Wellness Briefs

Rosetto Effect: Application in Integrative Medicine

2015-01-06T11:52:00.001-08:00

In the early 1960s, a small town in eastern Pennsylvania came to the attention of two researchers. Roseto, founded by Italian immigrants, is a town of fewer than 2,000 residents located in the foothills of the Appalachian Mountains. Stewart Wolf, a medical doctor, and sociologist John G. Bruhn became interested in Roseto when they discovered that the male death rate from heart attack was less than half that of neighboring towns. Intrigued, the researchers set out to discover why.

At first, it was thought that perhaps their Mediterranean diet played a role. Did they exercise more? Smoke less? Inherit great genes? Residents underwent physical exams. They completed family surveys. Dietitians observed their food shopping and eating habits. Surprisingly, the results showed that people in Roseto ate the same animal fats as other Americans, smoked as much, exercised as little, and suffered from hypertension and diabetes at the same rate as their counterparts in the region. The researchers were stumped, until they began to notice that the town possessed certain characteristics that were not in evidence elsewhere. The population was very homogenous and tightly knit. Most families lived in multi-generational households. People supported and looked out for one another with a sense of community and solidarity. Their sense of identity and cohesion was reinforced by shared religion, culture, history, and traditions.

As Wolf and Bruhn noted in their retrospective, The Power of Clan, “What seems to have been learned is an old but often forgotten conviction that mutual respect and cooperation contribute to the health and welfare of a community and its inhabitants, and that self-indulgence and lack of concern for others exert opposite influences.”

Over time, as the town grew more heterogeneous, younger residents became more integrated into the world outside Roseto and began to move away from the ways of their parents and grandparents, living independently and abandoning old-world traditions. Deaths by heart attack started to climb correspondingly until they reached the same levels as in surrounding towns. The “Roseto effect” disappeared.

As Americans, we value diversity, so we are not looking to replicate a physical Roseto, with its notable homogeneity. Americans also move around more than any other people in the world, so our neighborhoods are often in flux. How then, do we create the kind of community the people of Roseto enjoyed for generations? That is what we are attempting at Georgia Integrative Medicine. We want to create an atmosphere that provides the kind of support, encouragement, and nurturing that can have a Roseto-like effect on people’s physical and emotional well-being. We want Rosetto effect for our patients as well as for ourselves.

One of the reasons why I created Georgia Integrative Medicine was to create a community of healers. After a decade, we have dedicated team members, volunteers, and patients that creates an extraordinary healing environment. This effect was partly inspired by my reading about Rosetto effect while studying with Dr. Andrew Weil at University of Arizona.

from Dr. Kim's book - Tao of Healing: A Story of Georgia Integrative Medicine

Yoon Hang "John" Kim, M.D., M.P.H.

Georgia Integrative Medicine

Clinic 678.814.1333

Mobile 678.373.8034

Home 678.519.0822

Blog: www.mindfulwise.com

Facebook: https://www.facebook.com/georgiaintegrative

Twitter: @GAIntegrativMed

Author: Tao of Healing: A Story of Georgia Integrative Medicine

Instructor: 2015 Winter Integrative Health Studies e-course

Enhancing Your Immune System This Winter

2015-01-06T07:55:00.002-08:00

This year promises to be a difficult flu season.

Below are some of practical ways to enhance your immune system:

Self Care Program:
- Sleep early and wake up early (8 hours)
- Use food as medicine - Optimize your biochemistry through your choice of food - fresh vegetables and fruits can provide with many of micronutrients such as vitamins. High quality protein and fat are also important.
- Deep breathing - I do this first thing in the morning - easier to do when everyone else in the house is still sleeping (see first step - sleep early and wake up early)
- Walk under the sun 10 - 20 minutes three times a day
Supplements:
- For myself, I take a daily anti-inflammatory detox containing essential vitamins using WellJourney Clear.
- In addition, I take medicinal mushrooms (WellJourney Defend) daily.
- I also take a Chinese herbal formula containing astralagus when I am giving care to patients with respiratory infection - Bu Zhong Yi Qi Tang.

Please remember that supplements work best in addition to your self-care program. Be well this Winter.

Yoon Hang "John" Kim, M.D., M.P.H.

Georgia Integrative Medicine

678.814.1333

Blog: www.mindfulwise.com

Facebook: facebook.com/georgiaintegrative

Twitter: @GAIntegrativMed

Author: Tao of Healing: A Story of Georgia Integrative Medicine

Instructor: 2015 Winter Integrative Health Studies e-course

___________________________________

2014-11-17T09:40:00.003-08:00

Treating Depression with Integrative Medicine: An Evidence-Based Approach

Yoon Hang John Kim* MD MPH and **Jeanne Bowers LAPC

Georgia Integrative Medicine

www.georgiaintegrativemedicine.com

What is Depression?

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of wellbeing(1). Depressed people can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable and/or restless. They may lose interest in activities that were once pleasurable, experience either loss of appetite or overeat, have problems concentrating, have difficulty remembering details or making decisions, and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present. (2)

According to the CDC, about 9% of Americans report they are depressed at least occasionally, and 3.4% suffer from major depression.(3) The analysis, part of the CDC’s Morbidity and Mortality Weekly Report(MMWR) for Oct. 1, was based on a survey of 235,067 people aged 18 and older in 45 states, Washington, D.C., Puerto Rico, and the Virgin Islands.

Depressed mood may not require any professional treatment, and may be a normal reaction to certain life events, a symptom of some medical conditions, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition, e.g., of a mood disorder, which may benefit from treatment. (4)

What is Integrative Medicine?

Integrative medicine is healing-oriented medicine that takes into account the whole person. In integrative medicine, an examination of the whole extends to exploring a patient’s spirituality, emotional state, relationships, and behaviors as they relate to health and wellness. Integrative medicine draws from conventional as well as complementary and alternative medicine, and offers an array of treatment and care options from each field that may be used alone or in combination. (5)

Integrative medicine utilizes the strengths of conventional medicine and the wisdom of complementary and alternative healing modalities. Alternative modalities include acupuncture, Chinese herbs, and supplements (5).

Evidenced Based Medicine & Cochrane Library

Evidence-based medicine emphasizes the use of evidence from well-designed and conducted research in healthcare decision-making. The term “evidence-based medicine” was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians (6).

Cochrane Reviews, a database of systematic reviews and meta-analyses which summarize and interpret the results of medical research. The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine (7).

Evaluation of Integrative Medicine Modalities to Treat Depression:

Music therapy for depression
Authors’ concluded that the findings from individual randomized trials suggest that music is accepted by people with depression and is associated with improvements in mood. However, the authors express concern due to small number and low methodological quality of studies (8).

Exercise for depression
Authors concluded that exercise is moderately effective for reducing symptoms of depression, but methodologically robust trials only shows a small effect. When compared to psychological or pharmacological therapies, exercise appears to be no more effective, though this conclusion is based on a few small trials (9).

St. Johns-wort-for-treating-depression
Authors concluded that the hypericum extracts tested in the included trials a) are superior to in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants (10).

Light Treatment for Non-SAD Depression
Authors concluded that for patients suffering from non-seasonal depression, light offers modest though promising anti-depressive effect , especially when administered during the first week of treatment, in the morning. Authors caution that due to limited and of studies these results need to be interpreted with caution. (11)

Discussion:

The art of practicing medicine is based on science of medicine. However, the art goes further and deeper than what the current evidence provides the practitioners. For example, in addition to music therapy, exercise, light treatment, and St. John’s Wort, I have seen impressive results with acupuncture with electrical stimulation. In addition, Chinese herbs can also provide a valuable additional tool for treating depression. Lastly, counseling allows patients to experience growth and healing in a time of great suffering.

Conclusion:

A current review of evidence indicates that music therapy, exercise, St. John’s Wort, and light therapy all have positive anti-depressive effect. However, the number of studies are small and the quality of the studies are low.

Caution:

If you have symptoms of severe depression or suicidal ideations, you need to seek out an experienced integrative medicine physician, psychiatrist, or counselor.

References:

1. Salmans, Sandra (1997). Depression: Questions You Have – Answers You Need. People's Medical Society. ISBN 978-1-882606-14-6.
2. "NIMH · Depression". nimh.nih.gov. Retrieved 15 October 2012.
3. http://www.cdc.gov/mmwr/pdf/wk/mm5938.pdf
4. Cheog J et al. for PsychCentral.com. Last reviewed August 26, 2010. Frequently Asked Questions About Depression Accessed May 11, 2013
5. http://www.georgiaintegrativemedicine.com/Integrative_Medicine.html
6. Evidence-Based Medicine Working Group (November 1992). "Evidence-based medicine. A new approach to teaching the practice of medicine". JAMA 268 (17): 2420–5.
7. http://en.wikipedia.org/wiki/Cochrane_Library
8. Maratos A, Gold C, Wang X, Crawford M. Music therapy for depression. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004517. DOI: 10.1002/14651858.CD004517.pub2.
9.Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE. Exercise for depression. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub6 - See more at: http://summaries.cochrane.org/CD004366/DEPRESSN_exercise-for-depression#sthash.DrCaPbSh.dpuf
10. Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3

11. Tuunainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004050. DOI: 10.1002/14651858.CD004050.pub2.

* Yoon Hang John Kim, Director, Georgia Integrative Medicine. E-mail: drkim@georgiaintegrative.com

** Jeanne Bowers, Counselor, Georgia Integrative Medicine. E-mail: jeanne@georgiaintegrative.coms

Insured, but Bankrupted by Health Crises

2009-07-01T15:23:00.000-07:00

http://www.nytimes.com/2009/07/01/business/01meddebt.html?ref=business

Above is a link about the U.S. healthcare problems faced by millions of Americans.
As health care fix is being investigated by the Obama administration, I hope that it will consider the suffering of its people and come up with a viable solution.

How Safeway Is Cutting Health-Care Costs

2009-06-12T05:51:00.000-07:00

http://online.wsj.com/article/SB124476804026308603.html

Above is an article published by the Wall Street Journal written by the CEO of Safeway.

By all accounts, our health care is in deep trouble. The US spends the most of money in health care only to claim 37th in the world right after Costa Rica. There are growing population of the US, more than 48 million people, who does not have insurance. More and more businesses are not able to afford providing insurance to the employees.

The article points out how we can learn from the auto industry. Provide financial incentives for health associated behaviors and provide financial disincentives for illness associated behaviors. It's pretty simple really. When people realize preventive measurements such as blood pressure, cholesterol, and weight result in increased premiums, they have a tendency to want to self correct the behavior.

Safeway implemented this policy and found that they can save 40%. Perhaps, the rest of the U.S. can learn from this experience.

Cost-Effective Ways to Fight Insomnia

2009-06-10T12:31:00.000-07:00

http://www.nytimes.com/2009/06/06/health/06patient.html?_r=1&scp=1&sq=insomnia&st=cse

Dalai Lama said "Sleep is best meditation." I agree.
Lack of sleep can easily account for many of the chronic illnesses in the U.S. While, I cannot say that lack of sleep or chronic sleep deprivation causes illnesses, it can contribute to the ill effects of chronic illnesses.

I find that sleeping problems are often the most sensitive indicator of overall health and wellness. Often times, sleep disturbances will precede an episode of illness or a bout of depression or anxiety.

A good sleep resets our body and mind and renews our spirit. I find good sleep to be most cost effective ways for wellness. Integrative Medicine is a wonderful asset to help people to restore a good sleep.

Dr. Rubin Naiman, a faculty at Dr. Weil's faculty, suggest below suggestions for improving sleep:

Recommended Lifestyle Changes for Insomnia Treatment:

from Dr. Weil's website: http://www.drweil.com/drw/u/ART02004/insomnia

The following are some of the best possible insomnia remedies:

Establish a consistent bedtime routine. This is one of the most important factors in insomnia treatment and maintaining good sleeping habits. Routines may include taking a warm bath or a relaxing walk in the evening, or practicing meditation/relaxation exercises as part of your regular nighttime routine.
Try to go to bed at the same time every night, and get up at the same time each morning. This includes weekends.
Get plenty of exercise during the day. Studies have shown that people who are physically active sleep better than those who are sedentary. The more energy you expend during the day, the sleepier you will feel at bedtime. Just be sure not to engage in vigorous exercise too close to bedtime as that can make it more difficult to fall asleep.
Reduce your intake of caffeine, particularly in the evening.
Avoid stimulants like caffeine and limit alcohol. Both, even when consumed early in the day, can affect sleep and inhibit insomnia treatment.
Use your bed only for sleeping and sex. Don’t use it to do work or watch TV.
Avoid large meals late in the evening.
If you can’t fall asleep within half an hour of going to bed, get up and read or do something calming until you feel sleepy.
Learn and use a relaxation technique regularly.Breathing exercises, meditation and yoga are not insomnia cures, but do lead to a state conducive to sleep.
Use “white noise” devices to block out surrounding environmental noise.
Take a hot bath before bedtime. Try a few drops of relaxing oil of lavender in the water.
Short naps are good. Try to get into the habit of napping for insomnia treatment: ten to twenty minutes in the afternoon, preferably lying down in a darkened room.
Spend some time outdoors as often as you can to get exposure to bright, natural light. If you are concerned about harmful effects of solar radiation, do it before ten in the morning or after three in the afternoon or use sunscreen.
Try to give yourself some time - up to an hour - in dim light before you go to sleep at night. Lower the lighting in your house and bedroom and if other members of the household object, wear sunglasses.
The two best natural sleep aids are valerian and melatonin. Valerian is a sedative herb, used for centuries. You can find standardized extracts in health food stores and pharmacies. Take one to two capsules a half hour before bedtime. Melatonin is a hormone that regulates the wake/sleep cycle and other daily biorhythms. Try sublingual tablets (to be placed under the tongue and allowed to dissolve); take 2.5 mg at bedtime as an occasional dose, making sure that your bedroom is completely dark. A much lower dose, 0.25 to 0.3 mg, is more effective for regular use.
Don’t obsess about not sleeping. Not surprisingly, studies have shown that individuals who worry about falling asleep have greater trouble dropping off. It may help to remind yourself that while sleeplessness is troublesome, it isn’t life-threatening and there are insomnia remedies.

If All Doctors Had More Time to Listen

2009-06-10T12:09:00.000-07:00

http://www.nytimes.com/2009/06/07/health/07health.html?_r=1&em

Above is an article in NY Times on If All Doctors Had More Time to Listen.

I feel priviledged to be part of the team at Georgia Integrative Medicine. We make the time to listen to our patients. Patients have ready access to Dr. Kim. Patients spend about one hour being treated for each visit. For complex patients, we spend up to four hours performing a comprehensive evaluation known as the team visit.

We have patients who are choosing us over their regular physicians and over other integrative medicine physicians because we choose to listen to our patients. Even our growth is managed to ensure that our existing patients have a ready access to Dr. Kim.

At Georgia Integrative Medicine, we understand that our patients are the experts on their bodies and in order to help, we have to listen and understand to their healing journey. Carl Rogers was a humanistic psychologist who understood the importance of "client-centered" therapy. He understood the importance of listening mindfully to what his clients had to say. At Georgia Integrative Medicine, we honor the Rogerian tradition and perform that mindful listening to the best of our ability.

Jeanne Bowers
Clinic Manager

Helath Benefits of Omega 3 Fatty Acids

2009-06-09T06:49:00.001-07:00

http://en.wikipedia.org/wiki/Omega_3_fatty_acids

Above is a link for Omega 3 fatty acids from Wikipedia.
Omega 3 fatty acids is all the rage these days. So, what is omega 3 fatty acids?

First of all, omega 3 fatty acids are essential fatty acids. That means our body is not capable of making them ourselves. We have to obtain it from our nutrition or supplements.

Below are from the Wikipedia article:

The benefits of omega 3 fatty acids were discovered in the 1970s by researchers studying the Greenland Eskimos. The Greenland Eskimos consumed large amounts of fat from seafood, but displayed virtually no cardiovascular disease. The high level of omega-3 fatty acids consumed by the Eskimos reduced triglycerides, heart rate, blood pressure, and atherosclerosis.
On September 8, 2004, the U.S. Food and Drug Administration gave "qualified health claim" status to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) n−3 fatty acids, stating that "supportive but not conclusive research shows that consumption of EPA and DHA [n−3] fatty acids may reduce the risk of coronary heart disease." This updated and modified their health risk advice letter of 2001 (see below). Currently regulatory agencies do not accept that there is sufficient evidence for any of the other suggested benefits of DHA and EPA other than for cardiovascular health, and further claims should be treated with caution.

The Canadian Government has recognized the important of DHA omega-3 and permits the following biological role claim for DHA: "DHA, an omega-3 fatty acid, supports the normal development of the brain, eyes and nerves."
The 18 carbon α-linolenic acid has not been shown to have the same cardiovascular benefits as DHA or EPA. Currently there are many products on the market which claim to contain health promoting 'omega 3', but contain only α-linolenic acid (ALA), not EPA or DHA. These products contain mainly higher plant oils and must be converted by the body to create DHA and therefore considered less efficient. DHA and EPA are made by microalgae that live in seawater. These are then consumed by fish and accumulate to high levels in their internal organs. If a person is concerned about mercury and oceanborne contaminants in fish, DHA can be produced directly from microalgae as a vegetarian source.
Some benefits have been reported in conditions such as rheumatoid arthritis and cardiac arrhythmias.
Some research suggests that fish oil intake may reduce the risk of ischemic and thrombotic stroke.However, very large amounts may actually increase the risk of hemorrhagic stroke (see below). Lower amounts are not related to this risk, 3 grams of total EPA/DHA daily are considered safe with no increased risk of bleeding involved^[and many studies used substantially higher doses without major side effects (for example: 4.4 grams EPA/2.2 grams DHA in 2003 study).

At Georgia Integrative Medicine, the correct use of omega 3 fatty acids form an important part of the treatment protocol. Most plant sources yield ALA not EPA or DHA. Therefore, the preferred sources are from marine animals including Krill, Anchovies, Sardines, and Salmon. One potential problem taking marine based EPA/DHA is the exposure to heavy metal contaminants which can cause health problems. This can be avoided by buying from a reputable producer of omega 3 fatty acids with molecular distillation and asking to see the certificate of analysis.

Letting the Patient Call the Shots

2009-06-07T04:33:00.000-07:00

http://www.nytimes.com/2009/06/04/health/04chen.html?em

Above is an article on the NY Times about the idea about collaborative approach to health care. As a physician in training, I was taught that physicians were the authority figure in health care. I also remember when I was providing primary care that I was taught to deny the patient "unnecessary" prescription of antibiotics.

Today, given the information revolution, I am not sure that a physician, even a specialist, can know better than a motivated patient who is well-read on the subject. I often share with patients that I can provide the perspective, knowledge, and experience. Patients provide the context and subjective experience of how their condition is affecting their life.

I view integrative medicine as not just a combination of Eastern and Western medicine. Rather, it is a transformative way of practicing medicine in a collaborative approach with patients being of assistance to them. Also it is about honoring patients' experience of their suffering of their ill-ness and guiding them back to well-ness. I recall Dr. Bernie Siegel, who helped me through the development of my career, stating that [as physicians], we are a privileged listener.

Medical bills prompt more than 60 percent of U.S. bankruptcies

2009-06-06T03:53:00.001-07:00

http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/index.html

Story Highlights
Study: More than 60 percent of bankruptcies are linked to medical bills
Three-quarters of people with a medically-related bankruptcy had health insurance
Researcher: "You're one illness away from financial ruin in this country"
Situation likely to worsen: study was done a year before recession

Above link is an article featured on CNN focusing on the the importance of medical health insurance issues in the U.S. We currently have the dubious honor of being the first in medical expenditures with health care results being rated 37 in the world after Costa Rica.

Above article states that we are all one illness away from financial ruin in the U.S. As we are discussing universal health care for the U.S., I invite everyone to be active in participating the development. The first step of participating is knowing what is being proposed and understanding how it affects you.

Study: Alzheimer’s Drugs May Raise Death Risk in Elderly

2009-01-10T12:43:00.000-08:00

NY Times has published that Anti-psychotic drugs commonly used to treat Alzheimer's disease may double a patient's chance of dying within a few years, suggests a new study that adds to concerns already known about such medications.

I am not surprise at the finding. Western medicine has outstanding tools for acute problems such as trauma, heart attack, and stroke. However, my sense is that integrative medicine has much better handle on chronic degenerative illnesses such as Alzheimer's disease. The basis of all degenerative disorders involve abnormal inflammation. There are highly effective nutritional protocols that can be of help to reduce inflammation. In addition, there are mycomedicinal products that have been shown to have stimulation of nerve growth in-vitro.

At Georgia Integrative Medicine, we have used natural approaches to Alzheimer's disease successfully using all of above approaches. We also treated successful dementia resulting from other causes including Parkinson's disease.

Major Flu Strain Found Resistant to Leading Drug, Puzzling Scientists

2009-01-10T12:20:00.000-08:00

NY Times has reported that virtually all the dominant strain of flu in the United States this season is resistant to the leading antiviral drug Tamiflu, and scientists and health officials are trying to figure out why.

Western scientific breakthroughs in microbiology has led the scientific methods to become the core of medicine. Drs. Pasteur and Koch demonstrated how illness was caused by microorganisms. Then, the discovery of anti-biotics have changed the treatment options.

About one hundred years ago, people died of diseases related to infectious diseases. The whole society had to mount a comprehensive approaches including public health advances.

We have found with antibiotics we can benefit many people dying of infectious illness. Last century ended with HIV virus and Avian Flu virus reminding us of our vulnerabilities to infectious diseases.

Integrative approach to infection still have anti-biotic, anti-fungal, and anti-viral as central role. Many patients who develop Shingles receive anti-viral medication at Georgia Integrative Medicine. However, in addition, we also use Chinese herbs that support immune functions with scientific evidence. In addition, we also use anti-inflammatory nutrition to decrease possibility of post-herpetic neuralgia. Also, medicinal mushrooms can be helpful to shorten the duration of illness.

I believe that flu pandemic is just a matter of time and that most of our measures will not likely to be successful for treating a viral illness. Integrative medicine, I believe, can provide important tools for developing next generation of fighting microorganisms causing death & pestilence.

Wall Street Journal: Alternative Medicine is Mainstream

2009-01-10T05:00:00.000-08:00

JANUARY 9, 2009

Wall Street Journal has published an opinion written by Drs. Chopra, Ornish and Weil.

Below is my submission to the letters to the editor:

Dear Editor: The article by Chopra et. al summarizes my journey as a physician. I chose family medicine as my first specialty. The reactive nature of primary care where the system was overwhelmed with treating symptoms of patients precluded the possibility of providing a systematic proactive approach focusing on prevention.

I pursued further training through preventive medicine residency which included a master's degree in public health. The additonal training provided me with a valuable systems perspective. Our current health care model is largely based on social conditions prevailing in the early part of last century where infectious causes of diseases were most frequent. Today, the disease frequency has shifted to chronic illnesses where therapeutic lifestyle change has been shown to work.

As part of my residency, I also worked at Kaiser Permanente's Preventive Medicine Department and Positive Choice Wellness Center where health appraisal program identified individuals with high risk of developing chronic illnesses and therapeutic life style change was prescribed by physicians and implemented by nurses and counsellors. Another benefit of the preventive medicine training was academic training of evaluating evidence. The difficult part of evaluation of evidence is not evaluation but education of professionals and public of complexity of conditional truths rather a simple generalizable truth. I have written several review papers evaluating the effectiveness of acupuncture and other modalities for treating medical condition. The result is complex. While acupuncture does not appear to be effective as a sole therapy for addiction, there is a solid evidence for acupuncture for treating knee pain due to osteoarthritis.
Complexity is compounded by professional researchers who are not experts in the modality and experts in the modality who are not researchers collaborating.

After the preventive medicine residency, I was fortunate to be accepted to the residential integrative medicine fellowship program at University of Arizona founded by Dr. Andrew Weil. The program provided hands-on clinical training and academic training from evidence based medicine and complexity theory to total quality control. Since graduation, my attempts to help a healthcare system implement integrative medicine has been challenging. Most systems want a cosmetic integrative medicine program benefiting marketing position of the system. I have not yet found a system willing to use integrative medicine to revolutionize health care outcome.

Today I practice integrative medicine where I provide mindful choices to medicine. Patients needing medications are prescribed, patients needing specialists are referred, and the majority of patients needing healing are assisted with making the therapeutic life style change. To put it simply, it is common sense that we treat patients with cheaper and safer treatment modalities before exploring more expensive and risky procedures.

The quality of health care in the US has been deteriorating despite growing costs of health care. The burden on people are increasing and the access of healthcare is decreasing. We are in a desperate need for an overhaul of the system. The new system needs to take account of the fact that we need a new model based on current prevalence of chronic illnesses. I view the current economic crisis and the new administration a dangerous opportunity (characters combined meaning crisis in Chinese) for creating a model health care for the world in this century. Is there enough courage and political will to do so? For all of our sake, I hope so.

Yoon Hang "John" Kim, MD MPH FAAMA
Director
Georgia Integrative Medicine

click to read the article

Inflammation and Heart Health

2008-10-24T05:02:00.000-07:00

The cholesterol-inflammation connection

Above link is an article from CNN article on cholesterol & inflammation and their relationship to heart health.

One of the potential pit falls of conventional medical approach is that the thought processes are linear and do not take account of the complexity of biology. For example, many medications are used to improve the lipid profile including LDL (considered the bad cholesterol) and HDL (considered the good cholesterol). However, the reality is not so simple.

One of the benefits of studying with Dr. Andrew Weil was learning about systems approach to understanding illness. Dr. Weil taught that inflammation is a commonality in many illnesses and that a nutrition regimen that takes account of lowering inflammation can result in many benefits. It seems that more of physicians are discovering that is true. Below is a quote from the original CNN article.

"Inflammation is the common denominator in nearly all of the diseases we deal with," says James O'Keefe, MD, director of preventive cardiology at the Mid America Heart Institute in Kansas City, Missouri. "Heart disease, diabetes, dementia -- they're all tied to inappropriate, low-grade, chronic inflammation." CNN

To keep inflammation to a minimum, Dr. O'Keefe recommends a restricted-calorie diet (similar to the Mediterranean diet), consisting of fruits and vegetables, lean protein, nuts, vinegar, tea, and fish oil, as well as low to moderate alcohol intake.

"The key to restoring good health to America is getting people to tune in to the connection between the dynamic, hour-to-hour nature of inflammation and their general health and well-being -- of their heart, their brain, their blood," says Dr. O'Keefe. "From a health standpoint, nothing is more important than keeping those inflammation levels down." CNN

It's wonderful to see that even the medical profession is catching on to the one of the essential tools of integrative medicine.

Community CAM Clinic now Open @ GIM

2008-10-09T11:40:00.000-07:00

We are pleased to announce that medical care at Community CAM Clinic is now available at an affordable price!

Complementary and Alternative Medicine or CAM is very popular but in many instances is not covered by insurance.

WellJourney (www.welljourney.com) has addressed this problem for its current and future patients by making arrangements through Georgia Integrative Medicine to provide access to affordable CAM treatments at prices comparable to co-pay deductibles!

When: Saturdays at 1 PM - 3 PM (Registration)
What: Acupuncture, Naturopathy, Homeopathy, Energy Healing, Medical Intuition, and Primary Care
Cost: $25 per service

Boomers won't bust us - Health care will

2008-08-28T18:57:00.000-07:00

Boomers won't bust us - Health care will
Please click above link to read the CNN article.
Our economy appears to be suffering. The overall health of the future of american economy is described in CNBC article (http://www.cnbc.com/id/26001658) and the upcoming documentary, IOUSA.

Along with the trade deficits and the federal deficits are two culprits. A major portion of federal deficits, especially in the coming future, will be from Health Care. The U.S. government is the biggest payor of health care expenses including Medicaid and Medicare. http://www.cms.hhs.gov/nationalhealthexpenddata/ provides useful statitistics. In 2017, it is estimated that nearly 20% GDP will be dedicated to healthcare. That means nearly quarter of every dollar will be spent in health care.

What do we get from this very expensive health care system? The best in the world? No, not even close. http://healthcare-economist.com/2008/07/18/us-health-care-scores-poorly/ is an article that describes the health care system as sick. And this sick health care system is making our finances ill.

I believe that integrative medicine and preventive medicine can make a difference in the quality of care and quality of life. It is this firm belief that I chose to train beyond family medicine. I spent two years completing a preventive medicine residency and a master's in public health and another two years training with Dr. Andrew Weil at U of Arizona.

Integrative Medicine makes use of the Western diagnostic tools and also uses less invasive tools of healing for a problem before rushing to more invasive and more expensive modalities such as surgery. Preventive Medicine makes use of existing tools to prevent problems to become worse.

I hope that our politicians pay attention to the coming trends and attempt to correct the course before our financial future of the country will be threatened.

John Kim, MD MPH
Director
Georgia Integrative Medicine

UNM sets opening event for integrative medicine clinic

2008-08-07T14:11:00.000-07:00

http://www.bizjournals.com/albuquerque/stories/2008/08/04/daily15.html

Above is the link for the news announcing yet another University Medical Center (U of New Mexico) creating an integrative medicine center. U of Arizona, UCSF, and Duke University have started integrative medicine centers recognizing the value of integrative medicine.

In my training with Dr. Andrew Weil at University of Arizona, probably the most important lesson was that Integrative Medicine's mission is to focus on patients' healing rather than to focus on tools and modalities.

Physicians and healers have a tendency to develop attachment to techniques that they have learned and invested their resources. For example, physicians tend to prescribe medications and chiropractors tend to perform adjustments and acupuncturists to acupuncture.

Rather than focusing on tools of healing, integrative medicine focuses on the needs of the patients and weaves a comprehensive healing plan setting priorities on methods that are less invasive to patients that have higher probability of success. The techniques where patient can enhance their own healing ability is also encouraged through nutrition, meditation, mind-body techniques, and physical activity such as Tai Chi.

This way, patients can be empowered for their own healing of the mind, body, and spirit.

John Kim, MD MPH
www.georgiaintegrative.com

Drugs to Build Bones May Weaken Them

2008-07-23T12:31:00.000-07:00

Drugs to Build Bones May Weaken Them

Above link (click on it to read the original article) is NY Times News article on drugs that are used to treat osteoporosis may actually weaken them.

Osteoporosis is a serious health concern for American women. It is defined in women as bone mineral desnsity lower than 2.5 times the normal bone density. It is measured by DEXA. The main concern about osteoporosis is that it leads to increase risk of fracture. Hip fracture, especially, is traumatic to the patients, often requiring several months of rehab.

Osteoporosis is most common in post-menopausal women. It also is caused by the use of steroid medication. Osteoporosis can be prevented with lifestyle advice and sometimes medication, and in people with osteoporosis treatment may involve lifestyle advice, preventing falls and medication (calcium, vitamin D, bisphosphonates and several others).

There are a number of medications that are used to treat osteoporosis including fosamax. During my training at Dr. Andrew Weil's Program in Integrative Medicine, I was educated by my patients who researched about fosamax and was concerned about the possibility that fosamax actually may weaken the bone. The concern was a theoretical one at that time; it was thought that bone density increase was due to abnormal bone density growth that may not be as strong as normal bone. It seems that my patients may have been on to something.

Physicians at Weill Medical College of Cornell University are reporting that prolonged Fosamax—generically known as bisphosphonate alendronate—use may increase the risk of femur fractures, the large thigh bone that connects the leg to the hip. Continued evidence indicates that long-term alendronate use may overly suppress bone metabolism, which limits the repair of microdamage and increases fracture risk, Dr. Joseph M. Lane and colleagues report in the Journal of Orthopaedic Trauma. This report can be read by clicking following hyperlink http://www.newsinferno.com/archives/3443.

Meanwhile, earlier this year Canadian researchers issued a warning that bisphosphonates, sold under the names of Didrocal, Actonel, and Fosamax can lead to bone necrosis, a painful and disfiguring condition that results in bone death. The study found that such drugs almost tripled the risk of developing bone necrosis. The study was conducted by researchers at the University of British Columbia (UBC) and McGill University and is the largest study of its kind into the connection between bone necrosis and specific brands of bisphosphonates: Didrocal, Actonel, and Fosamax. Prior to that warning, the U.S. Food and Drug Administration (FDA) issued a warning about bisphosphonates and its link to a higher possibility of severe and sometimes incapacitating bone, joint, and muscle pain. “I think the study’s important just basically to let the public know if they do experience any severe, unusual pain they could tell their health professional,” said Dr. Mahyar Etminan, the principle investigator from the University of British Columbia. This report can be read by clicking following hyperlink http://www.newsinferno.com/archives/3443.

This puts many patients who are on Fosamax and related medicine at a catch 22. There are integrative approaches to slowing the bone loss using nutrition - calcium, magnesium, boron, and strontium. In addition, green tea extract, and ipraflavone can be useful. However, there is no documented study of strengthening the bone. From preventive point of view, the maximal protection comes from having had maximal bone density achieved in the teen years - which is affected by genetics, nutrition, and physical activity.

John Kim MD MPH
www.georgiaintegrative.com

Popular Fish, Tilapia, Contains Potentially Dangerous Fatty Acid Combination

2008-07-18T11:13:00.000-07:00

Popular Fish, Tilapia, Contains Potentially Dangerous Fatty Acid Combination

Last week, I posted an article about Tilapia containing potentially dangerous omega 6 fatty acids resulting in increased inflammation. Above article from Science Daily detail the account of the risk.

"The researchers say the combination could be a potentially dangerous food source for some patients with heart disease, arthritis, asthma and other allergic and auto-immune diseases that are particularly vulnerable to an "exaggerated inflammatory response." Inflammation is known to cause damage to blood vessels, the heart, lung and joint tissues, skin, and the digestive tract." (from http://www.sciencedaily.com/releases/2008/07/080708092228.htm)

During my study with Dr. Andrew Weil, I found above statement to be absolutely a true statement. Inflammation has become a rampant epidemic resulting in causing so much health problems in the developed countries. This has been made worse by the use of the industrial farming practices combined with our business modeling focused on the lowest price doctrine.

As a result, we pay heavily on the treatment side as a society and as members of the society. The solution is not simple; it involves consumer consciousness which must educate the industry. Organic is a good start, but not good enough; we need to be mindful of nutritional contents of the food. Salmon not enough - you need to know that it is either Organic fed with high omega 3 fatty acids feed or from the nature without heavy metal toxins.

John Kim, MD MPH
Director
www.georgiaintegrative.com

Why integrative medicine is the way of the future

2008-07-18T08:09:00.000-07:00

Why integrative medicine is the way of the future
Above is an article from an Austrian news discussing the application of integrative medicine for the treatment of cancer.

The 2008 Summer Wellness Brief is dedicated (click here to open Summer 2008 Cancer & Healing) on integrative oncology. When I worked with Dr. Andrew Weil at University Medical Center in Tucson, I was fortunate to witness a number of remissions that could not be attributed to medications alone.

There is a tendency in the medical field to give credit to the illness or to the disease and not to give enough credit to the individual's healing ability.

Integrative medicine explores the boundary of the healing ability of the person by providing a therapeutic healing partnership and by creating a synergy of healing techniques leveraged at helping the whole person, Mind, Body, and Spirit.

The therapeutic regimens that one can use using the mind, body, and spirit is almost limitless in its application. The goal is to empower our patients to feel comfortable about being an active participant in their healing.

This combination of empowerment, nutritional support, emotional support (we require our cancer patients to go to a support group and/or see a counsellor once a week), and conventional medicine and surgery can make a powerful impact. We saw two people achieve remission from Stage 4 cancer last year who followed above advise. We do not understand the exact mechanism of their healing at this point, but we are happy to see our patients enjoy a higher quality of life.

John Kim
Director
www.georgiaintegrative.com

Low-carb diet beats other diets in study

2008-07-16T19:52:00.000-07:00

Low-carb diet beats other diets in study

Above link describes the outcome of a study demonstrating that Low-carb diets show superior results compared to other diets. The article states, perhaps tongue-in cheek, that Atkins diet may have a point. Atkins diet's weakness is that it underestimates the danger of cholesterol and the types of fat coming from meat sources in the form of omega 6 fatty acids which result in increasing overall inflammation in the body.

Inflammation is a common pathway where multiple illnesses come together. As a result of increasing inflammation, you put yourself at risk for increasing degenerative illnesses including Alzheimer's disease, osteoarthritis, as well as coronary artery diseases.

I prefer a nutrition plan based largely on vegetable, 1 - 2 servings of whole grain per day, and a high quality protein either from grass fed meat or safe fish (list is available from Monterey Bay Aquarium). My favorite is wild Alaskan salmon providing omega 3 fatty acids as well as excellent source of protein.

Extinguishing the Fear at the Roots of Anxiety

2008-07-12T11:21:00.000-07:00

Extinguishing the Fear at the Roots of Anxiety

Above is the hyperlink to the New York Times article on anxiety. We live is a face paced world full of stress. The effect of stress can play havoc with both physical and mental health.

Perhaps the most well understood of effect of acute stress include production of cortisol, a stress hormone produced in our body, resulting in a number of problems including immune suppression, anxiety, blood sugar dysregulation, and weight gain. This understanding has helped to create a field of science referred as neuro-psycho-immunology.

Anxiety in Chinese medicine represents a Yang aspect of Shen (psych-emotional-spiritual) disturbance often leading to depletion of Shen energy resulting in symptoms of depression based on anxiety which is different from Yin aspec of Shen disturbance which results in depression based on fear, hopelessness, and helplessness.

There are many mind-body medicine combined with therapy that can result in significant transformative changes for mental health. An integrative approach focuses on understanding of the present mindfulness of the anxiety at a functional level. As to extinguishing the fear at the roots of anxiety, I am not sure any modality without transformative therapy work can be successful. Perhaps that is the reason, despite the explosion of mental illness medications, we still have an epidemic of mental illness negatively impacting quality of life...

Popular Tilapia Might Not Help Heart

2008-07-12T11:09:00.000-07:00

Popular Tilapia Might Not Help Heart
Study finds farm-raised fish has high levels of unhealthy omega-6 fatty acids
Above is a new article link to US News and World Report stating that the fish Tilapia may be harmful to people. The farm-raised Tilapia has high levels of unhealth omega-6 fatty acids. This is not unique to farm-raised Tilapia. The potential health risks of farm-raised salmon is also discussed in below hyperlink:
http://research.cals.cornell.edu/entity?home=6&id=20834

In both cases, underlies the complexity issue of the food web. We are what we eat. So, we do our best to eat well. However, due to our current industrial production model of our food, we focus on costs rather than nutrition of the food.

In order, for us to eat well, we need to feed the farm-raised animals a balanced nutrious meal so that they can provide that nutrition for us. These examples also extend to chickens who can provide eggs and meat.

I recommend that people look for organic meat. In Atlanta, we are fortunate to have Dekalb Farmer's Market providing us with cost-effective organic food.

The 11 Best Foods You Aren’t Eating

2008-07-11T13:09:00.000-07:00

The 11 Best Foods You Aren’t Eating

Above is a news article from the New York Times on 11 Best Foods to eat.
I am impressed with the emphasis on nutrition these days. In Georgia Integrative Medicine, we view problems at many levels. The first level is the understanding of the physical dimension or structure. The second level is the understanding of biochemical dimension. The next levels involve energetics and psycho-emotional-spiritual axis referred in Chinese medicine known as Shen.

The nutrition aspect impacts first on biochemistry but also effects structural, energetical, and psyco-emotional-spiritual axis. The old adage we are what we eat has a lot of truth in it.

What we eat provides for the ingredients for biochemistry. Sardine for example provides omega-3 fatty acids and bioavailable calcium (provides skins and bones were not removed). Omega 3 fatty acids results in lowering of inflammatory molecules in the body.

In Georgia Integrative Medicine, Chef Nola Daniel CNC provides both nutritional consultations and healthy cooking 101 classes to help our patients to eat for wellness.

Costly Cancer Drug Offers Hope, but Also a Dilemma

2008-07-10T10:40:00.000-07:00

Costly Cancer Drug Offers Hope, but Also a Dilemma

Above is a link from the New York Times on Avastin, a costly cancer drug.

The critics of integrative medicine have long been raising the lack of evidence as a reason for their skeptism. However, it comes to light that the lack of evidence of effectiveness is not limited to complementary and alternative medicine modalities.

Avastin which can cost up to $ 9000 per month. About 100,000 people take Avastin in the U.S. currently. The total amount spent for Avastin last year is estimated to top 2.3 Billion dollars.

According to the NY Times, "But there is another side to Avastin. Studies show the drug prolongs life by only a few months, if that. And some newer studies suggest the drug might be less effective against cancer than the Food and Drug Administration had understood when the agency approved its uses." This is to say that there may not be a clear benefit of Avastin for effectiveness. In treatment of an illness, there are other considerations other than effectiveness. These are also referred as "Quality of Life."

Given the on going financial crisis in health care due to unaffordability, this is an example where the critics of integrative medicines need to focus on evidence and conventional medicine. Dr. Andrew Weil advocates that there needs to be a logical way for us to evaluate the evidence. The more potential harm an agent can cause, the more rigorous evidence should be. In contrast to medications, many integrative therapeutics are less invasive and focus on improving quality of life.

I spent two years at San Diego State University for Masters in Public Health where I was educated in how to evaluate the evidence presented in a study. A result of my degree was the development of ability to discern if a treatment was effective reviewing all evidence in the scientific literature. This helped me to author more than 20 articles reviewing effectiveness of integrative medicine modalities using the scientific method.

In Georgia Integrative Medicine, we do our best to practice an evidence based medicine and we are mindful of the cost-effectivenss as well as cost-quality of life issues. Our evidence is our patients who get well and make the world a better place to be.