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WHAT? DO YOU MEAN THAT THE ILLNESS I’VE BEEN DIAGNOSED WITH CAN BE REVERSED?? YES!

By Dr DV, Dushyant Viswanathan, MD, ABIM, ABOIM, AACE

CCIM Medical Director

My heart goes out to all people who are struggling with daily symptoms, physical complaints, illnesses, which if they’ve been going on for longer than 3 months, I’d call chronic. Sometimes people find themselves in the hospital with an acute exacerbation of a chronic illness, or they find themselves in the hospital being diagnosed with a serious illness even though they had no prior complaints. It happens every day, and it usually is very scary and anxiety-provoking.

People in this situation want to “get better,” and this is the fundamental intention behind whatever treatment plan their doctors or the medical system provide. Doctors usually provide statistics from clinical trials to substantiate a decision to provide a treatment, but CANNOT promise that a patient will “get better.” Nor is the concept of disease reversal ever discussed with patients in the mainstream medical setting. Again, even the experience with doctors is usually confusing, anxiety-provoking, and scary.

Typically the treatment plan involves surgery, drugs, radiotherapy (for cancer), devices (such as pacemakers, prosthetics, etc.), or extensive physical rehabilitation programs. These treatments each are developed by multi-million dollar industries and are substantiated by clinical trials that occur in very controlled settings. Doctors essentially match a treatment to a disease and facilitate the execution of the treatment.

Yet the fact of the matter is that with very few exceptions, most patients do not “get better.” Even if one illness (such as cancer) improves, another one (such as heart failure, pneumonia, etc) manifests soon thereafter. Too many people suffer this way- one thing after another. The reason this happens is because simply matching a technology-driven treatment to a disease isn’t enough to address the complicated and nuanced aspects of human physiology and pathology.

All of this sounds like bad news. Very depressing. However, I come as the bearer of good news. What I want the reader to know is that many diseases are reversible. Not just be on medications for life. Not that. What I mean is that the illness can go away. This is about possibility-driven thinking.

There is a process that led to the illness in the first place, and there is a process that leads to the healing. It is that simple. My patients see themselves as dynamic participants in their experience, in their medical care, rather than as static sufferers doomed from the start. When we complete a diagnostic workup and we understand the causes of symptoms, then our next step is to say,

Well, the good news is, this is totally reversible. Let’s talk about how to do that.”

When my patients hear this, they find it a natural response to the problems they are experiencing. All medical conditions are either reversible or irreversible. An experienced doctor will be able to communicate without delay whether a particular clinical condition is reversible or not. In my case, as an internal medicine physician who specializes in enteroimmunology and endocrinology for patients in the community, in the hospital, in nursing homes, and at home, I identify immediately whether a medical condition is reversible or not. And then I proceed getting to work helping a patient reverse their illness.

You, as a patient, can have this conversation, in fact, you must! Make your physician accountable for this, and seek out reversibility of illness now! That opportunity is available to you now!

It is because I can have this conversation, engage this journey, with my patients that I love my work as a doctor so much. I see other doctors watch their patients slowly deteriorate over time, mostly because there is no plan of action addressing reversing the illness; meanwhile my patients’ health visibly improves; they not only get to the point having no symptoms but also achieve their health goals. I speak at conferences presenting my patient cases as examples of how to reverse illness.

The culture we create with our patients isn’t about aggressive treatments to destroy illness; rather, it is about intelligently and with a nuanced sensibility optimizing physiology, leading to improved organ function, eradication of inflammation, improved metabolism, and improved vitality and lifestyle. As a side effect of improving and optimizing the immune system, illness/symptoms go away, and wellness persists. Why the American public doesn’t expect treatments to reverse the underlying causes of illness is something that I still do not understand. Thankfully there are physicians available committed to exactly this. That is the only medical treatment I would want for my family and loved ones.

Dushyant Viswanathan, MD, ABIM, ABOIM, AACE
21900 Burbank Blvd. #300 Woodland Hills, CA 91367
10320 Little Patuxent Pkwy Ste. 200 Columbia, MD 21044
74075 El Paseo # B2, Palm Desert, CA 92260
1-888-250-CCIM
1-844-233-7639 (f)
ether@ccimhealth.com
ccimhealth.com

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About Dr. DV & CCIM:

Dr. DV, Dushyant Viswanathan, MD, ABIM, ABOIM, AACE, is Medical Director of The Columbia Center for Integrative Medicine (CCIM)

Mission statement:

It is with utmost humility that I accept the privilege to be of service, providing medical care for you. My work and intent is to provide sustainable, lasting solutions leading to true healing, by addressing and resolving the underlying causes of illness; once this is achieved, coherent strategies aimed at longevity and optimization of health are implemented. I am grateful to CCIM for providing me a platform by which my protocols can be of service, and I am grateful to you to be given an opportunity to be of service. CCIM makes use of a wide range of tools (pharmaceutical, compounded, naturopathic, lifestyle, nutritional, mind-body) in the creation of customized treatment programs after exhaustive diagnostic testing. The cardinal rule firstly is to do no harm, and secondly is to be effective.

Dr. DV is a dual board certified integrative internal medicine specialist and is licensed to practice medicine in California and Maryland. Prior to medical training, he worked as a physical trainer and Yogatherapist. He studied biological sciences and philosophy at the University of California, Irvine, pursued medical school at St. George’s University School of Medicine, and internal medicine residency at the University of Maryland Medical System. He formed CCIM in late November 2012. Dr. DV also is a classically trained musician, plays Veena and piano, and focuses on composition.

The Columbia Center for Integrative Medicine, LLC (CCIM) is a holistic wellness and medical center with offices in Columbia, MD, Palm Desert, CA, and Woodland Hills, CA. CCIM specializes in reversing, preventing, and treating chronic medical illness in the scope of internal medicine, via customized high-quality CCIM programs tailored to the individual needs of patients and clients. CCIM was born in late 2012 in Columbia, MD, as a partnership between Dr. DV and a physical therapy practice, focusing initially on treating chronic pain. CCIM has grown in direct proportion to Dr. DV’s growth and skill in integrative medicine, and now offers multiple highly useful programs such as Women’s Endocrine Health, GI Detox & Restoration, Type 1 Diabetes, Reversing Diabetes and Heart Disease, Immune Restoration, Pain Resolution & Joint Restoration, Kidney Stone Reversal, and Brain Chemistry Balancing Programs.

In 2013 CCIM was awarded “Top Integrative Internal Medicine Specialist in Maryland” by the International Association of Internists. In 2014 having opened offices in California, CCIM initiated a hospital contract with Desert Regional Medical Center in Palm Springs, MD, and in 2015 was awarded “Top 10 Holistic Doctor in LA” by Caster Magazine.

Today CCIM has hundreds of patients on both coasts and is enthusiastically accepting new patients.

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OPTIMIZING EFFECTIVENESS IN MEDICAL PRACTICE: IT’S ALL IN THE DETAILS!

By Dr. DV Dushyant Viswanathan, MD, ABIM, ABOIM

Principle: From a physician’s perspective, the ultimate purpose of the encounter with the patient is to formulate an assessment that leads to a plan of action, the execution of which leads to resolution of the complaints and symptoms which necessitated the encounter in the first place.

The fact that the majority of medical practices in the country today do not adhere to this principle is a problem which may contribute to the extraordinary burden of unresolved and progressive chronic illness among our fellow man. In the 20th century, medical practice transformed into an industry in which symptoms and human suffering are coded via an outdated and obsolete system, made financially profitable by a massively bureaucratic reimbursement system, then treated using pharmaceutical drugs that were proven to be effective during highly controlled clinical trials, (which are often funded by the companies that make the drugs themselves), trials that frequently do not replicate realistic clinical scenarios.

Totally absent from this all-too-common pattern are assessments of the patient’s health as a whole, and the presence or absence of physiological imbalances which predispose to certain illnesses. As a result, medical care is never proactive, and patients frequently experience illness after illness, affecting different organ systems progressively, and often this is complicated by depression, poor quality of life, disability and debility, and simply put abject human misery. Many doctors don’t even harbor the idea of reversibility of illness, simply because they’ve never seen it; they are the harbingers of negativity, false hope, and/or lack of hope. As a consequence, a major sector of the general public views doctors as simply agents of Big Pharma; people in whose “care” your health just might get worse.

As an internist specializing in integrative medicine, my goal is to strictly, even religiously, adhere to the principle stated at the beginning of this article: resolution of symptoms, optimization of health, and high quality of life are my pre-eminent clinical goals. This philosophical framework and the workflow required to make this happen in the day-to-day reality of our medical practice help ensure success and excellent patient outcomes. The specific aspects of this workflow will be the subjects of several articles I will write on the topic of Optimizing Effectiveness in Clinical Practice.

Of utmost importance to our medical practice is our practice to spend a lot of time with patients and be extremely detail oriented. The more information I have about a patient, the more likely I can be of service. How does one obtain such details? In comprehensive encounters, often taking 3-4 hours in length. At CCIM a physician on a busy day will see 4-5 patients in a 12 hour day, to allow for plenty of unrushed time for each encounter. A new patient typically will spend 2-4 hours with the physician and staff; usually, the patient leaves feeling better than when they came in, simply because of the high quality of experience; every detail about their health and concerns will be addressed and included in the comprehensive assessment.

While it is important to have a very comprehensive encounter, (typically I’ve already looked over past records, labs, and answers to an intake questionnaire even before the 1st encounter), it is vitally important to obtain a detailed life history and perform the complete physical examination. There are so many clues in a person’s medical history which suggest possible underlying physiological imbalances that require iteration. I take an extraordinarily detailed history, often going chronologically from early memories of childhood. Slowly over the course of the encounter, a holistic picture comprising physiology, emotional body, and psychospiritual being begins to emerge.

We get to know every detail about our patients- their relationships, their eating habits, their psychosocial issues, and their emotional history. We take time to make sure that we are on the same page when it comes to our goals. Eventually, lab testing is typically warranted, results of which are placed in context of the assessment and clinical picture to further its completeness. What eventually emerges is a holistic picture of patterns of behavior, physiology, and perceptions which are the ultimate causes of symptoms. Our customized treatment programs take all of this into account and are designed to resolve imbalanced patterns. When physiological and psychospiritual cycles and patterns are optimized as a result of the customized treatment patterns (this is measurable), symptoms go away, and patients feel better.

When people feel better, they realize they are capable of joy, of a high quality of life, of healthier relationships, and as a consequence, their spirituality and interest in proactive life and health choices typically burgeon. We have programs customized for people focused on longevity and wellness; they are no longer sick, and want to stay happy, healthy, and well into their elder years. These people have given us opportunities to serve them, and as a result of our work with these patients, we have been invited to speak at the Age Management Medicine Group Conference in Las Vegas in November of this year https://www.agemed.org/November2015/tabid/1342/language/en-US/Default.aspx

What is extraordinary for me as a physician is to participate in each patient’s healing trajectory, observe them become well and proactively stay well while optimizing their quality of experience.

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WE SPECIALIZE IN WOMEN’S HEALTHCARE

By Dr. DV, Dushyant Viswanathan, MD, ABIM, ABOIM Medical Director, The Columbia Center for Integrative Medicine (CCIM)

As an integrative internal medicine specialist, it is indeed an honor and a
privilege to be of service to my female patients. Approximately 90% of my patients are women, and as a result of working closely with them to optimize their health, what we witness routinely are beautiful stories of healing, wellness, reversal of illness, and proactive approaches to health and life in general. An alarming number of women over fifty in this country have hypothyroidism, and I am so impressed that my female patients are very interested to learn how they can heal, improve their physiology and health, and get to the underlying cause of hormone, gastrointestinal, psychospiritual, autonomic, and neurologic imbalances. The thyroid is just the beginning of the story. Our Hormone Balancing program starts with a comprehensive assessment including an initial encounter which may range from 2-4 hours, and close follow up thereafter. When indicated we pursue specialized hormone diagnostic testing using blood, saliva, urine, and stool samples which provide an abundance of data that can be used to articulate the underlying physiologic causes of symptoms. Simply put, we specialize in understanding the root causes of symptoms.
Although we start typically by assessing physiology, what ends up happening is an unfoldment of the true entirety of the person; we put together psychospiritual, nutritional, and emotional health assessments to fully round out the picture. As a result, our patients feel that we truly understand what they are going through and that we can help them achieve their goals. Once the assessment is complete, we make use of our specialized therapies and programs to be of service to our patients. All therapies are customized to the particular nuances and goals of each patient.

Therapies include:

  • Bioidentical Plant-based Hormone therapies prepared by the most experienced
    compounding pharmacists in the country
  • Certified Pure Therapeutic Grade Essential Oil therapies with customized
    protocols
  • Integrative Alchemy and Perception Reframing Strategies
  • Customized Clinical Yogatherapy
  • YogaSCULPT (healthy weight loss and muscle toning)
  • Micronutrient Therapies (isotonic, injected, bioavailable, pill)
  • Compounded Pharmaceutical therapies (if necessary)
  • Customized Nutritional Meal Planning featuring functional food
    based/phytohormone rich foods.
  • Medical Grade Naturopathic Herbal formulas
  • Lifestyle, Hormone, and Micronutrient therapies to reverse diabetes and insulin
    resistance
  • Gastrointestinal Detox & Restoration

Our weight loss program is called CCIM SCULPT and involves high-quality burst-type interval physical training, micronutrient-dense, YogaSCULPT, high-fiber variation of the ketogenic eating strategy, growth hormone or HCG therapy, amino acid therapies. However we only accept patients into this program after they have optimized their physiology, balanced hormones, optimized their food intake, optimized cellular health, resolved fatigue (and therefore started exercising), optimized sleep, and resolved adrenal fatigue (hypocortisolism / hypercortisolism). So as the reader can see, we get very deep with patients, and stay right with them throughout their healing journey. Our Integrative Alchemy program works with patients to create customized self-care and wellness plans which are inherently proactive and useful for day-to-day life. Strategies in this program include the use of essential oils for topical, aromatic, and internal use, mindfulness practices, customized clinical Yogatherapy protocols, and strategies to optimize both connection and belonging (two essential components of our Adrenal Restoration Program). As a result of optimizing physiology, emotional health, psychospiritual health, and social connection/belonging, our patients enter a state of optimal alignment, something we call Coherent Harmony. They are at their goal weight, have glowing skin and hair, have satisfying sexual lives, have excellent relationships; they honor their truth and authenticity; they accept the past, and embrace the totality of life. They are amazing grace. And the truth is that they get the credit- they did the work, they moved towards empowerment, unfoldment, and upliftment. They are what we all can be- superstars. I see my own mother, sister, wife, and daughter in each of them. Truly it is an honor to be of service to the goddess within each woman.

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BENEFITS OF COMPOUNDED BIOIDENTICAL HORMONE BALANCING

By Dushyant Viswanathan, MD

Medical Director, The Columbia Center for Integrative Medicine

INTRODUCTION

As a medical doctor, I am seeing an increasing number of people who come to me complaining of symptoms which are caused by hormone imbalances. There are countless explanations for this epidemic in hormone imbalances- some point at poor nutrition, poor soil quality, high stress, poor lifestyles, etc; regardless of the fundamental cause (a topic for another article), what is clear is that hormone imbalances are a major cause of illness.

For example, diabetes is a complicated illness originating from hormone imbalances related to the small intestine, and later from insulin resistance. Obesity is related to leptin resistance. Both insulin and leptin are very important hormones. Hypothyroidism is very common; most women over age 60 have some degree of thyroid dysfunction. Adrenal insufficiency is very common; many people who complain of chronic pain and fatigue have inadequate cortisol levels, which can impair immune function, and ultimately lead to worsened thyroid function. Vitamin D deficiency is a rampant epidemic recently. Low testosterone in the setting of high estrogen levels is very common in men and is the likely cause of the epidemic of prostate cancer in older men. All of these hormone dysfunctions, if untreated, lead to weight gain, early arthritis, poor endurance, all of which ultimately lead to life-threatening issues such as atherosclerosis (clogged arteries) and cancer.

As a result of my comprehensive hormone testing and balancing program at The Columbia Center for Integrative Medicine, my patients experience improved health, weight loss, improved brain function, increased exercise capacity, better sleep, and are consequently equipped to exercise, handle stress, eat healthy, lower inflammation via healthy lifestyles. Many have returned from disability back to work. Absolutely none of the patients enrolled in our program have had worsened health or side effects of therapy.

PHYSIOLOGY AND BIOCHEMISTRY ARE RELEVANT

Is there a mystery to all this? Some mystic explanation for this approach to clinical medicine? Absolutely not. Integrative physicians, and many naturopaths are deeply interested in basic physiology and biochemistry. The clinical goal is the restitution of optimal physiology and cellular metabolism. When such a situation is achieved, health is improved, symptoms are lessened, and quality of life is enhanced. This is a basic principle to all healing systems throughout the world, since Galen and Hippocrates.

Medical school did well to teach physicians pathology, the specifics of disease states, and the science of pharmacology. These are all essential. However, to provide high-quality clinical care to people in the community, it is essential for physicians to be trained (as I was) in clinical nutrition, biochemistry, and physiology, to better understand how concepts such as cellular metabolism are relevant to the patient seen in the office. Basic medical training plus integrative training leads to high-quality service.

HORMONE SYSTEMS ARE INTER-DEPENDENT

All too often I have people come to me complaining of having ongoing symptoms of hypothyroidism despite being on high dose Synthroid (Levothyroxine), which is synthetic free T4 (inactive thyroid hormone). These patients are seen by physicians who do not test for adrenal insufficiency, who do not aggressively titrate up Vitamin D levels, who do not have formal weight management programs, who do not treat nutrition with much importance, and who do not check the free T3 level (measurement of active thyroid hormone). As a result, the patients have ongoing symptoms. A large percentage of people in my hormone balancing program have come to me frustrated by the lack of thorough care from their endocrinologists and primary doctors.

A major contributing factor to this discrepancy in clinical care is an ongoing, aggressive paradigmatic difference between endocrinologists and integrative physicians. Endocrinologists generally treat thyroid physiology, estrogen metabolism, adrenal physiology, and insulin resistance as clinically separate issues. This is likely because pharmaceutical drug management of these issues requires this ideological stance. For example, there is a drug (Synthroid) for hypothyroidism and another drug (insulin) for diabetes. The paradigmatic emphasis on pharmaceutical treatment prevents endocrinologists from piecing together seemingly disparate aspects of hormone physiology into a syncretic whole.

Whereas integrative physicians such as myself see the various hormone systems as mutually inter-dependent and inter-connected. This approach is substantiated by basic human physiology and biochemistry. For example, cholesterol is the precursor to all steroid hormones. If you drop cholesterol levels, you will drop Vitamin D levels, which will precipitate insulin resistance (leading to diabetes) because of the importance of Vitamin D in regulation of cellular metabolism. Consequently, recent clinical trials have revealed that statin drugs put people at risk of developing diabetes. Another example- impaired cortisol secretion (demonstrable by saliva testing of cortisol) will lead to a drop in progesterone levels (because progesterone will be shunted into the pathway to make more cortisol), leading to elevated unopposed estrogen levels; this relative increase in estrogen will increase thyroid-binding globulin, which will bind thyroid hormone, taking it away from physiologic roles, leading to a measurable decrease in blood thyroid hormone levels, leading to hypothyroidism and its symptoms. This is basic physiology. Consequently, as part of a thorough hormone workup, it is important to check Vitamin D, estrogen, progesterone, testosterone, cortisol, free T3, free T4, and hemoglobin A1C levels. When all of these different hormones are balanced, people feel better and are better equipped to exercise, eat healthy, manage stress, and achieve peace of mind as a result of their mindful lifestyles and attitudes.

DIAGNOSIS

After a comprehensive history and physical exam, testing is mandatory. This is because one cannot simply guess about hormone status, and which hormone imbalance is causing which particular symptom. The basic principle for hormone testing is as follows:

  1. Water-soluble hormones (25-OH Vitamin D and thyroid hormone) are well measured in blood since they are freely circulating in blood
  2. Lipid-soluble hormones (that derive from cholesterol) are well measured in urine and/or saliva since binding proteins carry them in blood, and so blood levels aren’t accurate. More recent assays for unbound levels of steroid hormones may make up for this discrepancy. However plentiful evidence indicates that saliva testing is accurate, specific, and sensitive, and conveys more accurate information about HPA axis physiology than does blood testing (Clinical Endocrinology Volume 63, Issue 3, pages 336–341, September 2005)

TREATMENT

Treatment for hormone imbalances firstly emphasizes lifestyle. Generally, I begin by advocating a micronutrient-dense no-glycemic diet that lacks gluten and dairy, tailored to the palate of the patient, and I have my nutritionist work closely with the patient to address meal plans. Weight loss programs are useful as well because close supervision makes it easier for people to achieve their goals. I use the Ideal Protein program or Transitions Lifestyle System, both of which are predicated on the same principles of no-glycemic food intake.

Next, I make use of an exercise therapy (ET) program that is based on the principle of interval training. My ET program can be billed through physical therapy, and is very effective and enjoyable for patients at CCIM; they don’t have to join a gym and they can feel protected knowing that medical professionals are monitoring their exercise.

Next I make use of bioidentical hormones compounded by my pharmacist. In Maryland, I work closely with Brian Trentler, chief pharmacist and compounder at Hunt Valley Pharmacy, in Hunt Valley, MD, which is just north of Baltimore. He has 20+ years working with compounded formulations and simply put, my patients love him since he is prompt, is willing to ship formulations to peoples’ home, and is a great teacher.

In addition to bioidentical hormones, I make use of proprietary blends containing glandulars, nutraceuticals, and micronutrients, depending on the clinical situation. For example, B vitamins, melatonin, magnesium, and adrenal adaptogens are useful to treat adrenal disease. Selenium, iron, and iodine are useful to treat hypothyroidism with a low free T3. Pygeum and zinc are useful to treat prostate disease, etc.

DISTINGUISH BETWEEN SYNTHETIC AND BIOIDENTICAL

For those people at risk for breast cancer and who are daunted at the concept of using hormones because of the elevated risk of cancer and heart disease in people using synthetic hormones, it is important to know that there are major biochemical differences between synthetic hormones and bioidentical hormones. They have different effects on the body. For example, synthetic progestin increases the risk for bloating, blood clots, and heart disease, while bioidentical progesterone has no such side effects, and in fact protects people from these issues, just as our own endogenous progesterone protects us from heart disease, bone disease, and blood clots. See references below for more information about this. Please note that only you and your physician can decide what the right treatment for you is. This article is NOT a substitute for customized care tailored to your needs, created by your physician.

PHYSICIAN – PHARMACIST RELATIONSHIP

What is very important is the relationship between the prescribing physician trained in hormone balancing and the compounding pharmacist with experience in creating compounded formulations. I have been working with my pharmacist since the opening of my office, and his professional practice is in harmony with the high quality attention to detail that I expect in my medical practice.

REFERENCES

Could Transdermal Estradiol + Progesterone be a Safer Postmenopausal HRT? A review. L’Hermite M, Simoncini T, Fuller S, Genazzani AR. Maturitas. 2008 Jul-Aug; 60(3-4):185-201.

A review article that compares the use of non-orally administered HRT and advantages to the cardiovascular system compared to the more conventional oral hormones. Further review compares progesterone to synthetic progestins, and finds that their effects are vastly different with respect to breast cancer risk.

Cardiovascular Effects of Medroxyprogesterone Acetate and Progesterone: A Case of

Mistaken Identity? Hermsmeyer RK, Thompson TL, Pohost GM, Kaski JC. Nat Clin Pract Cardiovasc Med. 2008 Jul;5(7):387-95. Epub 2008 Jun 3. Review.

Natural hormone therapy for menopause. Mahmud K. Gynecol Edocrinol. 2009 Aug 19:1-5.

Study of 189 women were administered bioidentical estrogen plus progesterone with or without DHEA and testosterone and followed for 12 months. 97% of women experienced varying degrees of symptom amelioration including improvement in mental symptoms and weight loss. Complications common to traditional HRT were not seen.

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BEAUTY AS A SYMPTOM OF COHERENT HARMONY ™

By Dushyant Viswanathan, MD, ABIM, ABOIM, Medical Director of The Columbia Center for Integrative Medicine (CCIM)

March 8 2013
Published in Your Health magazine

From my perspective as a holistic physician, beauty from the inside out is achieved by optimizing function of the physical, mental, emotional, and spiritual systems in our lives. Optimizing occurs by systematically removing dysfunctions, and improving functionality in these different aspects. When all four systems are working optimally, people enter a state of “coherent harmony” which manifests with clearly noticeable beauty, happiness, peace of mind, health, and longevity. Beauty, in a sense, is a symptom of such harmony.

We may notice those individuals, who exist in a steady state of harmony, and we can’t help but wonder about their habits, their self-care, and their secret to have that certain “glow” from the inside out that make them seem beautiful. Their beauty is apparent in their speech, their movement, their skin, their attitude, their grace. We know that such beauty is both spiritual and physical at once; no wonder since from the perspective of integrative holistic thinking, soul and body are two aspects of the same phenomenon: the human experience.

So what I want to discuss here are the methods used to help you optimize the four systems mentioned above, which lead to coherent harmony and beauty. Any program of healing should be uniquely tailored to your needs, so please contact me directly to personalize these methods for you.

Firstly, any program aiming to optimize function must emphasize the following:

  1. minimize inflammation
  2. maximize cellular health

We need to minimize the intake of toxins: not smoking, and not eating processed foods are a good way to start. It is advisable to replace processed foods with a plant-based diet as espoused by the Mediterranean / Anti-Inflammatory / Ornish diets. Prepare food at your own home with your hands, with loving intentions, from organic / farmers market / local sources.

If you have chronic inflammation, make sure that you have formal evaluation of your GI (gastrointestinal) function. Depending on results of testing, you may require a detox program to heal your gut or liver; this may require the use of specialized diets. For example, if you have acidic pH and candida in your gut, you would temporarily need an alkaline, anti-fungal diet until the gut is healed. If the gut and immune systems are healthy and toxins are minimized, then metabolism and cellular health improve.

Next, to optimize heart, brain, lung, and vascular function, it is advisable to engage in regular enjoyable exercise and to enhance micronutrient intake. Firstly a word about exercise: the evidence that exercise benefits organ function is considerable. The key thing to remember about exercise is to slowly increase the intensity of the exercise over time. For example, if you walk one mile in 15 minutes today, slowly walk faster every day- walk the mile in 14 minutes tomorrow, in 13 minutes the next day, etc.

Micronutrients are essential in optimizing organ and overall physical health. Different organs need various amounts of micronutrients. For example, the thyroid needs selenium, the heart needs magnesium, the GI tract needs zinc, the liver needs choline, etc. I recommend isotonic delivery systems to maximize micronutrient absorption because I am unconvinced that pills available over the counter at vitamin stores get absorbed into the bloodstream. Besides vitamins, minerals, and cofactors, other important micronutrients include amino acids, omega 3 fatty acids, phytonutrients, and short chain fatty acids. Naturally, a micronutrient-dense diet will help considerably.

In addition to micronutrients, hormone function is important as well. Specifically, function of the thyroid and adrenal glands, and hormones such as leptin, insulin, cholecalciferol (Vitamin D), testosterone, estrogen, DHEA, and progesterone need to be optimized to achieve our beauty goals. Hormone balancing improves blood flow to the skin, reduces wrinkles (specifically compounded estriol), improves metabolic function (specifically Vitamin D and progesterone), and enhances youthful appearance and energy levels.

Ok, so now you are minimizing and removing toxins, lowering inflammation, taking in the right food and micronutrient fuel, have balanced your hormones, and are exercising. Physical optimization is moving in the right direction. Next step is to integrate mental and spiritual systems into the program. The easiest way to do this is with yoga or some martial art tailored to your needs and capabilities, in which mindfulness, concentration, breath, and body are “yoked together” in one activity that can be practiced daily. On a personal note, I cannot emphasize enough how much the practice of yoga and pranayama transformed my life, improving my mental, physical, social, and spiritual well-being. It was amazing to discover how my own breathing patterns could exert control over my heart rate, blood pressure, stress level, anxiety, etc. I think any martial art or tai chi also serves this purpose. We all know those regular practitioners of yoga who have a certain glow to their step- that’s beauty from the inside out.

Also essential for optimization of mental and spiritual systems include the following: feeling connected to community and family, having a sense of purpose in life, having a sense of spiritual connection, addressing past traumas (counseling and journaling are quite helpful) and being compassionate to one’s own emotions.

Emotional optimization is perhaps the most complicated of all since what we are talking about is the deepest, most private space that contains our vulnerabilities and frailties. Isolation, selfishness, fear, insecurity, and unexpressed frustration all weaken our emotional health and are detrimental to our mind, body, and spirit; these take us away from coherence and manifesting our beauty.

Methods to optimize emotional health include the following:

  1. Perform 1 act of kindness daily. This is an amazing method that can improve emotional health immediately.
  2. Perform 1 act of relaxation daily. This can include pleasurable activities, laughter, or anything that promotes joy and peacefulness
  3. Assess what it is in your life that brings you joy. If you discover that you don’t have any activity that brings joy, make addressing this a priority. Human beings need joy the way plants need water.
  4. Minimize toxic relationships
  5. Be compassionate towards your own feelings. Rather than judging them or being too cerebral about them, allow them to be noticed. Communicate with sentences that start with “I feel…”

We all have emotions, and these emotions keep us connected in a truthful way to our lives. Our emotional world is a barometer of overall health. Make yours a priority!

Optimizing the physical, emotional, mental, and spiritual aspects of our lives leads to coherent harmony, a dynamic state of order in which we are in balance with our lives. We can even handle imbalances and stresses well in such a state because we are equipped to deal with what life expects out of us. Our bodies, minds, emotional contours, and soul become equipped to be united together in the act of living life. In coherent harmony, we are happy, at peace, connected, helpful to others, and beautiful to behold.

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LIFESTYLE SHOULD BE FIRST-LINE TREATMENT IN CARE OF CHRONIC DISEASE

By Dushyant Viswanathan, MD | November 2, 2011

Over the past 100 years, we have seen the progressive advent of chronic medical illnesses such as systemic atherosclerosis, cancer, heart disease, kidney disease, and metabolic syndrome that is directly concordant with increasingly unhealthy lifestyles. Specifically, I refer to high stress, sedentary habits, and the ingestion of processed foodstuffs high in animal fat and synthetic chemicals. Every chronic illness we see today can be linked to the unhealthy lifestyle. Even with respect to cancer, only less than 5 percent of cancers are purely genetic in origin; the remainder is caused by damage to genes from insults that come from outside of the cell nucleus. Therefore, the theme of this column is to discuss essential aspects and emphasize the importance of the healthy lifestyle.

The healthy lifestyle is no secret to humanity nor to physicians; it has been the indubitable and reliable source of healing for thousands of years, and has been discussed by our ancestors and their physicians. Hippocrates said, “Walking is man’s best medicine; leave your drugs in the chemist’s pot if you can heal the patient with food.” More recent experts are in agreement. Dr. T.Colin Campbell of Cornell University has compiled a considerable amount of data attesting to the toxic effects of a processed meat and dairy rich diet, and the therapeutic benefits (unequalled by any medication) of a plant-based diet. Dr. Dean Ornish of the University of California, San Francisco has published data in numerous journals detailing how a comprehensive healthy lifestyle can not only prevent illness, but also reverse prostate cancer and ischemic cardiomyopathy.

Yet the majority of allopathic physicians rely almost exclusively on pharmaceutical drugs to treat medical illness. Simply put, this is colossally inadequate. Patients who receive care from allopathic physicians rarely heal, they become progressively sicker, and increasingly turn towards alternative and complementary forms of medicine: indeed the wellness industry has now blossomed into a trillion dollar industry.

My thesis is that the healthy lifestyle should be the first line treatment for any illness, and should be the first line of prevention for anyone who is headed for illness. In addition to having more substantiating data than any therapeutic modality known to mankind, the healthy lifestyle is exactly the lifestyle practiced by humans for millennia. Ingestion of fresh vegetables, fruits, legumes, grains, fresh lean meats, being highly physically active, responding to stresses but not holding onto the mental impressions of those stresses thereafter, a sense of belonging to one’s social network as well as to one’s land, a healthy emotional life, and a sense of spiritual connectedness, continued learning even into one’s elder years, and perhaps most important, a sense of having a purpose in one’s life, are all components of the healthy lifestyle that will be explored here and in future essays.

Pathophysiologically all of this makes sense: to survive, the human organism must have healthy organs and tissues, including bloodstream. The buildup of toxins, remodeling hormones, inflammatory cytokines, heavy metals, and free radicals have been shown to be etiologic in the pathogenesis of most chronic illnesses plaguing our brethren today. These substances lead to disease at the cellular level, and DNA is frequently damaged. This is why there are alarming rates of increased cancer incidence in the world today, significantly increased compared to even a few decades ago. This is explained because as a species we have moved away from the healthy lifestyle espoused by our ancestors, the lifestyle essential for existence as a human being.

Sociologically and from a systems perspective, this makes sense as well. Major companies are realizing this and incentivizing their employees to quit smoking and practice the healthy lifestyle. Insurance companies should also fix premium rates according to lifestyle issues (especially now that pre-existing conditions cannot be a reason to deny insurance). Hospital administrators should institutionalize the healthy lifestyle, as it has been proven repeatedly to be the best method for healing chronic illness. A healthier person is less likely to be medically expensive, and even a very sick person who has acutely improved lifestyle and diet is less likely to have complications than a comparable sick person who has not made such changes. A simple and inexpensive method that can be done now is to change the food given to patients in hospitals and nursing homes. The only food that should be served in such settings is plant-based, whole-grain diets with no dairy or meat.

It is common sense, isn’t it? Well, it isn’t so common. This necessitates the writing of this essay. I write this with an extraordinary sense of urgency. As an internal medicine specialist working in an urban American hospital, all I see are diseases related to lifestyle. These diseases are not managed adequately by most physicians who simply prescribe pharmaceutical drugs. People are getting sicker, more depressed, and have a worsened quality of life when chronically ill. Medicare expenditures are rising in a failing attempt to meet this crisis. It is finally time to pay attention to the obvious. We must make comprehensive lifestyle changes the cornerstone of healthcare today.

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THE IMPORTANCE OF DISCUSSING MICRONUTRIENTS WITH YOUR PATIENTS

By Dushyant Viswanathan, MD | September 7, 2011

Human beings, like any primates, require micronutrients for optimal cellular health. Cellular health, in turn, is necessary for organ system health and overall organismal health. There is considerable epidemiologic and retrospective evidence to indicate that insufficient micronutrient intake is an essential etiologic factor in the pathogenesis of the chronic disease and obesity epidemics that are threatening to overwhelm our species.

By micronutrients, I refer to essential cofactors, enzymes, vitamins, minerals, substrates, amino acids, nucleic acids, and fats that are the basic fuels that power each individual cell. I refer to cobalt, phosphatidylcholine, chromium, manganese, acetyl cysteine (Drug information on cysteine), cholecalciferol(Drug information on cholecalciferol), ascorbic acid(Drug information on ascorbic acid), zinc, glutamine, etc. When the human being doesn’t eat enough of such basic fuels, maladaptive physiologic processes occur due to cellular stress and disease. Such stress goes on to affect multiple organ systems and physiologic processes. For example, relative cobalt deficiency leads to gastrointestinal estrogen loss. This is significant to the millions of post-menopausal women dealing with estrogen insufficiency. Another example is inadequate anti-oxidant intake which leads to oxidative stress that overwhelms mitochondria. The net effect of such cellular disease is the release of inflammatory cytokines, another maladaptive mechanism which leads to more disease. It is now understood that chronic inflammation due to cellular stress and influenced by epigenetic mechanisms is the basic cause of all diseases of our modern world, from atherosclerosis to cancer.

Unfortunately, it is not known how much micronutrient intake is optimal for a human being. Plentiful evidence indicates that the USDA underestimates RDAs (recommended daily allowances). This doesn’t surprise me since it is no secret that the USDA is deeply connected to the food industry powers that be. Political corruption and market realities aside, it is imperative that physicians, especially internists, educate themselves and their patients on micronutrient science.

From a 2003 article in Comparative Biochemistry and Physiology:

Among primates, the great apes are most closely related to humans, and considerable data indicates that we shared a common ancestor 7 million years ago. The natural diets of wild orangutans, chimpanzees, and gorillas are composed almost exclusively of plant-based foods (>97%)… fruits available in the jungles of Panama, Samoa, and Cameroon contain more potassium, calcium, and phosphorus than do cultivated fruits available in the USA …Howler monkeys take in significantly higher quantities of minerals compared to human RDAs (recommended daily allowances). A 7kg howler monkey, for example, will consume 600g of fruit and 400g of plant material, which together yields 614mg of Vitamin C. The human RDA for Vitamin C is 70mg for a 70kg human…

I have two take-away points from this article: First, that processed/cultivated foods are nutritionally depleted compared to fresh/wild counterparts, and second, that humans do not eat enough micronutrients. Regardless of what the USDA tells people to do, the above evidence should speak for itself. Let me be clear: the USDA’s recommendations are nothing more than either corrupt untruths or quackery pseudoscience.

Even if we don’t know the micronutrient constitution of every edible thing in our lives, physicians must be able to provide basic common sense advice about micronutrient intake. The analogy I use when I speak with my patients is that of “putting fuel in one’s system.” Any of my patients acknowledge that pouring water or soda into a car gas tank is inappropriate and that the outcome of such an action is obvious. The same applies to the human body. The human body requires the proper fuel — that fuel is rich in micronutrients found in vegetables, whole grains, fruits, fresh water, herbs, roots, and lean meats including fish. I especially adore the micronutrient treasure-troves found in yams, squash, beets, lentils, and shitake mushrooms.

Micronutrients are noticeably absent in processed foods, junk food, processed red meats, packaged foods, and in foodstuffs containing carcinogenic substances such as high fructose corn syrup, phosphoric acid, indigestible starches, and meal replacements: all human-made food-like substances that cannot be called “food.” The fact that most American adults cannot define what real food is, and that food-like substances such as hot dogs suffice for their needs, boggles my mind to no end. This is what I call a dangerous cognitive discrepancy.

This cognitive discrepancy is something that requires medical intervention. It is by addressing this cognitive discrepancy that the physician can be of most service to his patients. Unfortunately many industries- the fast food, processed meat, GMO (genetically modified organisms), soy, and corn industries — profit by the perpetuation of this cognitive discrepancy: by American consumption of micronutrient-depleted food-like substances. This socioepidemiologic fact is heartbreaking, and I fight it every day.

But every day there are more obese children, more debilitated elders, more chronically ill people living pain-filled, miserable lives via atherosclerotic blood vessels hanging off of osteoporotic bones. In the hospital, we can temporarily stabilize the life-threatening problems engendered by disease-promoting lifestyles, but in the big picture, we just do not get the point, and we just perpetuate the discrepancy. Please, talk to your patients about what they eat and how they live. Or if you scoff at all this, send your patients to me. I’d be happy to do it. They can join my patients on a trajectory of healing.

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DR. DV WRITES ABOUT PHYSICAL ACTIVITY AND MOVEMENT IN IMPROVING QUALITY OF LIFE:

Moving Everyday Will Keep the Doctor Away

By Dushyant Viswanathan, MD | July 6, 2011
Physicians Practice magazine

The human organism requires movement. More specifically, it requires dynamicism. In the absence of dynamic states of being, we have stasis, which has pathophysiologic consequences. Essential for not only optimal health, but also overall quality of life is dynamicism manifest as: regular (as in daily) physical exercise, bowel habits, mental stimulation and activity, emotional dexterity (mandatory is the regular elimination of toxic emotional memories), and curiosity and awe for the inexplicable fact of existence itself.

First with regard to physical exercise. The medical benefits of physical exercise have been demonstrated in countless studies, although why such an obvious fact would need to be proven in clinical studies is beyond me. Physical exercise and movement-based therapies such as yoga stimulate not only muscle and the heart, but also the hypothalamic-pituitary-opiate axis. The body is flooded with endogenous opiates as a result of such therapies, and demonstrable benefit to immune function can be observed. Exercise also leads to improved cardiac performance and dilation of pulmonary vessels, improved oxygenation of the system, perfusion of viscera, and elimination of toxins via improvement in kidney and bowel function.

Perhaps one explanation for the benefit and importance of exercise is the promotion of a dynamic physiologic state as opposed to one that can be described as static. Stasis is an integral component of Virchow’s triad of hypercoagulability. Cigarette smoking, stress, enhanced sympathetic tone (leading to vasoconstriction), consumption of processed foodstuffs, and sedentary habits all promote stasis. Stasis, in turn, leads to the never-ending stories of inflammation, impaired immune function, arterial and venous thromboses, calcification of vessels and the cardiac electrical conduction system, and leads to the accumulation of toxins. These lead to the chronic illnesses we work so hard to manage. Ultimately they are not manageable unless the underlying issues of lifestyle are addressed.

It is difficult to measure the clinical impact of improved emotional and spiritual dynamicism. Trials evaluating these often rely on subjective questionnaires. But such aspects of human life cannot be denied. Even a cursory look into the lives of anyone points to the correlation between disease and emotional/psychoneurologic stasis. The one physician who integrates methods to promote emotional and spiritual dynamicism into his treatment program is also the one physician who has demonstrated in the clinical literature that coronary arterial stenoses can be reversed and that patients with ischemic cardiomyopathy can heal. Of course, I’m referring to Dean Ornish and his stunning clinical findings. The reader may simply perform a quick Google-scholar search to take a look at his articles published in Lancet. But literature aside, a bit of basic wisdom about the human condition should suffice to substantiate the importance of a dynamic interior landscape.

I look at my patients in their 80s who enjoy good health. Despite family history and genetic predisposition (can’t blame mom and dad for everything) towards illness, my healthy octogenarians are mindful people who stay active. They read books, they engage in meaningful family relationships (leading to emotional dynamicism), and avoid depression by avoiding stasis in all its forms.

The reality is that the human being desperately needs movement at every level for optimum functioning because all life is predicated on movement. The cycles of water, of the elements, of subatomic particles, of evolution, of galaxial phenomena, and of organic systems all are movement-based. So stay dynamic, and likely you won’t be wheeled into my emergency room complaining of chest pains anytime soon! The clinical relevance of curiosity and awe will be explored in the near future.

‘the body thrives when the heart has a mission’

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DR DV WRITES ABOUT INTEGRATIVE MEDICINE FOR PHYSICIANS PRACTICE MAGAZINE:

Integrative Medicine: The Future of Healthcare is Here

By Dushyant Viswanathan, MD | February 15, 2012

I have never been as impressed with the state of modern medicine as I was during the Integrative Healthcare Symposium this past weekend (Feb. 8-11) in New York City. While the attendees ranged from acupuncturists to physicians to naturopaths, homeopaths, and bodyworkers, the faculty presenters were mostly integrative medical physicians with strong backgrounds in internal medicine, strengthened by additional training in other fields such as naturopathic medicine, myofascial release methods, and nutrition.

Besides the fact that the presenters were technically highly trained and skilled, what impressed me so much was the absolute unshakeable commitment to getting patients better. Far from the depressing reality of reimbursement-based mainstream allopathic medicine, the compassionate, thorough, evidence-based care espoused by these practitioners reminded me of my own personal dreams, and of why I entered the healthcare field to begin with.

Especially memorable was the presentations given by UC San Francisco cardiologist and founder of the Preventative Medicine Research Institute, Dean Ornish, and integrative physician Richard Horowitz of Hyde Park, N.Y. Ornish spoke of his research in healing chronic illness, particularly ischemic cardiomyopathy and early-stage prostate cancer. Horowitz spoke about pain management strategies in patients with multiple chronic infectious disease syndrome and Lyme disease. Both practitioners convey a sense of compassionate dedication to proper diagnosis and treatment, always using clinical literature to back up any claims. I’ve never seen a more thorough presentation than that given by Horowitz.

Integrative internal medicine begins where standard mainstream reimbursement-based allopathic medicine ends. The former is about taking the patient from a state of disease to a state of health. The latter is about the quantity of tests, billing, and self-protection from liability. The former is about integrating effective therapeutic methods into a comprehensive strategy that works for the patient, and that emphasizes personal responsibility on the part of the patient as well. The latter is paternalistic, aggressively treating “at” the patient, with no emphasis on lifestyle or food intake. The former appreciates the complicated electromagnetic matrix which is the living organism. The latter is materialistic and positivistic, and basically ignores the emotional, spiritual, and quality-of-life issues which are essential in the human experience. The former appreciates pharmaceutical drugs, nutraceutical formulations, physical medicine, and even homeopathic formulations, always sticking to what works with minimal side effects, in an evidence-based way. The latter has been enslaved to the insurance and pharmaceutical companies since its inception.

Most piquantly, the former will undoubtedly represent the future; the latter will clearly be the past.

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CHRONIC PAIN- HOW DOES AN INTEGRATIVE INTERNIST APPROACH IT?

by Dushyant Viswanathan, MD, ABIM, ABOIM

June 2014

There is an epidemic of chronic pain occurring in the world today. There are more people nursing daily pain issues that impair quality of life than even one or two generations ago. Chronic pain is clearly something that every practitioner in the community today must contend with.

Concomitant to the increase in numbers of people who are experiencing chronic pain are also a few other facts: obesity is increasing; the amount of toxins in the environment that lead to disruptions of the human endocrine system is increasing (bioaccumulation of endocrine disruptors such as BPA, phthalenes, and plastic); the incidence of people with chronic gastrointestinal illness is increasing;  and people are living longer. All of these factors contribute to the pathogenesis of chronic pain.
So from the perspective of an integrative internal medicine specialist, when I meet someone with a chronic pain issue, what is very important is getting a good assessment of the person’s physiology- what are the cortisol levels? How is the thyroid function? Is there any insulin resistance or obesity? Any autoimmune arthropathy (autoimmune arthritis in which the immune system attacks the joints such as in lupus or rheumatoid arthritis)? Is there evidence of touch sensitivity that we see in people with fibromyalgia who lack small nerve fibers in the skin? Or is there premature arthritis that we see in progesterone or Vitamin D deficiency states? All these questions and more need to be answered.
After the diagnostic workup provides some answers, the next step is to create a therapeutic regimen with the ultimate goal of treating pain by treating the underlying cause of pain, and using therapies that foster regeneration of tissue, improvement of physical alignment, restitution of optimal joint and cellular health, and restitution of optimal endogenous opioid levels.
This last point about opioid levels is very important. People with low levels of natural endorphins / enkephalins (our natural painkiller chemicals) are predisposed to living in pain. Also, low levels of dopamine and cortisol can lead to the basic misery of feeling constantly uncomfortable, restless, sore, and in pain.
Finally, care needs to be given to the emotional and spiritual aspects of a person. Misery at these subtler levels are very common causes of chronic pain.
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YOGA THERAPY TO BALANCE BODY BIOCHEMISTRY

By Jennifer Martin
CCIM Contributing Writer
Sept 4, 2014

Mental health problems are increasingly common across the US with close to 20% of the adult population suffering from a condition that affects mental wellness1. Many factors can contribute to poor mental health, from poverty to physical illness and exposure to stressful situations, but whatever the root of the problem it is important to address the underlying cause. While this is sometimes easy to do, if a biochemical change has triggered the condition, the solution is not as obvious. Taking a look at your diet is one way to promote a healthy balance of hormones and brain chemicals, but exercise is another way to reset this balance. Indeed, there is an interest in the value of yoga to restore healthy levels of cortisol and brain neurotransmitters.

Yoga as a therapy for poor mental health

Although yoga can help with a range of problems that affect mental well-being, anxiety, depression and substance abuse are among those that respond well to yoga therapy. By adopting a variety of postures and taking control of your breathing, it is possible to achieve a state of relaxation through yoga, which can relieve feelings of stress and anxiety2. Equally, yoga appears a useful mind-body intervention to manage mood disorders. In fact, a recent review of the evidence for using yoga as a treatment for depression found that yoga shows promise as an additional therapy to treat depressive symptoms, particularly among people with significant levels of depression3. As addiction is now considered the most common mental health issue in America, it is welcome news that yoga is a useful adjunct to more traditional treatments4. With a holistic approach to addiction treatment now more widely adopted by substance abuse rehabilitation programs, with centers looking beyond substance abuse education and counseling sessions, addiction research is turning to the value of complementary therapies such as yoga. Current thinking is that the skills and awareness brought by practicing yoga and mindfulness can manage the various processes implicated in substance dependency and relapse, including those that have a biochemical basis.

Yoga reduces cortisol levels

Your body releases cortisol in response to stressful situations, as this stress hormone prepares your body for action by making glucose more available to power your muscles if the need arises. However, exposure to high levels of cortisol in the longer term can contribute to a range of serious health problems, including excessive weight gain, diabetes, high blood pressure, compromised immune function, digestive disorders, fertility issues and depression5. However, even if you suffer from stress, taking steps to lower your cortisol levels can reduce your risk of adverse health problems. One way to reduce cortisol is through practicing yoga. Indeed, a study that explored the impact of yoga on markers of stress found that within 10 days of taking part in yogic poses and breathing exercises levels of cortisol fell6.

Yoga enhances serotonin levels

Serotonin is one of the brain’s chemical messengers that not only elevates mood but also helps to reduce feelings of pain. Unsurprisingly, low levels of serotonin are frequently associated with depression and one treatment for low mood is a medication that helps to restore serotonin levels. Although a carbohydrate-rich diet may also help to raise serotonin levels, in the long-term this may lead to insulin resistance and the associated weight gain and diabetes development. Yoga, therefore, offers a safer option to boost serotonin levels. Certainly, a piece of research that explored the effects of a 12 week yoga program on back pain, mood and serotonin levels found that practicing yoga was connected to a brighter mood and elevated serotonin7.

Yoga boosts dopamine production

Dopamine is another of the brain’s neurotransmitters, which signals feelings of pleasure and low levels are again linked to depressive symptoms. This brain chemical also plays a role in reward pathways that are triggered through drug taking. Enhancing levels of dopamine may therefore boost mood and offer a natural high. While sugar rich foods can raise dopamine levels, a healthier way to do so is through yoga, with research showing that yogic meditation can increase dopamine production by up to 65%8.

Yoga improves GABA levels

A further neurotransmitter of interest is GABA, as levels of this chemical messenger are reduced in anxiety and mood disorders. While general exercise can reduce cortisol and increase serotonin and dopamine, a study investigated whether elevations in GABA were specific to yoga or aided by various forms of physical activity. The researchers found that people who took part in 60 minutes of yoga thrice weekly for 12 weeks achieved greater improvements in anxiety and mood than those who walked for a similar duration, which was correlated to levels of GABA9. This offers yet another possibility through which yoga exerts its effects on mental wellness.

Resources:

http://www.nimh.nih.gov/statistics/1anydis_adult.shtml

http://www.mayoclinic.org/healthy-living/stress-management/in-depth/yoga/art-20044733

http://onlinelibrary.wiley.com/doi/10.1002/da.22166/abstract;jsessionid=8C89D273056B192CCD25B404609E57EF.f04t02

http://my.clevelandclinic.org/neurological_institute/center-for-behavorial-health/disease-conditions/hic-addictions.aspx

http://www.todaysdietitian.com/newarchives/111609p38.shtml

http://connection.ebscohost.com/c/articles/78083737/efficacy-short-term-yoga-based-lifestyle-intervention-reducing-stress-inflammation-preliminary-results

http://www.hindawi.com/journals/ecam/2014/203173/

http://www.sciencedirect.com/science/article/pii/S0926641001001069

http://online.liebertpub.com/doi/abs/10.1089/acm.2010.0007

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BENEFITS OF COMPOUNDED BIOIDENTICAL HORMONE BALANCING

By Dushyant Viswanathan, MD Medical Director, The Columbia Center for Integrative Medicine Alwayspeaceofmind.com

INTRODUCTION As a medical doctor, I am seeing an increasing number of people who come to me complaining of symptoms which are caused by hormone imbalances. There are countless explanations for this epidemic in hormone imbalances- some point at poor nutrition, poor soil quality, high stress, poor lifestyles, etc; regardless of the fundamental cause (a topic for another article), what is clear is that hormone imbalances are a major cause of illness. For example, diabetes is a complicated illness originating from hormone imbalances related to the small intestine, and later from insulin resistance. Obesity is related to leptin resistance. Both insulin and leptin are very important hormones. Hypothyroidism is very common; most women over age 60 have some degree of thyroid dysfunction. Adrenal insufficiency is very common; many people who complain of chronic pain and fatigue have inadequate cortisol levels, which can impair immune function, and ultimately lead to worsened thyroid function. Vitamin D deficiency is a rampant epidemic recently. Low testosterone in the setting of high estrogen levels is very common in men, and is the likely cause of the epidemic of prostate cancer in older men. All of these hormone dysfunctions, if untreated, lead to weight gain, early arthritis, poor endurance, all of which ultimately lead to life-threatening issues such as atherosclerosis (clogged arteries) and cancer. As a result of my comprehensive hormone testing and balancing program at The Columbia Center for Integrative Medicine, my patients experience improved health, weight loss, improved brain function, increased exercise capacity, better sleep, and are consequently equipped to exercise, handle stress, eat healthy, lower inflammation via healthy lifestyles. Many have returned from disability back to work. Absolutely none of the patients enrolled in our program have had worsened health or side effects of therapy.

PHYSIOLOGY AND BIOCHEMISTRY ARE RELEVANT Is there a mystery to all this? Some mystic explanation for this approach to clinical medicine? Absolutely not. Integrative physicians, and many naturopaths, are deeply interested in basic physiology and biochemistry. The clinical goal is restitution of optimal physiology and cellular metabolism. When such a situation is achieved, health is improved, symptoms are lessened, and quality of life is enhanced. This is a basic principle to all healing systems throughout the world, since Galen and Hippocrates. Medical school did well to teach physicians pathology, the specifics of disease states, and the science of pharmacology. These are all essential. However, to provide high-quality clinical care to people in the community, it is essential for physicians to be trained (as I was) in clinical nutrition, biochemistry, and physiology, to better understand how concepts such as cellular metabolism are relevant to the patient seen in the office. Basic medical training plus integrative training leads to high-quality service.

HORMONE SYSTEMS ARE INTER-DEPENDENT All too often I have people come to me complaining of having ongoing symptoms of hypothyroidism despite being on high dose Synthroid (Levothyroxine), which is synthetic free T4 (inactive thyroid hormone). These patients are seen by physicians who do not test for adrenal insufficiency, who do not aggressively titrate up Vitamin D levels, who do not have formal weight management programs, who do not treat nutrition with much importance, and who do not check the free T3 level (measurement of active thyroid hormone). As a result, the patients have ongoing symptoms. A large percentage of people in my hormone balancing program have come to me frustrated by the lack of thorough care from their endocrinologists and primary doctors. A major contributing factor to this discrepancy in clinical care is an ongoing, aggressive paradigmatic difference between endocrinologists and integrative physicians. Endocrinologists generally treat thyroid physiology, estrogen metabolism, adrenal physiology, and insulin resistance as clinically separate issues. This is likely because pharmaceutical drug management of these issues requires this ideological stance. For example, there is a drug (Synthroid) for hypothyroidism, and another drug (insulin) for diabetes. The paradigmatic emphasis on pharmaceutical treatment prevents endocrinologists from piecing together seemingly disparate aspects of hormone physiology into a syncretic whole. Whereas integrative physicians such as myself see the various hormone systems as mutually inter-dependent and inter-connected. This approach is substantiated by basic human physiology and biochemistry. For example, cholesterol is the precursor to all steroid hormones. If you drop cholesterol levels, you will drop Vitamin D levels, which will precipitate insulin resistance (leading to diabetes) because of the importance of Vitamin D in the regulation of cellular metabolism. Consequently, recent clinical trials have revealed that statin drugs put people at risk of developing diabetes. Another example- impaired cortisol secretion (demonstrable by saliva testing of cortisol) will lead to a drop in progesterone levels (because progesterone will be shunted into the pathway to make more cortisol), leading to elevated unopposed estrogen levels; this relative increase in estrogen will increase thyroid-binding globulin, which will bind thyroid hormone, taking it away from physiologic roles, leading to a measurable decrease in blood thyroid hormone levels, leading to hypothyroidism and its symptoms. This is basic physiology. Consequently, as part of a thorough hormone workup, it is important to check Vitamin D, estrogen, progesterone, testosterone, cortisol, free T3, free T4, and hemoglobin A1C levels. When all of these different hormone are balanced, people feel better and are better equipped to exercise, eat healthy, manage stress, and achieve peace of mind as a result of their mindful lifestyles and attitudes.

DIAGNOSIS  After a comprehensive history and physical exam, testing is mandatory. This is because one cannot simply guess about hormone status, and which hormone imbalance is causing which particular symptom. The basic principle for hormone testing is as follows:

  1. Water-soluble hormones (25-OH Vitamin D and thyroid hormone) are well measured in blood since they are freely circulating in blood
  2. Lipid-soluble hormones (that derive from cholesterol) are well measured in urine and/or saliva since binding proteins carry them in blood, and so blood levels aren’t accurate. More recent assays for unbound levels of steroid hormones may make up for this discrepancy. However plentiful evidence indicates that saliva testing is accurate, specific, and sensitive, and conveys more accurate information about HPA axis physiology than does blood testing (Clinical Endocrinology Volume 63, Issue 3, pages 336–341, September 2005)

TREATMENT  Treatment for hormone imbalances firstly emphasizes lifestyle. Generally, I begin by advocating a micronutrient-dense no-glycemic diet that lacks gluten and dairy, tailored to the palate of the patient, and I have my nutritionist work closely with the patient to address meal plans. Weight loss programs are useful as well because close supervision makes it easier for people to achieve their goals. I use the Ideal Protein program or Transitions Lifestyle System, both of which are predicated on the same principles of no-glycemic food intake. Next, I make use of an exercise therapy (ET) program that is based on the principle of interval training. My ET program can be billed through physical therapy, and is very effective and enjoyable for patients at CCIM; they don’t have to join a gym and they can feel protected knowing that medical professionals are monitoring their exercise. Next, I make use of bioidentical hormones compounded by my pharmacist. In Maryland, I work closely with Brian Trentler, chief pharmacist and compounder at Hunt Valley Pharmacy, in Hunt Valley, MD, which is just north of Baltimore. He has 20+ years working with compounded formulations and simply put, my patients love him since he is prompt, is willing to ship formulations to peoples’ home, and is a great teacher. In addition to bioidentical hormones, I make use of proprietary blends containing glandulars, nutraceuticals, and micronutrients, depending on the clinical situation. For example, B vitamins, melatonin, magnesium, and adrenal adaptogens are useful to treat adrenal disease. Selenium, iron, and iodine are useful to treat hypothyroidism with a low free T3. Pygeum and zinc are useful to treat prostate disease, etc.

DISTINGUISH BETWEEN SYNTHETIC AND BIOIDENTICAL  For those people at risk for breast cancer and who are daunted at the concept of using hormones because of the elevated risk of cancer and heart disease in people using synthetic hormones, it is important to know that there are major biochemical differences between synthetic hormones and bioidentical hormones. They have different effects on the body. For example, synthetic progestin increases risk for bloating, blood clots, and heart disease, while bioidentical progesterone has no such side effects, and in fact protects people from these issues, just as our own endogenous progesterone protects us from heart disease, bone disease, and blood clots. See references below for more information about this. Please note that only you and your physician can decide what the right treatment for you is. This article is NOT a substitute for customized care tailored to your needs, created by your physician.

PHYSICIAN – PHARMACIST RELATIONSHIP  What is very important is the relationship between the prescribing physician trained in hormone balancing and the compounding pharmacist with experience in creating compounded formulations. I have been working with my pharmacist since the opening of my office, and his professional practice is in harmony with the high-quality attention to detail that I expect in my medical practice.

REFERENCES  Could Transdermal Estradiol + Progesterone be a Safer Postmenopausal HRT? A review. L’Hermite M, Simoncini T, Fuller S, Genazzani AR. Maturitas. 2008 Jul-Aug; 60(3-4):185-201. A review article that compares the use of non-orally administered HRT and advantages to the cardiovascular system compared to the more conventional oral hormones. Further review compares progesterone to synthetic progestins, and finds that their effects are vastly different with respect to breast cancer risk. Cardiovascular Effects of Medroxyprogesterone Acetate and Progesterone: A Case of Mistaken Identity? Hermsmeyer RK, Thompson TL, Pohost GM, Kaski JC. Nat Clin Pract Cardiovasc Med. 2008 Jul;5(7):387-95. Epub 2008 Jun 3. Review. Natural hormone therapy for menopause. Mahmud K. Gynecol Edocrinol. 2009 Aug 19:1-5. Study of 189 women were administered bioidentical estrogen plus progesterone with or without DHEA and testosterone and followed for 12 months. 97% of women experienced varying degrees of symptom ameioration including improvement in mental symptoms and weight loss. Complications common to traditional HRT were not seen.

Beauty as a Symptom of Coherent Harmony ™ By Dushyant Viswanathan, MD, ABIM, ABOIM, Medical Director of The Columbia Center for Integrative Medicine (CCIM)

March 8 2013 Published in Your Health magazine From my perspective as a holistic physician, beauty from the inside out is achieved by optimizing function of the physical, mental, emotional, and spiritual systems in our lives. Optimizing occurs by systematically removing dysfunctions, and improving functionality in these different aspects. When all four systems are working optimally, people enter a state of “coherent harmony” which manifests with clearly noticeable beauty, happiness, peace of mind, health, and longevity. Beauty, in a sense, is a symptom of such harmony. We may notice those individuals, who exist in a steady state of harmony, and we can’t help but wonder about their habits, their self-care, and their secret to have that certain “glow” from the inside out that make them seem beautiful. Their beauty is apparent in their speech, their movement, their skin, their attitude, their grace. We know that such beauty is both spiritual and physical at once; no wonder since from the perspective of integrative holistic thinking, soul and body are two aspects of the same phenomenon: the human experience. So what I want to discuss here are the methods used to help you optimize the four systems mentioned above, which lead to coherent harmony and beauty. Any program of healing should be uniquely tailored to your needs, so please contact me directly to personalize these methods for you. Firstly, any program aiming to optimize function must emphasize the following:

  1. minimize inflammation
  2. maximize cellular health

We need to minimize the intake of toxins: not smoking, and not eating processed foods are a good way to start. It is advisable to replace processed foods with a plant-based diet as espoused by the Mediterranean / Anti-Inflammatory / Ornish diets. Prepare food at your own home with your hands, with loving intentions, from organic / farmers market / local sources. If you have chronic inflammation, make sure that you have formal evaluation of your GI (gastrointestinal) function. Depending on results of testing, you may require a detox program to heal your gut or liver; this may require use of specialized diets. For example, if you have acidic pH and candida in your gut, you would temporarily need an alkaline, anti-fungal diet until the gut is healed. If the gut and immune systems are healthy and toxins are minimized, then metabolism and cellular health improve. Next, to optimize heart, brain, lung, and vascular function, it is advisable to engage in regular enjoyable exercise and to enhance micronutrient intake. Firstly a word about exercise: the evidence that exercise benefits organ function is considerable. The key thing to remember about exercise is to slowly increase the intensity of the exercise over time. For example, if you walk one mile in 15 minutes today, slowly walk faster every day- walk the mile in 14 minutes tomorrow, in 13 minutes the next day, etc. Micronutrients are essential in optimizing organ and overall physical health. Different organs need various amounts of micronutrients. For example, the thyroid needs selenium, the heart needs magnesium, the GI tract needs zinc, the liver needs choline, etc. I recommend isotonic delivery systems to maximize micronutrient absorption because I am unconvinced that pills available over the counter at vitamin stores get absorbed into the bloodstream. Besides vitamins, minerals, and cofactors, other important micronutrients include: amino acids, omega 3 fatty acids, phytonutrients, and short chain fatty acids. Naturally, a micronutrient-dense diet will help considerably. In addition to micronutrients, hormone function is important as well. Specifically, function of the thyroid and adrenal glands, and hormones such as leptin, insulin, cholecalciferol (Vitamin D), testosterone, estrogen, DHEA, and progesterone need to be optimized to achieve our beauty goals. Hormone balancing improves blood flow to the skin, reduces wrinkles (specifically compounded estriol), improves metabolic function (specifically Vitamin D and progesterone), and enhances youthful appearance and energy levels. Ok, so now you are minimizing and removing toxins, lowering inflammation, taking in the right food and micronutrient fuel, have balanced your hormones, and are exercising. Physical optimization is moving the right direction. Next step is to integrate mental and spiritual systems into the program. The easiest way to do this is with yoga or some martial art tailored to your needs and capabilities, in which mindfulness, concentration, breath, and body are “yoked together” in one activity that can be practiced daily. On a personal note, I cannot emphasize enough how much the practice of yoga and pranayama transformed my life, improving my mental, physical, social, and spiritual well-being. It was amazing to discover how my own breathing patterns could exert control over my heart rate, blood pressure, stress level, anxiety, etc. I think any martial art or tai chi also serves this purpose. We all know those regular practitioners of yoga who have a certain glow to their step- that’s beauty from the inside out. Also essential for optimization of mental and spiritual systems include the following: feeling connected to community and family, having a sense of purpose in life, having a sense of spiritual connection, addressing past traumas (counseling and journaling are quite helpful) and being compassionate to one’s own emotions. Emotional optimization is perhaps the most complicated of all since what we are talking about is the deepest, most private space that contains our vulnerabilities and frailties. Isolation, selfishness, fear, insecurity, and unexpressed frustration all weaken our emotional health and are detrimental to our mind, body, and spirit; these take us away from coherence and manifesting our beauty. Methods to optimize emotional health include the following:

  1. Perform 1 act of kindness daily. This is an amazing method that can improve emotional health immediately.
  2. Perform 1 act of relaxation daily. This can include pleasurable activities, laughter, or anything that promotes joy and peacefulness
  3. Assess what it is in your life that brings you joy. If you discover that you don’t have any activity that brings joy, make addressing this a priority. Human beings need joy the way plants need water.
  4. Minimize toxic relationships
  5. Be compassionate towards your own feelings. Rather than judging them or being too cerebral about them, allow them to be noticed. Communicate with sentences that start with “I feel…”

We all have emotions, and these emotions keep us connected in a truthful way to our lives. Our emotional world is a barometer of overall health. Make yours a priority! Optimizing the physical, emotional, mental, and spiritual aspects of our lives leads to coherent harmony, a dynamic state of order in which we are in balance with our lives. We can even handle imbalances and stresses well in such a state because we are equipped to deal with what life expects out of us. Our bodies, minds, emotional contours, and soul become equipped to be united together in the act of living life. In coherent harmony, we are happy, at peace, connected, helpful to others, and beautiful to behold.

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