by Sara Gottfried, MD and Noelle Patno, PhD As our understanding of the gut microbiome expands, many questions remain about the clinical relevance—particularly how emerging concepts translate into the front lines of patient care, including best practices for probiotics. What is a probiotic? Why use one, and what are the most well-substantiated clinical situations in which they affect patient outcomes? What is the mechanism of action for probiotics? How do we know probiotics “work” in our patients? How can I…

by Mark Houston, MD and Sara Gottfried, MD Abstract. Hypertension is the most common and modifiable risk factor for cardiovascular disease. Rather than a disease, hypertension is a manifestation of an abnormal vascular system. Therein is both the problem and opportunity: we need a systems biology approach to address the root cause of hypertension and reduce our patient’s risk of cardiovascular disease. In 2017, new guidelines lowered the criteria for the diagnosis of hypertension from 140/90 to 130/80. As more patients…

by Melissa Blake, ND Introduction The use of probiotics has grown substantially over the last several years. Propelled by development in sequencing methods and analytical techniques, we are now able to identify and study specific probiotic strains. This had led to a significant increase in the understanding of the importance of a healthy microbiome and the various ways probiotic strains may influence human health.1 With this increase in demand and knowledge of potential benefit, it is important for healthcare practitioners…

by Kari Hamrick, PhD, RD and Elnaz Karimian-Azari, PhD Introduction Since 2016, the US Department of Health and Human Services has brought a new level of awareness to the opioid crisis in America by declaring it a nationwide Public Health Emergency.1 In the US, it is approximated that 2.5 million people have been diagnosed with an opioid use disorder (OUD), and 4 in 5 new heroin users started out misusing opioid prescription pain medication.2 As part of the efforts aimed…

by Mark Houston, MD and Sara Gottfried, MD In the past, most of the emphasis on treating dyslipidemia and dyslipidemia-induced heart disease such as coronary heart disease (CHD) and myocardial infarction (MI) was directed toward low-density lipoprotein (LDL) cholesterol (LDL-C). The mainstay in the traditional cardiovascular community for treating LDL-C has been to prescribe statins. Herein a two-fold problem emerges. First, many people cannot take statins due to their adverse effects; others choose not to take them. Second, evaluation of…

by Sara Gottfried, MD and Kari Hamrick, PhD, RD Did you grow up with parents who told you that breakfast is the most important meal of the day?  The word “breakfast” comes from breaking the overnight fasting period, and replenishing the body with a supply of glucose and other nutrients. It implies a period of metabolic rest that we know from ancestral health is beneficial, but in recent time, that period has shortened. While physicians and dietitians have touted the…

 by Mark Houston, MD and Sara Gottfried, MD A precision and personalized medicine approach to dyslipidemia and dyslipidemia- induced cardiovascular disease—including high LDL cholesterol, elevated triglycerides, low high-density lipoprotein (HDL) and HDL function, and other related cardiometabolic conditions such as insulin resistance and metabolic syndrome—is completely different from the conventional medicine approach. In this article, we will review the major paradigm shift that has emerged in the past 10 to 15 years regarding HDL, which is best known for its…

by Sara Gottfried, MD and Elnaz Karimian-Azari, PhD The endocannabinoid system is a fascinating network involved in regulating many physiological, homeostatic, and cognitive functions—including appetite, immune function, pain, metabolism and energy balance, stress response, anxiety, mood, fertility, pregnancy, pre- and postnatal development, memory, and neurogenesis, as well as the well-known pharmacological effects of cannabis.1,2 In our developing understanding of network medicine, it’s important as clinicians to understand that the endocannabinoid system plays a role far beyond getting high and impacts…

by Sara Gottfried, MD Monday, 7:50 a.m. Cup of coffee in hand, I walked into my office and shut the door. I sat at my desk and reviewed my schedule of patients for the day. I was on call for my group of 14 obstetricians/gynecologists. There were 26 patients on the schedule, and several urgent slots remained open for the problems I’d triage throughout the day with the nurse manager and medical assistants. I could hear the clunk of messages…

by Sara Gottfried, MD; Kari Hamrick, PhD, RD; Lewis Chang, PhD We all know that it’s time for mainstream science to investigate—rigorously and on a large scale—whether eating a particular diet can help reduce or reverse chronic disease. While we have growing evidence on the Mediterranean diet, we know little about the molecular benefits and risks of eating certain foods, not eating specific macronutrients, or other emerging condition-based protocols that involve nutritional modulation, particularly related to insulin and glucose signaling.…