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

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/