, and she doesn’t seem to walk with that same happy energy that she used to. She doesn’t look you in the eye anymore and never likes to see her reflection in a mirror or picture. She always has an excuse why she can’t come out tonight. 

Acne can severely impact mental health. Due to acne being so prevalent, there is often a dismissive attitude toward the internal struggle one with acne can be dealing with. The burden of this condition on one’s life and mental status can be a heavy one, very difficult to deal with, and can severely affect quality of life (1). Acne can have a truly significant impact on mental health, with potential to affect self-esteem, cause depression, anxiety, impair social interactions, and even cause suicide (2).

It is important to be aware of the emotional hardship that acne can bring and provide extra attention to those suffering from this complex condition.

Functional medicine treatment of acne requires integrative understanding of deeper than skin issues. The reasons for unhealthy skin are complex and can involve imbalance of digestive system, hormonal, detoxification and even immune systems. The proper look at your history and test results by a certified functional medicine physician will help you to understand the holistic nature of this condition and take a deeper than skin dive into your health. 

The “Deeper Than Skin” Program, offered at our office, will address acne from the Functional Medicine perspective, along with the awareness and support needed for the inner and emotional healing that is truly important in this process. Functional Medicine physician Elena Klimenko, MD in collaboration with Daniella Epstein, Certified Health Coach and Social Worker, to support patients on the healing journey and ensure the mental health component does not go unchecked. The program aims to address the root cause of your acne, support you through implementation of relevant lifestyle changes, and provide the guidance and love to facilitate your healing both inside and out.

If you would like to get more information about acne preventative treatment or to schedule an integrative medicine consultation, please contact us.


Franz, Rachel. “New Study Links Mild Acne to Depression, Suicide in Young people”. Dermatology Nursing, Dec. 1998, p438. Health Reference Center Academic,

Gallitano, S., & Berson, D. (2018). How Acne Bumps Cause the Blues: The Influence of Acne Vulgaris on Self-Esteem. International Journal of Womens Dermatology, 4(1), 12-17. doi:10.1016/j.ijwd.2017.10.004

 Hull, Peter R. et. al.  Acne, Depression, and Suicide. Dermatologic Clinics , Volume 23 , Issue 4 , 665 – 674

Cognitive Decline

The importance of detecting the underlying reason and building a preventative plan

To date, there is no current treatment that can prevent or cure cognitive impairment. 

Dr. Dale Bredesen’s research helps us understand this complex and devastating condition; better understanding of disease at the molecular level, and underlying pathophysiological mechanisms could provide potential insights to develop novel treatment strategies to manage the cognitive impairment.  

You won’t hear about Dr. Bredesen’s work in reversing the cognitive decline on the 06.00 o’clock news as mainstream medicine still expects one drug to fix a condition that can be characterized by 36 separate contributory causes.

Dr. Bredesen explains that determining whether you have Alzheimer’s disease or not, does not help you to avoid it or reverse it. However, determining why you have Alzheimer’s is key to develop novel treatment options and preventative plans.

Most people who already have Alzheimer’s disease or MCI (mild cognitive impairment, the harbinger of Alzheimer’s) or SCI (subjective cognitive impairment, which precedes MCI) could show between 10-25 contributors to their cognitive decline. ³

Types of cognitive decline

Let’s jump right into Dr. Dale Bredesen’s six types of Alzheimer’s disease: ³

  • Type 1 Alzheimer’s is inflammatory, or hot, and driven by ongoing inflammation. One of the major mediators of the inflammatory response is called NF-κB (nuclear factor kappa-light-chain enhancer of activated B cells), and NF-κB increases the production of molecules that produce amyloid, so this shows a direct link between inflammation and occurrence of Alzheimer’s. ³
  • Type 2 Alzheimer’s is atrophic, or cold, and driven by suboptimal levels of nutrients, hormones, or trophic factors (cell growth factors like nerve growth factor). your brain is not receiving enough of the right building blocks to maintain your brain’s five hundred trillion (500,000,000,000,000) synaptic connections so cognitive problems ensue. ³
  • Type 1.5 Alzheimer’s is glycotoxic, or sweet, and driven by high blood sugar or high fasting insulin. We call this type 1.5 because it has features of both type 1 and type 2: chronic inflammation (type 1) occurs because the glucose attaches to many of your proteins causing an inflammatory response. Reduced trophic support (type 2) occurs because your brain cells become less sensitive to insulin, which is a critical growth factor for them. ³
  • Type 3 Alzheimer’s disease is toxic, or vile, and driven by exposure to toxins such as mercury, toluene, or mycotoxins (yes, exposure to some mold can cause Alzheimer’s through toxins made by certain molds such as Stachybotrys and Penicillium). Since we are exposed to toxins, we all experience this risk to a greater or lesser degree, so the key is to minimize exposure, identify the toxins to which we are exposed, and increase excretion and detoxification of them. ³
  • Type 4 Alzheimer’s disease is vascular, or pale, and driven by cardiovascular disease. Indeed, vascular dysfunction is identified as one of the main causes of the occurrence and development of Alzheimer’s disease. ³
  • Type 5 Alzheimer’s disease is traumatic and driven by head trauma. A traffic accident, a fall, or even repeated minor head injuries during sports could be a cause to develop Alzheimer’s disease. ³

We are all exposed to everyday toxins, the processed foods – the effects of pesticides and fertilizers on natural wildlife and our water supply is well-documented. Americans demand cheap food, so our agricultural policy for the past 30 years has focused on providing large amounts of inexpensive calories; the high-carbohydrate and unhealthy fat content of the standard American diet, the leaky gut syndrome so many of us have, and the lipid abnormalities (“cholesterol,” although the good cholesterol itself is not the problem), most of us have a significant risk for Alzheimer’s disease or some level of cognitive impairment, and yet…

The great news is we can prevent or reverse the problem as soon as we understand the contributors and underlying causes. 

As Dr. Dale Bredesen laid out at The End of Alzheimer’s Program and his protocol, here’s how we do that:

  • First, we address insulin resistance.
  • Second, we get into ketosis.
  • Third, we optimize all nutrient, hormone, and trophic (growth factor) support.
  • Fourth, we resolve and prevent inflammation.
  • Early interventions focused on modifiable lifestyle factors can help prevent and reduce the risk of cognitive impairment during aging.

Exercise/Physical activity

Regular physical activity and exercise can develop a better memory. Regular exercise has long been known to improve and maintain key aspects of cognitive function i.e. attention, learning, and memory.

A structure in the brain known as the hippocampus is linked to learning and memory. The hippocampus is in the medial temporal lobe (MTL), a well-connected hub of brain activity that is particularly sensitive to the effects of exercise. Alzheimer’s disease is often described as a syndrome of disconnection in the brain. Now, a study of healthy older adults aims to assess the effects of exercise on nerve connections within the MTL. ⁴

Exercise is one of the strategies that has been shown to optimize both mitochondrial and cognitive function, potentially decelerating cognitive decline and attenuating neurodegeneration.

Recent meta-analyses and controlled trials have found that several different types of physical activity, including the following, may improve attention, executive function, and memory: ⁶

  • Both low to moderate and high-intensity exercise ⁷, ⁸
  • Short-term interval training and aerobic exercise ⁸
  • Social dancing ⁸
  • Multimodal physical exercise ⁷, ⁸,⁹
  • Mind-body exercises such as tai chi, yoga, and qigong ⁹

And Mind-Body Therapies and Exercises

A 2019 systematic review and meta-analysis of 49 studies covering 4,506 participants found that mind-body therapies can be effective in treating insomnia and improving sleep quality for both healthy individuals and patients. The tested therapies included:¹⁹

  • Meditation
  • Tai chi
  • Qigong
  • Yoga

A Mediterranean or Keto Diet

Both the Mediterranean diet and the keto diet claim cognitive brain health benefits. Let’s take the keto diet, for example. How does the ketogenic diet affect the brain?

The first study, whose results appear in the journal Scientific Reports, looked at the effects of a keto diet on neurovascular function, which includes sensory and motor functions, as well as circulation.

“The keto diet seemed to boost the clearance of beta-amyloid protein in the brain — the “building blocks” that, in Alzheimer’s, stick together, forming toxic plaques which interfere with neuronal signaling.” – Scientific Reports

Nutrition is a key modulator of cognitive health, but what are those specific nutrients and vitamins that support cognition and reduce neurodegeneration?

Multi-pronged lifestyle interventions offer promise for the prevention and delay of cognitive decline. For example, personalized dietary plans that include neuroprotective foods provide nutrients for optimal cognitive functioning and potentially reduce neuroinflammation, as well as improve brain plasticity. ¹⁴

You may ask, what are specific nutrients and vitamins that support cognition and reduce neurodegeneration?

  • Neuroprotective Nutrients such as Q10 (CoQ10), acetyl-L-carnitine (ALC), and resveratrol.
  • Nutrient-dense anti-inflammatory whole diet approaches. Epidemiological and observational studies, as well as clinical trials, continue to demonstrate that higher adherence to specific diets that prioritize plant, whole grain, and healthy fat intake, such as the Mediterranean, DASH (Dietary Approaches to Stop Hypertension), and MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diets, is associated with less cognitive decline and reduced risk of dementia such as Alzheimer’s disease.15-19 For example, a 2021 observational study used questionnaires to evaluate the effect of Mediterranean diet adherence on the cognitive abilities and psychological state of 2,092 men and women (65 years or older) from seven different Greek cities.16 Results from the study indicated that higher diet adherence was significantly associated with both better cognitive status and fewer depression symptoms.¹⁵
  • Plant-rich diets, keto diets were positively correlated with anti-inflammatory microbial species, and animal product–rich diets were associated with a pro-inflammatory microbial profile; however, no association was found between cognition and microbiota composition. ¹⁶ “Research continues to explore the associations between neuroinflammation and gut dysbiosis and what role any alterations in the gut microbiota may play in cognitive health and prevention of neurodegeneration.”¹⁷

Research does suggest that the longer the healthy eating pattern persists, the greater the impact on cognitive function.


Certain nutrients have been shown to protect against oxidative damage to mitochondria, including:

  • Omega-3 fatty acids
  • Antioxidants (including vitamin C and zinc)
  • Members of the vitamin B family (including vitamin B12 and folic acid)
  • Magnesium

Sleep and Cognitive Decline

Several studies have suggested that sleep and sleep-wake rhythm disturbances are associated with an increased risk of incident dementia and cognitive decline in the elderly, independent of multiple confounders. ¹⁸

Sleep disturbances have a significant impact on cognitive and physical functions in individuals with cognitive decline and may be associated with important psychological distress and depression.

As Dr. Elena Klimenko says, ‘when we try to encourage a good night’s sleep for our patients, perhaps we are doing them better than we thought’ Sleep is a physiological necessity and being deprived of it has many harmful health effects. How do functional medicine practitioners can help their patients get more rest and limit the maladaptive mitochondrial changes that occur during states of stress?

Mental Stimulation

Mental exercise is one simple, yet effective, strategy. Exercise also changes chemical signaling in the brain, even in the short term. If you want to improve memory, increase focus, and feel sharper check our favorite platform called luminosity; you will learn a lot about how your brain works depending on how much you sleep, how much exercise you get, and more.

Manage Stress and Anxiety

Stress triggers inflammation in body that can lead to cognitive decline; stress management is helpful to overcome cognitive decline.

Stress and anxiety management another way to cure the cognitive declining diseases as researchers showed that psychological stress is the primary risk factor for the development of cognitive decline and dementia. 20 The physical or psychological stress can activate the peripheral process and neuronal circuits that can lead to triggering of inflammation and ultimately cognitive decline.21 Daily basis stress has also been linked with stimulation of release of inflammatory cytokines that’s why both stress need to manage to overcome the brain disorders and cognitive decline.

Environmental Toxins and Cognitive Decline: 5 Steps to Reduce Your Risk

In today’s world, we are all exposed to some level of toxins. These appear in our food, water, air, as well as in everyday items found around the home.
Research has shown that low-dose toxic exposure over long periods of time can add up, eventually contributing to cognitive decline disease. According to researchers, the top environmental toxin categories associated with cognitive decline are heavy metals, mold & mycotoxins, plastics, as well as pesticides.

  • Mercury – Mercury sources include dental fillings, contaminated fish, and air polluted from the combustion of fossil fuels and coal.)
  • Aluminum – Aluminum is the most abundant metal found on Earth; it’s used in many different daily-use products, including, cosmetics/personal care products, over-the-counter and prescription products, food additives and fillers, cookware, food packaging, etc. Studies now show that aluminum impairs our central nervous system
  • Mold & Mycotoxins – Mold is a fungus that usually grow at humid and damp environment. The poisons produced by mold can stimulate the inflammatory responses in the body. The exposure of toxic mold has been linked to the memory loss, depression, anxiety, brain fog and insomnia. Detoxification from toxic mold can help to treat these conditions and can treat cognitive decline effectively. 
  • Pesticides (Most conventionally farmed foods are exposed to some level of pesticides. Pesticides are substances that are used to kill insects, rodents, and weeds that may affect crop yield during food production.
  • Plastics – Use of plastic utensils, food containers, wrappers, water bottles, linings of cans/containers, coffee pods, to name a few sources, can cause bio-accumulation (build up in our bodies) from the leaching of plastic particles into food and beverages. Plastics are known “endocrine disrupters”, contributing to hormonal imbalances. They have also been linked with health risk including neurological diseases, like Parkinson’s Disease and cognitive decline.

Reducing your risk:

  • Upgrade your diet. (Include more nutrient-dense foods to enhance detoxification. Foods like dark leafy greens, cruciferous veggies (including broccoli, kale, and cabbage), and sulforaphane-rich foods like garlic and onion contain high concentrations of nutrients that increase our detoxification capacity. Load up on fiber and mineral-dense foods, which help trap and eliminate toxins through your digestive system. Last but not least, add cilantro, turmeric, and green tea to ramp up detox pathways.)
  • Incorporate detoxification practices into your daily routine. (Epsom-salt baths, sauna, lymphatic massage, sweat-inducing workouts*, and dry brushing are some examples of practices that improve detoxification. Daily bowel movements are essential. If you don’t have consistent bowel movements, consider working with a nutritionist to help you improve motility and, in turn, enhance your body’s natural ability to eliminate toxins.)
  • Live plastic FREE life. (It may be overwhelming at first, but slowly start to switch to glass bottles, paperware, or eco-friendly and plastic-free packaging.
  • Check your home Switch your home cleaning supplies to more natural alternatives, test your water for contaminants,, and get your home tested for possible air pollutants including mold and other toxic materials).


Overall, this article represents the importance of understanding contributing factors and underlying causes of cognitive decline disorders i.e., Alzheimer’s disease. A better understanding of disease at the molecular and biological level could lead to the development of novel treatment strategies to manage cognitive diseases. Some cognitive decline disorder management strategies include regular exercise, physical activity, keto diet, regular sleep, and management of stress and anxiety. These cognitive decline disease management strategies have proven as successful to manage the disorders such as Alzheimer’s disorder. 

If you would like to get more information about cognitive decline preventative treatment or to schedule an integrative medicine consultation, please contact us.


  1. The Impact of Age on Cognition

2. Smoking, dementia and cognitive decline in the elderly, a systematic review



5. Cellular and Molecular Neurobiology

6. Exercise, Mitochondrial Health, and Brain Fitness

7. Moreau D, Chou E. The acute effect of high-intensity exercise on executive function: a meta-analysis. Perspect Psychol Sci. 2019;14(5):734-764. doi:10.1177/1745691619850568

8. Zaenker P, Favret F, Lonsdorfer E, Muff G, de Seze J, Isner-Horobeti ME. High-intensity interval training combined with resistance training improves physiological capacities, strength and quality of life in multiple sclerosis patients: a pilot study. Eur J Phys Rehabil Med. 2018;54(1):58-67. doi:10.23736/S1973-9087.17.04637-8

9. Bouaziz W, Schmitt E, Vogel T, et al. Effects of a short-term Interval Aerobic Training Programme with active Recovery bouts (IATP-R) on cognitive and mental health, functional performance and quality of life: a randomised controlled trial in sedentary seniors. Int J Clin Pract. 2019;73(1):e13219. doi:10.1111/ijcp.13219

10. Hsu CL, Best JR, Davis JC, et al. Aerobic exercise promotes executive functions and impacts functional neural activity among older adults with vascular cognitive impairment. Br J Sports Med. 2018;52(3):184-191. doi:10.1136/bjsports-2016-096846

11. Vaccaro MG, Izzo G, Ilacqua A, et al. Characterization of the effects of six-month dancing as an approach for successful aging. Int J Endocrinol. 2019;2019:2048391. doi:10.1155/2019/2048391

12. de Oliveira Silva F, Ferreira JV, Plácido J, et al. Three months of multimodal training contributes to mobility and executive function in elderly individuals with mild cognitive impairment, but not in those with Alzheimer’s disease: a randomized controlled trial. Maturitas. 2019;126:28-33. doi:10.1016/j.maturitas.2019.04.217

13. Zou L, Loprinzi PD, Yeung AS, Zeng N, Huang T. The beneficial effects of mind-body exercises for people with mild cognitive impairment: a systematic review with meta-analysis. Arch Phys Med Rehabil. 2019;100(8):1556-1573. doi:10.1016/j.apmr.2019.03.009

14. Poulose SM, Miller MG, Scott T, Shukitt-Hale B. Nutritional factors affecting adult neurogenesis and cognitive function. Adv Nutr. 2017;8(6):804-811. doi:10.3945/an.117.016261

15. Mantzorou M, Vadikolias K, Pavlidou E, et al. Mediterranean diet adherence is associated with better cognitive status and less depressive symptoms in a Greek elderly population. Aging Clin Exp Res. 2021;33(4):1033-1040. doi:10.1007/s40520-020-01608-x

16. an Soest APM, Hermes GDA, Berendsen AAM, et al. Associations between pro- and anti-inflammatory gastro-intestinal microbiota, diet, and cognitive functioning in Dutch healthy older adults: the NU-AGE study. Nutrients. 2020;12(11):3471. doi:10.3390/nu12113471

17. Yuan C, Fondell E, Bhushan A, et al. Long-term intake of vegetables and fruits and subjective cognitive function in US men. Neurology. 2019;92(1):e63-e75. doi:10.1212/WNL.000000000000668

18. Tranah GJ, Blackwell T, Stone KL, Ancoli-Israel S, Paudel ML, Ensrud KE, Cauley JA, Redline S, Hillier TA, Cummings SR, Yaffe K; SOF Research Group: Circadian activity rhythms and risk of incident dementia and mild cognitive impairment in older women. Ann Neurol 2011;70:722-732.

19. Wang X, Li P, Pan C, Dai L, Wu Y, Deng Y. The effect of mind-body therapies on insomnia: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2019;2019:9359807. doi:1155/2019/9359807

20. Sussams R, Schlotz W, Clough Z, Amin J, Simpson S, Abbott A, Beardmore R, Sharples R, Raybould R, Brookes K, Morgan K. Psychological stress, cognitive decline and the development of dementia in amnestic mild cognitive impairment. Scientific reports. 2020 Feb 27;10(1):1-1.

movement is life

Movement as Medicine

We have heard it a bunch of times and from different sources “movement is life”. Without movement we grow old faster, losing viral functions and become more susceptible to various illnesses. I always say that if I can only make a pill out of movement, it would be the most effective medicine in the world, but unfortunately, there is no pill replacing our body’s moves.

I found that many of my patients find it motivating to understand the reason why it is so beneficial to move. Below we discuss many benefits of movement. Because just like food, exercise is the medicine!

Mental Health

First, movement has mental health benefits. Any exercise improves mood. During, and immediately after the exercise the brain releases endorphins. This creates a feeling or euphoric happiness. Exercise also stimulates the release of brain chemicals, neurotransmitters that regulate the mood: dopamine, norepinephrine and serotonin, and of course exercise reduces stress by regulating stress hormones such as adrenaline and cortisol. Have you tried to go for a long walk while feeling blue? If you did, you know how much better you feel once you get the blood flow going.


Sleep is one of the five pillars in Functional Medicine. Without proper sleep, our bodies can not repair and rejuvenate. Movement improves the quality of our sleep. Cardio exercise earlier in the day raises the body’s internal temperature which guides the body to decrease the temperature later in the day for better sleep. Also, the burst of energy created earlier in the day signals the body to rejuvenate and repair at night.


Movement reduces the risk for chronic disease. As we like to say in Functional Medicine, our genes load the gun, but our lifestyle pulls the trigger. By adhering to good lifestyle habits, we can control if and how our genes are expressed. Movement is one of those factors. Exercise reduces inflammation, the main cause of chronic illness. Exercise stimulates sweating, one of major detoxification pathways and getting rid of toxins that always contribute to aging and development of chronic disease. Exercise improves sugar metabolism, and in turn prevents diabetes and cardiovascular disease.

Brain Health

Another benefit of exercise is that it stimulates brain activity. We used to think that brain cells do not regenerate. However, now we know that during exercise brain releases BDNF (brain deprived neurotropic factor) which stimulates neurons regeneration and growth. Movement increases the size of the hypothalamus, the part of the brain responsible for learning and memory. And increased hearth rate promotes blood flow to the brain, therefore delivering more oxygen and nutrients.

Bone Health and Healthy Weight

Exercise is imperative to support bone health. Weight training increases bone density and hence prevents osteoporosis. Exercising stimulates our metabolism and as a result our body burns calories more willingly, and hence we lose weight more readily. During exercise we enhance our lean body mass (muscles) and get rid of fat tissue.

There are many forms of movements and they are not one size fits all. However, any movement will give you some degree of benefits. Finding what works for your body and schedule can be imperative to keeping exercise as part of your healthy lifestyle habits.

The bottom line is that it all starts with you and what you’re willing to do and sacrifice to get what you want or you think you deserve. Hopefully, this article has given you that nudge you’ve been needing.

If you would like to get more information about cardiovascular health and treatments from functional medicine perspectives, and how to add more movementi into your daily life schedule an integrative medicine consultation at our office, call 212-696-4325.

I’d love to talk to you and answer your questions.

Stay healthy and strong!

Elena Klimenko, MD

Women Cardiovascular Health

The Heart of a Woman: Cardiovascular Conditions Affecting the Neglected Gender

Why is Cardiovascular Health Not a Major Topic of Discussion When It Comes to Women’s Well-being?

Typically, heart diseases have always been a topic of discussion and concern in relation to male health, leading to a lack of awareness when it comes to women. Little attention is paid to the fact that cardiovascular conditions are a leading cause of morbidity and mortality in women, especially after menopause. Statistics reveal that heart conditions are the number one cause of death in women, with 1 in every 5 women in the US dying from heart disease, 1 which is 10 times greater than deaths caused by breast cancer.2

Factors Responsible for Relative Cardio-protection During Reproductive Years and Thus Neglection of this Age Group:

When looked into depth, the causes for the stereotypical mindset of cardiovascular conditions being men’s diseases, “the jogging heart” comes first. The concept of jogging heart can be understood by comparing the hormonal activity going on in a woman’s body to changes induced by physical exercise done by a male of the same age.5 It is based on the premise that during the second half of the menstrual cycle, a woman’s basal heart rate increases, offering benefits comparable to that of moderate exercise. Additionally, the natural protection offered by estrogen before menopause prevents heart-related complications, decreasing the risk significantly. Estrogen is known to positively affect numerous tissues in the body, including the heart and blood vessels. It increases HDL (the good cholesterol), decreases LDL (the bad cholesterol), and relaxes and dilates blood vessels, allowing for adequate blood flow to vital organs, including the heart. After menopause, however, the estrogen levels fall, significantly increasing the risk of a cardiovascular accident. Thus, after menopause, the risk of heart diseases in women becomes equal to that of men.2
The good news is that cardiovascular diseases and their complications are preventable, but the lack of awareness delays recognition of warning signs and subsequent actions, causing the development of heart diseases, that could otherwise have been avoided. Screening should be carried out for the prevention of heart diseases in the same manner as it is done for cervical cancer (Pap smear) and breast cancer (breast exams). Being conscious regarding your cardiac health substantially prevents complications in the long run and allows early detection and treatment of predisposing factors.

What are some reasons that you need to take a closer look at your heart health?

The overall mortality secondary to CVD may be decreasing in the US, but the situation is the opposite for women. The CVD mortality rate in women is rising.4 It has been noticed that even younger, childbearing age women are also having some sort of cardiac problems now. In addition to having traditional risk factors such as hypertension, diabetes mellitus, dyslipidemias, family history, physical inactivity, metabolic syndrome, and obesity, there are risk factors unique to the female gender.1

The unique risk factors in women are:6

  • Pregnancy-related disorders like pre-eclampsia, pregnancy-induced hypertension
  • Autoimmune disease
  • Hormonal disorders such as polycystic ovarian syndrome
  • Breast cancer treatment

Unique Risk Factors

The complex hormonal changes that occur in a female body throughout the reproductive years predispose them to a number of pathologies. While many times these are physiological changes, occasionally, they can turn pathological, leading to hormonal imbalance, collectively termed as hormonal disorders, which also affect the heart.5
Many of the risk factors are common for a widely prevalent hormonal disorder, polycystic ovarian syndrome (PCOS), and cardiac diseases. Having PCOS thus increases the risk of long-term cardiac complications. PCOS is frequently associated with obesity and dyslipidemias. According to studies, women with PCOS are twice as likely to suffer a cardiovascular event compared to healthy women. It also increases the risk of type 2 diabetes mellitus which again is a prominent risk factor for CVDs. Moreover, many women of reproductive age use hormonal contraceptive methods, combined oral contraceptive pills (COCPs – containing both estrogen and progesterone) being the most common. COCPs are known to increase the risk of developing hypertension, and thrombosis (blood clotting), thus predisposing to serious cardiac events.
Pregnancy-related hypertensive disorder, called pre-eclampsia, is also of particular interest here. It leads to generalized vasoconstriction (blood vessel constriction) and thus high blood pressure. Although it resolves after delivery, the subsequent risk of developing essential hypertension significantly increases. Pregnancy-related hypertension and weight gain double the risk for the development of ischemic heart disease and stroke. Pregnancy itself is a hypercoagulable state. This means the risk of developing a thromboembolic event increases during pregnancy. One of the common complications after delivery is the development of thrombosis which may gain entry to cardiac vessels leading to serious acute cardiac manifestations. The risk of the development of insulin insensitivity also significantly increases during pregnancy leading to the development of gestational diabetes mellitus (GDM). GDM increases the risk of a cardiac event to seven times.
Autoimmune disorders such as systemic lupus erythematosus (SLE) increase the risk of cardiac diseases to a staggering nine times. Clinical interventions for common disorders in reproductive women, breast cancer being a prime example, come with their own set of side effects. The risk of cardiovascular events is significantly increased with radiotherapy. It is therefore essential that such cases are managed by a multidisciplinary team.

Risk factors unique to certain age groups

Some of the risk factors for CVDs are specific to age


  • Early menarche
  • Being overweight
  • Acne
  • High blood sugar levels


  • Irregular periods
  • Obesity
  • Acne
  • Hirsutism

Reproductive period:

  • Infertility
  • Gestational diabetes mellitus
  • Pre-eclampsia

Perimenopausal period:

  • Diabetes
  • Essential hypertension
  • Obesity
  • Stroke

Post-menopausal period:

  • Withdrawal of protective effect of estrogen
  • Numerous chronic health conditions

Atypical Presentation

For women, CVD may present with atypical symptoms like profound sudden fatigue, shortness of breath, a general feeling of being unwell, neck pain or sensation of constriction or strangling in the throat, sense of foreboding – impending doom (due to intuition), syncope, dizziness or vertigo, indigestion (often feeling that if they burp, they will feel better), nausea, and vomiting. Because of a lack of knowledge regarding the presentation of CVD in women, these symptoms are often ignored.6 The result is that the cardiac health starts to worsen until it reaches a morbid state and then presents with an acute clinical event like myocardial infarction (heart attack).

Every woman must know the following factors that can increase the risk of CVD and related complications:

  • Age 
  • Diabetes 
  • Smoking 
  • Physical inactivity 
  • Hypertension 
  • Dyslipidemia 
  • Metabolic syndrome 
  • Obesity

Gender disparities

Women going through an acute cardiac event are not managed in a similar way as men. Younger women, in particular, are less likely to be properly managed by the acute MI protocol, and prescribed guideline-directed medical therapy (GDMT). They also do not often receive adequate treatment in a timely fashion or suitable prophylactic therapy such as fibrinolytic therapy. Furthermore, cardiological interventions like angioplasty, cardiac catheterization, thrombolytic therapy, and bypass surgeries are not routinely seen being performed in women.6 The studies regarding heart health also recruit male participants more frequently.5 Which means we are not well-aware of any unique risk factors and manifestations of cardiac diseases in women. Although heart disease kills more women than men every year, the treatment of women’s heart disease was based—until recently—on medical research performed on men.

This disparity leads to increased mortality when the treatment is finally administered. Studies have shown that women treated by a male cardiologist are more likely to suffer mortality.6 Treatment given by female cardiologists has comparatively better outcomes.7 Usually, there is a similar outcome for both genders when treated by a female cardiologist. Female cardiologists, however, are very few in number which means women are more likely to die in ER if treatment is administered by a male cardiologist. Even though there are fewer men dying from heart diseases, there are more male cardiologists than female. There is a need to draw attention to this fact and encourage more women to pick cardiology as their field of specialization.

The Barbara Streisand Women’s Health Center is working to correct these gender inequalities and to educate women on how to recognize female-pattern heart disease symptoms. Additionally, The center provides convenient access to all of Cedars-Sinai’s diagnostic and treatment resources for heart disease and is designed to help women reduce their chances of heart disease through a preventive approach, including state-of-the-art screening and testing.

What are some daily actions women can start implementing to take a preventative approach and preserve the health of their hearts?

As mentioned earlier the risk can be reduced and heart diseases can be prevented in women. Just following some simple tips and sticking to them can help a lot. Even if you do not have any of the aforementioned risk factors, you still need to take the necessary precautions. 

  1. Dietary modifications:

Whatever you eat reflects on and from your body. The healthier food you consume, the better your body will perform. Add more vegetables, fruits, and a small amount of whole grains, and cut down on sugars and processed food in your diet. Avoid consuming empty calories, which are foods that only provide energy but have no nutritional value, fast food for example. The idea is to eliminate harmful and toxic substances (like pesticides and herbacides) from the diet and take nutritionally rich food items that serve as important metabolites. This not only improves cardiac health but also improves general well-being.

  1. Mind-body techniques:

Try yoga and meditation. They relieve stress, balance the autonomic nervous system and positively affect healthy functioning. The cardiovascular system is under the influence of the autonomic nervous system, which has two arms: parasympathetic and sympathetic nervous system. The parasympathetic system is activated in a relaxed state, while the sympathetic tone of the autonomic nervous system prepares the body for fight and flight response.

To understand this, consider an example. Imagine you are sitting peacefully in a garden, relaxing and all of a sudden, a lion comes in. Facing an unanticipated danger you will start to sweat profusely, your heart will beat much faster (palpitations), your eyes will open wide and your blood pressure will shoot up. All of this happens because the sympathetic system has become activated and caused these changes, also collectively referred to as ‘Fight, Flight and Fright’ response. 

The point of emphasizing the functioning of the sympathetic autonomic nervous system is that the majority of the heart and vessel disorders are associated with an increased sympathetic tone.8 The treatment, therefore, often comes in the form of sympathetic blockers.

Yoga and meditation have been proven to relieve stress and thus decrease sympathetic overactivity.9 The result is heart and vessel functions returning to normal.

  1. Move Your Body:

The most important of all risk factors is the presence of visceral fat, the fat that is accumulated around our internal organs such as the heart, liver, and intestines. It is highly inflammatory and contributes to the acceleration of atherosclerosis. Movement is the most important preventive and curative option for all types of CVDs. Inflamed cholesterol (fat)  in the body deposits in the arterial wall and blocks the lumen causing atherosclerosis. With time, the lumen becomes so narrow that the blood flow to the respective organ diminishes or even gets completely obliterated. When fat deposits in the vessels that supply blood to the heart, cardiac events like myocardial infarction and angina occur, which if severe, may lead to death.

If you would like to get more information about cardiovascular disease and treatments from functional medicine perspectives, schedule an integrative medicine consultation at our office, call 212-696-4325.

I’d love to talk to you and answer your questions.

Stay healthy and strong!

Elena Klimenko, MD 


  2. Alkabban FM, Ferguson T. Breast Cancer. [Updated 2020 Nov 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
  3. Eskes, T., & Haanen, C. (2007). Why do women live longer than men?. European journal of obstetrics, gynaecology, and reproductive biology, 133(2), 126–133. 
  4. Garcia, M., Mulvagh, S. L., Merz, C. N., Buring, J. E., & Manson, J. E. (2016). Cardiovascular Disease in Women: Clinical Perspectives. Circulation research, 118(8), 1273–1293. 
  5. Garcia, M., Mulvagh, S. L., Merz, C. N., Buring, J. E., & Manson, J. E. (2016). Cardiovascular Disease in Women: Clinical Perspectives. Circulation research, 118(8), 1273–1293. 
  6. Giardina E. G. (2000). Heart disease in women. International journal of fertility and women’s medicine, 45(6), 350–357.
  7. Nakayama, A., Morita, H., Fujiwara, T., & Komuro, I. (2019). Effect of Treatment by Female Cardiologists on Short-Term Readmission Rates of Patients Hospitalized With Cardiovascular Diseases. Circulation journal : official journal of the Japanese Circulation Society, 83(9), 1937–1943. 
  8. Remme W. J. (1998). The sympathetic nervous system and ischaemic heart disease. European heart journal, 19 Suppl F, F62–F71.

Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, D. A., & Brown, R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical hypotheses, 78(5), 571–579.

An Extensive Guide to Holistic Medicine

Beyond conventional medicine, you may have heard references being made to alternative medicine and lifestyles involving holistic practices. You may have also heard of integrative and functional medicine, and wondered if they were any different from holistic medicine. In fact, holistic medicine is actually involved in both integrative and functional medicine. That is why we have prepared this Guide to holistic medicine for you.

First, what is Holistic Medicine? Simply put, holistic medicine involves caring for not only a person’s physical health, but also mental, spiritual, and emotional health. The Complete Herbal Guide’s article on the history of holistic medicine traces it back to 5000 years ago in ancient China. The philosophy of Chinese medicine was based on their Taoist and Buddhist belief that man and nature are closely linked, and that the body and spirit must be balanced. Internal forces being out of balance causes a sickness. In the West, it was introduced by the ancient Greeks. In modern times, the principles of holistic medicine remain similar: to treat the patient by naturally fixing any imbalance in their lifestyle.

What happens when thyroxine level fluctuates?

Integrative medicine is — as the name implies — when a doctor/practitioner integrates two kinds of medical systems and practices them together. These systems are usually holistic medicine and conventional medicine, which treats a patient through drugs, radiation, or surgery. In integrative medicine, the doctor takes into account the patient’s physical, mental, and spiritual conditions before offering a solution. Treatment usually involves a mix of medications and changes in lifestyle.

Functional medicine is a more specific field. It is similar to integrative medicine but is more systematic and conventional in terms of finding the cause of the health problem. As with integrative healing, it prescribes medicines and suggests lifestyle changes. However, it utilizes laboratory testing to determine the physical root of the sickness rather than relying on anecdotal evidence from the patient.

The term “holistic medicine” might sound new, but it is actually more common than you think. My Domaine’s guide to holistic medicine explains some holistic healing practices. The most heard of would be acupuncture, which uses needles to stimulate certain points in the body to release energy. Another familiar practice is aromatherapy. This uses the sense of smell to calm the body. Meanwhile, chiropractic involves tweaking the spine to alleviate pain.

These practices might make it sound like holistic medicine will cost you. But keep in mind that holistic healing takes care of the person as a whole. This means that it is always applicable, not only when you’re sick. Here are some simple holistic practices you can do every day:

What happens when thyroxine level fluctuates?

Being stressed will affect other aspects of your life, so it’s important to control and possibly prevent it. HelpGuide presents tips to help manage stress. The first is to identify the sources of stress in your life. Knowing why you are stressed helps you figure out what you should do next to relieve that. Try to point out which sources of stress are controllable, such as extra work you could say no to. However, this also means learning to accept the stressors that you cannot change. Regardless of the source of stress, don’t bottle your emotions up. Instead, engage in healthy coping habits, such as writing in a journal or sharing your thoughts with friends.

What happens when thyroxine level fluctuates?

Moisturizers and cleansers can only do so much to help achieve healthy skin. It is important to remember that the skin health goes beyond what we can see externally. This means we should rethink the things we put on our skin, and ensure that everything is formulated for holistic wellness. PrettyMe’s review of AR Vitamin E Cream explains that creams made from natural ingredients and enriched with vitamin E can help treat a variety of conditions, such as melasma, cellulite, scars, and dark spots. Consider investing in creams and products that are only made from natural ingredients. However, also consider how other factors such as diet, stress, and hormones are impacting your skin.

What happens when thyroxine level fluctuates?

The stomach contains microbes and bacteria, and absorbs nutrients and removes waste. Our article on “Can Environmental Toxins Affects Our Gut Microbiome?” warns how an imbalanced stomach can lead to diseases that will lead to other complications. Practicing a holistic diet can help prevent health problems. Choose organic food, read food labels and check that they are not genetically-engineered. Drinking tea also helps by boosting the immune system and preventing some diseases. In fact, different teas will have different effects on the body. Healthline’s article on green tea benefits show that it is high in antioxidants, boosts brain function, and helps weight loss.

What happens when thyroxine level fluctuates?

Not having enough sleep will make you irritable. Not to mention your brain and body functions will suffer more, the more hours of sleep you miss. Sleep deprivation can lead to memory issues, heart disease, and mood disorders, among others. Dr. Michael John Badanek’s discussion on the importance of sleep talks about the effects of sleep, or lack thereof, and how this is connected with other activities. The article answers for functional medicine, but remember that holistic medicine is tied to it as well. Sleep detoxifies the body, consolidates memories, and heals the body as a whole. Having a good night’s sleep regularly will definitely help you stay healthy — not just physically, but mentally too.

What happens when thyroxine level fluctuates?

Your job might require you to be seated for hours on end, and you might want to do anything but lie down when you can finally catch a break. No matter your circumstances, it’s important to still exercise. Physical activity doesn’t have to mean going to the gym or doing any of the heavy exercises. It can be as simple as going for a walk or stretching for about half an hour every day. What’s more, research shows how physical activity affects mental health, explaining that exercise tells the brain to release serotonin and endorphins, which improves self-esteem and mood.

Holistic medicine is gaining traction, and with good reason. By taking care of ourselves holistically, we can prevent physical, mental, and emotional problems.

Written by Jannice Belle for


Barriers to Our Internal Drive – What Keeps Us from Manifesting Our Potential

Fatigue, exhaustion, and tiredness are the terms that are often used interchangeably. However, it is important to understand these terminologies and what each one actually means, as the root cause is different for each. Fatigue is a state of feeling drained constantly, without doing anything or meeting anyone. The difference between being tired and fatigued is, tiredness goes away with adequate sleep and rest; while, fatigue always remains there and is often a symptom of something wrong within the body. Exhaustion is usually a result of the accumulation of psychological stress, just as physical stress causes tiredness.

Your energy levels, and subsequently, the feelings of enthusiasm, determination, and will power, depend on how smoothly the body and its organs function. The brain constantly monitors and controls the functions of the body organs via nerves and hormones. Hormonal imbalances influence the energy level of an individual, which correspond to the concentration of Adenosine triphosphate (ATP).1

The energy required to do something comes in the form of ATP, generated by various metabolic processes, under the influence of hormones. In simple words, as long as the body generates an adequate number of ATPs, the person feels enthusiastic and remains active. But once the supply of ATP is halted, the energy levels decrease. Here is a brief discussion on how different hormones affect metabolic activities and alter an individual’s energy level, subsequently leading to decreased motivation and will power.

Thyroid Hormones:

The thyroid gland is the most important gland involved in controlling the basal metabolic rate (BMR) of the body. It is a butterfly-shaped structure located at the base of the neck, stimulated by the thyroid-stimulating hormone (TSH), released from the pituitary gland. It secretes thyroxine hormone (T4), which performs the following functions:

  • Thyroxine acts on almost all cells of the body, increases their metabolic activities, and generates lots of ATPs, which translates to ample energy supply.
  • It acts on the heart to increase both the heart rate and the contractility; subsequently, cardiac output increases. As the cardiac output rises, more blood is available to supply oxygen to different body organs and enhance their functioning.
  • The major effect of thyroxine is on growth. It is essential for bone development, brain health, and muscle control.
  • It modulates the hepatic function, which in turn facilitates other systemic endocrine effects.

What happens when thyroxine level fluctuates?

As mentioned earlier, the thyroid hormone affects pretty much all bodily organs, so its imbalance results in alteration of the body’s functioning as a whole. During the stressed state, the thyroid-stimulating hormone (TSH) level falls, which results in a low level of thyroxine. This subsequently leads to slowing down of metabolic processes, and ultimately, decreased energy levels. 2 Other features of fluctuating levels of thyroid hormone are:

Hypothyroidism (Decreased thyroid hormones):

  • Fatigue
  • Cold intolerance
  • Weight gain despite the loss of appetite
  • Cold peripheries
  • Constipation
  • Depression
  • Muscle cramping

Hyperthyroidism (Increased thyroid hormones):

  • Hyperactivity
  • Heat intolerance
  • Fatigue
  • Loss of weight despite increased appetite
  • Diarrhea
  • Anxiety, nervousness
  • Muscle weakness

Fatigue is a common symptom of both hyper and hypothyroidism. The explanation is straightforward for hypothyroidism, that is – the metabolism is slowed down, and the body cannot produce enough energy. In hyperthyroidism, on the other hand, the body’s hyperactive state drains all energy, making the person feel tired.3

Adrenal Gland Secretions

Adrenal glands are two triangular structures located on the top of each kidney, therefore, also known as suprarenal glands. They are composed of an outer part – the adrenal cortex – and an inner part – the adrenal medulla. Each of these parts secretes different hormones under the influence of adrenocorticotropic hormone (ACTH) released from the pituitary gland.

The hormones of the adrenal cortex are:

  • Mineralocorticoids
  • Glucocorticoids
  • Sex steroid hormones

The adrenal medulla produces catecholamines that are:

  • Adrenaline
  • Noradrenaline
  • Dopamine

Mineralocorticoids are responsible for maintaining the salt and water balance in the body, thus regulating the blood pressure. Sex steroid hormones are discussed later. Following is a detailed discussion of glucocorticoids and catecholamines and how they affect the energy levels of the body.


The most important of these is cortisol. It is also known as the stress hormone of the body. 4 It performs the following functions:

  • It stimulates glucose production by utilizing the body’s energy stores. The increasing levels of glucose in the blood mean lots of energy.  
  • It modulates the immune system to produce anti-inflammatory effects. Cortisol supplies the body with the reparative substances that allow prompt recovery.
  • In the stressed state, it activates the sympathetic nervous system, which prepares the body for fight and flight response.4

Some medical diseases result in excessive stimulation of the adrenal glands. Cushing’s syndrome is one such condition in which excessive glucocorticoid secretion causes extreme fatigue and weight gain. Other associated symptoms are:

  • Thinning and bruising of the skin
  • Diabetes
  • High blood pressure
  • Muscle weakness 
  • Bone pain secondary to osteoporosis
  • Excessive facial hair
  • Menstrual disturbances in women

Addison’s disease is a condition in which there is adrenal insufficiency. The hormonal disturbance drops the blood pressure and results in fatigue.5

Other symptoms are:

  • Weight loss
  • Anorexia
  • Nausea
  • Vomiting
  • Abdominal pain
  • Salt craving
  • Low blood sugar
  • Increased pigmentation in a chronic case


The two major arms of the autonomic system of the body, maintaining the organs’ functioning, are sympathetic and parasympathetic nervous systems. The effects of both fluctuate with the physiologic state of the body and then balance each other, so that the organs function smoothly and healthily. Overactivation of any of these diverts the autonomic system towards that side. 

The catecholamines’ release activates the sympathetic nervous system.  In a stressful state, the autonomic nervous system effects are predominantly contributed by catecholamines, which is the normal, physiologic response of the body. The following changes occur in the body to prepare it for the fight and flight response:

  • Increased heart rate
  • Increased blood pressure
  • Decreased digestive glands secretion
  • Dry mouth
  • Sweating

Overstimulation of the sympathetic arm of the autonomic nervous system leads to the aforementioned changes occurring permanently in the body. Chronic excessive sympathetic activity results in fatigue.6

What happens when adrenal secretion fluctuates?

During the stressed state, the blood supply to the vital organs (heart, lungs, brain, and kidney) and adrenal glands increases. This is how our body responds to the stress. 4 It is done to increase the concentration of stress hormones, that are, cortisol and adrenaline. These hormones increase the survival chances and help cope with stress by reserving the energy. Under the influence of these, the basal metabolic rate (BMR) decreases, the glucose and oxygen are supplied limitedly to the peripheries to curb all activities redundant for healing, and the reparative activity increases. The long-term elevation of stress hormones and resultant unnecessary suppression of the metabolism causes chronic fatigue. Similarly, an extremely low level of cortisol possibly drops blood glucose levels and results in tiredness. 

On the contrary, the decreased levels of stress hormones in the body also have negative consequences, leading to stress intolerance.

Sex hormones:

Several hormones are produced in the body that control the reproductive system. The major sex hormone in a female is estrogen and in a male is testosterone. Both hormones are present in male and female body and both are very important. DHEA is the precursor of both sex hormone produced by adrenal glands. In the gonads, the DHEA converts to the respective sex hormone.


In the female body, it is produced by ovaries and performs the following functions:

  • It is responsible for developing the secondary sexual characteristics and the internal reproductive organs
  • It preserves bone density by preventing bone loss
  • It increases muscle strength
  • The balanced level of estrogen keeps the body energetic 
  • Estrogen raises fat stores in the body
  • It enhances cognition and memory

At menopause, the level of estrogen falls in the blood. This results in fatigue, weight gain, bone loss, sexual dysfunction, mood changes, increased cardio-vascular risk and memory issues.


In the male body, it is produced by testes and has the following functions:

  • It is responsible for developing the secondary sexual characteristics and the internal reproductive organs
  • It increases the muscles mass and strength
  • Collagen production also increases under the influence of testosterone
  • The cardiac output increases so large amounts of blood are available to be supplied to the organs
  • It builds up the bone mass and maintains it
  • The endurance and power both boost up, and the person feel active
  • It enhances cognition and memory
  • It is responsible for a “drive”

What happens when sex hormones fluctuate?

Imbalanced levels of sex hormones primarily affect libido and mood. 7 The declining sex drive further contributes to negative energy in the body. Mood swings, such as anxiety and depression, low energy, aggression, and weight changes, are some other features of hormonal imbalance. 8,9,10 The sex hormones contribute to other metabolic activities too. Their imbalance, therefore, disturbs the functioning of the organs and results in chronic fatigue. 

Many of my clients come complaining of fatigue or exhaustion or just inability to “get things done”. As you can see, there are so many things to consider and investigate. In my practice after the initial 60 min interview with the new client, I usually order some conventional tests as well as some test to investigate the common hormonal imbalances: sex hormones (estrogen, progesteron, testosterone, as well as cortisol), detailed thyroid test (8-12 markers).

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

Stay healthy and strong!

Dr. Elena Klimenko


  1. Sánchez López de Nava A, Raja A. Physiology, Metabolism. [Updated 2020 Sep 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
  2. Kaltsas, G., Vgontzas, A., & Chrousos, G. (2010). Fatigue, endocrinopathies, and metabolic disorders. PM & R : the journal of injury, function, and rehabilitation, 2(5), 393–398.
  3. Fischer, S., Markert, C., Strahler, J., Doerr, J. M., Skoluda, N., Kappert, M., & Nater, U. M. (2018). Thyroid Functioning and Fatigue in Women With Functional Somatic Syndromes – Role of Early Life Adversity. Frontiers in physiology, 9, 564.
  4. Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI journal, 16, 1057–1072. 
  5. Giebels, V., Repping-Wuts, H., Bleijenberg, G., Kroese, J. M., Stikkelbroeck, N., & Hermus, A. (2014). Severe fatigue in patients with adrenal insufficiency: physical, psychosocial, and endocrine determinants. Journal of endocrinological investigation, 37(3), 293–301.
  6. Tanaka, M., Mizuno, K., Yamaguti, K., Kuratsune, H., Fujii, A., Baba, H., Matsuda, K., Nishimae, A., Takesaka, T., & Watanabe, Y. (2011). Autonomic nervous alterations associated with daily level of fatigue. Behavioral and brain functions : BBF, 7, 46.
  7. AlAwlaqi, A., Amor, H., & Hammadeh, M. E. (2017). Role of hormones in hypoactive sexual desire disorder and current treatment. Journal of the Turkish German Gynecological Association, 18(4), 210–218. 
  8. Zhang, H., & Sairam, M. R. (2014). Sex hormone imbalances and adipose tissue dysfunction impacting on metabolic syndrome; a paradigm for the discovery of novel adipokines. Hormone molecular biology and clinical investigation, 17(2), 89–97.
  9. Gambineri, A., & Pelusi, C. (2019). Sex hormones, obesity and type 2 diabetes: is there a link?. Endocrine connections, 8(1), R1–R9.
  10. Barth, C., Villringer, A., & Sacher, J. (2015). Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Frontiers in neuroscience, 9, 37.
12 tips to stay healthy during holidays

12 Tips to Stay Healthy During Holidays

The year 2020 will go down as one marked by enormous changes and uncertainty, which is why this time around, the most thoughtful gifts to give are ones that provide something we could all benefit from: health and wellbeing.
Read on to learn how to protect your health and wellbeing, and how to survive the holiday hustles and bustles with a smile on your face, even though this year’s holidays will look different than we’re used to.

1. Eat an Anti-inflammatory Diet

The holidays are full of temptations and indulgences. Unfortunately, many of our holiday classics from mac ‘n cheese to holiday roasts, from sugary cookies to sweet pumpkin pie, from egg nog to New Year’s Eve cocktails, are often promoting inflammation and therefore weaken our immune system.  Eating heavy, sugary, and inflammatory foods for a month or longer can be incredibly hard on your body. These foods zap your energy, decrease immune defenses, and increase the risk of disease.

Instead, I recommend that you stick to anti-inflammatory foods during the holidays. Whole foods vegetables cooked or fresh, small amounts of seasonal fruit, warming herbs and spices, nuts and seeds, and fermented foods are your best friends. If you eat animal products, always choose organic, pasture-raised beef, free-range poultry and eggs, wild-caught fish, or wild game. There are so many healthy holiday recipes made with whole foods to enjoy nutrient-dense foods without missing out on anything. If you still want to reach for some of your old favorites, I recommend that you limit them for the actual days of the holidays instead of eating them the entire month. If you are focusing on a nutrient-dense diet, you will notice how much better you feel!

2. Take Probiotics

Since your gut is connected to all parts of your body, its health is incredibly important. Inflammatory foods and stress may both compromise your gut integrity, causing increased intestinal permeability or leaky gut. If your gut flora and gut health are out of balance, your entire health can become compromised. Your risk of increased inflammation, fatigue, stress, pain, and disease increases.

A healthy gut, on the other hand, creates a strong base that supports your entire health and well-being. While eating an anti-inflammatory diet is essential for gut health, I also recommend that you eat plenty of probiotic-rich fermented foods, such as sauerkrauts, kimchi, and kefir (dairy and non-dairy), and take daily probiotic supplements to support your gut microbiome. In my practice I use a variety of different probiotics, so feel free to call us and inquire about our monthly special for probiotics.

3. Use Adaptogens

Burning the candle at both ends during the holidays can drain your adrenals. Too much stress, too little sleep, too much sugar, and junk food, or too many holiday alcoholic drinks may force your adrenals to overwork and may lead to adrenal fatigue, which leads to a sluggish immune system. 

To support your adrenal health and balanced stress response, I recommend adaptogenic herbs. Adaptogens have been used in Ayurvedic and Chinese medicine for centuries. They help your body to regulate cortisol, combat stress and improve fatigue. My favorite adaptogenic herbs are Ashwagandha, Rhodiola, Licorice and Ginseng.

4. Exercise

Exercise may be the last thing on your mind during the busy holiday season. However, it is crucial for your health and energy levels. Regular exercise can help to reduce stress, improve your mood, and boost your energy.

Ideally, you want to get some exercise for 20 to 30 minutes five times a week and stay generally active. Mix up your routine by including some cardiovascular exercise, such as swimming, running, or biking, strength- and resistance training, such as bodyweight exercises, weight lifting, or TRX, and low-impact exercises, such as yoga, pilates, and stretching. Stay active by getting a standing work desk (“sitting is a new smoking”), stretching throughout the day, going for a walk during lunch, playing with your kids, taking the stairs, or walking your dog.

5. Make Time for Yourself

If you are like most people, you try to please everyone during the holiday season and end up forgetting about yourself. It is certainly wonderful to have this opportunity to reconnect with family and friends and create beautiful memories together. But you also need some love – from yourself.

You deserve and need some quality “me-time”. Make “an appointment with yourself” time during the holiday season. Go for a nature walk. Take a hot, relaxing bath. Meditate. Breathe. Journal. Try some yoga. Curl up with your favorite book. Watch your favorite holiday movie. Even if it’s just a few minutes, try to make a little time for yourself each day. You deserve and need it. 

And don’t forget that sleep is so important for your immune system and overall health. During the holidays we all cut down on sleep, but it is one of the most important parameters in a healthy lifestyle. If you have a problem falling asleep or staying asleep try some simple homeopathic medicine like Quetude or Sedalia that you can obtain at our office. If that does not help, come see me for a consultation. We have many tools to investigate sleep issues by getting to the root cause of YOUR sleep problems.

6. Practice Gratitude

Anxiety and gratitude cannot exist at the same time. Having a gratitude practice is the perfect way to improve your mood, reduce stress, and increase your zest for life. Remember the ‘little things’ throughout the day. Keep a gratitude journal jotting down the things that you are grateful for each morning and evening. Tell your loved ones that you are grateful for them and why you appreciate them. Do “daily inventory” in your mind by the end of the day  and find 2-3 things you are grateful for and let this day go with appreciation.

7. Show Your Support While You Show Your Appreciation

One of my favorite things about the holidays is gift-giving.I am making a conscious effort to support as many small-owned businesses as possible and suggest curating a basket of some of your local favorites or industry-specific items.

This month we are giving thanks and support to our delicious friend, Stylish Spoon.

If you are looking for a healthier way to satisfy your sweet tooth, visit Stylish Spoon ( Stylish Spoon is a gluten-free, dairy-free, soy-free and refined sugar-free online bakery located in Harlem and they ship right to your door. Their signature baked OatMEAL Cups are a healthy and satisfying breakfast option. Pop them in your freezer to reheat and eat in the mornings or for dessert. Stylish Spoon is offering 15% off with code DRK15.

8. Be Present

When you spend too much time in the future, it increases anxiety and stress. Being in the present moment, on the other hand, can decrease anxiety and stress, and increase happiness. Spending only 15 to 30 seconds in the present being aware of your body can make a difference. Savoring positive experiences can stimulate and strengthen neural connections in your brain, increasing positive emotions. Meditation and breathwork are fantastic ways to spend some time focusing your awareness on the present moment. You can also set your timer a few times a day reminding you to stop and slow down and check-in with the moment for 30 seconds.

9. Keep It Simple

Even though this year’s holidays will look different than we’re used to, the holidays still can be an incredibly stressful time. If you have a large family, it can be quite a hassle. Try to keep it as simple as possible. Your family loves you no matter what, so by doing less, you are doing more. 

Try not to set unrealistic expectations for yourself. Don’t be a perfectionist. Ask for help if you need to. Ask everyone to bring/make a dish or dessert instead of doing everything by yourself. Make decorations a family event. Involve others in planning games and other holiday activities. Most importantly, know your limitations and say “no” when you have to.

10. Remember to Have Fun

During the holiday season, we tend to spend too much time running around and trying to make everything perfect. You have to take care of your holiday shopping, plan your holiday meals, and decorate your house. It can be a lot when you are a busy person.

But remember the time when you were a kid? The holidays were fun! All the decorations, lights, holiday cookies, movies, and music. It was magical. Be a kid again for a moment. Allow yourself to have a bit of fun. Dance to your favorite song. Sing along with the radio. Play some games with your family. Be silly. This is what the holidays are all about.

11. Ensure You Wear Your Face Mask

Ensure you wear your face masks when you travel. Here is a great site if you’re searching for a cloth mask to shop. But a simple disposable KN95 is still the best protection from increasing virus.

12. Be Smarter than the COVID-19. Take the Right Supplements and Minerals

Giving your body key supplements is also extremely important when you are supporting your immune system or battling Covid-19. I suggest the following:

  • Zinc: 30 to 50 mg per day (It can cause nausea, so take it with food.). If you can’t get your hands on the supplement, these food sources are rich in zinc: 
    • Oysters 
    • Ground beef
    • Alaskan king crab 
    • Cooked lobster 
    • Pumpkin seeds (raw)
  • Vitamin D: 5,000 IUs per day. (Ideally, you would have your level checked and keep the blood level between 50-80 ng/mL). 
  • N-Acetyl Cysteine (NAC): 600- 800 mg twice a day. It protects the lungs and supports the production of the master antioxidant glutathione in the body.
  • Glutathione. Have it handy and start using it only when you feel you are getting sick. Take 400mg 1-5 times per day (sicker you feel, more you need). It will help your immune system function optimally. 
  • Vitamin A: 5,000 IUS per day. 
  • Vitamin C: 500 mg every 1 to 2 hours with big glass of water until irregular bowel movement 
  • Herbs like Echinacea, Andrographis and Elderberry
  • Homeopathic Silver and Homeopathic Oscillococcinum

Take these supplements to support your immune system. If you are running low, you can order them from our office at 212-696-4325.

Final Thoughts

Remember, the holidays don’t have to be stressful. You can enjoy this season with your loved ones in happiness and health. If fatigue, chronic pain, health complaints, or health issues slow you down this holiday season, I recommend that you stay home and call your functional medicine doctor, like myself. 

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 body in order to uncover the root cause of your health issues 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 an integrative medicine consultation, please call my office at 212-696-4325.

Stay healthy and strong!

Dr. Elena Klimenko


fasting mimicking support your health

The Power of the Pause: How the Fasting Mimicking Diet Can Heal the Body and Mind

Are you feeling overwhelmed and burned out?

Maybe you’re suffering from a lack of motivation or constant, low-level anxiety?

You’re certainly not alone:
Our fast paced lifestyles, combined with the stresses and strains of balancing a family life with a successful career can quickly become overwhelming.

Add in a global pandemic and the threat of financial instability, and well, you probably get the picture!

Pause for Thought…

When everything seems to be up against us, and motivation and productivity begin to tank, it’s tempting to try and push through the problem and work even harder.

But you know what? That’s a huge mistake.

In situations of stress, lethargy and procrastination, it’s absolutely vital to take a pause and reassess the root causes of your mental and physical overwhelm.

In this article, we’re going to look at how fasting, and specifically the “Fasting Mimicking Diet”, can form the cornerstone of successful life realignment or reset.

Fasting? But My Issues are Purely Stress Related!

Fasting has risen greatly in popularity over the last five or so years, and with very good reason: studies have repeatedly shown that not only does fasting promote weight loss, it’s also associated with boosts in general mood and wellbeing, with many of the physical benefits of fasting being closely tied to improved mental health and brain function.  Back in Russia, some hospitals treated most difficult cases of depression and bipolar disorders with water fasting up to 30 days, and those patients would reach the complete remission.   It is still done in some cases, but under physician supervision in the hospital setting.

Here are just a few of the positive health outcomes you can expect from a well-designed fasting program:

A Reduction in Elevated Blood Sugar and Lower Cholesterol

Repeated studies have shown that fasting can reduce “bad” cholesterol and promote more healthy insulin production, stabilizing elevated blood sugar levels.

Lowered cholesterol and insulin will reduce your likelihood of developing heart disease and diabetes respectively.  And, once your blood sugar is under control and stable, it will reduce mood swings, irritability and food cravings.  All of it can be accomplished once you successfully adjust to a lifestyle of periodic fasting.

A Reduction in Inflammation

Several studies on both animal and human subjects have shown a reduction in overall inflammation, once the body is allowed a rest from the demanding task of food digestion and processing, allowing the stomach and intestinal lining time to heal and repair.

We also see from the studies that fasting will change the gut microbiome (microorganisms populating the gut).  The science is still in its infancy, but having the wrong types (and ratios) of gut bacteria can be a key reason behind symptoms of lethargy, listlessness and anxiety.

The Slowing of Mental Decline and Improvements in Cognition

Autophagy is a complex process in which old and damaged cells are recycled to produce new, healthy ones. During the process of fasting or significant reduction of caloric intake, the process of autophagy kicks in around the third day.

Animal studies have repeatedly shown that fasting can improve lifespan and cognitive ability, and often drastically so. As a bonus, the process of autophagy can also help to ward off cancers and the growth of malicious tumors.

Overall, the evidence is mounting that far from being stressful, a well implemented fasting regime can do wonders for your health, both mental and physical.

Sounds Great! But What Do You Mean By the “Fasting Mimicking Diet”?

“The Fasting Mimicking Diet”, created by Valter Longo, PhD aims to give all of the positive benefits of a long fast, without severe calorie deprivation of a full-blown starvation diet.

So How Does It Work?

The “5 Days Fasting Mimicking Diet” called ProLonis designed by company L-Nutra. The company’s plan is based around specially formulated kits that feature pre-packaged meals and instructions. Here’s how the diet is structured:

  • During the five-day period, participants consume only the meals contained within the kit.
  • The first day of meals and snacks provides around 1,090 calories, with 10% protein, 56% fat and 34% carbohydrate.
  • From the second day onwards, the kit provides just 725 calories, with 9% protein, 44% fat and 47% carbohydrate.

The specially formulated meals cause your body to slowly deplete it’s stores of glycogen (stored sugar), and eventually burn energy from non-carbohydrate sources (your own body fat reserves).

This staggered calorie restriction triggers the body’s physiological fasting response, boosting cell regeneration, decreasing inflammation, and promoting  fat loss, without the dangers of eliminating food and nutrients entirely.

For optimal results, the Fasting Mimicking Diet should be undertaken at least once every 4-6 months, and shouldn’t be thought of as a one-time cleanse.

What Will I Be Eating?

If you decide to undertake a Fasting Mimicking Diet, you’ll need to order a ProLon meal kit from our office. The kit makes sticking to this protocol extremely easy, as you won’t need to worry about getting meal timings wrong or selecting the wrong types of food.

The ProLon kit is spread over five individual boxes, one for each day of the fast, and includes an easy to understand chart to help you make sense of the meal timings and order.

The kits are vegetarian, as well as being lactose and gluten free, but allergy sufferers should note that the meals do contain both nuts and soy.

There’s a broad list of foods to keep you on track, with nut bars, soup blends and vegetable chips all thrown into the mix. In addition, you’ll also get a range of herbal teas, as well as a comprehensive stack of vegetable supplements and specially formulated drinks.

Should You Try the Fasting Mimicking Diet?

Right away, it should be mentioned that breastfeeding or pregnant women should avoid lowering calories. That means a fasting protocol is not appropriate if you’re in either of those positions.

Likewise, if you already suffer from a serious medical condition such as diabetes or have a history of disordered eating, you shouldn’t undertake any kind of dietary intervention without consulting your doctor first.

Other than that, if you’re felling stuck in a rut and looking to improve your mood, energy levels and overall health, why not give it a shot? The benefits of a healthy fast are hard to ignore!

Watch: How can fasting support your health:

Call our functional medical office for a more explanations or simply click on the recording of the educational webinar that further discusses the science and process of fasting mimicking diet. 212-696-4325

Watch: The Power of the Pause in Business and Life:

Environmental Toxins and Gut Microbiome

Can Environmental Toxins, Like Glyphosate, Affect Our Gut Microbiome?

Glyphosate, a weedkiller also known as Roundup, has made many headlines in the past year.
It was named a “probable human carcinogen” in 2015 by the WHO’s International Agency for Research on Cancer. And shockingly, levels found in the human bloodstream have increased by more than 1,000% in the last two decades.

Now, more recent research is pointing to the negative effects that glyphosate has on our gut microbiome.

So, what is glyphosate exactly?

Glyphosate is the active ingredient in Monsanto’s weedkiller, Roundup. It is used to kill weeds that interfere with agricultural crops like soy, canola, corn, and wheat.

What is the gut microbiome?

The gut microbiome may be one of the most complex biological systems on Earth. It contains trillions of microbes and bacteria and is the entire system of organs that is in charge of digestion, removing waste from your body, and taking in energy and nutrients.

Research suggests that when the gut microbiome is in balance, it may prevent and treat many common diseases.

And alternatively, when the gut is out of balance it can be linked to dozens of chronic diseases, potentially being the origin point of dis-ease. The gut has a direct effect on our body’s inflammation, immune system, brain health, hormonal balance, and even skin. Studies show that obesity, asthma, rheumatoid arthritis, and depression all have been linked to an imbalance of the gut microbiome (and this is an incomplete list!).

Environmental toxins like Glyphosate can affect our Gut Microbiome
Image: Getty Images

How do environmental toxins impact our gut health?

Pesticides and other toxic chemicals, like glyphosate, can make their way from our food, into our mouths and into our gut. Anything we put in our mouths will impact the health of our gut, negatively or positively. For example, an organic vegetable may provide the necessary nutrients and fiber, called prebiotics, to help our gut microbes thrive. But, lace that vegetable with a toxin like glyphosate, and this healthy produce is no longer a source of just nutrients and fiber – it’s now also a vehicle for a harmful toxin.

In a 2018 study, rats were exposed to what was considered “safe” doses of glyphosate in their drinking water, over a 13-week period. The study “provided initial evidence that exposures to glyphosate, at doses considered safe, are capable of modifying the gut microbiota and warrant future studies on potential health effects of Glyphosate-based herbicides.”

Glyphosate and Leaky Gut

Glyphosate and other pesticides are also thought to increase intestinal permeability, commonly known as “leaky gut”, by irritating the gut lining. Leaky gut develops when the intestinal lining is damaged, allowing for undigested food and toxins to leak into your bloodstream, causing an immune reaction.

What symptoms should I look out for to know if my gut is imbalanced?

If there is one thing you should know, it’s that it is possible to feel well 100% of the time! As stated earlier, a lot of chronic dis-ease begins in the gut! If you have any of these symptoms, it might be attributed to an imbalance in the gut:

  • Chronic diarrhea, constipation or bloating
  • Nutritional deficiencies
  • Fatigue
  • Headaches
  • Moodiness, anxiety, depression
  • Difficulty concentrating
  • Skin problems like acne, rash, eczema
  • Joint pain

Tips to avoid environmental toxin exposure

While you might not be able to eliminate exposure of pesticides and glyphosate 100% of the time, there are steps you can take to minimize your exposure risk:

  1. Read your labels and choose foods that aren’t genetically engineered. Genetically modified crops are typically sprayed heavily with pesticides and glyphosate. So, choosing foods that aren’t genetically engineered is a simple way to avoid unnecessary exposure to this chemical. You can find labels on foods that let you know if they are genetically engineered or not. Labels to look for could be, “Partially produced with genetic engineering”. Alternatively, the label “No genetically engineered ingredients” suggests that there are no GMOs in the product. Not every single brand uses these labels, so it’s hard to tell 100% of the time, but you can start to remove extra known sources of these foods by simply reading the label.
  2. Buy organic when you can. Pesticides are never sprayed on organic crops. So you can try to buy as much organic food as possible. The good news is that you don’t have to buy 100% organic all the time. The Environmental Working Group, a non-profit organization that specializes in research and advocacy in the areas of agricultural subsidies, toxic chemicals & pollutants and corporate accountability, releases their “Dirty Dozen” and “Clean Fifteen” Food lists every year.
    Fruits and Vegetables that have the highest amount of harmful pesticides are on the “Dirty Dozen” list . Foods that have the lowest amount of harmful pesticides are on the “Clean Fifteen” list. Focus your attention on buying organic from the Dirty Dozen list to lower your exposure to pesticides and glyphosate. And you can buy conventional fruits and vegetables from the Clean Fifteen list without worrying about toxic exposure. Keep this list handy for reference.
    Additionally, many carbohydrate-type crops are most likely sprayed with glyphosate like wheat, oats, soybeans, corn and rye. Most recently it was discovered that some hummus (chickpea) brands contain high levels of glyphosate. Knowing which crops might be contaminated and can help you choose which to buy organic as well.
    A study done by Environmental Health News showed that levels of glyphosate fell by more than 70 percent in both children and adults, with reductions seen after just three days after switching to an all organic diet.
  3. Support Community Supported Agriculture (CSA) and Organic Food Co-Ops. CSA’s in New York are a great way to obtain high-quality organic foods from ethical farmers. If you are in New York, I like Local Roots, but you can find a full list of CSAs here. An added bonus of buying organic produce from your local farmer, you are working to maintain a healthy environment, a vibrant community, and a strong and sustainable local economy for you and your kids to thrive in.

Being Realistic

It might be completely impossible to avoid toxic chemicals like glyphosate 100% of the time, so making small changes and buying organic when you can to minimize your risk can be very helpful. If you are exposed to glyphosate and other pesticides, make sure to keep your microbiome in the best shape possible by eating a variety of organic fruits and vegetables, reducing processed foods and seed oils, and taking high-quality probiotics.

Next step

If you need help to stabilize and reverse chronic medical conditions including a variety of illnesses related to gut health, look for a certified functional medicine practitioner here. Or simply call our practice at 212-696-HEAL. In our practice, we test for glyphosates and recommend treatment protocols to detoxify you from glyphosate and toxicants alike. We also prescribe treatments to stabilize and enrich healthy beneficial microbes in your gut with nutrition and food like supplements. Feel free to call our office to schedule a consultation with Elena Klimenko, MD IFMCP at 212 696 4325.

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 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.


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