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Carin Nielsen MD

Carin Nielsen, M.D., is a board-certified family physician specializing in Integrative Medicine, Wellness and medical weight management. Dr. Nielsen received a B.S. in Microbiology from the University of Montana before receiving her medical degree in 2001 from the University of Washington in Seattle, Washington. She completed her residency in family medicine in Grand Rapids, Michigan before practicing family medicine/primary care in Harbor Springs, Michigan for five years prior to her decision to pursue a career in Integrative Medicine. She is certified by the American Board of Integrative Holistic Medicine and has completed additional training through the American Board of Bariatric Medicine, the Institute of Functional Medicine, and the University of Arizona Program in Integrative Medicine under the direction of Andrew Weil, MD. Dr. Nielsen lives in Petoskey, Michigan with her husband and twin sons.
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Non-toxic Skincare - The Why, What and How.  
Part two:  The WHAT

This month we are highlighting healthy skin, including skincare basics, healthy skin care products, food and skin and more. This is part two of a three-part series going in-depth on the topic of toxic skincare products, including why it’s important to choose healthy skincare products, ingredients to be aware of, and resources to help you choose safe, healthy skin care products for you and your family.


PART TWO: THE WHAT

As explained in my previous blog, your skin absorbs up to 60% of what you apply to it, and serves in some cases as a direct route to your blood. Chemicals in skin care products can bioaccumulate, or store and accumulate in your body over time, potentially causing hormone disruption, inflammation, weight gain and increased cancer risk. Unfortunately, the FDA does not require proof of safety before cosmetics and other skincare products reach the market, so you need to be your own advocate to protect yourself and your family!

There are so many potentially toxic ingredients in skin care products that I had trouble choosing which ones to feature! I’ve chosen three of the most pervasive, and potentially most dangerous chemicals for today’s blog, and I provide links to articles I used in my research with more extensive information should you choose to read more!


b2ap3_thumbnail_natural-shampoo-label.jpgPARABENS

Parabens serve as preservatives in a wide variety of skincare products. Parabens are everywhere, and it’s likely that most of us have been exposed to Parabens through a number of different products throughout our lifetime. Some researchers have estimated that some 90 percent of typical grocery items contain measurable amounts of parabens. Scary!

The main concern with Parabens is that they have hormone-mimicking and estrogenic properties. This means that they can act like estrogen in the body, competing with naturally-produced estrogen and binding to estrogen receptors on cells. This can potentially create an “estrogen overload” effect in the body, which may increase the risk of hormonally-driven cancers like Breast Cancer and fuel other hormone-mediated conditions such as endometriosis.

Ingredient Keywords: methylparaben, ethylparaben, propylparaben, butylparaben, and isobutylparaben


b2ap3_thumbnail_makeup__large.jpgPHTHALATES 

Phthalates serve as plasticizers They are used to make skincare products flexible and better able to hold color and scent.

The concern with Phthalates is that they belong to a group of chemicals referred to as endocrine disrupters, which means they have the potential to disrupt your hormones. Phthalates have been shown to reduce fertility in both men and women, reduce testosterone production in men, reduce egg quality and quantity in women, and are associated with endometriosis.

How to find them? You can look for phthalates on labels, but unfortunately, you won't always find them. The FDA does not require manufacturers to list every ingredient in proprietary fragrances, so they may be hidden in the term ‘fragrance/parfum’.


b2ap3_thumbnail_Triclosan.jpgTRICLOSAN

Triclosan is added to a variety of skin care products to reduce or prevent bacterial contamination. Exposure to Triclosan is so pervasive that the U.S. Centers for Disease Control and Prevention reports that it can be found in the urine of 75 percent of all U.S. residents, as well as in plasma and breast milk.

There are a variety of concerns with Triclosan. Not only does it function as an endocrine disruptor (like phthalates), it also promotes antibiotic resistance, has been shown to be a skin irritant, and is considered to be carcinogenic, increasing the risk of certain cancers. In addition, Triclosan has been shown to have a negative environmental impact, most notably in aquatic ecosystems.

While the FDA banned the use of Triclosan in over-the-counter antiseptic soaps, gels and wipes ion 2016, it is still in widespread use in personal care products like toothpastes, shampoos, and deodorants.

Look for “Triclosan” directly on your label.

Looking for more information? Check out these resources:

Sara Gottfried, MD: Ten Toxic Ingredients That Might Be in Your Skin Care (And What to Use Instead).

MindBodyGreen: 12 Toxic Ingredients to AVOID in Cosmetics & Skin Care Products

Andrew Weil, MD: What's Wrong With Triclosan?

Scientific American: Should People be Concerned about Parabens in Beauty Products?



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, as well as general wellness and healthy aging. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances, and provide treatment options that go beyond the prescription pad. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Alpha-hydroxyl Acids (AHAs)


HOW AHAs WORK

Our skin has a natural ability to exfoliate dead skin cells and does so daily. Unfortunately, this process slows down with age, which can lead to an accumulation of dead skin cells, leaving skin appearing dull and uneven.

AHAs dissolve the upper layer of skin cells by weakening the cellular “glue” that holds dead skin cells together, encouraging exfoliation and triggering skin repair.


HOW AHAs IMPROVE YOUR SKIN.

AHAs have a number of proven skin benefits.

AHAs remove dead skin cells, revealing healthy, younger skin cells, resulting in a brighter complexion and more even skin tone. This increase in cell turnover is also effective in treating sun-damaged skin, hyperpigmentation, and melasma.

AHAs trigger collagen regeneration, thickening the outer skin layers. This works to firm and tighten skin. minimize fine lines/wrinkles, and fade blotches. (When combined with a retinol, these results can be even more dramatic, but we’ll save that for another blog...)


AHAs AND DRY OR SENSITIVE SKIN.  

Many of my clients with dry or sensitive skin get nervous when they hear the word “acid“. Have no fear! Even those with dry or sensitive skin can benefit from regular use of a quality AHA product with proper pH balance.

AHAs may actually be a better choice to exfoliate sensitive skin because they are less likely to irritate then manual exfoliation. AHAs are gently applied to the skin, no need to scrub. AHAs can also be effective for dry skin. By removing the outer layer of dead skin cells, healthy skin cells become more receptive to the skin care products you apply. Regular AHA use, combined with appropriate product, can significantly increase your skin’s moisture factor.


GETTING STARTED WITH AHAs. 
While there are a number of AHAs, the two most commonly used in skin care are Glycolic Acid and Lactic Acid. Glycolic Acid is considered to be the most powerful because it has the smallest molecular size of all AHAs. The smaller the molecule, the deeper it is able to penetrate skin layers.

When beginning an AHA regimen, it is important to “start low and go slow”.
Start low - choose a product with a lower concentration of acid to start. Over time, and under the supervision of your skin care provider, you can gradually increase the concentration of your product for added benefits.

Go slow - don’t overdo it! Start your AHA routine only 1-2 times per week, giving your skin plenty of time in between treatments to rest and repair. You can gradually work up two more frequent use. I typically recommend an every other day regimen for my patients, using AHAs twice daily on “active“ days, with “rest“ days in between.

You can add an AHA right into your regular skincare routine. Apply your AHA after cleansing, and follow with serum and/or moisturizer. Don’t forget sun protection! Use of AHAs can make your skin more susceptible to sun damage, so don’t forget your daily sunblock!

b2ap3_thumbnail_BL_Sanitas3.jpg

RECOMMENDED PRODUCTS FROM OUR SANITAS SKINCARE LINE:   

Glycosolution 5% 
The perfect starting point. Removes spent skin cells and helps stimulate skin renewal. An amino acid complex, blended with glycolic acid, helps smooth the appearance of wrinkles, boost moisture retention and brighten dark spots. (also included in all Sanitas System Kits)

Brightening Peel Pads 
Instant results! These pads contain a triple acid blend to brighten, tone and reveal clear, radiant skin. Follow with 3 drops of Vita C Serum for an instant glow.

Solar Block 
A natural, non-toxic broad-spectrum sunscreen for daily use. Contains a blend of zinc oxide and antioxidants. Absorbs quickly and will not clog pores.

All Sanitas products are cruelty-free and contain no parabens, phthalates, dyes, harsh preservatives or gluten.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, as well as general wellness and healthy aging. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances, and providing treatment options that go beyond the prescription pad. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Non-Toxic Skincare - The Why, What and How
Part One:  The WHY

This month we are highlighting healthy skin, including skincare basics, healthy skin care products, food and skin, and more. This is part one in a series of three blogs going in-depth on the topic of toxic skincare products, including why it’s important to choose healthy skincare products, ingredients to be aware of, and resources to help you choose safe, healthy skin care products for you and your family.

PART ONE: THE WHY

Our skin is our largest organ! The average adult has about 8 pounds, or 22 square feet of skin. That is a lot of surface! Not only is that a large area that requires care and protection, but it’s also like a big sponge. What we put on our skin can be absorbed by the body and enter our blood. In fact, we absorb up to 60 percent of what we put on our skin, even more through delicate areas such as the face and armpits.
b2ap3_thumbnail_SKIN2.jpg

So WHY care about the safety of your skincare products? Because what you put on your skin can go directly into your blood.

Toxic ingredients in your skincare products can be sneaky. While you generally won’t notice a problem right away, many toxic ingredients bioaccumulate in the body, meaning they store in the body and build up over time. When it comes to toxic skincare chemicals, this can lead, over time, to hormone disruption, inflammation, weight gain and increased risk of certain cancers.

Bioaccumulation = The accumulation of a substance, such as a toxic chemical, in various tissues of a living organism.

“The FDA protects me from potentially harmful chemicals, right?”

Absolutely not! The FDA does not require proof of safety before cosmetics and other skincare products reach the market. In addition, there is no skincare industry standard for claims like “natural,” “organic,” “green,” “clean”, or “non-toxic.” Buyer beware! You have to do your own research and be your own advocate.

The FDA is not protecting you against potentially harmful chemicals in your skincare products.

Stay tuned…next up we’ll be reviewing a few of the toxic chemicals that you need to be aware of in your skincare products.




Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, as well as general wellness and healthy aging. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances, and going beyond the prescription pad for true health and wellness. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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FOOD SENSITIVITY TESTING and
The FIT Test by KBMO Diagnostics


In my medical practice, we look for root causes of symptoms and chronic disease, rather than focusing on simply treating symptoms with prescriptions. This is what sets Integrative and Functional Medicine apart from traditional Western Medicine. 

b2ap3_thumbnail_inflammation.jpg Inflammation is one of the main root causes of nearly everything I see wrong with my patients.  Food is a primary trigger for inflammation and should be considered as playing a large role in most symptoms, chronic disease, and autoimmune disease.  Like I often say to my patients:

Every time that you eat, you are making a decision to either
increase or decrease inflammation in your body.


FOOD SENSITIVITIES & SYMPTOMS
First things first, we are not talking about food allergies.  Food allergies are mediated by an IgE immune system reaction, which produces immediate and often serious or life-threatening symptoms that require immediate medical attention.  In contrast, food sensitivities (also referred to as food intolerances) are mediated by an IgG immune system reaction that is more delayed and generally less serious. Reactions may take up to 3 days to develop, and the IgG antibodies can remain in your body for up to three weeks.
Click here to read more about Food Allergy vs. Food Sensitivity

With food being a primary driver of inflammation, and inflammation underlying most symptoms, the argument could be made that food may be a trigger of nearly any symptom in the body!  The most common symptoms that I see in my practice that have a strong association with food include:

  • b2ap3_thumbnail_Abdominal-Pain-Is-It-Appendicitis_article_main.jpgRashes, Acne, Eczema and other Skin Conditions
  • Joint Pain
  • Digestive Issues, including IBS
  • Headaches
  • Fatigue/Energy and "Brain Fog"
  • Autoimmunity of any kind
  • Hormone Imbalance
  • Weight Gain
  • Mood Disorders, including Depression, Anxiety and more

 

DETERMINING FOOD SENSITIVITIES
Traditionally, the Comprehensive Elimination Diet has been considered the “gold standard” for determining food sensitivities. The Comprehensive Elimination Diet involves removing the food, drink, and additives that are most commonly associated with inflammation and symptoms, including:

  • b2ap3_thumbnail_Donuts.jpgGluten/Wheat
  • Dairy
  • Sugar
  • Eggs
  • Soy 
  • Corn
  • Peanuts
  • Nightshade Vegetables
  • Citrus Fruits
  • Caffeine 
  • Alcohol

The Comprehensive Elimination Diet needs to be done for at least three weeks (if you recall from above, the IgG antibodies associated with food sensitivities can remain in the body for three weeks, this allows time for them to "flush out").  After this time foods may be re-introduced one at a time while monitoring for an increase in symptoms.  For those patients who are able to complete a Comprehensive Elimination Diet, the process can be life-changing.  In my patients who complete this process, I frequently see a dramatic reduction in symptoms, improved energy and mental clarity, and better sleep. However, for many others, this process can be difficult or nearly impossible.


FOOD SENSITIVITY TESTING and the FIT TEST
One of the most common Food Sensitivity laboratory tests (and the one I have previously used) involves measuring IgG antibodies in the blood to a variety of foods.  The presence of these IgG antibodies indicates an immune system reaction to that food.  While the information on an IgG food sensitivity test can be useful, I have found several problems associated with this testing:

  • Some patients have so many IgG food reactions that they could not possibly remove these many foods from their diet.
  • We cannot always correlate a positive IgG food reaction directly to inflammation or a patient's symptoms.
  • These tests can be expensive!

FIT = FOOD AND INFLAMMATION TEST
b2ap3_thumbnail_KBMO.jpgThe FIT Test by KBMO Diagnostics is, in my opinion, the next generation in Food Sensitivity Testing.  Rather than simply measuring IgG antibody reactions, the FIT Test measures IgG and Complement-mediated Immune Complexes.  Translation = by adding the measurement of immune complexes the FIT test may more accurately identify the foods that are actually causing inflammation in the body.  

Other benefits of the FIT Test:
  • The FIT Test measures sensitivities to up to 132 different foods,  as well as coloring and additives.
  • The FIT Test can diagnose increased intestinal permeability, or "Leaky Gut", through the identification of a positive Candida immune-complex response.
  • There are less positive reactions to work with, allowing patients to more easily remove inflammation and symptom-triggering foods.
  • In addition to the 132 item option (currently $275), the FIT Test offers a more-affordable 22 item option which includes the most commonly identified food and antigen triggers (currently $100).*
Click here to learn more about the FIT test, see a list of the foods tested, and view a sample report.

Are you interested in the FIT Food Sensitivity Testing?  Do you have questions?  Feel free to send me an email at This email address is being protected from spambots. You need JavaScript enabled to view it. or contact our office 231-638-5585.

*I do not make any profit of the FIT Test, or any other laboratory test offered in my practice. Any costs associated with laboratory testing are related to the laboratories themselves.



Carin Nielsen, MD Integrative MedicineLooking for a personalized approach to your healthcare? I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms and chronic disease simply by prescribing medication doesn't address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface" to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

 
 
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FEMALE HORMONE TESTING 101

Which test is right for you?


Achieving Hormone Balance in women starts with evaluating your hormone levels. While symptoms can often suggest hormonal patterns, I use laboratory data to confirm these patterns, and also to evaluate the safety and effectiveness of prescribed hormones, supplements and lifestyle recommendations.


WHICH HORMONES DO WE TEST?
The term “hormone balance” refers to the interaction and balance of a variety of hormones in the body, therefore when evaluating hormones we need to do so BY keeping all of these interactions in mind. While there are many hormones we are able to test, the hormones I most routinely test in my patients include:
  • Adrenal (stress hormones) - cortisol, DHEA-S
  • Sex-steroid hormones- estrogen, progesterone, testosterone, DHEA
  • Thyroid - TSH and free thyroid hormone levels
  • Other - insulin (think blood sugar regulation), pregnenolone (a hormone precursor often referred to as “the mother of all hormones”)
b2ap3_thumbnail_TESTTUBES.pngThere is no perfect hormone test for everyone.

Hormone levels can be measured in blood, urine or saliva. There are many factors taken into consideration when choosing which test is appropriate for each patient, including:
  • patient age
  • type of hormone(s) being measured
  • the number of samples needed to test
  • pre-, peri- or post-menopausal
  • whether the patient is currently on hormone therapy
  • cost of test

So which test is right for you?

Below I’ve broken down the pros and cons of each test and provided information on the tests I most often order in my practice.


HORMONE TESTING 101

BLOOD
Pros: Blood testing is simple and cost-effective (covered by most commercial insurance policies as well as Medicare and Medicaid).

I routinely use blood testing for thyroid hormones and fasting insulin regardless of age. Blood testing of DHEA and pregnenolone is useful for both baseline levels and to monitor when supplementing these hormone precursors. For sex-steroid hormones (estrogen, progesterone, testosterone), blood testing can be useful in the following situations:
  • Pre-menopause - an early-cycle draw (around day 5) can help evaluate for PCOS (polycystic ovarian syndrome).
  • Peri-menopause - a luteal phase draw (day 22-24) helps to evaluate PMS imbalances and estrogen: progesterone balance.
  • Post-menopause - blood hormone levels can be used to confirm menopause and also to monitor hormone levels while on hormone therapy.
Cons: Blood hormone testing gives us information on one moment in time. It is not practical to use blood for multiple-day specimens, or for several samples in one day. Blood measurements are also limited in their ability to provide information on hormone metabolites. Hormone metabolites give valuable insight info which “pathways” hormones take in your body, some of which are healthier than others, and can help stratify risk for hormone-related cancers.

Click HERE to read my previous blog on estrogen metabolite testing.


SALIVA
Pros: Saliva tests can be performed and shipped from anywhere, bypassing a trip to the laboratory. Saliva tests are convenient when multiple specimens are needed and can be kept in your freezer if testing over a month cycle.
I routinely use saliva hormone testing to test adrenal hormones. I also use saliva sex-steroid hormone testing in pre- or peri-menopause to look at cyclical trends and hormone fluctuations, testing anywhere from 5-28 day periods.

Cons: While Medicare covers saliva hormone testing, most commercial insurance companies do not. Saliva hormone testing does not provide hormone metabolite information. While saliva testing can be useful for adrenal and sex-steroid hormones, it is not used to measure thyroid hormones or insulin. Some patients have trouble producing enough saliva for testing, especially if they have chronic dry mouth or are on medications that reduce saliva production.

MY MOST ORDERED SALIVA HORMONE TESTS BY GENOVA DIAGNOSTICS:

URINE

Pros: Urine hormone testing can be done and shipped from home, bypassing a trip to the laboratory. One of the biggest benefits of urine hormone testing is the ability to get an abundance of information on hormone metabolites (see above and my prior blog). Hormone metabolites are especially useful in stratifying risk for hormone-related cancers and also in evaluating the efficacy and safety of hormone replacement therapy.

Cons: Most commercial insurance companies do not cover the cost of urine hormone testing. Some urine hormone tests in postmenopausal women require a 24-hour urine collection, which can be cumbersome for patients. While I use urine hormone testing to measure adrenal and sex-steroid hormones, I do not use urine to measure thyroid hormone or insulin.


b2ap3_thumbnail_DUTCHwheel.pngMY MOST ORDERED URINE HORMONE TEST BY GENOVA DIAGNOSTICS:
Complete Hormones (either 24-hour or first-morning urine, depending upon patient age)

MY NEW FAVORITE TEST BY PRECISION ANALYTICAL INC. COMBINES BOTH SALIVA AND URINE:
DUTCH Complete and DUTCH Plus testing




Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many that are linked to unhealthy hormone imbalance. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like estrogen metabolite testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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ADVANCED LABORATORY SPOTLIGHT:

THE NutraEval PLASMA ® TEST

A Comprehensive Test for Identifying Nutritional Deficiencies, Toxicities, Gut Imbalances, and More

by Genova Diagnostics


b2ap3_thumbnail_nutreval-fm-nutritional-test-blood-urine-small-1.pngThe NutrEval® laboratory test by Genova Diagnostics is one of the most commonly ordered specialty laboratory tests in my practice. This test serves as an excellent starting point for evaluating nutritional status and investigating the root causes of chronic illness, as well as a useful follow-up tool to measure how well lifestyle changes and supplement regimens are working.


OVERVIEW

The NutrEval® test is an advanced nutritional analysis designed to reveal nutritional imbalances or inadequacies. NutrEval Plasma® evaluates the functional need for antioxidants, B-vitamins, minerals, essential fatty acids, amino acids, digestive support, and other select nutrients. The test also provides insight into gut health, heavy metal toxicity, mitochondrial function and more.


YOUR REPORT INCLUDES:

Metabolic Analysis (urine organic acids)
Urine organic acids are not something I learned about in Medical School. This analysis, often utilized by Naturopathic Physicians, measures metabolites in the urine that reflect processes going on in your body. This analysis provides insight into:
  • Digestion
  • Bacteria and/or Fungal Overgrowth in the Gut
  • Mitochondrial Function (cellular energy production/Krebs Cycle)
  • Neurotransmitter Balance (stress/mood)
  • Functional B-vitamin Need (not measured values in your body but rather a measurement of how your body is utilizing these vitamins)
  • Need for Detoxification Support
Plasma Amino Acid Analysis (essential and non-essential amino acids, plus intermediary metabolites)
The Amino Acid Analysis represents a 21-day “window” into your protein intake and amino acid balance. I use this section most often to:
  • Evaluate protein intake, digestion and absorption.
  • Evaluate amino acid balance in relationship to mood disorders.

Essential and Metabolic Fatty Acids (red blood cell essential and non-essential fatty acids, including Omega-3 and Omega-6 fatty acids) The Fatty Acid Analysis is a red blood cell measurement, representing approximately 100-120 days prior to testing. When interpreting these results with patients, I am able to accurately identify what type of diet they are following, which types of oils they are cooking with, and whether or not they are supplementing with fatty acids. This section can provide valuable insight insight for diet and supplement recommendations for:
  • General Wellness
  • Inflammatory Disorders
  • Cardiovascular Risk
  • Mood and Brain Disorders

Oxidative Stress Analysis (blood and urine biomarkers indicative of oxidative stress) Oxidative Stress represents the balance of antioxidants and free radical damage in the body. When describing Oxidative Stress to patients, I often describe it as “rusting” on your cells and DNA. This analysis measures markers of this “rusting”, as well as levels of Glutathione, a powerful antioxidant that plays key roles in healthy aging and detoxification (learn more here). Our levels of Glutathione are determined by both our genes and our lifestyle, so if low levels are detected, we can implement protocols for improvement.

Learn more about Glutathione HERE.

Elemental Markers (both mineral nutrients and toxic metals in red blood cells or plasma) This section provides direct measurements of minerals and heavy metals. Mineral results can be used to identify mineral deficiencies or excess. Heavy Metal results can be a useful screening tool, if elevated levels are identified, provoked urine heavy metal testing is often recommended. Analyses measured include:
  • Copper
  • Lead
  • Magnesium
  • Mercury
  • Manganese
  • Antimony
  • Potassium
  • Arsenic
  • Selenium
  • Cadmium
  • Zinc
  • Tin
  • Mood and Brain Disorders
b2ap3_thumbnail_LabTesting.jpg


SPECIMENS:

First-morning urine and a blood draw at a participating laboratory.

COST:
  • Varies per insurance.
  • Covered completely by many Medicare plans.
  • Commercial plans require and out-of-pocket co-pay of $200-300.
  • Not covered by Medicaid.

Note: I do not profit off of ordering this (or any other) laboratory test. Any co-pay goes directly to Genova Diagnostics.

Visit the Genova Diagnostics Website and view a Sample Report HERE.  



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like advanced laboratory testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Book Review

FOOD: WHAT THE HECK SHOULD I EAT? 
Dr. Mark Hyman

b2ap3_thumbnail_MARKHYMAN.jpgFROM THE PUBLISHER: When it comes to diet, there's so much changing and conflicting information flying around that it's impossible to know where to look for sound advice. Decades of misguided "common sense," food-industry lobbying, bad science, and corrupt food policies and guidelines have only deepened our crisis of nutritional confusion, leaving us overwhelmed and anxious when we head to the grocery store.

Bestselling author Dr. Mark Hyman is here to set the record straight. In Food: What the Heck Should I Eat? -- his most comprehensive book yet -- he takes a close look at every food group and explains what we've gotten wrong, revealing which foods nurture our health and which pose a threat. From grains to legumes, meat to dairy, fats to artificial sweeteners, and beyond, Dr. Hyman debunks misconceptions and breaks down the fascinating science in his signature accessible style. He also explains food's role as powerful medicine capable of reversing chronic disease and shows how our food system and policies impact the environment, the economy, social justice, and personal health, painting a holistic picture of growing, cooking, and eating food in ways that nourish our bodies and the earth while creating a healthy society.

With myth-busting insights, easy-to-understand science, and delicious, wholesome recipes, Food: What the Heck Should I Eat? is a no-nonsense guide to achieving optimal weight and lifelong health.

MY THOUGHTS: This book is a MUST READ, and will forever change the way you think about food. When I began reading this book I set aside a notebook, thinking that I would take brief notes of information “pearls” to share with my patients - I stopped after 2 chapters because there was so much relevant and useful information on EVERY PAGE I couldn’t possibly write it all down!

In this book, Dr. Mark Hyman acknowledges that there is no one “perfect” diet for everybody, instead of focusing on basic dietary principles that simply make sense. He breaks down macronutrients (carbohydrates, proteins, and fats), providing education on each group’s benefits, as well as information on how to make safe, quality food choices. For example, not only will you learn more about why protein is important for our health, but also which sources of protein provide the most benefit and the “dos and don’ts” of choosing quality sources of protein for you and your family.

The book is packed with information, yet easy to read, and each recommendation is backed by sound research, not simply opinion. I found this book to be eye-opening, thought-compelling, and forever life-changing when it comes to thinking about the food that we eat. Consider adding this book to your Summer reading list!

Carin Nielsen, MD



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, and using a "Food First" approach is a common theme in our office. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office at This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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b2ap3_thumbnail_SupplementSwap3.jpgIf you take nutritional supplements, the changing of seasons is a great time to clean and organize your supplement cupboard and re-think your routine. The demands on your mind and body vary with the seasons, and adjusting your supplements to meet seasonal needs can help you to look and feel your best all year long!

Check out these “Summer Supplement Swaps” from my personal routine to help you get started:

SWAP OUT IMMUNE SUPPORT FOR ANTIOXIDANTS

During Winter months I take Vira-Resist herbal immune support daily to fight off coughs, colds, and flu. In the Summer months, I take a break from my immune support and tighten the cap and store the bottle in a cool, dark cupboard.

Summer months bring the potential for increased oxidative stress from sun exposure, summer cocktails and restaurant meals. To fight the effects of oxidative stress I increase my antioxidant routine, adding extra Antioxidant Support Formula, which contains the powerful antioxidants Selenium, Alpha-Lipoic Acid, and N-Acetyl Cysteine, as well as Milk Thistle, which helps to protect my liver from potentially damaging effects of summer cocktails. I also add extra antioxidant-rich Vitamin C in the form of Buffered Vitamin C (which is more gentle on the stomach) to help protect my skin from sun damage and boost collagen synthesis.

ADD EXTRA MINERALS

Summer = Sweat. Combining the increased perspiration of summer with regular infrared sauna use puts me at risk for excess mineral loss, so I add extra Zinc and Magnesium to my routine to replenish losses. In addition, I am liberal with my use of sea salt to replenish minerals and stay hydrated.

KEEP YOUR VITAMIN D DOSE IN CHECK

For myself and many of my patients, a hefty dose of Vitamin D is recommended during Fall and Winter months. During Summer months, with increased sun exposure, this may not be necessary. I check my 25, OH Vitamin D levels and adjust my dose of Vitamin D3 as necessary. Why is this important? You can overdose on Vitamin D! Vitamin D is one of four fat-soluble vitamins (along with Vitamins A, E, and K), so levels can build up in your system and become toxic. It’s important to know your number!

Here’s to a happy, healthy Summer!

Carin Nielsen, MD


Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office at This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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BACKGROUND
b2ap3_thumbnail_Abdominal-Pain-Is-It-Appendicitis_article_main.jpgI first met Todd* with his wife in October 2016. He had been diagnosed with Crohn's disease (an autoimmune inflammatory bowel disorder) three years prior.  His symptoms included abdominal pain and loose stools with blood and mucous.

During our first visit, I learned that during the time his symptoms began Todd had been under increased stress with an upcoming wedding, a change in employment, and home renovations.

He had originally been treated with sulfasalazine, a common prescription medication for Crohn's, however, the medication made him nauseated and his symptoms were not well controlled. He had been unable to increase the dose as recommended due to side effects.

Todd continued to have frequent loose bowel movements within 15 minutes of eating, often associated with mucus and blood. He was experiencing sharp localized abdominal pain with activity, and the pain was limiting his ability to perform his physically strenuous job as an electrical lineman.

Prior to our first visit, Todd and his wife had already explored holistic options for his treatment. He had tried digestive enzymes, probiotics, and homeopathic remedies without relief. He had also completed a two month trial of a gluten-free diet but was unsure if that made any difference.


INITIAL WORK UP
At our first visit, I ordered a comprehensive laboratory evaluation to screen for:
  • Inflammation
  • Nutritional deficiencies
  • Anemia
  • Hormone balance
  • Candida/Yeast
  • Celiac disease
I also ordered Functional Stool Testing.

While waiting for results, I recommended that Todd begin a four-week Comprehensive Elimination Diet, and provided educational materials and book recommendations for support with this.

Blood testing revealed low levels of zinc, and significant vitamin D deficiency, but was otherwise normal. Functional stool testing indicated significant intestinal inflammation and low levels of "good" gut bacteria.

Recommendations were customized for Todd based on his laboratory results (no more “guessing game” when it comes to supplements):
  • Vitamin D (which supports the immune system response)
  • Zinc carnosine (a key factor in the health of the intestinal lining)
  • Fish Oil (a natural anti-inflammatory)
  • Immunoglobulin powder (derived from colostrum)
  • VSL#3 - A high-dose prescription-grade probiotic (this brand has solid evidence supporting its use in the treatment of Crohn’s)
I also prescribed Low-Dose Naltrexone (LDN), an opioid antagonist that has an outstanding safety profile and has shown promise in the treatment of Crohn’s in both adults and children with minimal side effects.


TWO MONTHS LATER–IMPROVEMENT!
Two months after initiating diet changes, LDN and targeted supplementation, Todd reported his pain improved by at least 50% with some pain-free days and improved energy. While still experiencing blood in his stools, he described it as much less than before.

I recommended he add a glutamine/aloe combination to promote further healing of the intestinal lining.


SIX MONTHS LATER–MORE IMPROVEMENT!
b2ap3_thumbnail_intestines.jpgAt six months Todd reported that he continued to experience significant improvement and was very pleased with his progress. He described his pain as minimal, with only minor flares "nothing like it was before”. He had good energy and stamina and was no longer having any work pain. He had become a “believer” in his regimen of supplements and LDN, having forgotten them on two nights, each time with a symptom flare.

While bowel movements had earlier been improved, he had since noticed increased blood and mucus in his stools, so a low dose of Sulfasalazine had been restarted.

He continued to cautiously experiment with his diet, determining his “trigger foods”.


ONE YEAR LATER
This past fall I was able to meet with Todd and his wife for his one-year follow-up. He reported great energy and stamina, no work pain, and no blood in his stools.

While still on the low dose of Sulfasalazine, it was a dose that did not give him side effects and his symptoms as a whole were nearly resolved. Follow up laboratory testing showed normalized levels of iron, zinc and Vitamin D.

I ordered comprehensive nutritional testing at this visit, which allowed us to customize Todd’s diet and supplement needs. His testing showed a need for B-vitamins, as well as magnesium and enhanced antioxidant support to reduce oxidative stress in the intestinal lining. Based on this testing, I also recommended he begin to reduce the amount of animal protein in his diet, transitioning to plant-based proteins.

In just one year, Todd was able to get much better control of his Crohn’s disease through changes in diet, targeted supplementation, and lower-doses of prescription medications without side effects. He had normalized bowel movements, no blood in his stool, minimal pain and improved energy. I look forward to continuing to work with Todd and his wife to optimize his nutrition, simplify his regimen as he continues to heal, and achieve further success!

*Patient names are changed to protect privacy

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many autoimmune conditions. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like estrogen metabolite testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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b2ap3_thumbnail_sanitasgeneral2.jpg

THREE REASONS TO CHOOSE SANITAS:


1. MAKE YOUR SKIN WORK FOR YOU
Sanitas products give skin everything it needs to do what it already does best: repair and strengthen itself.

The human skin has miraculous built-in mechanisms for constant repair and renewal of its surface. Unfortunately, the combined assaults of lifestyle, environment and time can compromise the body’s ability to keep up – which is why every technology, ingredient, and dosage in every Sanitas product is selected to foster and improve your skin’s own natural processes to regenerate and protect itself.


2. “EXERCISE & REST” - YOUR NEW SKINCARE ROUTINE
The heart of Sanitas’ tested and proven skincare routines lies in the concept of “exercise and rest.”

A resting phase and strengthening phase are both necessary to build continuous skin strength. “Exercising” products utilize alpha hydroxy acids to encourage skin renewal and strengthen the skin’s barrier. On resting days, exercising products are eliminated and only pH neutral products are used to keep the skin’s barrier intact. Limiting the use of exercising products to three to four days per week allows the skin to recover and regenerate.


3. CLEAN, SAFE INGREDIENTS
All Sanitas products are cruelty-free and contain no parabens, phthalates, dyes, harsh preservatives or gluten.

Sanitas Skincare pharmaceutical-grade ingredients are obtained from fair trade, earth conscious, sustainable suppliers. All Sanitas facial care products that remain on the skin are completely fragrance-free and only essential oils that are medicinal in purpose are used.

Want to learn more? Stop by our Downtown Petoskey office to sample or browse products online.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Your skin has the amazing ability to repair and regenerate itself, especially when you treat it with the right balance of stimulation and nourishment. This simple truth is the foundation of the Sanitas Skin Care line.

I have been using products from this Boulder, Colorado based company for years and am excited to share them with my clients.  All Sanitas products are cruelty free and contain no parabens, phthalates, dyes, harsh preservatives or gluten.


b2ap3_thumbnail_SAN_CURRENT-PHOTO-groupsm.jpgPROGENERATE • ACTIVATE • OPTIMIZE

AN OVERVIEW OF THE SANITAS SKIN CARE SYSTEM
 

PROGENERATE
The foundation for healthy skin starts here.
Start with daily essentials: Cleanser - Serum - Moisturizer

Looking to change up your skin care routine? This is the place to start. This collection features customized, daily essentials that are specially formulated for various skin types. A simple daily regimen of cleanser, serum, and moisturizer will help strengthen and prepare your skin to progress to the Activate and Optimize categories for rapid results.  Formulas available for all skin types.
Dr. Nielsen's favorites: The Lemon Cream Cleanser is addictive - one smell and you will be hooked! I alternate between the Vita Rich Serum (very hydrating and packed with antioxidants) and the Weightless Serum (more of a matte finish) depending on the time of year.

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ACTIVATE
Looking to take your skin care routine up a notch?
Integrate one or more of the Active skin care products into your routine. 

Designed to activate skin rejuvenation levels and elevate results, this collection of products integrates powerful technologies for progressing the health of the skin. Activate products include alpha-hydroxy acids, retinols, high-potency topical Vitamin C and more. Product concentrations may increase over time to prevent your progress from plateauing.
Dr. Nielsen's favorites: I'm obsessed with the Vitamin C Lactic cleanser (used 2-3 days per week).  I use the Vita C Serum at night - this high-potency Vitamin C serum is rich in antioxidants and essential fatty acids.  

b2ap3_thumbnail_SAN_BrighteningPeelPads_sm.jpg
OPTIMIZE
Have a specific need?
Try these targeted, therapeutic products.

Whether you are looking to reduce blemishes, brighten, hydrate, or reverse the effects of aging, this collection of targeted, therapeutic products is designed to help rehabilitate challenged skin. When combined with the proper Progenerate and Activate programs, the correct selection of Optimize products will advance skin to its most healthy, optimal state.
Dr. Nielsen's favorites: I LOVE the Brightening Peel Pads - these pads can be used 2-3 times per week for an instant glow. The Hyaluronic Concentrate is combined with your usual moisturizer to boost hydration and reduce the appearance of fine lines - instant results!

Want to learn more? Stop by our Downtown Petoskey office to sample or browse products online.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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b2ap3_thumbnail_HealingArthritis.jpgIn Healing Arthritis, Dr. Susan Blum, author of the bestselling The Immune System Recovery Plan shares her science-based, drug-free treatment plan for the almost fifty million people who suffer from arthritis.

FROM THE PUBLISHER:
Arthritis is the most common cause of disability in the world—greater than both back pain and heart disease. One example, Rheumatoid Arthritis (RA), is the most common autoimmune disease, affecting 1% of the US population, and almost 68 million people worldwide. Conventional medicine tends to treat arthritis with strong, gut-damaging, immune-suppressing pain medications, temporarily relieving the symptoms of the disease without addressing its root causes. Now, in her groundbreaking new book, Dr. Susan Blum, a leading expert in functional medicine, offers a better approach to healing arthritis permanently.

MY THOUGHTS:
This book is a must-read for anyone suffering from joint pain or arthritis. While I’ve been recommending Dr. Blum’s first book The Immune System Recovery Plan to my patients for years, I find Healing Arthritis easier to read and more user-friendly for my patients to navigate. The book provides an overview of the root causes of inflammation/arthritis, focusing on:
  • inflammatory foods
  • gut health
  • the role of stress/trauma
Dr. Blum includes a straightforward two-week plan to quickly reduce pain through anti-inflammatory foods and supplements; followed by an intensive gut repair program. Once through this initial phase, her plan addresses the emotional issues that contribute to inflammation and outlines a simple, Mediterranean inspired diet to maintain a healthy gut.

I was pleased to see that the diet and supplement recommendations are given are the same available to patients in my office! This book will serve as a useful companion for patients navigating the world of Functional Medicine in treating arthritis and controlling inflammation.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including arthritis. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. When treating arthritis and autoimmune disease, my approach involves treating root causes such as toxicity, food allergy/sensitivity, stress/trauma and underlying infection. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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In one year, this 10-year-old has made significant behavioral improvements, has stopped two of three medications, is no longer experiencing insomnia or constipation, and is thriving at school.  Read today's blog to hear his story!

BACKGROUND

I first met nine-year-old Luke* and his mother in late 2016. Luke had been diagnosed with a variety of psychological and neurological disorders, including ADHD, PDD-NOS (pervasive developmental disorder-not otherwise specified), Anxiety, OCD (obsessive-compulsive disorder), ODD (oppositional defiant disorder), and a sensory processing disorder.

b2ap3_thumbnail_boy-attacked.jpg

Since the age of five, Luke had been evaluated and treated by a variety of psychologists, psychiatrists, neuropsychologists, and pediatricians, as well as a number of occupational and physical therapists. By age nine he was on three different prescription medications for mood and attention.

At that first visit, Luke’s mom described him as "consistently inconsistent". She illustrated a child who on one day would appear happy, calm and content, while the next day appeared ”tormented" by irritability, anger, hyperactivity, impulsiveness, and anxiety.

I also learned that Luke had suffered from both chronic interrupted sleep and lifelong constipation. At times he would go 5–7 days without a bowel movement, and his mother would notice worsening behavior during these times. Complicating matters, his multiple psychiatric medications only seemed to worsen both his sleep and constipation.

INITIAL WORKUP AND RECOMMENDATIONS 
After hearing Luke’s story and performing an examination, a comprehensive laboratory evaluation was ordered which included testing for:
  • nutritional deficiencies
  • inflammation
  • blood levels of heavy metals
  • thyroid function
  • food allergies and sensitivities
  • micronutrient testing
  • functional stool testing
Prior to our first visit, Luke's parents had already implemented changes to his diet by eliminating additives and preservatives, most processed foods, sugar, soy, and conventional dairy products. I asked them to expand upon this and completely remove gluten from his diet.

FOLLOW UP AND PLAN 
I met again with Luke and his mother in early March 2017 to review the results of his testing. With the exception of low Vitamin D, Luke’s blood lab results were overwhelmingly normal. His stool testing, however, was not.

Luke’s functional stool testing revealed several abnormalities, including:
  • poor digestion, with evidence of high levels of protein and fat in his stool
  • bacterial dysbiosis, an overgrowth of “bad” bacteria in the gut
  • low microbial diversity
I recommended they add both fish oil and vitamin D with specific dosing recommendations given. We also initiated a protocol to rebalance his gut which included:
  • continued food restriction, avoiding gluten and other inflammatory foods
  • chewable digestive enzymes with meals
  • pharmaceutical-grade probiotics
  • an herbal blend to reduce the overgrowth of “bad” gut bacteria while still promoting the growth of “good” gut bacteria
TWO MONTHS LATER - PROGRESS! 
Off one medication and behavior improved!

Luke’s mother and I followed up via email in May after completing the herbal gut protocol. I was thrilled to learn of the progress that Luke had made! He had been off of Concerta (a medicine for hyperactivity and attention) for 2 months and was experiencing less behavioral problems. I advised them to continue the probiotics, enzymes, fish oil and vitamin D, and we added magnesium.

A FEW MORE MONTHS - MORE PROGRESS!
Off two medications, sleeping well and regular bowel movements!

b2ap3_thumbnail_GUT.jpgBy August 2017 Luke was down from three to only one medication. His mother reported that he was sleeping well and was having daily well-formed bowel movements! While Luke was still often impulsive and defiant, overall significant behavior improvement had continued since his initial visit.

In November Luke’s mother and I touched base after he had been back in school. She reported that he was “loving school” and was excited to report that he had not had any behavioral or academic problems. His anxiety and impulsiveness had improved. and his mother commented that “he looks really healthy”.

ONE YEAR LATER 
To follow up our gut protocol, we repeated Luke’s Functional Stool Testing, as well as a Urine Organic Acid Panel (which can give us a wealth of information without another blood draw). His stool testing had significantly improved, with better microbial diversity however he continued to show signs of poor digestion and bacterial levels, while much better, were still trending toward imbalance.

Using this follow up information we were able to “tweak” his current program, adding back digestive enzymes (which had been phased out), and repeating a one-month herbal program to further balance gut bacteria. We also added back L-glutamine to further heal and strengthen his small intestinal lining.

His diet restrictions have loosened slightly, but key concepts remain in place, including a whole food diet, and keeping sugar and processed foods to a minimum. They have identified significant gluten intolerance with increased anxiety and agitation, as well as a slightly less pronounced sugar intolerance.

Through the use of a thorough history, appropriate laboratory testing, and evidence-based Functional Medicine protocols, Luke has made significant behavioral improvements, has stopped two of three medications, is sleeping well, having regular bowel movements and thriving at school. I look forward to seeing his progress continue over the years to come!

*patient name has been changed to protect privacy

Carin Nielsen, MD Integrative MedicineI use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including both adult and childhood mood and behavior disorders. Rather than focusing solely on the use of prescription medication, consider addressing potential "root causes" of you or your loved one's symptoms, such as nutrition, gut health, toxicities/impaired detoxification, hormone imbalance, deficiencies and more. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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b2ap3_thumbnail_Shop_17FiberCapsules.jpgGlucomannan is a “Super Fiber” that has been shown to reduce appetite, aid in weight loss, lower cholesterol and blood sugars, and relieve constipation.*

Glucomannan is an ancient fiber that comes from the Asian elephant yam, also known as Amorphophallus konjac. This soluble fiber is one of the most viscous dietary fibers known - it can absorb up to 50 times its weight in water.

APPETITE AND WEIGHT LOSS

When combined with water, glucomannan forms a viscous gel-like substance that slows digestion, delays the emptying of food from the stomach into the small intestine, slows down the influx of carbohydrates and fats into the bloodstream, binds to bile acids, and impedes dietary fat absorption.* [1,2]  Studies suggest that glucomannan supplementation significantly reduces weight at doses of 3 g/d to 4 g/d when compared to placebo. [1-7]

Bottom line: When combined with water, Glucomannan expands in your stomach, helping to reduce hunger and promote weight loss.*

GLUCOSE AND LIPID METABOLISM

Soluble fiber slows the absorption of carbohydrates, which influences the release of insulin and the rate of fat storage. Glucomannan studies have not only demonstrated a positive impact on postprandial glucose handling and glucose metabolism but also on cholesterol metabolism.* [1-4,7-9]

Bottom line: When combined with food, studies show that Glucommanan can lower blood sugars and cholesterol.*

HEALTHY BOWEL FUNCTION, PREBIOTIC

Glucomannan not only allows more water to remain in the stool, thereby making waste softer, larger, and easier to pass through the intestines, but it is also an excellent prebiotic. In a placebo-controlled, randomized, parallel, double-blind, crossover trial, doses of 3 g/d and 4 g/d of glucomannan had a positive impact on bowel regularity when compared to placebo. [10] Glucomannan has also been shown to increased the fecal concentration of lactobacilli as well as the daily output of bifidobacteria, lactobacilli, and total bacteria. In addition, fermentation of glucomannan resulted in greater fecal concentrations of short-chain fatty acids and lower fecal pH.*[11]

Bottom line: Glucomannan promotes regular bowel movements and the growth of more "good bacteria" in your gut.*


FIBER LEAN

b2ap3_thumbnail_Shop_17FiberLean.jpgFIBER LEAN
features Shimizu Propol® A propolmannan - a konjac-derived glucomannan using proprietary processing techniques that allow the fiber to maintain high viscosity yet remain stable through the digestive tract.
  • Supports Appetite and Weight Control* 
  • Supports Glucose and Cholesterol Metabolism* 
  • Supports Healthy Bowel Movements* 
  • Serves as a Prebiotic for Intestinal Bacteria* 
When taken with adequate amounts of water, Fiber Lean expands in the stomach, creating a viscous “gel-like” substance which promotes a sense of fullness, slows the rate at which food enters your bloodstream and increases the speed at which food exits the body through the digestive tract (pushing more calories out through the colon, rather than letting them be absorbed). Fiber Lean binds and quickly eliminates toxins from the gut.*
  • Take 30-60 minutes before a meal to feel full with reduced portion sizes*
  • Take prior to heading out to a party/event to reduce cravings and temptation*

Fiber Lean comes in both powder and capsule form.  
Visit our Downtown Petoskey office for a free Fiber Lean sample, 

or visit our online store to buy online.


1. Walsh DE, Yaghoubian V, Behforooz A. Effect of glucomannan on obese patients: a clinical study. Int J Obes. 1984;8(4):289-93. [PMID: 6096282]
2. Doi K, Nakamura T, Aoyama N, et al. Metabolic and nutritional effects of long- term use of glucomannan in the treatment of obese diabetics. In: Oomura Y, Tarue S, Inoue S, Shimazu T, eds. Progress in Obesity Research 1990. London: John Libbey; 1991:507-14. [on file]
3. Kaats GR, Bagchi D, Preuss HG. Konjac glucomannan dietary supplementation causes significant fat loss in compliant overweight adults. J Am Coll Nutr. 2015 Oct 22:1-7. [PMID: 26492494] 4. Biancardi G, Palmiero L, Ghirardi PE. Glucomannan in the treatment of overweight patients with osteoarthritis. Curr Ther Res. 1989;46:908-12. [on file]
5. Reffo GC, Ghirardi PE, Foranttini C. Glucomannan in hypertensive outpatients: pilot clinical trial. Curr Ther Res. 1988;44(1):22-27. [on file]
6. Salvatoni A, Bosetti G, Gambarini G. Lipid pro le and excess body weight in obese children: effect of a dietary drug supplement (glucomannan vs detastranum). Ped Oggi. 1991;11:243-45. [on file]
7. Kraemer WJ, Vingren JL, Silvestre R, et al. Effect of adding exercise to a diet containing glucomannan. Metabolism. 2007 Aug; 56(8):1149-58. [PMID: 17618964]
8. Hopman WP, Houben PG, Speth PA, et al. Glucomannan prevents postprandial hypoglycaemia in patients with previous gastric surgery. Gut. 1988;29(7):930- 34. [PMID: 2840365]
9. Vita PM, Restelli A, Caspani P, et al. Chronic use of glucomannan in the dietary treatment of severe obesity [in Italian]. Minerva Med. 1992 Mar;83(3):135-39. [PMID: 1313163]
10. Marsicano LJ, Berrizbeitia ML, Mondelo A. Use of glucomannan dietary ber in changes in intestinal habit [in Spanish]. G E N. 1995 Jan-Mar;49(1):7-14. [PMID: 8566676]
11. Chen HL, Cheng HC, Wu WT, et al. Supplementation of konjac glucomannan into a low- ber Chinese diet promoted bowel movement and improved colonic ecology in constipated adults: a placebo-controlled, diet-controlled trial. J Am Coll Nutr. 2008 Feb;27(1):102-08. [PMID: 18460488]

Consult your healthcare practitioner prior to use. Individuals taking medication, especially hypoglycemic agents, should discuss potential interactions with their healthcare practitioner. Do not take Fiber Lean at the same time as medication as it may reduce medication absorption.

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many that are linked to unhealthy eating habits and lifestyle patterns Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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THE THREE BOOKS I MOST OFTEN RECOMMEND TO PATIENTS

Summer is a great time to relax in the hammock or on the beach with a good book.  Below are three books I frequently recommend to patients.  Each is the type of book that you can come back to over time, re-reading chapters and absorbing more information.  Happy reading!


b2ap3_thumbnail_ImmuneSystemRecovery.jpg THE IMMUNE SYSTEM RECOVERY PLAN: A DOCTOR'S 4-STEP PROGRAM TO TREAT AUTOIMMUNE DISEASE

By Susan Blum, MD, MPH

A must-read for anyone seeking a Functional Medicine approach to Autoimmune Disease, and a great companion to my office protocols.

This book provides:

 -A basic science “primer” of the immune system and its dysfunction in Autoimmune Disease (you can skip ahead if it’s too much).
- An overview of a Functional Medicine approach to Autoimmune Disease.
- Sep-by-step protocols for managing stress, cleaning up the gut and optimizing detoxification.


b2ap3_thumbnail_HormoneCure.jpg THE HORMONE CURE:
RECLAIM BALANCE, SLEEP, AND SEX DRIVE; LOSE WEIGHT; FEEL FOCUSED, VITAL, AND ENERGIZED NATURALLY WITH THE GOTTFRIED PROTOCOL

by Sara Gottfried, MD

If you are a female between the ages of 35-65, you should read this book!

Harvard-trained physician Dr. Sara Gottfried provides an easy-to-read, well-organized summary of a Functional Medicine approach to hormone balance, including:
  • - Adrenal dysfunction
  • - Thyroid disorders
  • - Peri-menopause and Menopause
Dr. Gottfried explains how stress impacts hormones at many levels and provides evidence-based protocols to get you started on the path to hormone balance.


b2ap3_thumbnail_GrainBrain.jpg GRAIN BRAIN:
THE SURPRISING TRUTH ABOUT WHEAT, CARBS, AND SUGAR--YOUR BRAIN'S SILENT KILLERS

by David Perlmutter, MD

Looking to learn more about gluten and its potentially damaging effects on the body? Considering a more “Paleo” diet? This best-selling book by board-certified Neurologist David Perlmutter is thought-provocative and research-oriented, and will certainly cause you to pause before you put that bagel in your mouth! Included is a practical four-week plan to get you started on a grain-free lifestyle, including gluten-free recipes.

Want to learn more? Consider a few of Dr. Perlmutter’s other books:
  • “The Grain Brain Cookbook” and “The Grain Brain Whole Life Plan” offer even more practical, day-to-day applications.
  • “Brain Maker” a compelling read that describes the relationship between gut health and brain function.
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b2ap3_thumbnail_Scale.jpg
The National Weight Control Registry (NWCR) is an ongoing research study established in 1994 that includes over 10,000 adults who have lost at least 30 pounds of weight and kept it off for at least one year.

Members complete annual questionnaires about their current weight, diet, exercise habits and behavioral strategies for weight loss maintenance.

The NWCR was developed to identify and investigate the characteristics of individuals who have succeeded at long-term weight loss.


HOW DID NWCR MEMBERS LOSE THE WEIGHT?
  • 98% of NWCR participants report that they modified their food intake in some way to lose weight.
  • 94% increased their physical activity, with the most frequently reported form of activity being walking.
  • Over half of participants lost weight with the help of some type of program.

HOW HAVE NWCR MEMBERS KEPT THEIR WEIGHT OFF? HERE ARE SOME LIFESTYLE HABITS THEY HAVE IN COMMON:
  • 78% eat breakfast every day.
  • 75% weigh themselves at least once a week.
  • 62% watch less than 10 hours of TV per week.
  • 90% exercise, on average, about 1 hour per day.
Like I frequently discuss with clients. this is not rocket science! These people (over 10,000) lost weight simply by changing their eating patterns in some way and moving more!


WANT TO LEARN MORE?

Visit the NWCR website www.nwcr.ws




Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including weight gain and obesity. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like estrogen metabolite testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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b2ap3_thumbnail_Alpha-lipoic-acid.jpgWHAT IS ALPHA-LIPOIC ACID?

Alpha-lipoic acid (sometimes referred to as ALA) is a co-enzyme found in every cell of the body, and is used to turn glucose into energy. Alpha-lipoic acid also functions as a powerful antioxidant, attacking "free radicals". Free radicals are produced in the body as a byproduct of energy production, and cause harmful chemical reactions that can damage cells, organs and tissues, and make it harder for the body to fight off infections.

Alpha-lipoic acid is the only antioxidant that is both water and fat-soluble, which means it has access too all parts of our body to attack free radicals and prevent oxidative damage. Alpha-lipoic acid also helps to regenerate other powerful antioxidants and make them active again.

WHAT IS ALPHA-LIPOIC ACID USED FOR?
  • Diabetes, Pre-Diabetes and Insulin Resistance
  • Peripheral Neuropathy
  • Heavy Metal clearance
  • General Antioxidant Support
Researchers believe Alpha-lipoic acid helps improve insulin sensitivity. More simply put, Alpha-lipoic acid may make it easier for your body to use blood sugar for fuel. Alpha-lipoic acid is also used to treat the symptoms and delay progression of diabetic and alcoholic peripheral neuropathy. Studies show Alpha-lipoic acid binds with toxic metals, such as mercury, arsenic, iron, and other metals that act as free radicals. Because alpha-lipoic acid can pass easily into the brain, it may help protect the brain and nerve tissue, researchers are investigating it as a potential treatment for stroke and other brain problems involving free radical damage, such as dementia.

HOW TO SUPPLEMENT: ADULTS
  • General antioxidant support: 50-400 mg per day
  • Diabetes and diabetic neuropathy: 600-800 mg per day

PRECAUTIONS/POSSIBLE INTERACTIONS


Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a health care provider. Side effects are generally rare and may include insomnia, fatigue, diarrhea, and skin rash.

Alpha-lipoic acid has not been studied in children, pregnant or breastfeeding women and is therefore not recommended for use in these populations.

Caution:
  • If you are diabetic or have low blood sugar, as Alpha-lipoic acid many lower blood sugars further.
  • If you are an alcoholic, or have Vitamin B1 (Thiamine) deficiency, as animal studies have shown that Alpha-lipoic acid may lower Vitamin B1 levels.
  • If you are on thyroid medication, monitor thyroid levels as Alpha-lipoic acid may reduce thyroid hormone levels.
  • If you are on chemotherapy, you should check with your oncologist prior to using Alpha-lipoic acid.
SOURCES:
  • University of Wisconsin Integrative Medicine - Supplement Samplers
  • University of Maryland Medical Center - Complementary and Alternative Medicine Guide
  • Oregon State University, Linus Pauling Institute - Micronutrient Information Center



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like estrogen metabolite testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Interested in learning more about our 12-week Weight Loss/Lifestyle Change programs?

Wondering how a program might work for you?


TODAY'S BLOG COMES FROM A PATIENT'S OWN WORDS AFTER HER RECENT
“12-WEEK TRANSFORMATION”.


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“The program was personalized to fit my needs, concerns. Once I learned how and what to eat I have been able to continue almost automatically. It works because it changes how you see food and gives you a healthy change, instead of yo-yo diets or a fad diet that you won't be able to do long-term.

It is a lifestyle change, one that my body needed. I am able to pinpoint which foods make me feel sick and which ones add weight, and eliminate them.”  EL, Age 36.

In just 12 weeks, she lost:

28 POUNDS
7 INCHES OFF HER WAIST 
4.5 INCHES OFF HER HIPS
3.75 INCHES OFF HER CHEST
3.25 INCHES OFF HER ARM

 And she even took a three-week vacation during her program!  


Are you ready to get started?


Call 231-638-5585 to book your appointment today, or feel free to email me with questions at This email address is being protected from spambots. You need JavaScript enabled to view it.



Carin Nielsen, MD Integrative MedicineLooking for a personalized approach to your healthcare? I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms and chronic disease simply by prescribing medication doesn't address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface" to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Have you or a loved one been diagnosed with high cholesterol? Have you been prescribed a statin medication? Functional Medicine provides a framework to determine why you have high cholesterol, assess other cardiovascular risk factors, and outline a treatment plan that is cu
stomized for your individual needs.

1. FUNCTIONAL MEDICINE ASKS THE QUESTION- WHY DO YOU HAVE HIGH CHOLESTEROL?

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As Functional Medicine physician and best-selling author Dr. Mark Hyman likes to say, “High Cholesterol is not a Lipitor deficiency”.

Before jumping to a prescription, Functional Medicine asks the question why? By addressing the root cause of your elevated cholesterol you may be able to avoid medication and lessen cardiovascular risk.

Obviously, diet can play a big role in elevated cholesterol, but there are other factors that may be contributing to or causing high cholesterol that a Functional Medicine doctor considers, including:

  • Genetics
  • Hormone Imbalance (especially thyroid and insulin/blood sugar)
  • Hidden Infections
  • Toxicity (especially heavy metals)


2. FUNCTIONAL MEDICINE GOES BEYOND THE STANDARD LIPID PANEL WITH ADVANCED LABORATORY TESTING.

Why do we even care about high cholesterol? Because of risk for heart and vascular disease! Yet many physicians base risk and treatment decisions on a standard lipid panel alone.

Functional Medicine uses Advanced Laboratory Testing to get a more accurate assessment of risk and to develop individualized treatment plans that are not simply focused on statin medication.

b2ap3_thumbnail_ExampleLipidPanel_Click.jpgLDL cholesterol is typically referred to as “bad cholesterol”, but not all LDL cholesterol is created equal!

Advanced Laboratory Testing measures the size and number of your LDL particles - which is a better predictor of heart and vascular disease risk. If you have small, dense “sticky” LDL particles, these are much more concerning than large, buoyant “beach ball”-like particles, which carry less risk. In addition to measuring the size of your LDL particles, Advanced Laboratory Testing measures another type of lipid protein called lipoprotein(a). Lipoprotein(a) is a highly atherogenic “troublemaker” that has a strong genetic component and does not readily decrease with diet change or statin drugs. Knowing your lipoprotein(a) levels can help to direct a more individualized treatment plan.

What is LDL?
LDL is a “carrier protein”. Its job is to “carry” cholesterol particles around the body.

LDL isn't always "bad" because your body needs cholesterol!

Cholesterol is an important component of cell membranes and has an antioxidant effect on the brain. Cholesterol is also an important “building block” from which we make our hormones and Vitamin D.

LDL cholesterol itself isn't necessarily a bad thing, yet when LDL cholesterol is in an inflamed environment, your risk of heart and vascular disease increases.

Advanced Laboratory Testing measures the factors that make your LDL cholesterol more of a problem:

  • Inflammation (think of as “fire” in your arteries) measured with hsCRP and fibrinogen
  • Oxidation (think of as “rusting” in your arteries) measured by myeloperoxidase or oxidized LDL
  • Glycation ( think of as “sugar coating” LDL and making it stickier) measured with fasting glucose, insulin, and HbA1c

Advanced testing can also look for signs of plaque formation in the arteries - measured with LP-PLA2 activity laboratory testing, or imaging studies such as carotid artery ultrasound or coronary calcium CT scoring.


3. FUNCTIONAL MEDICINE OFFERS TREATMENT FOR HIGH CHOLESTEROL THAT GOES BEYOND STATIN DRUGS.

b2ap3_thumbnail_Blog_vegetables.jpgDon’t get me wrong, a Functional Medicine doctor may prescribe statin medications if indicated, but not as first-line therapy. These days it seems almost a “knee-jerk” reaction for doctors to prescribe statin medications at the first sign of elevated cholesterol. In fact, statin drugs are one of the most frequently prescribed classes of medication worldwide and account for hundreds of billions of dollars in revenue for pharmaceutical companies.

Once you’ve determined why your cholesterol is elevated, and what other risk factors are present, Functional Medicine then outlines a treatment plan that is individual for each patient, based on this information.

Food First!

Diet is first and foremost in the treatment of high cholesterol and the discussion of heart and vascular disease risk. This doesn’t have to be difficult! The principles of a heart-healthy diet can be broken down to a few simple goals:

  • reduce the “white stuff” (sugar and processed and refined carbohydrates)
  • avoid unhealthy fats
  • eat more plants
  • choose high-quality protein sources

Functional Medicine does not believe in a “one-size-fits-all” diet approach. Based upon a person’s genetics, testing results, and the current state of health, various diet plans may be recommended, including:

  • A low glycemic load diet, such as “The Blood Sugar Solution” by Dr. Mark Hyman
  • A modified Mediterranean Diet such as the Institute for Functional Medicine’s Cardiometabolic Food Plan
  • A plant-based diet such as Rip Esselstyn’s Engine 2 Diet
  • A “paleo” diet such as Chris Kresser’s “Your Personal Paleo Code”

Laboratory studies are re-checked about three months after making diet change to assess the impact on disease risk.

Beyond Diet

Moving “beyond diet”, a Functional Medicine treatment plan for high cholesterol will focus on the underlying causes listed above, and the results of Advanced Laboratory Testing, and may include:

  • Treatment of low thyroid to achieve optimal thyroid levels (not simply “normal range”)
  • Stress-reduction and mind-body tools to lower cortisol output
  • Weight reduction to lower blood pressure and reduce sleep apnea
  • Treating insulin resistance and lowering blood sugars
  • Treating infections in the gut and restoring gut balance
  • Antioxidant support to reduce oxidation stress
  • Detoxification/chelation of heavy metals
  • A regular exercise program to increase cardiovascular fitness


Carin Nielsen, MD Integrative MedicineDo you have questions about a Functional Medicine approach to High Cholesterol or Cardiovascular disease risk? Are you ready to get your own evaluation started? If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

 
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b2ap3_thumbnail_6DayDetox.jpg

“Detox Jump-Start” - Five Tips for Success



1. GIVE YOURSELF TIME TO PREPARE.

Take time to look the kit over and become familiar with the diet plan. Make a shopping list and stock your kitchen for success!

2. IF YOU ARE CONSTIPATED, START THE COLON-X AND DRAINAGE PRODUCTS FOUR DAYS PRIOR TO THE DETOX START, RATHER THAN TWO.

You should never detox if you are constipated, you need to be able to “take the garbage out”! Ensure adequate bowel movements prior to starting.

3. IF YOU DRINK COFFEE, CUT BACK SLOWLY.

Stopping coffee “cold turkey” can cause headaches! Cut back slowly, down to 1/2-1 cup in the AM. If you desire, eventually stop completely or switch to decaf.

4. KEEP IN MIND - YOU MIGHT NOT FEEL WELL THE FIRST FEW DAYS OF THE DETOX PROGRAM. 

This is common. As your body begins to detox, you may experience symptoms such as headaches, fatigue, mental fog or irritability. Don’t worry! After a day or two these symptoms should subside. Drink plenty of water and get plenty of rest.

5. PLAN FOR LONGER THAN SIX DAYS!

While the kit says “6-Day Detox”, you will get more benefits if you extend your program. We ask clients to try to commit to a minimum of two weeks. With the exception of OptiCleanse GHI, all products in the kit contain a 30 day supply! As you wrap up your program, make note of how you are feeling, and consider re-introducing food groups one at a time. Allow about three days before re-introducing new foods, and monitor how you feel for 1-3 days after reintroduction. This will allow you to identify food sensitivities you may not have been aware of.

If you have any questions or concerns, don't hesitate to contact me at This email address is being protected from spambots. You need JavaScript enabled to view it.

Carin Nielsen, MD
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