Uterine Fibroids: Mechanisms, Treatment Challenges and the Power of Embracing a Functional Approach

Uterine fibroids are a huge, underappreciated issue. They are the most common gynecological disorder, affecting nearly half of women younger than 40 years old, and far more (~80%) for those older. Frankly, I don’t think we are doing enough to help these patients. Fibroids are the leading indication for hysterectomy in the US, accounting for 39% of all hysterectomies each year, and while some are asymptomatic, symptoms include heavy and prolonged periods, difficulty with intercourse, bowel dysfunction, non-cyclic pelvic pain, low back pain, urinary frequency and urgency, and constipation. Because not all fibroids cause heavy bleeding, their impact can be missed, think: refractory constipation or incontinence. Conventional treatments include pharmacotherapy, surgical interventions, and uterine artery embolization, however, these treatments leave much to be desired. Oral contraceptives are used to manage bleeding, and even after myomectomy, fibroids often recur and 10% of women will undergo hysterectomy within 5 – 10 years.

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Navigating Obesity in Immune Dysfunction

Everyone’s awareness about comorbidities, especially overweight and obesity, is heightened due to COVID-19. And in two recent WebMD polls, up to 47% of women and 55% of men report gaining weight during the lockdown – no surprise there – but this may imply patients may be more interested in achieving weight loss goals as part of their overall health care than in previous times. Except we know conventional weight loss programs that lead to a calorie deficit are woefully inadequate (even counterproductive), leading to poor resistance to infection and malnutrition, as Corey Schuler from Integrative Therapeutics explains in this blog below. Read on to learn about the immunometabolic changes brought about in obesity, how to counter them, and I for one, am super grateful Corey relays this encouraging fact: losing just 5% of body mass leads to significant benefits.

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Obstructive Sleep Apnea: Using Orofacial Myofunctional Therapy as a Part of a FxMed Approach to Treatment

Obstructive Sleep Apnea is a condition affecting up to 22 million Americans and close to 1 billion people worldwide.

This condition can have serious impacts on overall health and has been shown to be a contributing factor to:

heart disease
diabetes
stroke
cognitive decline
weight gain
daytime fatigue
anxiety
depression
chronic pain
teeth grinding
and chronic headaches

There are a variety of treatment options available to manage Obstructive Sleep Apnea including Positive Airway Pressure devices (the most common being CPAP), dental mandibular advancement appliances, and various surgeries, but there are also functional treatment approaches that can target the underlying causes of the disease.  

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Respiratory Health and the Microbiome: The Gut-Lung Axis

Respiratory conditions, both chronic and acute, are some of the most common issues seen in clinical practice. In 2016, chronic obstructive pulmonary disease (COPD) alone accounted for around 3 million deaths, and was the third leading cause of death worldwide. Asthma is one of the most common chronic diseases globally affecting nearly eight percent of people (over 24 million) in the US alone. Childhood onset of asthma can impair airway development, and persist into adulthood. Adult asthma may accelerate the decline of pulmonary function, and increase susceptibility to infection

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A Few Surprises About Ketogenic Diets and Their Effects on the Microbiota and Th17

As you know, here at drkarafitzgerald.com we like to push the boundaries of what we know, and sometimes this means being a little contrarian. In this blog, our Nutrition Director, Romilly Hodges CNS takes us on a tour of some of the emerging research on Th17 prompted by a new paper in the journal Cell, that postulated a reduction in Bifidobacteria may mediate some of the benefits of a ketogenic diet for epilepsy by reducing Th17.

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Eosinophilic Esophagitis (EOE): A Deeper Look at Antecedents, Triggers, and Mediators

My first EOE patient in the early 2000’s was fortunately, already diagnosed by a very savvy Yale gastroenterologist. I hadn’t heard of EOE at that time, but quickly learned about this highly challenging and potentially disabling mixed IgE allergic condition. It was clear immediately that functional medicine was the solution, and despite my lack of awareness of EOE, I had much to offer my first patient. Since then, we’ve seen more and more EOE patients in clinical practice, unfortunately, due to the meteoric rise of this condition. Fortunately, our tools continue to benefit.

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How Gut Health Impacts Cardiometabolic Disease

As research on gut barrier function and gut microbes (aka the gut “microbiota”) expands, more is realized about the interconnectedness of the human body.  One of the surprising areas is in the way that an unhealthy microbiota is a key driver of obesity, fatty liver disease, metabolic syndrome, type 2 diabetes, and cardiac risk.

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In Pursuit of Best Practice: Menopausal Hormone Therapy (MHT)

I have practiced medicine for more than 30 years. Throughout, I, like most of you, always wished I had more time to read. My wish came true! This past year, I had the opportunity to roll up my sleeves, dig in, and really understand the literature. Literature on what? In addition to being a cardiovascular disease (CVD) expert, I wanted to continue my growth and development as a hormone expert. I wanted to know everything I could about hormones, hormones in health and disease, hormones in both men and women, hormone dosing, delivery systems, and monitoring, such that I could educate myself, fellow clinicians, and patients. And that is exactly what I have done.

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A few additional treatment possibilities in COVID19 (SARS Cov-2) addressing furin-like cleavage and pyroptosis (caspacin-1 activation of inflammasome NLRP3)

The cytokine storm seen in SARS Cov1 and Cov2 might be due to chronic pyroptosis activation. However, known activators of NLRP3 in SARS-CoV differ from CoV2.  While SARS Cov1 and COVID19 are genetically very similar, the extraordinarily high rate of infectivity of COVID19 is unique. Prepublication research suggests the cause might be a unique furin-like cleavage site on the spike protein of Cov2 that was absent in Cov1.  

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Eosinophilic Esophagitis in a 16yo Female: A Case Report

Allie was 16 years old when she first presented in my office with episodic abdominal pain in the lower right quadrant, onset 6 weeks prior, ranging from 2 to 10 on a visual analog pain scale (0=no pain, 10=worst possible pain). Her pain was not associated with reflux, fever, or blood in her stools. Allie had a prior diagnosis of eosinophilic esophagitis (EE), however treatment with diet and a proton pump inhibitor had not been successful.

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