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Recently I saw someone whose Rheumatoid Arthritis symptoms were in remission with low dose naltrexone. It's remarkable because this person no longer requires medications or supplements to control the symptoms. The symptoms have simply disappeared. How would functional medicine approach treating rheumatoid arthritis: A functional medicine approach to rheumatoid arthritis (RA) focuses on treating the root causes of the disease rather than just alleviating symptoms. This personalized and integrative method aims to balance the body's systems, support the immune system, reduce inflammation, and improve overall health. Key Principles of Functional Medicine for RA Identifying Root Causes : Genetics : Understanding genetic predispositions that may increase the risk of RA. Gut Health : Investigating and addressing gut dysbiosis, leaky gut, and food sensitivities that can contribute to inflammation. Chronic Infections : Identifying and treating underlying chronic infections (e.g., viral, bacterial, or fungal) that may trigger or exacerbate RA. Toxins : Reducing exposure to environmental toxins, heavy metals, and chemicals that can burden the immune system. Personalized Nutrition : Anti-inflammatory Diet : Emphasizing whole, unprocessed foods with anti-inflammatory properties, such as fruits, vegetables, fatty fish, nuts, and seeds. Specific diets like the Mediterranean or Paleo diet might be recommended. Elimination Diet : Identifying and avoiding foods that may trigger inflammation or immune reactions, such as gluten, dairy, or nightshades (tomatoes, peppers, eggplants). Nutritional Supplements : Using targeted supplements like omega-3 fatty acids, curcumin, vitamin D, and probiotics to reduce inflammation and support immune function. Balancing the Immune System : Modulating Immune Response : Addressing imbalances in the immune system through lifestyle changes, stress management, and targeted therapies. Autoimmune Protocol (AIP) : A specialized diet and lifestyle plan designed to reduce autoimmune activity. Low Dose Naltrexone would fit here. Lifestyle Modifications : Stress Management : Techniques like mindfulness, meditation, yoga, and breathing exercises to reduce stress, which can exacerbate RA symptoms. Regular Exercise : Incorporating low-impact exercises like swimming, walking, and strength training to maintain joint mobility and reduce inflammation. Sleep Optimization : Ensuring adequate, restorative sleep to support immune function and reduce systemic inflammation. Detoxification Support : Liver Support : Enhancing the body's natural detoxification processes through dietary changes, supplements, and possibly detox programs. Reducing Toxic Exposure : Identifying and minimizing exposure to environmental toxins, such as pesticides, heavy metals, and plastics. Mind-Body Connection : Emotional and Psychological Support : Addressing emotional health, trauma, and psychological stressors that may contribute to or worsen RA. Integrative Therapies : Considering acupuncture, chiropractic care, or other holistic therapies to support overall well-being. Ongoing Monitoring and Adjustments : Regular Testing : Using advanced testing methods to monitor inflammation levels, gut health, nutrient deficiencies, and immune function. Continuous Adjustment : Tailoring the treatment plan based on ongoing assessments to ensure optimal management of RA. Conclusion Functional medicine offers a comprehensive approach to managing rheumatoid arthritis by focusing on the individual as a whole and addressing the root causes of the disease. By integrating diet, lifestyle changes, targeted supplements, and stress management, this approach aims to reduce inflammation, support immune function, and improve overall quality of life. Working with a healthcare provider trained in functional medicine is essential for developing a personalized treatment plan.

This week, I saw someone who rheumatoid arthritis symptoms have disappeared after starting low dose naltrexone (LDN). Once rheumatoid arthritis symptoms disappeared also stopped all supplements. Still, the symptoms did not return. I love witnessing the miracles LDN can bring to my clients. Having said that, I have probably equal number of patients whose conditions appear to be resistant to LDN, supplements, and anti-inflammatory supplements. It is these patients to keep me motivated to learn and grow as a functional medicine physician. The different responses illustrate our diversity as individuals - what makes us different and unique also makes us have unique responses to LDN. Thankfully, usually about 50-70% of the time, LDN is an excellent tool for many autoimmune conditions. For me, advantages of using LDN for autoimmune conditions far outweigh potential side effects.

Leaky gut syndrome, also known as increased intestinal permeability, is a condition where the lining of the small intestine becomes damaged, allowing bacteria, toxins, and undigested food particles to "leak" through the intestinal wall and enter the bloodstream. This can trigger inflammation and potentially lead to a variety of health issues. Here are some strategies to help improve and manage leaky gut syndrome: 1. Dietary Changes Eliminate Trigger Foods: Identify and remove foods that may be contributing to inflammation and irritation in your gut. Common triggers include grains, gluten, dairy, fruits, high carb vegetables, processed foods, and refined sugars. Increase Anti-inflammatory Foods: Include foods rich in omega-3 fatty acids (like fatty fish, flaxseeds, and walnuts) - spices like curcumin, quercetin, bromelain, Add Gut-Healing Foods: Foods such as bone broth, fermented foods (like yogurt, kefir, sauerkraut, and kimchi), and fiber-rich foods can support gut health and repair. 2. Nutritional Supplements Probiotics: These beneficial bacteria can help restore balance in the gut microbiome. Choose high-quality probiotic supplements or consume probiotic-rich foods. Prebiotics: Prebiotics are non-digestible fibers that feed beneficial gut bacteria. Foods rich in prebiotics include garlic, onions, leeks, asparagus, and bananas. L-glutamine: An amino acid that may help repair and maintain the intestinal barrier. Zinc: Plays a role in maintaining the integrity of the intestinal lining. 3. Avoid Excessive Use of Medications Certain medications, like nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics, can affect gut health.

Metabolisms that use ketosis (fat burning - as opposed to sugar burning - for most of metabolic needs) can be achieved with multiple ways including plant-based. Below are some ways to enter ketosis Fasting greater than 72 hours or Intermitten Fasting (Jason Fung MD) Plant Based - green juicing - low carb, low protein, low fat - high in micronutrient and fiber - not to exceed 1 month - recommend medical supervision Terry Wahl diet - with limiting carbs Duke Keto - Eric Westman MD - low carb, moderate protein, moderate fat Carnivore - Ken Berry MD - no carb, high protein, high fat (although Dr. Berry may not agree) It's ketosis that is resulting in healing - ketosis appears to have a wide range of effect from insulin sensitization, anti-inflammatory, and anti-neoplastic. In my practice, we focus on metabolic state and how to reach that state taking account of patients' preferences.

I have been waiting for a sensible approach to incorporate genetic testing in my practice. Initially, there were specific genetic tests that answered one question about one gene. Then, there were services that would map out the entire genome often requiring a secondary database services resulting in overwhelming amount of data. 3 x 4 Genetic Test can generate a health report similar to the idea of weather report. Weather Report When we want to know about the weather, we consult our favorite web services to obtain a prediction about weather which often can be incorrect. Yet, when we need to know, even with understanding weather report can be wrong, we feel it is better than not knowing. So, before going out to run our errands, meet our friends, or run our errands, some of us will consult weather report. Health Report 3 x 4 Genetic Test can serve in similar function. There are certain genetic mutations that determine disease occurrence or the occurrence is predictable and potentially disastrous such as BRCA gene mutation now we accept surgeries to remove breasts and ovaries are well accepted practices. 3 x 4 Genetic Test looks into a number of potential outcomes such as: Cellular Pathways like methylation, oxidative stress, detox, and inflammation Systems Pathways like Glucose, Memory, Collagen, Mood, Hormone balance, Histamine Cardiovascular Health Energy Activity Nutrients The organization and interpretation of the test results are also practical and give you multiple ways to work on your potential concerns such as lifestyle, supplements, and food. Lastly, 3 x 4 Genetic Test provides you with the specific mutations which can be used to perform futher research using medical databases such as pubmed.gov.

American Society of Clinical Oncology (ASCO) is a professional organization for oncology practitioners and researchers. Recently, ASCO has endorsed the use of integrative medicine to treat breast cancer patients as proposed by Society for Integrative Oncology (SIO). SIO advocates for evidence based approach to using. integrative medicine for cancer patients. SIO also publishes practice guidelines - https://integrativeonc.org/practice-guidelines. While SIO approach is optimized for treating patients with cancer, sometimes it is also limited by available evidence. There are many modalities which does not yet have clear evidence - and this can be frustrating for patients. For me, the role of integrative medicine practitioner caring for cancer patients have to balance between evidence based v. balancing over all benefit of patients. Also, understanding where evidence based medicine works best is helpful. For example, when patients have stage I cancer, there are lots of data that can help to guide towards optimal outcome. However, for stage IV cancer patients, there is not lot of evidence of effective treatments. Integrative oncology differs in practice setting. For example, MD Anderson and MSK utilize mostly evidence based approach following practice guideline below: https://integrativeonc.org/practice-guidelie nes/guidelines My approach has been to use evidence based medicine and evidence based integrative oncology when appropriate especially in the early stages of cancer. Also, approaches with harnessing patient's willpower into specific lifestyles that have been shown to have survival benefits and low dose naltrexone often do not interfere with chemotherapy and radiation therapy. My approach is to support patients undergoing cancer treatments and enhance vitality of my patient. One of my teachers in acupuncture shared how to enhance vitality using a specific treatment protocol. The overall purpose of integrative oncology is to serve patients with cancer and assist in enhancing quality of life and outcome. If you are interested, please fill out the contact me form. Yoon Hang Kim MD www.directintegrativecare.com

One of advantages of functional medicine is its emphasis in advances in scientific technology - especially labs. My three favorite labs are listed below: Micronutrient Testing Microbiome Testing Comprehensive Food Allergy Testing Micronutrient testing includes some 31 vitamins, mineral, amino acids, fatty acids, anti-oxidants and metabolites. This allows for decisions on personalized supplementation. Microbiome Testing allows for mapping out microbiomes within our body where there is more roles of microbiome's contribution to health and diseases are being discovered. This utilizes quantitative PCR technology to detect parasites, bacteria, fungi, and more allowing better understanding of overall condition of the digestive system. If abnormalities are found, further testing such as comprehensive diagnostic stool analysis + parasitology can be used to confirm the diagnosis.' Comprehensive Food Allergy Testing - while environmental allergies focus on IgE reaction and such tests are readily available, food allergies are much more complex. The main advantage of this test is that this can help to distinguish between food allergy and food sensitivity. In addition, it also allows for evaluating IgG4, IgG, and C3b/d (complement). This approach, while not infallible, offers most comprehensive way to evaluate food allergy. If you are interested in above functional medicine testing, please fill out contact us form. Yoon Hang Kim MD www.directintegrativecare.com

Small Intestine Bacterial Overgrowth (SIBO) is caused by bacterial overgrowth in small intestines resulting in a number of uncomfortable symptoms including bloating, extreme abdominal pain (some describe as if stomach may explode!), nausea, vomiting, and diarrhea. In extreme case, it also causes fear of eating as episodes follow eating (often rich in carbohydrates). The bloating is caused by gas (either hydrogen or methane) which can be detected by tests. While many antibiotics can be used to to treat SIBO, rifaximin (poorly absorbed antibiotic) has best evidence for treating SIBO. However, rifaximin does not have 100% success rate. There are studies that show that herbal therapy is equivalent to rifaximin. (Chedid V, Dhalla S, Clarke JO, Roland BC, Dunbar KB, Koh J, Justino E, Rn ET, Mullin GE. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Global advances in health and medicine. 2014 May;3(3):16-24.) For my patients, I recommend food based approach to healing. There are two main approaches - 1. Ketogenic diet with no added sugar 2. Elemental diet. Of the two approaches, elemental diet shows up to 85% success rate. Below is an excellent article on SIBO: https://en.wikipedia.org/wiki/Small_intestinal_bacterial_overgrowth

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