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Do You Want to Take Your Workout to the Next Level? These Tips May Help!


By Jessica Kelner, D.O. - September 17, 2019

 

Are you thinking about upgrading your workout program or starting a new one? A successful fitness regimen requires thoughtful pre-workout planning so you can get the most out of your workouts and ultimately reach your goals. 

Here are some tips from a functional medicine perspective on how to achieve those goals and insight on other health factors that may hinder your progress.

Energy and motivation are fundamental to achieving exercise goals and maintaining endurance.

If fatigue and a lack of motivation is preventing you from starting a new fitness program or increasing the goals of your present one, that may be a sign of a hormonal imbalance, nutritional deficiency or other health issue brimming beneath the surface.

Thyroid balance, respiratory health, heart health, adrenal balance, hormone balance, and being free of allergies and inflammation affect your motivation and energy levels. If there is an imbalance of any of these, exercising can be very challenging or leave you feeling even more depleted so perhaps you don't want to work out again.

For example:
  • Low testosterone for both men and women may lead to low motivation, poor focus, lack of endurance, and poor workout recovery. Testosterone is an anabolic hormone that affects mental clarity, drive, and tissue regeneration/growth.
  • Adrenal Dysfunction/Imbalance leads to unbalanced stress hormones (like cortisol) that may make you feel too tired to work out and leave you exhausted afterward.
  • Heart health is vital to exercising safely and having enough blood flow to vital organs and muscles during it. Your heart is essentially the motor that pushes blood around your body (carrying nutrients and oxygen). If your heart is not healthy, symptoms could be exacerbated with a new work out if not diagnosed and dealt with by your physician.
  • Optimal Respiratory health is necessary for being able to get oxygen into your body during exercise. When you exercise, the body demands more oxygen and more efficient exchanging of oxygen in the lungs. If you happen to have an underlying lung disease, this may make your workouts difficult to get through. This can be affected by inflammation in the body (often in the gut).
  • Abnormal thyroid function may make you feel too fatigued to get to the gym.

What is Functional Medicine anyway?

Functional medicine involves evaluating the core systems in the body, then applying targeted interventions to correct and optimize areas that are indicating a dysfunction. Once those areas are addressed, your body will have restored function with the energy and drive needed to achieve your fitness goals.

Are you too inflamed to work out?

There are some people that have inflammation in the joints, ligaments, sinuses, and other areas of the body. They may feel physically incapable of working out. These types of inflammation can be diagnosed and then decreased or eliminated to better support a healthy exercise regimen. 

There are many different approaches to decreasing inflammation in the body depending on the source or cause of it, like dietary modification (removing foods that create inflammation in the gut), acupuncture, decreasing stress with meditation, IV therapy, low dose immunotherapy, removing other toxic environmental triggers, and/or other nutritional supplementation.

Is your diet energizing and supporting you or depleting and inflaming you?

"Let food be thy medicine and medicine be thy food" - Hippocrates


Food should nourish and energize you. With the pre-packaged food, mass production of food, and over farmed lands, so much of the "food" that is available to us may be inflaming us rather than supporting our bodies. Most people are unaware that this is even happening. If the food we eat is inflaming our bodies, this leaves us feeling potentially bloated, more fatigued and often less motivated to work out.

Food sensitivities or allergies can create more inflammation than providing nourishment. For example, if you're eating chicken every day, but your immune system is constantly reacting to the chicken, your body may not be able to break this down properly (due to inflammation), absorb the nutrients from this as well as from other foods. Sometimes even the "healthy foods" people are eating are inflaming their bodies causing joint pain, digestive tract inflammation, sinus inflammation and more.

Determining if you have any nutrient deficiencies can be very helpful to achieve optimal wellness, vitality, energy, and support your exercise efforts.

Leveraging the benefits of exercise: Knowing which type of exercises best suit your body, goals, and individual healthy.

There are many different types of workouts and exercises. Picking the right one or combination of exercise types for your unique health, body and goals is critical to keep your brain motivated and see the results you desire.

For example, if you have adrenal fatigue, HIIT (High-Intensity Interval Training) will likely leave you feeling worse after than did before. If you run long distances often, this may not help you lean-out based on your particular wellness picture. A functional medicine evaluation will shed some light on these issues, so a personalized exercise plan can be created for you.

Make sure your workout routine is actually helping energize and motivate you and not leaving you feeling depleted. 

If you are ready to challenge your present exercise program or start a new exercise regimen, a comprehensive Functional Medicine evaluation is a great place to start. During the evaluation, areas that can be optimized to best support your workout efforts will be assessed to determine the type activity that may be most supportive of you and your goals, and an individualized treatment plan will help you optimize your overall health and wellness.

FORM Medical can help you with your Functional Medicine evaluation. If you'd like to learn more, check out FORM-medical.com or call 720-370-9559. 
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The Perfect Triad of Fitness - Are you fit?


By Jessica Kelner, D.O. - August 12, 2019

People will often tell me that they feel they are in shape because they exercise a few times a week.  Is this true?  Does just the simple fact that you make an attempt to exercise qualify as being "in shape"? 

It really depends on what kind of exercising the person is doing.  If all the person does is lift weights, they may have a rockin' 6 pack, but they are most likely not "in shape".   When this person is asked to bend over to touch their toes or to run a 5k, they may not be able to do that.  

To be truly "fit" or "in shape", one must have a balance of strength, flexibility, and endurance.  Imagine an equilateral triangle with each one of these components sitting at each pointed end of the triangle.  One needs to have as much endurance as they do strength as well as be just as flexible as they are strong.  This is what I would call the perfect triad of fitness. 

Daily life is busy.  It is hard to manage the adult responsibilities that we have to do every day.  People get busy with work, kids, other life stressors and they may not make time for exercising at all (which is no excuse).  Those that do exercise, may exercise in a more habitual way (I am guilty of this), where they may gravitate toward one type of exercise or activity because that is easy for them to do, easy to access, or they really like the feeling of it. 

Let's use the weight lifting guy again as an example (I just made the person a guy for ease of discussion); He may really dislike endurance training because he has trained his muscles for so long to perform at weight lifting activities. He probably is a heavier guy with larger muscles, which makes cardio activity a bit more challenging. Subsequently, this person may shy away from endurance training for that very reason. He may also believe that if he does endurance training, he will lose his muscles and become "too skinny". This is not exactly true.  We aren't talking about completely shifting his exercise to only endurance training.   Then, there is the flexibility component. The weight lifter will be less able to bend and move in certain directions due to his sheer muscle size alone. Without proper stretching and flexibility training the large muscles can become a limitation to the movement of the body, which doesn't lead to being "fit". 

How does one achieve "fitness" or be "in shape"? 

Cross Training! 
Cross training is when you utilize multiple different sports or exercises to train.  I wrote more about cross training in this blog called " Active Recovery vs Rest Days".  You want to maintain balance between your strength training, endurance training, and flexibility. There are many ways to achieve this and for each person, their training schedule may be different based on their interest, body type, health, and goals.  One way to achieve this is to choose different exercise activities like yoga, rock climbing, swimming, and basketball. You will get your endurance from basketball and swimming, strength training from rock climbing, and flexibility from rock climbing and yoga. 

What is endurance training? 
Endurance training is a type of training that utilizes the aerobic system to make energy.  This means  your body is utilizing  oxygen to make energy for your muscles. This is what people like to think of as "cardio". 

Anaerobic Exercise 
Cardiovascular or endurance training is different, in contrast to anaerobic exercise which  is a form of exercise that is intense, short (<2 min) and causes lactate to form in the muscle.  Cardiovascular exercise works on steady state, long term activity, while anaerobic exercise is focused on short term strength/energy bursts. Lactate is an acid that forms in an energy demanding environment in the body that doesn't have enough oxygen. An example of this is weight lifting. 

It is important to train utilizing both aerobic and anaerobic training.

Why does any of this being "in shape" or being "fit" matter when it comes to my health? 
1. Cardiovascular activity is actually protective for your heart. 1 day of cardio activity protects you from having a heart attack for 9 days after!
2. Having balanced muscle tone and strength in your body will prevent injuries and pain.   For example, having core strength will balance out your back muscles and prevent you from lower back injury and back pain. Another good example is the shoulder. If the shoulder is balanced, you're less likely to have shoulders that are rolled forward and less likely to tear a rotator cuff muscle when you try to lift that dog food out of the car. 
3. Being flexible and maintaining that flexibility will also prevent you from injuring or tearing things.  Imagine if you have a really tight tissue that you then go to use, it is more likely to tear, like a frozen rubber band will snap. 
4. Flexibility will also allow you to perform at activities that you may not otherwise be able to do.  For example, with rock climbing, while you have to be strong, you also have to be flexible enough to flex your hips and legs to climb higher. 
5. Flexibility allows for the rest of your body to have the ability to utilize proper biomechanics.  Your body is a machine that has to be allowed to freely move.  If parts of the machine are tight and restricted, it can cause a kink or a blockage in the machine.  You may develop abnormal or compensatory movements, which can cause further injuries. 
6. Endurance allows you to do physical things, like hike a mountain (or hill), clean your house (or pool), walk for long periods of time. Imagine going on a trip to NYC and not being able to walk around all day long to do sight seeing because you physically can't do it. 

At FORM Medical, we can perform a biomechanics analysis, guide you in correcting your imbalances, treat any injuries you may have developed and help you achieve your goals of getting in shape. 
 
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IV Vitamin Therapy - Medical Treatment, Health Fad or Both?


By Jessica Kelner, D.O. - June 21, 2019

What is IV Vitamin Therapy? Why has it become so popular? 

IV Therapy Treatments aren't a new medical therapy. 

These IV treatments aren’t exactly new — they’ve traditionally been used in hospitals to help patients rehydrate or restore nutritional deficiencies, but they have become more popular now because they’re more of "a quick fix" that’s been made available to the masses. There are functional medicine doctors using IV Therapy to replace nutrients in their patients and treat heavy metal toxicity, there are companies that have set up brick-and-mortar clinics in many cities, and other companies that offer concierge-style services where they bring needles and infusions straight to a client’s home or office.

IV therapy is a medical treatment in which fluids, nutrients, and medications can be administered directly into a patient's blood stream without having to go through the stomach or the skin.  While some people may be squeamish with needles, others prefer this method of delivery. 

IV Fluids in their most basic form are either salt water, salt water + electrolytes, salt water + sugar or sugar water.  These fluids are used to maintain the body's homeostasis when the patient may be very dehydrating from vomiting for example, or when they are not allowed to eat due to a medical condition. Maintaining the body's homeostasis is very important because without the proper balance of fluids and electrolytes in the body, fluid can leak out of the blood stream into places where it isn't supposed to be, tissues may have pressure in them (that shouldn't have) and then the blood stream will have less fluid to circulate oxygen in. You can see why this may be an issue.  In a hospital setting, doctors are very careful to make sure their patients have adequate fluid intake and when they don't they will give them IV fluids. 

IV fluids have become grown to become super fancy. We now have the ability to deliver vital nutrients right into the blood stream that are custom tailored for specific medical conditions. With Americans nutritional deficiencies growing over the years, this has become more and more vital for treatment. 

Intravenous Vitamin Therapy (IVT) is the most efficient way to deliver the nutrients your cells need directly into your bloodstream. The vitamin-rich fluid cocktails contain a myriad of required nutrients to encourage improvement in health, reduce fatigue, and super charge the immune system to help fight against chronic illnesses. IV Vitamin Therapy is among the most effective ways to penetrate the cells in for quick revitalization in higher quantities than oral doses can provide.

 IV Vitamin Therapy has a long history of providing relief for a variety of illnesses.  IV Vitamin Therapy was founded back in the 1930s and after experiments, Dr. Klenner developed a megadose of intravenous vitamin C treatments in the 1940s.  This was followed by William Kaufman who published articles that verified the idea of IV Vitamin Therapy with his treatment of arthritis with frequent megadoses of niacinamide (also known as Vitamin B3, which is shown to improve cholesterol and lower cardiovascular risks).  The research and publication of studies continued throughout the 1950s and 60s with individualized vitamins and nutrients being studied. Results of niacin improving cholesterol was confirmed in 1986.

Not only has vitamin therapy existed since the 1930s, but it has gained traction and popularity as a component of the functional and integrative medical practice. Following the work of Dr. Klenner, Dr. John Myers, MD a Baltimore physician  further developed and popularized the use of IV Vitamin Therapy as a medical treatment for various medical conditions. Since the 1980s, IV Vitamin Therapy has helped people with chronic medical conditions, such as fatigue, depression, fibromyalgia, asthma and more. 
 

Fun Fact:
Although you may see only nurses administering IVs today, only doctors were allowed to administer IVs until the 1940s. Delegating this task to nurses occurred during WW1 and WW2 to expedite care to soldiers. 

Dr. Myers developed a special formulation of nutrients that is now called the “Myers’ Cocktail”. This is a cocktail designed with specific selected vitamins necessary to improve health and vitality. 

What Medical Conditions Can IV Vitamin Therapy BENEFIT?
Some of the many common problems that IV Vitamin therapy can address include:
  • Chronic Fatigue
  • Asthma
  • Anxiety
  • Headaches
  • Resistant Infections
  • Immune Deficiency
  • Stress
  • Brain Fog
  • Sleep Disorders
  • Fibromyalgia 
  • Sports Proficiency and Exercise Stamina
  • Atherosclerosis (plaques in arteries)
  • Anti-Aging

Benefits of the Vitamins in the Myers' Cocktail?

Each of the vitamins in the Myers' Cocktail were chosen for their known benefits of improving specific acute and chronic illnesses. These nutrients are given in a much higher dose via the blood stream than can be absorbed by mouth. 

Magnesium:  Magnesium is a crucial nutrient the body needs that is involved in energy production, muscle contraction, and DNA synthesis. It also contributes to the structural development of bone.

Calcium:  Our body uses calcium to make our teeth and bones, while adequate quantities are
required to maintain the strength of bone and teeth. 

Vitamin B12:  Vitamin B12 is necessary for neurotransmitter formation, cholesterol synthesis, energy production and much more.  Optimal levels of B12 assist in reducing depression, anxiety, fatigue, stress, and mental clarity. 

Vitamin B6:  Vitamin B6 assist with neurotransmitter formation as well, helps maintain adrenal function, and metabolic processes. 

Vitamin B5:  Vitamin B5, also called Pantothenic Acid, is a highly effective treatment for various medical conditions.  It has a role in energy production, nervous system function, anti-inflammatory role in treating allergies, asthma, wound healing and acne. 

B-Complex:  B-Complex Vitamins such as Niacin, Riboflavin, and Thiamin benefit cholesterol, cardiovascular health, neurotransmitter production, energy production, and many other cellular processes.  

Vitamin C: We all know vitamin C is available in great quantities in oranges, but our food sources of vitamin C are unable to provide us orally with what an IV can provide. Megadoses of vitamin C have been shown in lab studies to have anti-inflammatory abilities.  It can have oxidative ability to help the body attack viruses and bacteria.  In cancer patients, it can reduce the side effects and improve overall quality of life.   

The Meyers' Cocktail is only one formulation of vitamins that can be given IV, there are many other custom tailored nutrients that can be given to help with medical conditions such as asthma, muscle fatigue, chronic fatigue, heavy metal toxicity, and many more. 

All of these vitamins are essential to the body's normal daily function,  however, many people are not getting adequate nutrition through their foot intake alone.  Why is this the case?  The food of the American diet is more processed than ever before.  All those packed products: bars, cereals, breads, frozen food, esentially everything in the middle isles of the grocery store. Additionally, the fruits and vegetables we grow in America do not have the nutrients in them they used to due to our present farming methods.  With daily consumption of your typical over the counter oral multi-vitamin, the digestive system isn't able to absorb all of the necessary nutrients.  Getting IV Vitamin Therapy every week or every few weeks benefits the entire body with improved vitality and health.

Are there any risks with receiving IV Nutrient Therapy? 
You want to make sure you go to a reputable IV Therapy Center.  What makes a center reputable you ask? Do they have well trained staff? Is the facility clean? Are they particular about where they obtain their supplies and nutrients? Do they have a health care professional such as a Physician, Nurse Practioner or PA available for an emergency? If there is an emergency, do they maintain records? Do they obtain adequate information about your health and history prior to giving the IV? Was thought put into the formulations of their IVs?  Are they claiming to treat specific medical conditions? If they are, there should be a qualified health care professional there to guide you through the process.  If a person is looking for IV Nutrient Therapy as a medical treatment for a condition, it would be best to see a physician first to be evaluated for the specific treatment that will work best for the condition.   These are just some questions you can and should ask prior to starting IV Nutrient Therapy. 

Make sure to tell the staff if you have any allergies. People with allergies may have reactions to some of the nutrients in the IV.  Some people may also have difficulty processing some of the nutrients and it is important that proper blood tests be performed before receiving high doses of nutrients, particularly Vitamin C. You should run this by your physician before starting an IV Nutrient Program.

There is always a small risk of infection anytime a needle passes through the skin, but with proper technique in administration, these risks are small. 

Most people tolerate IV Nutrient Therapy well and enjoy the benefits of it. 

Last Tips on IV Nutrient Therapy
One IV Nutrient treatment may feel great for you, but again if you have any medical conditions or nutrient deficiencies you are trying to address, you most likely will need more than one treatment and may benefit from an IV Therapy Treatment program. 

Some people have a defective enzyme called MTHFR that methylates (puts a carbon and 3 hydrogen molecules) onto folate and B-12. If a patient has this, then those patients need different formulations of vitamins for their body. If you aren't sure if you have this, you may want to get screened for this first.  It is a simple DNA test that can be done though a cheek swab or through the blood.  People that may have this defective enzyme may be suffering from chronic fatigue, depression, anxiety, mental fogginess, paresthesias, and other non specific symptoms.  

If you are interested in IV Nutrient Therapy and would like more information on it, you can check out form-medical.com/IV-Therapy.  If you would like to discuss the details of IV Nutrient Therapy and how it can help improve your health, you're welcome to come into FORM Medical for a consultation. Call us today at 720-370-9559. 
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Headache, Migraine, Sinus Headache: Everything You Wanted to Know About What Is Causing Your Head Pain


By Jessica Kelner, D.O. - May 21, 2019

What is a Headache?
headache is pain in the head or upper neck (or a pain in the butt, kidding).  It may feel like a dull ache, a sharp pain, or a throbbing sensation. Headaches can be located in one specific area of the head or be present on both sides of the head.  Experiencing a headache is a very common thing for most people. However, "most" people do not experience headaches often.  

Is Sinus Pressure a Headache?
A headache is different from sinus pressure or discomfort in the face.  People often will call this sensation a "sinus headache", but this is not a true headache as it has a different cause.  Specifically, the paranasal sinuses are hollow air cavities in our face that allow for voice resonance, moisturizing the air we breathe as well as filtering the air we breathe.   The tissue lining the sinus cavities can become inflamed as well as the air flow tract may get blocked flowing in or out of the sinus cavities.  When this happens, pressure and discomfort may result.  This is different than a headache.  You may have a headache and sinus pressure at the same time.

Types of Headaches
The two major types of headaches are:

1. Primary Headaches, which are not associated with a medical condition or disease.
2. Secondary Headaches, which are caused by an injury or underlying illness, such as a concussion, bleeding in the brain, an infection or a brain tumor.

Primary Headaches include tension headaches, migraine headaches and cluster headaches.

Tension Headaches: Symptoms of a tension headache include pressure and a band-like tightness that begins in the back of the head and upper neck, and gradually encircles the head. These occur due to tight muscles, stress, dehydration, poor posture, bio-mechanical imbalances, nutritional deficiencies, glasses that are too tight, vision that is not properly corrected by glasses, or a mixture of these. 

Cluster Headaches: are headaches that occur in groups, or clusters, over a period of several weeks or months separated by headache-free periods of months or years. During the headache period, the cluster headache sufferer experiences several episodes of pain during the day, each of which lasts 30 to 90 minutes. These attacks, which often occur at the same time of day, include sharp, penetrating pain around or behind one eye, watering of the eye and a stuffy nose.

A Migraine isn't just a Headaches and a Headaches isn't necessarily a Migraine
Migraines are a specific type of episodic headache that is severe in nature. Migraines progress through a cascade of events that may last for hours or days.   It is generally associated with nausea, light and/or sound sensitivity.  Migraines affect only 12% of the population. They are more common between the ages of 30-39 and 3 times as more common in women than men. 

Migraines have a classic course consisting of 4 phases:  Prodrome, Aura, Migraine Headache, and Postdrome. 

4 Phases of Migraine Headaches
1. Prodrome: May occur up to 24 to 48 hours before the onset of the headache. It consists of  increased yawning, euphoria (happy feeling), depression, feeling irritable, food cravings, and neck discomfort. 

2. Aura:  This phase may overlap with the headache phase.  Auras develop gradually, over longer than 5 minutes, but no longer than over one hour, and have a mix of positive and negative symptoms.  Positive symptoms are symptoms that are added to what is "normal". They can be visual (bright lines, shapes, wavy lines, ect), auditory (tinnitus, ringing in the ears), paraesthesia (or burning pain), or motor (jerky movements) symptoms.  Negative symptoms are the loss of function, such as vision (blind spots), hearing, body movement (decreased).  Some patients actually experience an aura without a headache.

3. Migraine Headache: Often unilateral and tends to feel like a throbbing or pulsating sensation.  This feeling can increase over 1 to a few hours.  Patients report sensitivity to light and sound.  Patients also often feel nausea and sometimes experience vomiting during this phase. 

4. Postdrome: After the throbbing subsides, the person may have pain in the location where the headache was with sudden head movement.  They may feel drained or exhausted. 

Migraine Triggers
Migraine suffers may have triggers associated with specific foods or environmental changes such as:  hormonal changes/fluctuations, wine, aspartame, nitrates (found in deli meat), visual stimuli, stress, not eating, alcohol, smoke, and sleep disturbances.

Headaches Can Be A Warning Sign

If you experience a headache that falls into any of these categories, you should seek immediate medical attention.
  • The headache is severe. If you believe it is your "worst headache ever," seek emergency medical care.
  • The headache is different from your usual headaches in terms of its location, severity or accompanying symptoms, such as numbness or vision loss.
  • The headache starts suddenly, or is aggravated by exertion.
  • The headache causes pain significant enough to wake you from sleep.
  • The headache does not respond to treatment and instead worsens over time.
  • The headache reoccurs frequently.
  • The headache is accompanied by any of the following:
  • A head injury that involves a loss of consciousness, even for a few seconds
  • Seizures or convulsions
  • Recurrent vomiting
  • Dizziness and impaired balance
  • Fever or stiff neck
  • Changes in speech, vision or behavior.

Most headaches are benign in nature and can be resolved by figuring out the cause of the headaches. Traditional headaches should not re-occur on a regular basis. If they do, you should seek medical care.  Migraine Headaches are a special kind of headache that has 4 phases. Only 12% of the population experiences migraines and they are more common in women than men. Migraines can be treated with medication or through natural treatments.  Even migraines have a root cause. 

At FORM Medical, we try to get to the root cause of the issue, to get rid of the pain or injury naturally, without medications.  If you would like to learn more about the types of treatments that we offer at FORM Medical, you can check out form-medical.com. If you would like to schedule an appointment to find out how we can help get rid of your headaches, call 720-370-9559. 
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Low Dose Naltrexone: An Effective Treatment for Chronic Pain and Fatigue


By Jessica Kelner, D.O. - May 8, 2019

Low-dose naltrexone (LDN) is often confused with naltrexone, which is a pharmaceutical medication that is typically used in higher doses of 50 mg or more to treat conditions such as alcohol and narcotic medication addiction as well as other opiate abuse. Naltrexone is an opiod antagonist. This means it is meant to bind to opioid receptors in the body and traditionally would block medications or drugs that bind to the receptor. 

Low-dose
 naltrexone (LDN) is a much lower dose than the traditional naltrexone dose.  LDN is  compounded by a reliable pharmacist specifically for each patient to make the doses very low. The dose of LDN starts between 1.0 to 4.5 mg of naltrexone/dose.  The lower dose of naltrexone helps the body combat chronic illness states.

LDN works by reducing inflammation in the brain caused by over-active microglia. Microglia are a type of glial cell of the Central Nervous System (CNS) (brain and spinal cord) and an important line of defense. When there is an assault on the CNS, the microglia are activated and release inflammatory substances (called cytokines) to destroy the foreign invaders. When the assault is over, the microglia go back to their normal resting state. However, when they react too often from repeated injury, infection, toxins, traumas, or emotional blows, they can  remain hyperactive, keeping the brain in a chronic state of inflammation.  

LDN also causes an adaptive increase in endorphin and enkephalin production (chemicals in the body that make you feel less pain). Endorphin and Enkephalin molecules work on opioid receptors to produce analgesia (pain relief).  The increase in endorphins also helps to normalizes immune response.  Additionally, it increases Met (5) aka Opioid Growth Factor which regulates cell division in normal and abnormal cells.  This may be why LDN is helpful in cancer. 

The inflammatory cytokines created by an assault to the CNS can increase pain sensitivity and fatigue and trigger other inflammation cascades in the body. Although doctors and scientists can't say what specifically causes fibromyalgia, it’s suspected that chronic glial cell activation is involved. This may explain why a 2010 study of LDN treatment in women with fibromyalgia found a 30% reduction in symptom severity. An even stronger response in symptom reduction has been found in studies on patients with Crohn’s Disease; Up to 80% saw significant improvement.

The effect that LDN has on chronic pain caused by autoimmune conditions like psoriatic arthritis works similarly, suppressing glial cells and therefore reducing inflammation. In addition, as mentioned before, there’s some evidence that LDN retains some of its regular dosing activity and blocks opioid receptors, which causes the body to release more endorphins, thus reducing pain.

Research on LDN suggests that it’s able to suppress the inflammatory response of the microglia.  Some of the inflammatory conditions that have shown to benefit from LDN include fibromyalgiamultiple sclerosisCrohn’s diseasecomplex regional pain syndrome and cancer.
Other conditions LDN may treat are: Autoimmune conditions such as: Multiple Sclerosis, Hashimoto’s Thyroiditis, Rheumatoid Arthritis, Lupus, Celiac, Ulcerative Colitis, Crohn's,  as well as IBS/IBD, Eczema, Psoriasis, and Chronic Fatigue. 

Because low-dose naltrexone blocks opioid receptors,  you cannot continue taking narcotic pain medication with LDN.  Otherwise, LDN has virtually no side effects and is well tolerated by most patients. Most people notice an increase in dreaming and some people notice a bit of sleep disruption during the initial few days of treatment but this improves over time.

You can read more about low-dose naltrexone for auto-immune disorders, and other illnesses at www.lowdosenaltrexone.org.

If you have questions about Low Dose Naltrexone or would like to know if this is the right treatment for you, please contact FORM Medical today 720-370-9559. 
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Steroid Joint Injections - Friend or Foe?


By Jessica Kelner, D.O. - April 24, 2019

What are "steroids"? 

When you are talking about joint pain or an upper respiratory infection and you hear someone say they were treated with "steroids", this means they were given a drug that stoped the body's immune system from reacting to their injury or illness.  

"Steroid" or cortisone injections have been used by the traditional medicine world for a long time to help relieve pain that people have from "arthritis".  These steroid shots are not solving the problem, but simply just putting a bandaid on the issue.  The steroids may help temporarily, but a few weeks later, the pain will be back.  There are many patients that end up with a multitude of steroid injections for the same issue and subsequently, end up with pain that seems to get worse over time.  Even their injury can get worse.  They may loose more cartilage and be in worse shape.  What many don't realize is their joint is actually deteriorating at a faster pace because of these injections. 
 

What Steroid Injections Really Do:

Most  people have heard about steroid injections, but have never heard about Platelet Rich Plasma (PRP) or prolotherapy as an alternative to treat many of the same issues.  It has been known for a long time that steroids are damaging on the body, but patients often agree to these injections with hopes that the steroid injection will benefit them more than it will harm them.  Maybe people aren't aware  of how bad these injections really are for you?  If patients were only told about the long term side effects and the alternative options out there, would they still choose to have the steroid injection?

Cartilage and Bone Loss
Traditionally, in medicine doctors may continue to use a drug or perform a surgery that doesn't have great odds at resolving an issue until there is enough evidence to say that it is not helping, but may be even harming the patient.  When it comes to steroids for joint injections, there have been countless studies  reporting that steroids cause cartilage loss and do not provide a significant difference in pain relief when compared to saline (salt water). 

Doctors are injecting steroids into tendons for their "anti- inflammatory" properties.  However, research has shown us that  steroids can actually impair tendon healing and lead to tendon rupture.   It is also well known that long term steroid use, either by mouth or injection causes bone loss and bone necrosis, therefore putting the patient at a higher risk for bone fractures.   

Damage Stem Cells 
The body has an incredibly ability to repair itself.  When you're in pain from an injury, that is your body's way of telling you not to use the area and allow it to heal itself.  If you go to a traditional doctor with shoulder pain for example, they may offer you a steroid injection, while this may help you in the short term, studies have shown that not only do steroids damage the cartilage that protects the bones, but steroids also  impair your natural stem cells that are trying to heal your body.  Stem cells are pre-cursor cells that are able to help you regrow new tissue. Even as adults, we do have some stem cells that can help re-build and repair. 

Adrenal Insufficiency 
Steroids are esentially artificial cortisol. Cortisol is the body's natural stress hormone made in the adrenal glands that your body needs to function. Cortisol is produced in high amounts with stress and it naturally suppresses your immune system to get through the challenging time. If you give the body artificial cortisol, this will suppress the body's own natural cortisol production and have long term consequences.  A study looked at patients that had either received steroid knee injections or hyaluronic acid knee injections.  60% of the steroid knee injection participants end up with secondary adrenal insufficiency vs 15% of the hyaluronic acid group. 

 

What Regenerative Medicine Injections Do:

Regenerative Medicine injections like Platelet Rich Plasma (PRP) or Prolotherapy are essentially the polar opposite of steroids. They harness your body's natural immune system and repair mechanisms by recruiting them to come heal the area.  When you cut yourself, do you notice how you stop bleeding in a minute or so and eventually the cut will heal and be sealed up? It is your body's platelets that start that repair process. They are the first to the scene when you have a new injury. They bring with them a patch for the repair and an army of signaling molecules to tell your body what is needed to get the job done.  Platelet Rich Plasma is a type of prolotherapy ("prolo" means to proliferate or regrow) treatment where  platelets are isolated from your blood and then injected back into the injured area. PRP and prolotherapy can be used to treat many conditions like muscle, ligament,  tendon injuries, arthritis, and much more.  

There have been many studies published more recently showing that PRP has long lasting healing benefits, while steroids may help in the short term, they do not provide a long term benefit to the patient.  So, the next time you have an issue and are offered a steroid injection, consider regenerative medicine instead.  While steroids may be covered by insurance and Regenerative Medicine may not be, the damage from steroids may be detrimental and cause you more pain in the long run.  The short term out of pocket cost will give you a long term benefit and pain relief. 
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Active Recovery vs Rest Days


By Jessica Kelner, D.O. - March 29, 2019

Is exercise your escape, your happy place, or maybe even a borderline obsession? You may exercise every day thinking your helping yourself and your body. 

Is working out every day good for you?  
It depends on what kind of work outs you are doing and the demands you are placing on your body. The body does need a break from stress put on it so it can heal and recover. 

Yes, exercise is good for you.  Exercise increases neurotransmitters in the brain that make you feel happy, it detoxifies your body, AND it can prevent you from having a heart attack for 9 days after just one day of cardiovascular exercise.  On the other hand, the body does need a break from a heavy exercise training schedule.  

What is a heavy exercise training schedule? 

A heavy exercise training schedule is one where you push your self hard, doing the same type of activity on a daily basis. For example, if you are a runner and you run daily, your joints and tissues will never have a chance to fully recover.  You're more likely to end up with an injury later on or may not perform your best without built in rest days.  If you stress your body constantly without any rest and recover, you will get to a point of diminishing returns, where you are not seeing any more progress from your efforts.

What does a rest day look like you ask? A rest day doesn't have to equal you sitting in front of the TV on your couch not moving at all.  A rest day could be an "active recovery" day; Maybe instead of running, you do some yoga or go swimming.  Check out these ideas:

"Active Recovery" Ideas
1. Yoga - Helps with core strength, breathing, flexibility, body control, balance, and promotes blood flow.
2. Tai Chi - Low impact martial arts. Helps with body awareness and activation of the parasympathetic nervous system.
3. Light resistance training. 
4. Core training activities 
5. Swimming 
6. Low intensity steady state walking or running.  - Get your heart rate up without going full force. 
7. Low intensity cycling. - It is low impact and easy on your joints. Hop on your bike (indoors or outside) and pedal away.

This leads me to another thought about how to train:  One great method of training is to cross train (of course this depends on your work out goals).  For most people that are not olympic athletes, doing different sports or activities that complement your present goal is a great way to optimize your performance goals without injuring yourself. 

We will use running as an example again to explain "cross training".  So, if you are a runner, you wouldn't want to have strong legs with a weak core and scrawny arms, right?  Your body would be unbalanced.  To "cross train", you could do strength training for your upper body 1-2 days a week. One of those days you could use cables or weights and the other day, let's say you rock climb.  Rock climbing will help your core strength as well.  One day of the week you can focus on doing a core work out, perhaps you could do yoga that day. This would also help with your flexibility which is very important for maintaining overall "fitness" and preventing you from injuring yourself.  You get the idea.  So, you may run longer distances 4 days a week, 1 day you would just do core strength or yoga, one day you would rock climb and one day you would do upper body strength training (you could do a very short run on this day).  In this example, your legs have a chance to recover from the intense pounding on the ground on yoga and upper body days.  

As I keep mentioning preventing injury, I realize there are other things aside from "rest" that can help you prevent future injury. 

Here are a list of ways to stay in shape and avoid injury:


1. Have at lease one active recovery/rest day per week. 
2. Cross train  
3. Work on your core strength 
4. Maintain good posture. It is essential to having proper function and achieving your goals. 
5. Include daily stretching in your work outs before and after you exercise.
6. Hydration: Make sure to drink plenty of water. 
7. Consume healthy calories. Your body will have increased demands of specific nutrients with intense physical activity.  Talk to a doctor or a nutritionist for assistance with this. 
8.  Supplement your diet with oral or IV nutrients to meet the demands of your body.
9.  Optimize your body's FORM, so you can optimize your body's function.  If you are struggling with this or are unsure what FORM is, you can ask a conditioning coach to observe you exercise, have someone help train you, or ask your sports medicine physician for help with this. 

Hope this helped to inspire creative ways to switch up your work out schedule to include a fun active recovery day!
 
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Intermittent fasting: Something for You to "Chew On"


By Jessica Kelner, D.O. - March 11, 2019


Throughout human history, there have been periods of time where people have not eaten. This wasn't a diet, a fad, or even a choice at times.   Not eating for a period of time may seem like a punishment of sort.  However, historically, humans experienced periods of fasting that  may have been over  hours, a day, or sometimes days. Fasting is normal part of human survival and written into our genetic code for periods of time that we didn't have access to food or sustenance.  Our bodies are built to deal with this type of "intermittent fasting". Intermittent fasting referring to periods of time in which we would not consume useful calories.  

There are also known voluntary abstinence from food and drink (intermittent fasting) that has been practiced around the world for thousands of years.  Books on anthropology and religious practices describe a vast variety of fasting forms and practices. People may have not known the scietific effects of what they were doing to their bodies, but for some it allowed them to achieve other goals.  

In today’s modern world, we are fortunate enough to  have constant access to food.  You just go to your local grocery store and there is the food waiting for you to purchase it.  You know,  those perfectly ripe bananas and pre-packaged meats.  You can buy these items 365 days a year, even when things are out of season! Amazing!   We are incredibly fortunate not to have to go and hunt and gather our meals every day.  Although doing so would give us plenty of exercise that most American's aren't getting.  That would lead down another tangent on the lack of physical activity in our country and the constant calorie consumption. Especially high carbohydrate and sugar calorie consumption. Doesn't that sound like a health crisis just waiting to happen? 

Back to intermittent fasting... 

There has been a recent renewed interest in types of fasting regimens as scientist and physicians search for “cures” to the major health issues facing the  United States and other developing countries.   

You may be asking yourself, "what does a "fast" look like?"

Here are some Different Types of Fasting Regimens: 
  1. Complete Alternating Day Fasting: Involves alternating fasting days (no energy containing foods or beverages with eating days (food and beverages consumed ad-libitum)
  1. Modified Fasting Regimens: Consumption of 20-25% of the energy needs on scheduled fasting days.  
  1. Time Restricted Feeding: Protocols allow individuals to consume ad-libitum energy intake within specific windows of time, which induces fasting periods on a routine basis.
  1. Religious Fasting: A variety of fasting regimens for religious or spiritual purposes

Alternate Day Fasting
Involves fasting days, in which no calories or beverages are consumed, alternating with days of ad libitum food and beverage consumption. This was found to be as effective as caloric restriction in decreasing fasting insulin and glucose concentrations. It also had beneficial effects for cancer risks.  The studies the have been done aon this show weight loss, decrease of regulatory glucose markers like insulin, potential for improvement in lipid profiles, and improvement in inflammatory markers. 

Modified Fasting Regimens
These type of fasts allow for consumption of 20-25% of the caloric energy requirements of the individual on regularly scheduled “fast” days.  The term “fast” here is referring to “severely limited energy intake” and not “no energy intake”.  This is the popular 5:2 diet, which involves severe energy restriction for 2 non-consecutive days/week and ad-libitum eating the other 5 days/week.  Studies of this fasting regimen have showed decreased visceral fat, decreases in insulin like growth factor, and adipocyte size (fat cells).  Previous research on this diet has shown weight loss, improvement of inflammatory markers, improvement of lipid profiles, improvement of fatigue, increases of self confidence and improvement of mood. 

Time Restricted Feedings
This seems to be one of the more popular methods of intermittent fasting.  There are many different protocols that allow the individual to eat and drink ad-libitum for a certain period of time during the day, and “fast” for a certain period of the day on a regular basis.  Daily fasting intervals range from 12-20 hours. With this method of intermittent fasting, it is important to synchronize intermittent fasting regimens with daily circadian rhythms (sleep/wake cycles). Studies show even just an 11 hour fasting interval produced 1.3% of weight loss.  They also found that eating one meal per day reduced fasting glucose levels (sugar). However, there were no changes in mood that they could find.

Religious Fasts
In the Islamic religion,  there is a fast that occurs from dawn to sunset during the entire month of Ramadan. They are also forbidden from consuming fluids and medications. Depending on the location the person is in, their fast can carry from 11-22 hours.  Research on this type of fasting has found  weight loss during this period of time of 2.7 pounds during the month of Ramadan, with an average weight regain of 1.5 lbs 2 weeks after Ramadan. They also found that fasting blood glucose levels and LDL levels decreased during this period.  This fasting pattern is opposite of normal human circadian rhythm patterns and is not ideal for a weight loss intervention.

In the Jewish religion, there are 6 fast days, with the most well known fast day being Yom Kippur, the Day of Atonement. Two of the fast days are “major fast days” which are a period of 25 hours (sunset to nightfall the next day). On the major fast days, they are not allowed to eat or drink, work, bathe, or experience other life pleasures.  During the minor fast days, the fast lasts from before sunrise to nightfall on the same day. Only food and water is restricted during this time.  The length of time of the minor fasts can vary depending on the season of the year.

How does intermittent fasting improve health? 
By limiting food consumption to the daytime, we are able to harness the natural circadian rhythm to improve metabolism.  Animals that are restricted to activity during a certain period of time develop an internal clock (circadian rhythm) that allows for physiological processes to be optimized during the time the animal is awake.  Wake/sleep cycles (circadian rhythm) affect the integration of the body's metabolism, hormone production, physical coordination, and sleep.  

The circadian rhythm has an impact on the GI (gastrointestinal) tract as well.  For example, gastric emptying and blood flow are greatest during the day time and slower during the evening time. This is also when humans are most active.  Intermittent fasting may also directly effect the microbiome in the GI tract. The microbes in our GI tract help us to process and break down our food.  The gut microbiome (bacteria in our GI tract) influence energy absorption and storage. They actually help us break down food.   Certain microbes that are increased with obesity can directly alter the permeability (holes in the membranes) of the GI tract membrane, leading to increase gut permeability and promoting systemic inflammation. 

Lastly, there have been many studies showing that night eating is associated with reduced sleep and poor quality sleep. This can lead to increased risks of obesity, diabetes, cardiovascular disease, and cancer.    Eating at night time can de-synchronize the natural circadian rhythm and disrupt normal sleep cycles. 

One additonal thing that none of the studies I referenced is exercise.  With any dietary plan, I would highly encourage an exercise program to be used along with it to achieve optimal health benefits and results.  If you are going to try an intermittent fasting diet, make sure to drink plenty of water on your fast days. 

Is intermittent fasting for everyone?  Certainly not.  Can it be utilized for certain people to help with medical conditions, weight loss, or mood? Yes, it can.  Please consult your personal physician before starting any specialized diet. 

If you have questions about intermittent fasting or would like to learn more about how your diet is influencing your health, you can visit FORM-medical.com for more information.  If you would like to schedule an appointment to come in to discuss these things in person, please call 720-370-9559. 

Reference:
R. Patterson, G. Laughlin, D. Sears, A. LaCroix, C. Marinac, L. Gallow, S. Hartman, L. Natarajan, C. Senger, M. Martinez, A. Villasenor. "Intermittent Fasting and Human Metabolic Health." J Acad Nutr Diet. 2015 Aug; 115(8): 1203–1212. 

 
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Alternative to Knee Surgery? 1/4 of Patients End up with a Knee Replacement


By Jessica Kelner, D.O. - February 20, 2019

Contrary to the widespread belief that arthroscopic knee surgery "fixes" the knee, recent research has shown that is not always the case. The research is strongly encouraging us to consider an alternative to knee arthroscopy.  Why? An alarming 1/4 patients that undergo knee arthroscopic surgery will end up with a knee replacement within 3 years! 

Arthroscopic knee surgery began in the 1980s and at that time, seemed to be a great advancement in the surgeries that came before it.  Arthroscopic knee surgery for degenerative knee disease is the most common orthopedic procedure performed in the US and globally.   It is performed more than two million times each year.  This type of procedure when used for degenerative knee disease cost over 3 billion dollars in the US alone.  Why is this procedure still so popular despite the recommendations against it? Some continue to advocate for this type of surgery for meniscal tears, mechanical symptoms, and acute symptoms as well as there is the financial incentives for the health care system.  

Another reason not to rush into surgery:  35% of people greater than 50 years of age have evidence of a meniscal tear on MRI, even though two thirds of these tears are asymptomatic. the meniscus isn't always the problem.  There are many reasons one may have pain in the knee; some may not be revealed on an MRI. 

This report published in the May 2017 Journal BMJ compares the effectiveness of of arthroscopic surgery for treating degenerative knee disease to conservative treatments like physical therapy and medication.  This report revealed that <15% of participants that had  arthroscopic surgery resulted in even a small improvement in pain or function at three months after surgery.  Moreover, this benefit was not sustained at one year. 

This study looked at patients over the age of 50 who had arthroscopic surgery to "repair" a meniscus tear.  Something to note, is at this age, most often meniscus tissue is removed that is degraded.  These patients were then evaluated for the nee for a Total Knee Replacement after failing the arthroscopic surgery. Unfortunately, 26% of them needed a knee replacement within 3 years

Another study, called the MeTeOR trial was trying to assess two different treatment strategies for knee pain: conservative therapy vs arthroscopic surgical repair. The study was composed of 351  participants with knee pain, meniscal tear, or osteoarthritic changes on x-ray. They were randomized into two groups, arthroscopic repair or physical therapy. During a 5 year follow up of the 351 participants of the study, it was determined that both the conservative group and surgery group had similar degrees of improvement, however,  10% of those that had arthroscopic surgery ended up getting a Total Knee Replacement. Given that more than 400,000 Total Knee Replacements are done in the US every year, this study suggests that an excess of 40,000 knee replacements are performed in surgically treated patients.

These studies are only the beginning of the research into the alternatives to orthopedic surgery. As advancements are made through alternative treatments like regenerative medicine, I suspect more studies, like this one , will be done on prolotherapy, Platelet Rich Plasma, and Stem Cell treatments. Hopefully, with more research and more education and incorporation of these types of treatments into the clinical setting, more patients will have this as an available treatment option.  

If you would like to learn more about non-surgical alternatives to knee pain, check out FORM-medical.com. 
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Cold Symptoms - How to Prevent Them and Recover Faster


By Jessica Kelner, D.O. - February 11, 2019

Uhgg colds. No one likes them. Everyone wants them to go away as fast as possible. They seem to be an annoying, gross inconvenience in life.  

Why does it seem like people get sicker during winter time? 

You can get a cold anytime during the year, however, the winter months are commonly considered  to be "cold season".  During the winter, people spend more time indoors in close quarters, travel more frequently to see family or friends, and people get less vitamin D (from the sun).  The viruses that cause colds are spread more easily in colder, drier air.  So, if we had to put a time frame to "cold season", we could say it starts sometime around September and ends sometime around April in the United States.

Reasons why colds are more common during winter months:
1. Children spend more time indoors and in school sharing germs during the winter vs the summer. 
2. Being indoors means less sunlight exposure, which means less vitamin D production, and potentially weaker immune systems. 
3. People travel more frequently on planes during the winter months.  There are people that travel when they are sick and with re-circulated air on planes and the stress of traveling on the body, you are bound to get sick. 

Common Cold Symptoms
1. runny/stuffy nose
2. sore throat
3. headache
4. fever
5. body aches
6. sneezing
7. pressure in the head or face
8. fatigue
9. foggy feeling
10. post nasal drip
11. cough

How to Avoid Getting Sick During Cold Season 
1. Wash your hands often.  Make sure to wash them with warm water and antibacterial soap. You could use hand sanitizer between some good hand scrubbing.   

2.  Public places. If you are in a public place or on a public form of transportation and someone is coughing, sniffling or appearing to be sick, try to avoid sitting or standing close to them.  You can buy a face mask at your local pharmacy and put one of those babies on during more emergent situations (ie. you're stuck on a plane sitting next to someone that looks like deaths door).  Yea, you may look a little funny, but hey you won't be suffering for the next week feeling crummy. 

3.  Have sick co-workers? Maybe your pal in the cubicle next to you is hacking up a storm and you just are wishing she would go home and get better.  If you aren't her boss, you may not be able to get her to go home, but you can make sure that you sanitize/wash your hands often, get plenty of sleep a night, eat a healthy diet, and keep your stress levels low.  If you do have employees that you manage or supervise, you may want to consider initiating a sick policy at your work place.  This may include sick days and or other things people can do at the office to prevent the spread of germs. 

4. What if my family member is sick?  While this may be quite challenging to avoid your loved one at home, there are some things you can do to prevent the spread of their infection.  Ask them to wash their hands, keep their tissues contained to trash can (yes people leave them on counters), don't share food, silverware, or drinks with them.  Make sure to take care of yourself by getting plenty of sleep, eating heathy, and keeping low stress levels so your immune system will be tough and strong during that time. 

If I have a cold, do I need antibiotics? 
No. Colds are caused by viruses. You may feel terrible, have body aches, a fever, a really stuffy nose, or a terrible sore throat.  Supportive care to help your body fight off the cold is the best thing for you.  

How do I get rid of this cold?
Most colds last anywhere from 7 days to 3 weeks. Yes, that is right, 3 weeks. The better care you take of yourself during your illness, the faster you will get better.

Here are some things you can do if you feel like you have a cold:  get plenty of rest, do not drink alcohol, keep your stress levels low, take extra vitamin C, zinc, echinacea, and vitamin D, drink plenty of water and eat a healthy diet.  

If you feel like you need additional advise of what to do when you're under the weather, you can go see your primary care doctor or call a telemedicine service.  Telemedicine is a form of medical care that uses technology (ie the internet and face-to-face software) to allow you to talk to a physician  and be examined.  Telemedicine  has become an invaluable resource for patients.  You can reach a physician without having to get out of bed, thus making seeing a doctor easier than ever.  Your primary care doctor may offer a telemedicine service or there are other companies that provide telemedicine across the country.  

How do I know if I have the cold or the flu?
If you feel as though your cold is worse than any other cold you have had before, you may in fact have the flu.  A visit to your local physician may be warranted in that case. 
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