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Brooklyn Integrative Medicine

The Medical Practice of Ilana Zablozki-Amir, M.D.                                                      

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Diabesity- Am I at risk?

Diabesity- classically thought of as a combination of diabetes and obesity- can also happen in those who are thin and in those not yet diabetic. This is the new way of thinking about it. Diabesity is a continuum of abnormal biology that ranges from mild insulin resistance to full-blown diabetes and all its complications. Almost half of all Americans fall somewhere on the spectrum. Many don’t know it. Some have classic symptoms of pre-diabetes and metabolic syndrome such as elevated blood sugar with high cholesterol, triglycerides and blood pressure along with a big belly. Some are eating a diet full of sugar, artificial sweeteners, and blood sugar spiking refined white flour carbohydrates – bread, pasta, white rice,etc. yet look thin and don’t yet have high blood pressure or classic blood test marker changes. But there is something that is not typically tested for. The level of Insulin in the blood.

A primary role of Insulin is to let glucose in the blood go into cells to be metabolized for energy. In many people with lifestyles that are characterized by poor nutrition, lack of exercise, a lot of unbalanced stress, and/or pollution, the cells, become resistant to insulin’s signals- so more and more insulin becomes needed to get the glucose in. It becomes a vicious cycle until the cells that make insulin poop out and the cells that would normally use the glucose are so resistant that too way too much glucose, sugar, ends up in the blood. This is type 2 diabetes. A downward spiral results in many medical complications related both to insulin and too much blood sugar that the body has lost the ability to process.

Could you be at the early stages of insulin resistance? Insulin testing (fasting and 2 hours after a sugar load) can be very helpful to find out. Any of the following- hormonal dysfunction, sugar cravings, fatigue after meals, energy swings, difficulty losing weight, and as mentioned, high blood pressure, elevated triglycerides and elevated blood sugar markers should all be red flags to encourage you to be evaluated. A functional medicine evaluation for insulin resistance, can help identify the stage of diabesity you may be in, underlying causes, and personalized strategies to improve cells’ sensitivity to insulin’s call, to optimize a healthy blood sugar balance.

Could I Be Gluten Sensitive?

Gluten is a protein typically found in wheat, barley and rye. Some people are genetically predisposed to and develop an immune reaction against gluten, triggering an autoimmune reaction against their own intestinal tissue. This is Celiac Disease. It causes severe dysfunction in digestion, absorption and immunity, and has many resultant complications. Many people with celiac disease have gastrointestinal symptoms, but many don’t. There are blood tests that can help diagnose celiac disease, but they are not always abnormal. A small bowel biopsy can help determine if an attack is happening.

Nutritional deficiencies, autoimmune conditions, thyroid disease, fatigue, infertility, poor growth, brain fog, or really any other chronic condition, as well as gastrointestinal symptoms, should trigger a suspicion to evaluate for Celiac Disease. Now, the tricky thing is, is that many people have many symptoms, but are found to not have Celiac Disease. They are often told that they have no problem with gluten. But it is becoming more and more well known now that Non-Celiac Gluten Sensitivity is a very common issue and can present in many many ways. Especially, in autoimmune conditions.

Celiac is the presentation of gluten reaction in the gut. The other diagnoses can essentially be the presentation of gluten reaction elsewhere. Multiple Sclerosis (MS), or an MS-like picture is a common presentation. So is Hashimoto's Thyroiditis. A google search for Gluten Sensitivity would result in dozens of signs and symptoms. New blood tests are now emerging to test for gluten sensitivity, but are not yet mainstream.

In diagnosed Celiac Disease, gluten abstinence is essential. If Celiac Disease is not-diagnosed and you are unable to get the emerging blood tests for Gluten Sensitivity, then a trial of at least a few weeks of going gluten free is helpful to see if it makes a difference. But- it must be done mindfully. It should be done without gluten free “junk food” and sometimes may need to be done in conjunction with eliminating dairy or other sensitizing foods. It should also be done while replacing B vitamins and other nutrients that may be missing in a general gluten free diet. Making sure to get nutrients that promote healing of damaged tissues is ideal. An evaluation by a nutritionally oriented physician or other professional can help safely and effectively guide a gluten free challenge and lifestyle.

Breathe In, Breathe Out, Move on…..

This is one of my favorite quotes! It comes from a Jimmy Buffett song of the same name, I think about it as  stopping, resetting, energizing and moving on empowered.

It’s the deep breath in and the deep breath out that allows everything to happen.The breath is a powerful thing. Taking a deep breath has many benefits, which happen almost immediately. It gets rid of toxins and metabolic wastes. Deep breathing releases tension and brings clarity. It brings in oxygen which is vital to every function and part of the body. It helps to ease pain. As the diaphragm moves during deep breathing, organs get massaged and stimulated, and flow of the lymphatic system is encouraged. It encourages good posture and it promotes healthy digestion. Deep breathing strengthens the lungs and the heart. It boosts energy and moods. These all exponentially affect the body as a whole.

The key to deep breathing is to feel like you are breathing into your chest and abdomen, not just stopping at the chest. There are many types of breathing exercises which are so extremely beneficial in stressful situations and medical conditions.See if you could schedule times throughout the day to stop and take a deep breath. Slowly, into your chest, abdomen and out. And next time a stressful or uneasy situation arises- try it-
Breathe in, Breathe out, Move on….

What Are Environmental Toxins?

Environmental Toxins - Environmental toxins are chemicals and other materials created largely from industry and carelessness. These chemicals have saturated our water, food and the very air we breathe. You can't see, feel, or smell many toxins--at least, not right away. We don't realize their affects until we come down with a chronic disease after years of exposure.

A study by The British Medical Journal says that 75% of most cancers are caused by environmental and lifestyle factors. A report by the Columbia University School of Public Health estimates that 95% of cancer is caused by diet and environmental toxicity. Mercury is a common culprit contributing to neurological damage. Most Americans have hundreds of chemicals that are stored in their bodies, typically in fat cells. Common toxins are heavy metals such as mercury and lead, industrial chemicals such as PCBs (polychlorinated biphenyls), Pthalates, VOCs (Volatile Organic Compounds), pesticides. Tobacco belongs right there too. So do the chemicals that fill processed foods. With toxins- the keys are to minimize exposure and maximize the body’s detoxifying capabilities. It is possible to assess the body’s burden of toxins and design individually tailored programs to boost and optimize their elimination.

What Does Stress Balacing Mean?

Stress Balancing - Chronic excessive stress, both emotional and physical, has a direct relationship to the development of illness. It has an effect on the both the mind and the body with fascinating physiological and biochemical changes that occur in its presence. There are times when stressful situations can and should be avoided to minimize the stress load. As we all know, though, there are certain excessive or ongoing stresses that cannot be avoided. These, then, must be BALANCED! There are many ways to balance stresses. Making time for deep breathing, meditation, sleeping/napping, eating a clean, nutrient filled diet, taking supplemental stress-balancing nutrients and herbs, laughing, exercising responsibly, minimizing toxins and toxic thoughts, venting at support groups, prayer, yoga, tai chi, etc. etc.- the more of these things that are incorporated into a person’s life, the better chance that the stress scale will be balanced. The more a person will then be armed for health.

What is Adrenal Fatigue?

Adrenal Fatigue - The adrenal glands, which produce many important hormones, are our primary “stress glands”. In the face of stress (emotional or physical), the adrenal glands secrete Cortisol, a stress hormone, to produce physiological changes that allow the body deal with the stress. When stress is excessive, cortisol production goes on overdrive. When stress becomes chronic, eventually the adrenals start burning out and are not able to produce enough of it. This causes a cascade of detrimental events in the body resulting in fatigue, hormonal imbalances, blood sugar abnormalities, immune impairments, increased susceptibility to infection, and a myriad of signs and symptoms. Adrenal fatigue is often found in conjunction with thyroid abnormalities. Conventional medical thinking typically recognizes adrenal disorders when Cortisol levels are at the extremes of high or low, so cases of adrenal fatigue which are along a spectrum are often missed. We evaluate for these fatigued states and guide treatment plans for their recovery.

Why Bioidentical Hormones?

Bioidentical Hormones - Many people are suffering with symptoms and illnesses that result, at least in part, from hormonal deficiencies and imbalances. Bioidentical hormones are made with the same molecular structure as the body’s natural hormones. The hormones (such as Premarin, Prempro and Provera) that have gotten a “bad rap” have different molecular structures than the body is used to, so have inherent great risks and side effects with their use. There are many studies supporting the use, safety and efficacy of bioidentical hormones. However, because everyone has unique needs, the greatest success and safety with their use comes from an individualized approach. When a patient’s concerns suggest a hormone imbalance, we order a hormone test for levels. We then, when warranted, prescribe a precise dosage of the hormone. Each patient is then monitored carefully through regular follow-up hormone panels to ensure he or she gets benefit at the lowest possible dosage.

Dysbiosis - What Does That Mean?

GI Dysbiosis - When the normal healthy intestinal flora (bacteria and other micro-organisms) is out of balance. This occurs most often from a poor, imbalanced diet, recurrent antibiotic use, food allergies, infection with yeast, harmful bacteria or parasites. When there is dysbiosis, digestion is affected, immunity is impacted (much of our immune system is located in the “gut”), toxins form, inflammation is created, and a huge array of symptoms and diseases can result. The gut is often referred to as being at the root of health and disease. There are great stool tests available that we utilize to help evaluate a person’s gastrointestinal environment and function.





Don't try to explain it, just nod your head...breathe in, breathe out, move on.....  

-Jimmy Buffett

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