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Functional medicine aims at understanding the root causes of illnesses when possible. There are hundreds of functional medicine labs available. Below is a list of labs I use the most in the beginning. Micronutrient Testing (Spectra Cell) provides a comprehensive nutritional analysis. This approach provides a snap shot of nutritional state in the body. The results provide for deciding daily nutritional supplements. Vitamins Vitamin A Vitamin B1 Vitamin B2 Vitamin B3 Vitamin B6 Vitamin B12 Biotin Folate Pantothenate Vitamin C Vitamin D3 Vitamin K2 Minerals Calcium Magnesium Manganese Zinc Copper Amino Acids Asparagine Glutamine Serine Fatty Acids Oleic Acid Antioxidants Alpha Lipoic Acid Coenzyme Q10 Cysteine Glutathione Selenium Vitamin E Carbohydrate Metabolism Chromium Fructose Sensitivity Glucose-Insulin Metabolism Metabolites Choline Inositol Carnitine Spectrox® Total Antioxidant Function Immunidex Immune Response Score https://www.spectracell.com/micronutrients-clinician 2. DUTCH COMPLETE (Precision Analytical) The Dutch Complete™ provides a comprehensive assessment of sex and adrenal hormones and their metabolites. It also includes the daily, free cortisol pattern, organic acids, melatonin (6-OHMS), and 8-OHdG. I use this test as a starting point for assessing adrenal hormone patterns (for cause of fatigue), sex hormone status, and rudimentary organic acid analysis which serve as metabolic markers for various functions such as B12, B6, Biotin, Glutathione, Dysbiosis, Neurotransmitter, Neuroinflamation, Melatonin, and Oxidative Stress. The major difference between Micronutrient Analysis and organic acids is that the former offers direct measurement while the latter offers metabolic inferences. https://dutchtest.com/info-dutch-complete/ 3. Food Allergy/Sensitivity Test There are many companies utilizing different technologies to assess food allergy and food sensitivity. I favor a test that at least provides IgE and IgG anti-body response. P88 Dietary Antigen Test (Precision Point Diagnostics) provides IgE, IgG, IgG4 and complement (C3d) reactions to 88 of the most common foods found in the diet. https://precisionpointdiagnostics.com/test/p88-dietary-antigen-serum/ This topic is fully explored in below article - https://www.functionalnutritionanswers.com/what-is-the-best-food-sensitivity-test/

According NIH: "More than a year and a half into the COVID-19 pandemic, much about how the human body responds to SARS-CoV-2, the virus that causes COVID-19, remains unclear. Some people have a severe or fatal reaction to infection, while others show no obvious symptoms. Some people bounce back quickly. Others experience so-called “long COVID,” symptoms that persist long past recovery from the initial stages of illness." [from NIH Research Matters] While we are learning to live with COVID, a disturbing picture is beginning to emerge. More than 40% of COVID patients appears to have long COVID symptoms. According Wikipedia, a wide range of symptoms are commonly reported, including fatigue, malaise, headaches, shortness of breath, anosmia (loss of smell), parosmia (distorted smell), muscle weakness, low fever and cognitive dysfunction. [Wikipedia] While conventional medical approach to long COVID is being developed, I believe integrative medicine offers an ideal approach to long COVID as integrative medicine offers many tools to treat autoimmune conditions including LDN (low dose naltrexone), lifestyle medicine, and supplements. In addition, functional medicine labs can be used to evaluate hormones, adrenal functions, and nutrient status. Because long COVID a chronic condition that may be like an auto-immune condition, this is a condition I would treat in my practice. Having a membership based practice makes per month cost affordable and have services accessible to chronic conditions. Yoon Hang Kim MD www.directintegrativecare.com

Below entry is from Wikipedia on Lyme Disease: Lyme disease, also known as Lyme borreliosis, is a vector-borne disease caused by the Borrelia bacterium, which is spread by ticks in the genus Ixodes. The most common sign of infection is an expanding red rash, known as erythema migrans, which appears at the site of the tick bite about a week afterwards. The rash is typically neither itchy nor painful. Approximately 70–80% of infected people develop a rash. Early diagnosis can be difficult. Other early symptoms may include fever, headaches and tiredness. If untreated, symptoms may include loss of the ability to move one or both sides of the face, joint pains, severe headaches with neck stiffness or heart palpitations. Months to years later repeated episodes of joint pain and swelling may occur.Occasionally shooting pains or tingling in the arms and legs may develop. Despite appropriate treatment about 10 to 20% of those affected develop joint pains, memory problems and tiredness for at least six months. [From Wikipedia] It clearly states that Lyme disease is caused by Borrelia bacterium spread by ticks (genus Ixodes). So, it is an infectious disease caused by bacteria transmitted by ticks. While everyone agrees how the disease is caused, there are much still is unknown about optimal treatment and long-term outcome of Lyme disease. In my early career, I have seen neurological complications of Lyme disease which can be devastating. Because early diagnosis IS difficult and initial treatment (doxycycline) is often not given long enough, patients can suffer the late disease consequences. Exposure to the Borrelia bacterium during Lyme disease possibly causes a long-lived and damaging inflammatory response, a form of pathogen-induced autoimmune disease. The production of this reaction might be due to a form of molecular mimicry, where Borrelia avoids being killed by the immune system by resembling normal parts of the body's tissues. Chronic symptoms from an autoimmune reaction could explain why some symptoms persist even after the spirochetes have been eliminated from the body. [from Wikipedia] This is the reason why treatment of post-infectious Lyme patients should be approached with autoimmune approach. There are several ways to achieve this including the use of low dose naltrexone, anti-autoimmune diet, and supplements. Because post-infectious Lyme condition is a chronic condition that is like an auto-immune condition, this is a condition I would treat in my practice. Having a membership based practice makes per month cost affordable and have services accessible. Yoon Hang Kim MD www.directintegrativecare.com

Direct Care provides services based on membership. Most direct care models bill a monthly membership fee - like a gym. In exchange for the membership fee, there are services that are included. For example, for Direct Integrative Care, there are 20 face to face visits and 100 telephone and telemedicine visits. For the majority of patients, above should suffice meeting their integrative/functional/lifestyle needs. Because Direct Care model is NOT an insurance, the limitations on membership (again like a gym) is limited to services at the specific clinic. I recommend to my patients that an access to high deductible insurance (also known as catastrophic health insurance) and/or health share ministry should be considered. For a high deductible insurance, you should find a licensed insurance agent/broker. To be clear, health share ministry IS NOT insurance. It is estimated that more than 1 million Americans participated in health care sharing as of Feb of 2019 sharing more than $670 million in medical bills annually. The membership is growing due to the fact the cost of membership in health care sharing ministry is generally lower than the cost of insurance rates. (Source: Wikipedia). Just like insurance products, not all health sharing ministries are made equal. Below is an article that reviewed 10 best health share plans. https://healthsharingreviews.com/10-best-healthshare-plans/ Top 3 were: Zion Health One Share Health Samaritan Ministries Zion Health has two unique features: Zion Health does not decline membership to anyone based on their religious beliefs Zion Health offers a membership plan that includes Direct Primary Care A suggestion was made to add Sedera Below is a review of Sedera. https://healthsharingreviews.com/review/sedera-healthshare-review/ I am grateful that there is more interfacing of health share ministry and direct care model. Yoon Hang Kim MD www.directintegrativecare.com

Talk of inflation is all the rage these days. It appears like inflation is here to stay. Just the other day, I noticed gas was as high as $ 4.22 (I am told this is lower than the West Coast). Fortunately, saving money for medications, especially generic medications (non-name brand medications) can be easy. GoodRx is a health care company with multiple service lines to help people save money. Below is a summary for how to save money on medications. Visit goodrx.com Type medication name in the search box Compare prices Get free coupon Bring coupon to pharmacy According to GoodRx: 75% of GoodRx customers have insurance 70,000+ U.S. pharmacies accept GoodRx $100+ is how much prices can differ between pharmacies Let me know your experience of GoodRx - please feel free to share with me your experience of GoodRx. My e-mail is drkim@georgiaintegrative.com. After this blog posted, I was given another lead - https://costplusdrugs.com/ Mark Cuban's Cost Plus Drugs. I checked the prices. It was very competitive. Yoon Hang Kim MD www.directintegrativecare.com

Last blog entry focused on commonalities between integrative medicine and functional medicine. A good integrative medicine and functional medicine shares solid lifestyle medicine. To me, the main difference between integrative medicine and functional medicine is that integrative medicine focuses on wisdom of mind-body medicine, ethnobotany, and traditional healing systems such as Chinese medicine and Ayurveda. In contrast, functional medicine represents advances in our technology. Just as you want your physician to have have wisdom and knowledge, today it is not enough for an integrative medicine practitioner to be versed only in wisdom or a functional medicine practitioner to be versed in knowledge. Both are needed for healing. I view my two decades of pursing integrative medicine a journey that enhanced my wisdom in healing and that increased my knowledge. For example, I am a better listener. I understand and can converse in the language of unconscious. I can now communicate with the body utilizing ancient techniques to reset pain. However, I learned how to reverse certain autoimmune conditions and allergies which testing can be helpful. When a patient is seeking desperately for help, it seems to me that the healer must do all he/she can do drawing from both sets of skills - wisdom and knowledge. Yoon Hang Kim MD Direct Integrative Care Providing Affordable Alternative Solutions

Before the word integrative medicine was popular or even existed, other words such as holistic medicine, complementary medicine, alternative medicine, and complementary and alternative medicine was popular. Andrew Weil, MD who is widely regarded as the pioneer of integrative medicine, popularized the use of the term and academic medicine and health systems quickly adopted the term. Today, many of strongest academic medical centers and many of prominent health systems offer integrative medicine programs. Many of practitioners undergo training through University of Arizona. Functional medicine was developed by Jeffrey Blands, PhD a biochemist who focused on the enhancing plausibility biochemical mechanisms which later exploded to include genetic testing, epigenetics, organic acid testing, micronutrient testing. Previously most practitioners underwent training through Institute of Functional Medicine (IFM) Today there are other programs which are taught by graduates of IFM. Integrative Medicine is still the preferred term for most of the academic medicine and health systems, but there are signs of institutions beginning to embrace functional medicine including Cleveland Clinic. To me, good Integrative Medicine and Functional Medicine share lifestyle medicine as a commonality. There are some differences in that functional medicine relies more on testing while integrative medicine focuses on mind-body medicine and integration of whole system healing such as Chinese medicine. The important commonality is that both help patients to solve their problems that are resistant to treatment with conventional medicine. To me, I have had operated Integrative Medicine where I did no functional medicine testing, and I have had operated in Functional Medicine environment where there was all the testing that was available. Today, I have found a happy medium where I utilize some test to ask questions and explore potential explanations behind patient's symptoms. Some call this approach root cause of disease. For example, micronutrient testing allows for me to assess patient's nutritional status - there is direct method where one can measure the micronutrient level directly and indirect method of assessing metabolism by measuring metabolites. Both techniques have validity and limitations. For environmental and food allergy, testing is needed so that immune system can be desensitized in a safe manner - which addresses the root cause of allergy. Other tests help to determine cause of fatigue, lack of libido through measuring hormones in saliva and/or urine (blood, too). GI labs are invaluable in assessing functional health of digestive system. I think the most important thing to remember is that we need to treat the whole person - not their labs. My role as a responsible physician who practice integrative medicine and functional medicine is to guide patients to the minimum number of tests to answer as much questions as possible. There are many stories of functional medicine causing financial hardship and toxic financial conditions. This is the reason for my creating a direct care integrative and functional medicine clinic. Yoon Hang Kim MD Direct Integrative Care

Chapter I. History of Low Dose Naltrexone Naltrexone was created in 1963 as an opioid receptor blocker. This means naltrexone binds to opiate receptor and neutralizes the action of opiates on the opiate receptor. Naltrexone was approved by FDA in 1984 for the treatment of opioid addiction. The typical daily dosage for opioid addiction is 50 to 100 mg daily. Low Dose Naltrexone or LDN refers to daily dosages of naltrexone that are between 1.5 is 4.5 mg. Basic science work examining the use of opioid antagonists for treating other diseases did not appear until the late 1980s, and the first published LDN trial in humans was presented in 2007. Since that time, LDN has been studied and has been slowly gaining attention as a possible treatment for some chronic medical conditions. Currently, the best documented scientific use of LDN is in treating autoimmune conditions such as multiple sclerosis, Crohn’s disease, and Hashimoto’s thyroiditis. However, late Bernard Bihari, MD has also documented use of LDN for treating HIV and cancer. The review of literature revealed one case study of long-term survival of a pancreatic cancer patient with liver metastases treated with LDN and alpha lipoic acid for four years resulting in patient surviving without symptoms and patient being able to work. Follow up study documented survival of the original patient to 78 months and also shared two more cases of patients with metastatic cancer responding positively to the LDN plus alpha lipoic acid treatment. Another documented use of LDN is for treating obesity. Contrave, a new medication approved to treat obesity in 2014, combines LDN and bupropion in a sustained release formula. Both bupropion and LDN individually have shown evidence of weight loss and the combination aims to create a synergistic effect. Contrave is a sustained release formulation of LDN and bupropion. The FDA has placed a boxed warning onto Contrave stating that it may affect mood and it may increase the likelihood of suicide. This potential adverse effect is most probably due to bupropion as such adverse effects have been observed with medications designed to treat mood disorders. In addition to LDN, there is also ultralow dose naltrexone using microgram dosing (one millionth of a gram). Ultralow dose naltrexone when given with narcotic medication appears to enhance the duration and depth of pain relief while minimizing side effects of narcotic medications. Investigation of this phenomenon has resulted in developing Oxytrex – an investigational medication combining oxycodone with ultralow dose naltrexone. A phase III clinical trial has shown that Oxytrex has been as effective in providing pain relief while causing less physical dependence than oxycodone alone. Yoon Hang Kim MD Direct Integrative Care www.directintegrativecare.com

Yoon Hang Kim MD and Andrew Weil MD One of the gifts I received from working with Dr. Andrew Weil was the idea of collaboration rather than competition and/or even coopetition. Today, I had an opportunity to connect with Dr. Yoo Lee Kwon representing evolving of acupuncture field. I was introduced to acupuncture by some of masters of acupuncture and served as a Dean of Acupuncture and Integrative Medicine College - Berkeley where we had created a "Master Class" inviting every master in Chinese medicine who was willing to share their wisdom. Dr. Kwon has the highest level of training an acupuncturist can obtain through education. Once a upon a time in the past, (still one school) simple certificate of completion. Then, the field evolved to offering master's degree which enabled the candidates to go through a national certification examination and subsequently state licensure. Now, there are individuals who choose to go through another level of training by obtaining a doctorate degree often allowing for specialization. In preparation to launching Direct Integrative Care services offering affordable integrative medicine and functional medicine lab testing services, I am beginning to gather names of gifted healers in San Antonio and Austin area. Below are some of her recommendations: South Austin: Dr. Zhenni Jin at AOMA South New Braunfels: Dr. Claudia Sandoval, DAcOM, MAcOM, LAc Round Rock: Dr. Yoo Lee Kwon, DAcOM, LAc, Dipl OM

Austin Wellness Collaborative is for professionals dedicated to wellness created by Ashley Maltz, MD with more than 2200 members. I have been inspired by Dr. Maltz; my comment was that this feels like an Oasis in the desert called "healthScare." Dr. Andrew Weil, my mentor since 2002, shared that to create an integrative medicine revolution, you have to first create a counter-culture which will shift consciousness and change the climate within the medical community. Clearly, Dr. Weil has created that - today, most respected medical institutions pride in having an integrative medicine program. Dr. Maltz has created such a counterculture in Austin. They say that imitation is the sincerest form of flattery. I have imitated Dr. Maltz and created San Antonio Wellness Cooperative. It is a bit different in that both professionals and interested public can join. One of the reasons is that San Antonio will probably have less number of healers than Austin which is a magnet for open-minded individuals - it is our Mid-Coast (reference to East Coast (NYC) and West Coast (SF Bay Area). It remains to be seen if this can take off. Ever so gracious, Dr. Maltz offered to help. Below is a draft version of my Austin referral list which is heavy on mind-body practitioners. I went back several months of entries in the Austin Wellness Collaborative and noted practitioners of interest. It will be updated - and entered into new blog entry - Austin Referral List at a later time. My Thanks to Dr. Maltz and members of Austin Wellness Collaborative. Austin Acupuncture https://valentinecare.com/ Legendsacupuncture.com List of Acupuncturists Recommended by Dr. Kwon Bodywork https://www.austinrevolt.com/ https://David-Lauterstein.com Neurology http://www.optimizeneurology.com/ Hematology/Oncology http://www.nextdoorphysician.com/ Integrative Medicine/Medical Acupuncture https://www.ashleymaltzmd.com/ Psychiatry https://www.drsandhuintegrativepsychiatry.com/ Psychology/Counseling/Meditation ADHD https://www.delaneymenell.com/ CBT https://infinitepotentialinctx.com/ Clinical Hypnosis (licensed professional counselors) http://www.anitajung.com Eating Disorder Dietician https://empathynutritiontherapy.com EMDR (Highly Sensitive People) https://www.shiraklazmer.com/ Mindfulness https://www.mindfulwellnessaustin.org/ Pelvic Floor Dysfunction PT www.resilient-rx.com www.phoenixpttx.com https://pranaphw.com/ Spanish Speaking www.debbieradzinskylcsw.com Teen http://www.austinteentherapy.com/ Residential https://paradigmtreatment.com/mental-health-treatment-austin-texas/ (May 22) PTSD https://www.ettaustin.com/ Speech Pathology www.amyspeechtherapy.com PCP Charu Sawhney Peechu PCP (DPC) https://www.mywavemd.com/ https://www.metsicare.com/ Yoon Hang Kim MD Direct Integrative Care Serving SanAntonio| Austin directintegrativecare.com http://affordablealternativesolutions.com/

Your physician may not know about LDN. LDN is not taught in medical schools; LDN is not taught in residencies and fellowships where doctors receive clinical training in their chosen specialties. For example, I have gone through medical school, family medicine residency, preventive medicine residency, UCLA acupuncture training, and a residential integrative medicine fellowship with Dr. Andrew Weil. Surely, I must have learned about LDN from one of these sources. My own introduction came from a highly intelligent patient whom I respect tremendously. She asked me if I would be willing to research LDN. I did and I could not find any potential harm. So, I began prescribing LDN and never stopped. My point is that someone like me who had been trained by the best minds in healing did not know about it and I had to learn from my patient. Fortunately I have an open mind and tremendous respect for my patients. Below is the steps I recommend how to approach your doctor: 1. Use scholar.google.com or pubmed.gov to do the research. Scholar.google.com captures more studies than pubmed.gov. Type in LDN and *condition* i.e. LDN and Pain 1. Find a review article which will summarize clinical trials 2. Find a clinical trial For discussion about use of general LDN below is an excellent resource: Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization https://www.mdpi.com/2076-3271/6/4/82 For discussion about use of LDN for pain, below is an excellent resource: Treating chronic pain with low dose naltrexone and ultralow dose naltrexone: a review paper https://www.yoonhangkim.com/_files/ugd/989c76_d02e148980704b6db5e74069eac349ab.pdf PRINT the article(s) - but not more than three. Then ask "Would you mind reading these articles? These seems to indicate LDN can help - at least it would not hurt me." If run into trouble, ask the LDN FB group for advice. Also, now we have telemedicine outfits which can facilitate obtaining LDN. Best of luck! Yoon Hang Kim MD www.directintegrativecare.com http://affordablealternativesolutions.com/