What is Celiac Disease? Celiac disease is an autoimmune disorder triggered by the ingestion of gluten , a protein found in wheat, barley, and rye. The pathogenesis of celiac disease involves both genetic and environmental factors. Individuals with specific genetic markers, such as HLA-DQ2 and HLA-DQ8, are predisposed to developing the disease. When these individuals consume gluten, their immune system mounts an abnormal response. Gluten fragments, particularly gliadin , are modified by the enzyme tissue transglutaminase (tTG) in the small intestine. This modified gliadin is then presented by antigen-presenting cells to CD4+ T cells, triggering an inflammatory immune response. The resulting inflammation damages the intestinal villi, leading to malabsorption, nutrient deficiencies, and gastrointestinal symptoms. In addition to the immune response, other factors such as changes in the gut microbiome and increased intestinal permeability (often referred to as "leaky gut") contribute to the pathogenesis of celiac disease. In some cases, environmental triggers like infections may also influence the onset of the disease. Over time, the chronic inflammation caused by repeated gluten exposure can lead to more severe complications, including an increased risk for certain cancers and other autoimmune disorders. The only effective treatment for celiac disease is a strict, lifelong gluten-free diet, which helps prevent further immune activation and allows the intestinal lining to heal. What is Gluten Sensitivity? Gluten sensitivity, also known as non-celiac gluten sensitivity (NCGS), is a condition in which individuals experience symptoms related to gluten consumption, despite not having celiac disease or a wheat allergy. People with NCGS may experience gastrointestinal symptoms such as bloating, diarrhea, and abdominal pain, as well as extra-intestinal symptoms like headaches, fatigue, joint pain, and brain fog. Unlike celiac disease, gluten sensitivity does not involve an autoimmune response or damage to the intestinal lining. The exact mechanism of NCGS is not well understood. Diagnosis is typically made after ruling out celiac disease and wheat allergy, and symptoms usually improve on a gluten-free diet, although some may tolerate small amounts of gluten. How to test for this? Functional medicine offers many tools that can help to explore GI function, intestinal permeability, as well as IgE, IgG, IgG4, and complement reaction.

I recently saw a patient who came to me with hives. A functional medicine approach to treating hives (also known as urticaria) aims to address the root cause of the condition rather than merely managing symptoms. Functional medicine considers a variety of factors including diet, lifestyle, environment, and underlying health conditions that could be contributing to the hives. 1. Identifying Triggers and Root Causes Functional medicine looks for what might be driving the hives, such as: Food Sensitivities: I usually perform a food allergy test to include IgE (food allergy) and IgG, IgG4, and complement. Allergies: Because environmental allergens (dust, pollen, mold, pet dander) may trigger hives, I usually recommend patients to consider respiratory allergy tests. Gut Health Imbalance: Because conditions like leaky gut or dysbiosis (imbalance of gut bacteria) can result in food particle (molecules) to cross over, it can trigger hives. Chronic Infections: Underlying infections (such as candida, H. pylori, or viral infections) can sometimes provoke an immune response resulting in hives. Toxin Exposure: Chemicals, heavy metals, or other environmental toxins might play a role in immune dysregulation. Stress and Hormonal Imbalances: Stress or conditions like adrenal fatigue, thyroid issues, or hormonal fluctuations can trigger hives. 2. Testing and Diagnostics For this patient, below tests were chosen to start with: Comprehensive Stool Testing to check gut health Food Allergen test 3. Dietary Interventions Elimination Diet: Removing common allergens and inflammatory foods like gluten, dairy, soy, and sugar, then gradually reintroducing them to identify any triggers. Anti-inflammatory Diet - low carbohydrate diet promoting ketosis consistent with Duke Keto Diet developed by Eric Westman MD at Duke University Results: complete resolution of hives on keto diet and elimination diet based on food allergy list

I recently saw a patient with hives whose condition is in remission. In this person, two factors played crucial role for success: Elimination diet and ketosis. At first we used multiple approaches including anti-inflammatory diet in the form of ketosis (fat burning state), low dose naltrexone to normalize immune function (addressing autoimmunity), eliminating foods that were responsible for allergic/food sensitivity reactions, and anti-inflammatory supplements. When condition improved with ketosis and elimination diet, additional measures were discontinued - such as LDN and supplements. Success continued. Additional experiments of adding allergic foods were done resulting in hives. Functional medicine approaches the treatment of hives (also known as urticaria) by identifying and addressing the root causes rather than just managing symptoms. Here’s how functional medicine may help treat hives: Identifying Underlying Triggers: Functional medicine practitioners look for potential triggers contributing to hives, such as: Food sensitivities/allergies: Common culprits include dairy, gluten, corn, soy, nuts, and shellfish, but often requires testing Environmental triggers: Pollens, dust mites, mold, or chemical exposure can add to the immune inflammation burden. Stress and emotional health: Chronic stress or acute stress can trigger or worsen hives. Infections and gut imbalances: Hidden bacterial, viral, or parasitic infections, as well as conditions like small intestinal bacterial overgrowth (SIBO), leaky gut, or dysbiosis can make it easier to trigger hives. Functional Medicine Testing: Food sensitivity testing: Identify specific foods that might be causing or exacerbating hives. Gut health assessment: Evaluate for imbalances in the microbiome, leaky gut, or infections. Hormone and stress level testing: Measuring cortisol and other stress-related markers. 3. Personalized Nutrition and Dietary Changes: There are many types of diets including anti-inflammatory diet What I have seen most effective is the state of ketosis (fat burning state) 4. Gut Health Restoration: If gut issues are identified, treatments might involve: pre-biotics, probiotics, fiber etc. probiotic foods, prebiotics foods, and fiber 5. Detoxification and Reducing Environmental Exposures: Reducing exposure to toxins, pollutants, and heavy metals also may help in reducing hives. 6. Addressing Autoimmunity: If autoimmune issues are suspected (e.g., chronic urticaria), functional medicine focuses on calming the immune system.

What is Longevity Medicine? Longevity medicine focuses on extending the human lifespan and promoting healthy aging. It combines advancements from fields like biotechnology, genomics, and personalized medicine with traditional healthcare practices to prevent age-related diseases and enhance the quality of life as people age. Below are some approaches that are now available. 1. Preventive Care and Risk Assessment: Advanced functional medicine test for genetic, metabolic, and other screening tests for chronic diseases (e.g., heart disease, diabetes, cancer). 2. Precision Medicine or Individualized Medicine: Using genetic, metabolic, and other biological information to create tailored interventions, such as customized nutrition, exercise plans, and pharmaceutical treatments. 3. Biological Age Measurement Tools like epigenetic clocks and other biomarkers assess biological age, which may differ from chronological age, guiding interventions to slow down or reverse aspects of aging. 4. Regenerative Medicine: Employing therapies like stem cells, tissue engineering, and cellular reprogramming to repair or replace damaged tissues and organs. 5. Lifestyle and Wellness Optimization: Integrating evidence-based practices in diet, exercise, stress management, and sleep to optimize longevity. 6. Pharmacological Interventions: Investigating and applying compounds (like metformin, rapamycin, and senolytics) that have shown potential in delaying aging and age-related conditions. Longevity medicine aims to not only increase lifespan but also improve "healthspan"—the period of life spent in good health. It is an interdisciplinary field combining insights from gerontology, molecular biology, and functional, integrative, lifestyle & anti-aging medicine to help individuals live longer, healthier lives.

I recently saw a patient that has multiple complex issues including: RA or Rheumatoid Arthritis Autoimmune thyroid disorder Food allergy - eating peanuts can cause rash all over the body After being treated with LDN, patient noticed that pain from RA disappeared. When patient stopped taking LDN, the pain returned. In this case, patient has not yet achieved remission. However, there are significant improvement in quality of life not having the debilitating pain RA and there is the promise of trial of reducing her current RA medication which can be attempted as a next step after starting additional anti-inflammatory supplements and anti-inflammatory diet. Without LDN, likelihood is that this person's condition will continue to worsen and would need additional medications. I feel extremely grateful to be a privileged observer.

Recently I saw a client whose multiple sclerosis (MS) symptoms have disappeared. When I asked her if she feels she has reached remission, she said yes - definitely. One of the ways I can tell when someone has reached remission from an autoimmune condition is when that person can begin to forget about the fact they have or they had an autoimmune condition, in this case MS. In these situations, I feel so fortunate to be a privileged observer witnessing a miracle of healing through LDN. This is one reason why since when I learned about LDN (from a patient who asked me to research about LDN about 20 years ago), I continued to use LDN, write about LDN, and give lectures about LDN. Functional medicine offers a personalized approach to managing multiple sclerosis (MS), focusing on addressing the root causes and symptoms of the disease rather than just treating the symptoms. Here's how functional medicine might help with MS: 1. Personalized Assessment Comprehensive Testing : Functional medicine practitioners often conduct extensive testing to identify triggers and imbalances in the body, including nutrient deficiencies, hormonal imbalances, and gut health issues such as micronutrient testing. Genetic Factors : They may also explore genetic predispositions that could influence disease progression or treatment response such as 3 x 4 genetic testing. 2. Nutritional Support Anti-Inflammatory Diet : Diet plays a crucial role in managing MS. Functional medicine often emphasizes an anti-inflammatory diet rich in whole foods, healthy fats, and antioxidants to reduce inflammation and support overall health. Nutrient Optimization : Addressing deficiencies in vitamins and minerals, such as vitamin D, B vitamins, and omega-3 fatty acids, can be essential, as these nutrients are known to support neurological function and reduce inflammation. 3. Gut Health Microbiome Balance : There is growing evidence that gut health is linked to autoimmune conditions like MS. Functional medicine might focus on restoring a healthy gut microbiome through diet, probiotics, and other interventions. This can be achieved by using GI Map tests. Leaky Gut Syndrome : Addressing intestinal permeability, also known as "leaky gut," can help reduce autoimmune reactions that may exacerbate MS symptoms. 4. Stress Management Mind-Body Techniques : Functional medicine often incorporates stress-reduction techniques such as meditation, yoga, and other mind-body practices, recognizing that stress can exacerbate MS symptoms. Adrenal Support : Supporting the adrenal glands and balancing cortisol levels can be crucial, as chronic stress is a known trigger for autoimmune flare-ups. 5. Detoxification Environmental Toxins : Functional medicine practitioners may assess exposure to environmental toxins (like heavy metals) and implement detoxification strategies to reduce the toxic load on the body, which might help in reducing MS symptoms. 6. Lifestyle Modifications Exercise and Movement : Regular, moderate exercise tailored to the individual's abilities can help maintain muscle strength and improve mobility, while also reducing fatigue. Sleep Optimization : Improving sleep quality is another focus, as poor sleep can worsen MS symptoms. 7. Targeted Supplementation Immune System Modulation : Specific supplements might be recommended to modulate the immune system, reducing the intensity of the autoimmune response that characterizes MS. Neuroprotection : Supplements aimed at protecting nerve cells and reducing oxidative stress may also be part of the treatment plan. 8. Holistic Approach Whole-Body Focus : Functional medicine views the body as an interconnected system, so treatment often involves addressing multiple aspects of health simultaneously, rather than focusing solely on MS symptoms. By taking a holistic, individualized approach, functional medicine aims to improve the quality of life for people with MS, potentially slowing disease progression and alleviating symptoms. However, it is essential for individuals to work closely with both their conventional neurologist and a qualified functional medicine practitioner to ensure a safe and effective treatment plan.

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