Berberine, a natural alkaloid found in various plants like goldenseal and barberry, has been extensively studied for its diverse medicinal properties, showcasing potential benefits across several health domains. One prominent area of interest lies in its role in metabolic health. Berberine has demonstrated significant efficacy in managing diabetes and metabolic syndrome by improving insulin sensitivity, reducing blood sugar levels, and regulating lipid metabolism(1). These effects make it a valuable adjunct therapy for individuals with diabetes or those at risk of developing metabolic disorders. Moreover, berberine exhibits notable anti-inflammatory properties (2). This attribute extends its potential therapeutic applications to conditions characterized by chronic inflammation, such as arthritis and inflammatory bowel disease. By modulating inflammatory pathways, berberine offers a natural alternative for alleviating symptoms associated with these ailments, potentially complementing existing treatment strategies. Berberine's antimicrobial activity further enhances its medical utility (3). Research indicates its effectiveness against various pathogens, including bacteria, viruses, and fungi. This broad-spectrum antimicrobial action suggests berberine's potential in treating infectious diseases and underscores its role as a natural antimicrobial agent. In addition to its metabolic and anti-inflammatory properties, berberine has emerged as a promising cardioprotective agent (4) . Studies have shown that berberine can help lower blood pressure, reduce cholesterol levels, and inhibit plaque formation in arteries, thus reducing the risk of cardiovascular diseases such as hypertension and atherosclerosis. Berberine's neuroprotective effects have also garnered attention (5). Research suggests its potential in mitigating neurodegenerative disorders like Alzheimer's and Parkinson's diseases. Its ability to modulate neuronal function and protect against neurotoxicity makes it a compelling candidate for further investigation in the realm of neurological health. Furthermore, berberine has shown promise in cancer therapy (6). Preclinical studies have demonstrated its ability to inhibit cancer cell growth, induce apoptosis, and suppress tumor metastasis. While further clinical research is needed, berberine's multifaceted anti-cancer mechanisms present exciting prospects for its inclusion in cancer treatment regimens. Weight management and obesity treatment represent another area of interest for berberine research (7). Studies have indicated its potential to reduce body weight, visceral fat accumulation, and improve metabolic parameters in overweight and obese individuals. These findings suggest berberine's role in addressing the global challenge of obesity and its associated health complications. In summary, berberine exhibits a wide array of medical benefits, including its effects on metabolic health, inflammation, antimicrobial activity, cardiovascular health, neuro-protection, cancer therapy, and weight management. While much of the evidence supporting these benefits comes from preclinical studies, the accumulating research underscores berberine's potential as a versatile natural compound for promoting health and treating various diseases and conditions. Further clinical investigations are warranted to validate its efficacy, safety profile, and optimal therapeutic applications in clinical settings. Note Well: The preferred genus and specie to get the most alkaloid per gram, best effect and best value, is Berberis Vulgaris. The Aristata Specie is not nearly as effective, although it is easier to find in most preparations. The real value is to look for the Vulgaris Specie. Our typical regimen for Berberine: For Diabetes and/or insulin resistance syndrome, we start with 500 mg twice daily, taken with food. Check blood sugar levels and adjust the dosage by an additional 500 mg until the blood sugar drops to the desired range. Many patient experience loose bowel movements for the first few weeks, until the insulin and blood sugar levels equilibrate. Anticipate weight loss during this period to average 2-3 pounds per month, if you get the insulin below 10 and blood sugar below 90. References: Yin, J., Xing, H., & Li, D. (2008). Antidiabetic activities of aqueous extract from Berberis holstii and berberine in vivo and in vitro. Journal of Ethnopharmacology, 118(3), 479–484. Xu, D., Hu, M.-J., Wang, Y.-Q., & Cui, Y.-L. (2019). Antioxidant Activities of Quercetin and Its Complexes for Medicinal Application. Molecules, 24(6), 1123. Imenshahidi, M., & Hosseinzadeh, H. (2019). Berberis Vulgaris and Berberine: An Update Review. Phytotherapy Research, 33(3), 504–523. Kong, W., Wei, J., Abidi, P., Lin, M., Inaba, S., Li, C., Wang, Y., Wang, Z., Si, S., & Pan, H. (2004). Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins. Nature Medicine, 10(12), 1344–1351. Ahmed, T., Gilani, A.-u.-H., & Abdollahi, M. (2015). Berberine and Neurodegeneration: A Review of Literature. Pharmacological Reports, 67(5), 970–979. Wang, N., Feng, Y., Zhu, M., Tsang, C.-M., Man, K., Tong, Y., & Tsao, S. W. (2019). Berberine Induces Autophagic Cell Death and Mitochondrial Apoptosis in Liver Cancer Cells: The Cellular Mechanism. Journal of Cellular Biochemistry, 120(4), 6616–6626. Zhang, H., Wei, J., Xue, R., Wu, J.-D., Zhao, W., Wang, Z.-Z., Wang, S.-K., Zhou, Z.-X., Song, D.-Q., Wang, Y.-M., & Pan, H.-N. (2018). Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin receptor expression. Metabolism, 59(2), 285–292. 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Molds survive by creating chemicals called beta glucans. These protect the mold from being eaten by bacteria. These same chemicals can help protect us from infection, in exactly the same manner. Think about the history of Penicillin, a mold derivative. Beta-glucans are a type of polysaccharide found in the cell walls of certain fungi, yeast, bacteria, and grains like oats and barley. They have gained attention for their potential health benefits, including their ability to modulate the immune system and potentially help with infections. Here's how beta-glucans may be relevant to infection: Immune system modulation: Beta-glucans are known as immunomodulators. They can activate various immune cells, such as macrophages, neutrophils, and natural killer (NK) cells, which play essential roles in the body's defense against infections. By enhancing the activity of these immune cells, beta-glucans may help the body respond more effectively to pathogens. Beta Glucans derived from mold helps fight infections! Antimicrobial properties: Some studies suggest that beta-glucans may have direct antimicrobial effects against certain pathogens, including bacteria and fungi. They can inhibit the growth of these microorganisms, making it harder for them to cause infections. Best use of Beta Glucans may be in the treatment of viral upper respiratory tract infection, including the common cold and influenza. Remember, COVID is a 'common cold virus.' Respiratory infections: Beta-glucans have been studied in the context of respiratory infections, such as the common cold and influenza a. Some research suggests that beta-glucan supplementation may reduce the incidence and severity of respiratory infections, potentially by enhancing the immune response in the respiratory tract. Wound Healing may be improved with beta glucans derived from Mold! Wound healing: Beta-glucans may also have a role in wound healing by promoting tissue repair and reducing the risk of infection in wounds. It's important to note that while beta-glucans have shown promise in some studies, their effectiveness can vary depending on factors such as the specific source of the beta-glucans, the dosage, and the type of infection. Additionally, beta-glucans are typically considered as part of a broader approach to supporting immune health and infection prevention, rather than as a standalone treatment. If you are considering using beta-glucans to support your immune system or for infection prevention, it's often advisable to consult with a healthcare professional. They can provide guidance on the appropriate dosage, potential interactions with medications, and whether beta-glucans are a suitable option for your specific health needs. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

What do you need when you injury your ankle or foot? What do you need if you are having or expecting to have surgery? Less pain during your recovery time. If you wait until you are being driven home from the hospital, sorting through how you are going to feed yourself, get the mail and function as an adult, you are going to find yourself in trouble. lf you anticipate the need, get this ahead of your scheduled surgery! Do not wait until the last minute to find the essentials that you need to survive. The surgeons may not be particularly helpful, here. The physical therapists, vocational rehabilitation specialists and family physicians may not be aware of what you need. The pillow above, is not the only way to keep your foot elevated, but it is extremely practical and cost-effective. Reduce swelling by elevation, protect the foot from blankets and sheet 'pulling your foot the wrong way.' For acute injury, this includes fracture and surgery, keeping the extremity elevated results in reduced swelling, and reduced pain. Reducing swelling reduces recovery time! Worth a try, available to be delivered to your door. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Dealing with the increase in adolescent depression and suicide In recent years, there has been a concerning increase in adolescent depression and suicide rates, drawing attention from researchers, healthcare professionals, and policymakers worldwide. This alarming trend reflects a complex interplay of various factors, including societal changes, increased academic pressure, the pervasive influence of social media, and the COVID-19 pandemic. These factors have converged to create a perfect storm of mental health challenges for today's adolescents. The COVID-19 pandemic has added another layer of complexity to this issue. Lockdowns, social distancing measures, and remote learning have disrupted the routines and social connections that are crucial for adolescent well-being. Many adolescents have reported feelings of loneliness, anxiety, and depression as a result of the isolation and uncertainty brought on by the pandemic. Addressing this concerning increase in adolescent depression and suicide requires a multifaceted approach. Reducing the stigma associated with seeking mental health care and fostering open conversations about mental health can help create a more supportive environment for adolescents to seek help and find hope in difficult times. The relationship between sleep and depression is a well-established and intricate one. Sleep plays a crucial role in maintaining mental health, and disturbances in sleep patterns often accompany the onset and exacerbation of depressive symptoms. Individuals with depression frequently experience sleep disturbances such as insomnia, characterized by difficulty falling asleep, staying asleep, or early morning awakenings, or hypersomnia, which involves excessive daytime sleepiness and prolonged sleep durations. These disruptions can further exacerbate the depressive symptoms, creating a vicious cycle where depression leads to poor sleep, and poor sleep worsens depression. Research has shown that sleep and depression are interconnected at a neurobiological level. The regulation of mood and emotions involves intricate neurotransmitter systems, including serotonin and norepinephrine, which also play a role in the regulation of sleep. Imbalances in these neurotransmitters can disrupt both mood and sleep patterns, contributing to the development or persistence of depression. Addressing sleep disturbances is an essential component of treating and managing depression. Cognitive-behavioral therapy for insomnia (CBT-I) and other sleep-focused interventions can help individuals with depression improve their sleep quality and, in turn, alleviate some of their depressive symptoms. Conversely, effective treatment of depression can lead to improvements in sleep, as individuals often report better sleep when their mood stabilizes. Recognizing and addressing the intricate connection between sleep and depression is vital in providing comprehensive care for individuals struggling with these conditions. Improving sleep habits, include turning off all cell phones and computers, lower the temperature of the room to 70 degrees or lower and darken the room as much as possible. The addition of a sleep aid, such as Melatonin, may assist in regulating sleep cycles. Melatonin may be safely used in this population Dosages of Melatonin for this population may be as little as 1 mg, but the dosage increases as the child grows. By adolescence, the effective dosage may range from 5 mg to as much as 15 mg. Always use the lowest effective dosage. For more information, please use the link, below, to a marvelous article on this important topic. From the National Library of Medicine: Melatonin use and the risk of self-harm and unintentional injuries in youths with and without psychiatric disorders: Leone M, Kuja-Halkola R,  Lagerberg T, et al:  J Child Psychol Psychiatry (2023): Jul;64(7):1027-1036 Link to the above article: David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Introducing 'NOX Support:' Opens small blood vessels, improves blood flow and reduces the inconvenience of erectile dysfunction. Natural Supplement for E.D. There are many products on the market from which to choose. It seems that every week or two, another one emerges. Pay very close attention to the supplement information label, and more importantly, learn what the 'effective dose' is for each of the many ingredients. It is easy for manufacturers to 'sprinkle' a little in, give them a line on the ingredients list, and make it look better. At Stages of Life, we formulate with the effective dose up front, and work out the 'number of capsules per serving,' later. It makes no sense to worry with how many capsules it takes when taking too few results in lower effectiveness. We broke the treatment into two very important supplements that effective help patients with Erectile Dysfunction. NOX SUPPORT is a beautiful formulation that is helpful to deal with dilating the small arteries, or arterioles in many tissues. This can make it much safer than the Viagra, Cialis or Levitra effects that can influence the heart. NOX SUPPORT will have the same effect on the heart as it does on the genitals, making it very suitable for daily use. You just never know when it may be 'show time.' Step Number 2: Stud Mix, 3 capsules at bed time. A natural alternative to prescription ED medications. Testosterone levels increase at night, usually between 3 and 4 in the morning. If you inhibit the degradation of testosterone to estradiol then, men will awaken with a surprise. It generally takes about 6 weeks of use for this to become a regular event in your love life. As you continue with the regimen, you will find that you need far fewer 'blue pills.' One of favorite metaphors for designing a patient treatment involves a jigsaw puzzle. Each person, each disease state, each age and gender requires a different twist. So it goes with men and sexuality. When a man reaches the age of 40, his estrogen has already risen to a level that exceeds his (female) partner. This results in a 'dirty trick' of nature that involves the ratio of Testosterone to total estrogens in the blood stream. For that reason, we add STUD MIX to the regimen. Taken every evening, this natural mixture increases testosterone AND decreases estrogen resulting in a healthier balance. Maximal effect is observed first thing in the morning, so additional time should be allowed on work days. The combination of morning/afternoon use of NOX Support with evening use of STUD MIX results in dramatic improvement in performance. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Listen to our I-Heart Podcast: Pain in the foot is a very common clinical entity.  Causes of foot pain can include arthritis, tendinitis, ligament inflammation, sprain and fracture. Metabolic diseases can cause foot pain, including gout, diabetes and vitamin deficiencies. Often overlooked causes of foot pain include enthesopathies (tendinitis) of the knee, muscular spasm in the calf and nerve irritation in the thigh. Foot pain can be a debilitating and distressing condition that affects individuals of all ages and lifestyles. Understanding the various causes of foot pain is crucial for effective diagnosis and management. Structural Abnormalities: One of the most common causes of foot pain is structural abnormalities. Conditions such as flat feet, high arches, or abnormalities in the bones and joints can lead to improper weight distribution and strain on the feet. This often results in discomfort, especially after prolonged periods of standing or walking. Footwear Choices: Wearing ill-fitting or unsupportive shoes can contribute significantly to foot pain. Shoes that lack proper arch support, cushioning, or have narrow toe boxes can lead to conditions like plantar fasciitis, bunions, and metatarsalgia. High heels, in particular, can place excessive pressure on the forefoot and alter the natural alignment of the foot, leading to pain and deformities. Overuse and Repetitive Stress: Engaging in activities that involve repetitive motions or excessive pressure on the feet can lead to overuse injuries. Runners, athletes, and individuals who spend long hours on their feet are prone to conditions like stress fractures, tendonitis, and ligament strains. Poor training techniques and sudden increases in activity levels can exacerbate these issues. Arthritis and Inflammatory Conditions: Arthritis, including osteoarthritis and rheumatoid arthritis, can affect the joints in the foot, leading to chronic pain, stiffness, and inflammation. These conditions can deteriorate the cartilage and synovial fluid in the joints, causing discomfort with every step. Trauma and Injuries: Accidents, falls, and sports-related injuries can result in fractures, sprains, and contusions in the foot. These traumatic incidents can lead to acute pain and, if not treated promptly and properly, can result in chronic pain and long-term complications. Neurological and Systemic Causes: Foot pain can also be a manifestation of underlying systemic conditions such as diabetes, neuropathy, or circulatory problems. Nerve damage, reduced blood flow, or inflammation can affect the sensory nerves in the feet, leading to sensations of burning, tingling, or numbness, along with pain. Foot pain can stem from a multitude of causes, encompassing structural issues, footwear choices, overuse and repetitive stress, arthritis, injuries, and underlying systemic conditions. Understanding the specific cause of foot pain is crucial for accurate diagnosis and appropriate treatment. Consultation with a medical professional or podiatrist is often necessary to determine the root cause and develop an effective management plan, which may include lifestyle modifications, physical therapy, orthotics, or medication to alleviate pain and improve foot health. The very first "step" in the treatment of foot pain is to determine the precise cause or causes for any particular patient. Multiple causes are common, for example: A. Inflammation and swelling from arthritis can cause nerve compression, like tarsal tunnel B. Hypothyroidism, low thyroid function, can similarly cause impingement of the Tibial Nerve and cause Tarsal Tunnel Syndrome C. Swelling from Plantar Fasciitis can cause impingement of the same Tibial Nerve, causing similar symptoms. The treatment for each of these (3) situations is entirely different. Precise diagnosis is essential to the success of treatment in each and every patient and in each and every situation. At Stages of Life Medical Institute, we are fully equipped to perform the necessary electrodiagnostic studies that are needed, we are capable of treatment using a variety of traditional medicines as well as utilizing the best of natural or functional medicine approaches. Moreover, we have our own in-house laboratory to use if needed to evaluate for underlying endocrine causes. Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750 T: 407-679-3337 F: 407-678-7246 www.suffernomore.com

David S. Klein, MD, FACA, FACPM Osteoporosis is not just a condition of the elderly, or a disease that only hits 'old ladies.' Bone is not a simple tissue, but a complex living structure that is continuously building and redefining itself. As we get older, we become less efficient in absorbing the necessary nutrients from the gut, we produce less and less estradiol (essential to both men and women in maintaining bone density), and we acquire disease states that worsen the health of our bones. You do not need an intense background in chemistry to appreciate what we have presented here. It might help, but you do not need to understand everything discussed. What is important is knowing that there is easily reference science behind what is being presented. Introduction The incidence of osteoporosis increases with age, and is develops at an earlier age in woman than in men. About 55 % of Americans, women more so than men, are at risk of developing osteoporosis. This disease is characterized by a demineralization of the bones, which become porous and fragile, this causing a higher susceptibility to fractures. Bone is largely calcium in nature, and if demineralization were the issue than common sense would dictate that increasing dietary intake of calcium would arrest, reverse or at least minimize the ravages of this illness. For years, physicians recommended increase in dietary calcium as the principal intervention in this illness. It is only now becoming more obvious that calcium intake is but one of many nutritional concerns that must be addressed in order to effectively treat osteoporosis. This is the principal reason why teenagers eat poorly, yet they grow, and now that you are a mature adult, eating well, your bone is melting away. Many factors, including age, menopausal status, total calcium, vitamin K2 and vitamin D intake, as well as consumption of cigarettes, saturated fats, alcohol, and cola proved to be linked to a lower bone mineral density. It is far more complex than a simple fix with 'go get some calcium tablets!' FACT #1: The human adult requires approximately 200 mg of elemental calcium per day, and if absorption is between 20% and 40%, the nutritional allowance is approximately 1,000 mg per day. Too much calcium causes more immediate problems involving muscle and nerve. These regulatory mechanisms modulate the absorption of calcium. That is, calcium in excess of 1,200 mg or so will cause the body to reduce the percentage absorbed. While this would appear to be ‘wasteful’ of an inexpensive nutrient, the real cost is that the excess calcium competes with absorption of other micronutrients, resulting in poor absorption of these. Too much of a good thing is, in fact, a very bad thing. Calcium ingestion in excess of the requisite amount reduces rates of absorption of calcium thereby limiting the calcium burden in the vascular system, but dietary cations, including calcium compete for absorption. Increasing dietary calcium past a fairly modest level actually inhibits the absorption of other cations, including magnesium and strontium, both essential for development and maintenance of bone. My preferred calcium salt is a chelated form, calcium hydroxyapetite. This is a calcium-phosphorus compound, essentially identical to what is found in your bone. This product contains a chelated of calcium and phosphorus, as well as a small amount of vitamin D. My instructions to patients iare: "one tablet to prevent, two tablets for mild osteoporosis, three for moderate osteoporosis and four capsules for severe osteoporosis. " FACT #2: Taking a properly balanced mineral supplement minimizes the danger of ‘overdoing it.’ FACT #3: Most commercially available vitamin/mineral supplements are worthless because they present the minerals in a poorly absorbed, inorganic form. This is done so that the manufacturer can provide a ‘1-tablet solution’ to all of your needs. It is better that you should keep your money in your pocket than to purchase this junk. Dietary Phosphoric Acid Accelerates Osteoporosis Dietary influences that increases bone demineralization are becoming more and more problematic. Intake of phosphoric acid, as an example, can dramatically accelerate the development of osteoporosis. Cola beverages are the greatest risk in this regard. Phosphoric acid is present in high concentration in cola beverages, and with intake of these soft-drinks, excretion of the phosphate moiety takes place in the form of calcium phosphate. With intake of excessive amounts of phosphoric acid, drinking cola beverages may hasten the development of osteoporosis by worsening calcium deficiency in the bone itself, which in turn causes weakening of the teeth and weak bone density (osteoporosis). FACT #4 : Phosphoric acid intake, in the form of carbonated soft-drinks can hasten the development of osteoporosis. Vitamin K-2 Vitamin K is a lesser known vitamin group, composed of three major chemicals, structurally similar, fat-soluble, 2-methyl-l,4-naphthoquinones, including phylloquinone (K1), menaquinones (K2), and menadione (K3). Vitamin K2 (menaquinone), stimulates bone formation by way of hormone-regulation. This is thought to consist of gamma-carboxylation of osteocalcin and/or steroid and xenobiotic receptors (SXRs). This modulation reduces the incidence of vertebral fractures, despite having only modest direct effects on the bone mineral density (BMD). The most common form of vitamin K2 in animals is menaquinone (menatetrenone; MK-4), produced by the processing of exogenous and bacterial naphthoquinones Vitamin K is a coenzyme for glutamate carboxylase, an enzyme which mediates the conversion of the amino acid glutamate to gamma-carboxyglutamate (Gla). The gamma-carboxylation of the these proteins is essential for the proteins to attract calcium, and to incorporate calcium into the hydroxyapatite crystals that form bone. Vitamin K-2 is found in certain vegetables, but it is absorbed best if in jested simultaneously with butter. Further, the production of Vitamin K-2 is accomplished through ‘normal’ gastro-intestinal bacteria. Supplementation of vitamin K-2 can prevent the development of osteoporosis and reduce the risk of lumbar compression fractures from osteoporosis. FACT #1: Gastrointestinal flora are important to the production of Vitamin K2. Anti-biotics kill off the ‘good bacteria’ right along with the pathogenic bacteria. Patients demand anti-biotics for all manners of problems that would best be treated without anti-biotics. By altering gastrointestinal bacterial flora, we are crippling our ability to get K-2, thereby worsening our skeletal strength. FACT #2: Taking the wrong form or formulation of Vitamin K, or Vitamin K-2 is worthless in therapeutic benefit. You've got to know your chemistry, here. Vitamin D-3 Insufficient ingestion and/or absorption of vitamin D-3 (cholecalciferol) can lead to the development of osteoporosis and damage to the joints. Cholecalciferol is necessary for the absorption of calcium from the gut as well as for deposition of calcium in the bone. Adequate Vitamin D-3 is necessary to ensure that the bones remain strong and are less prone to being brittle or fractured. Vitamin D-3 can also delay the effects of arthritis and reduce back pain. Vitamin D-3 deficiency leads to Osteoporosis. In so far as Cholecalciferol is absorbed in the small intestine, disease states that involve the liver, intestines and gall bladder can hamper the proper absorption and result in Vitamin D-3 and other vitamin/nutrient deficiencies. Vitamin D-3 is unlike any other vitamin. In fact, it really is not a vitamin, at all, but it is a hormone. Its metabolic product, Calcitrol is a secosteroid that has genetic receptors in over 200 genes in the human body. Research studies have implicated vitamin D deficiency as a major factor in the pathology of at least 17 varieties of cancer as well as heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, muscle wasting, birth defects, and periodontal disease. In addition to Vitamin D-3 being important for bone metabolism, sufficient supplementary cholecalciferol has been demonstrated to reduce the risk of breast cancer, prostate and colon cancers as well as reduce the risk of developing multiple sclerosis (MS). Strontium Strontium is an element necessary for the maintenance of calcium matrix. It has been assessed in patients with post-menopausal osteoporosis where it was demonstrated to decrease the risk of vertebral fractures, by 41% over 3 yrs, and by 49% within the first year of treatment. Further, this risk of non-vertebral fractures is decreased by 16% and, in patients at high risk for such a fracture, the risk of hip fracture is decreased by 36% over 3 yrs. Instructions to patients is usually "one capsule daily if you are 40 to 60 years of age, 2 capsules daily if you are 60 to 70 and three per day if you are blessed to be over 70 years of age." Other Important Nutrients However, there are several other vitamins and minerals needed for metabolic processes related to bone, including manganese, copper, boron, iron, zinc, vitamin A, vitamin C, and the B vitamins. The diet must be sufficient in balanced protein as well as balanced with the appropriate fats and oils. Two good choices are demonstrated, below: The American diet, as it is true in most of the developed world, has become increasingly deficient in basic nutrient assay. As a result of soil depletion of micronutrients, deficiencies in micronutrients is becoming commonplace. Deficiencies in zinc, magnesium, manganese, strontium, vanadium and chromium, result in many disease states ranging from obesity and diabetes to Alzheimer’s Disease and cancer. To this end, I find it easiest to start my patients on a balanced mineral supplement, separate and distinct from the vitamin and hormonal supplement requirements. This permits adjustment for age, gender, and disease state. To this, I add Strontium Citrate, Vitamin D-3 and Vitamin K-2. The dosage requirement of strontium increases with advancing age, while the dosage of Vitamin D-3 and Vitamin K-2 remains relatively static. Administering the B-complex separately permits for upward adjustment for the peculiar needs of diabetics. Administering Vitamin E separately permits adjustment of other nutrients without increasing risks of Vitamin E overdose and treatment induced pathology. Patients that suffer from gastro-intestinal disorders require higher dosages of the chelated minerals, due to hampered absorption. Patients with a family history of breast or prostate cancer receive higher doses of Vitamin D-3. Summary Bone is a dynamic organ system. As the sand on the beach is forever changing, so is the matrix of bone. Physiologic forces promote bone deposition and production, while others promote resorption and destruction. Nutritional influences are extremely important, both in positive and negative terms. It takes a wide variety of essential substances, mineral, vitamin, protein, and hormonal to maintain the health and integrity of each and every organ system, including the musculoskeletal system. It is important to realize that there is no simple, easy way to ensure adequate nutritional support of bone. There is no simple or single product that provides all of the nutritional needs of bone. It takes a combination of products, tailored to the unique medical condition, age and gender of an individual to properly provide for basic metabolic need, disease prevention and improved performance. Estradiol supplementation is often necessary, particularly in post-menopausal women. This is best done using carefully controlled bio-identical estradiol, followed with intemittent blood level determination to try to keep it between 20 and 80. Further blogs will be posted on this topic. Unfortunately, few medical practitioners understand the complexity of bone metabolism, and this leads to reflex-prescription writing to slow the progression of this illness, when nutritional prevention is cost-effective and easily implemented. The most important nutrient in the treatment or prevention of any disease state is the nutrient(s) that is(are) missing from the diet. David S. Klein, MD, FACA, FACPM copyright 2023 Stages of Life Medical Institute

Listen to our Thyroid Podcast on YouTube: Patients have trouble finding doctors to prescribe 'natural' thyroid replacement medicines. Natural Products seem to be out of fashion in the Mainstream Medical World. Physicians are trained in treating patients with disease states and rarely get meaningful training on preventive medicine. Bad enough as this is, fewer physicians, still get any training or experienced in treating diseases states with 'naturally occurring medicines.' Specialization in treatment with molecules 'not new to nature' is what is most commonly available. Natural Thyroid replacement treatment with Thyroid USP, glandular thyroid or desiccated thyroid extract is actually the first manner in which hypothyroidism was treated, and it remained that way for decades. After the introduction of Synthroid, things changed. Fewer and fewer physicians used the older medication, and eventually, few became aware that it actually existed. My patients and those of fellow 'functional medicine physicians' are quite aware of the advantages of using the more natural approach. Yes, the natural thyroids have both T-3 and T-4 while the currently available preparations provide only T-3 (Cytomel being an exception.) But few are aware that T-2 and T-1 are also present in glandular thyroid preparations. T-2 and T-1 may actually be important in weight-related issues, something of particular concern to patients with under active thyroid diseases. Thyro Complete by Nutritional Frontiers I am pleased to introduce a high quality product that may help individuals that are unable to convince their physician to prescribe NP Thyroid, Armour Thyroid or Adthyza. My patients receive regular, periodic thyroid levels, that is, determining serum T-3, T-4, TSH, TPA and ATG. Many have the free T-3 and free T-4 components checked, as well. These patients might benefit from the addition of a glandular product like this, if they are not taking the components in another form. I believe that it would be best to add this to a T-4 product to round it out, if the patient/physician pays attention to regular blood work, at least until stability is achieved. For those patients that are unable to get a natural thyroid product, I would use this alone for a period of 4-6 weeks, and then get a TSH, T-3 and T-4 level. Adjust the dosage, accordingly. SUPPLEMENT FACTS Available Bottle Sizes: 60 Amount Per Serving: 2 Capsules Servings Per Container: 30 Amount Per Serving: Iodine (Thorvin™)‡ 130 mcg (Ascophyllum nosodum)(L)(Kelp) Zinc 10 mg (as Zinc Bisglycinate Chelate) (TRAACS™) Selenium 250 mcg (as Selenium Glycinate) (Albion™) Copper 0.1 mg (as Copper Bisglycinate Chelate) (TRAACS™) L-Tyrosine 450 mg Thyroid (Bovine, New Zealand, Freeze Dried) 200 mg Sensoril® Ashwaghanda Extract 150 mg (Withania somnifera)(Roots and Leaves) (Std. to 10% Withania glycosides) ForsLean® Coleus forskohlii Extract 125 mg (Root)(Std. to 10% Forskolin) Hypothalamus Tissue (Bovine, Argentina) 25 mg Pituitary Tissue (Bovine, Argentina) 25 mg Other Ingredients: Vegetable Cellulose (Capsule) Minerals: Iodine (Thorvin™) is a deep water exclusive Icelandic kelp, Thorvin’s Laminaria digitata is higher in total nutrients, particularly iodine, potassium, and specific amino acids. A highly bioavailable form, Thorvin’s Asco Iodine content averages 780 parts per million (ppm), the highest on the market. Zinc (TRACCS™) is essential for the conversion of T4 to T3 and also lends itself to the integrity and functionality of the T3 receptor itself. Selenium (Albion™) is required for thyroid hormone production, activation and metabolism. It is an essential component of deiodinase enzymes which convert T4 to T3. Copper (TRACCS™) plays an important role in the production of thyroid hormone and also acts as an antagonist to Zinc, helping to promote a balanced mineral profile. Amino Acid: L-Tyrosine is a building block for the production of thyroid hormone. Thyroxine is a tyrosine-based hormone, which is also comprised of iodine. Herbal extracts: Sensoril® Ashwagandha: Recent studies have indicated that in addition to the support provided by Sensoril® for healthy cortisol levels (which will in turn support a healthy level of T3 hormone) it may also support T4 production directly. (1) Coleus Forskohlii (ForsLean® Brand) Extract: Supports thyroid function directly and also supports lean body mass through ergogenic activity.* It stimulates AMP (adenosine monophosphate), which then stimulates metabolism for greater fat burning.* You can get this product through a direct association with our office. This is easily obtained by simply registering at Nutritional Frontiers, and use our associate number. David S. Klein, MD, FACA, FACPM Nutritional Frontiers: Log onto: www.nutritionalfrontiers.com Click the 'login' icon, which is a little person with a head. Register and use our affiliate code: Register using the ‘Affiliate ID’ below: Code: 18368 Open an online account with them. Of course, you can stop by our store, we would love to meet you! David S. Klein, MD, FACA, FACPM copyright 2023 Stages of Life Medical Institute

Introduction Are you struggling to achieve your weight loss goals despite diet and exercise? We'd like to introduce you to a potential solution that may help you on your journey to a healthier you – Contrave is a prescription weight loss medication designed to support individuals in their weight management efforts. Weight Loss Challenges Many people face obstacles when trying to lose weight. Factors like genetics, metabolism, and lifestyle can make it difficult to shed those extra pounds. Contrave is here to offer additional assistance in your quest for a healthier lifestyle. After ruling out metabolic issues that cause weight gain, such as elevation in blood insulin level, high blood estradiol levels and hypothyroidism, hunger may be safely reduced in an attempt to lower weight through caloric restriction. That is, make dieting a little easier by making you less hungry. How is this possible? Medications exist that have been proven safe for other uses that reduce the desire to eat, smoke or consume alcohol.. When used appropriately, they can help you reduce your appetite. Contrave works by suppressing your appetite, helping you consume fewer calories. It also enhances your metabolism, making it easier for your body to burn fat. This dual-action approach can assist you in achieving your weight loss goals more effectively. Contrave is a prescription medication that is used to assist in weight loss and weight management. It is a combination of two active ingredients: bupropion and naltrexone. Here, we'll explore the benefits of Contrave in helping individuals achieve their weight loss goals. Dual Mechanism of Action. Contrave's unique advantage lies in its dual mechanism of action. Bupropion, an antidepressant and smoking cessation aid, helps reduce appetite and cravings, making it easier to consume fewer calories. Naltrexone, primarily used to manage opioid and alcohol dependence, complements this by dampening the reward system associated with food, reducing the pleasure derived from overeating. This dual action can provide greater control over eating behaviors. Effective Weight Loss. Clinical studies have shown that Contrave can lead to significant weight loss when used in conjunction with a reduced-calorie diet and increased physical activity. Participants in these studies typically lost more weight than those who followed the same lifestyle changes without the medication. Improved Health Outcomes. Contrave not only aids in weight loss but also contributes to improved health outcomes. Losing excess weight can reduce the risk of obesity-related conditions such as heart disease, type 2 diabetes, and hypertension. It can also alleviate joint pain and sleep apnea, enhancing overall well-being. Individualized Treatment Plans Healthcare providers can tailor Contrave treatment to each patient's unique needs. They assess factors such as medical history, current medications, and potential side effects to ensure a personalized and safe weight management plan. Clinical Studies. Contrave has undergone rigorous clinical trials to ensure its safety and effectiveness. In these studies, participants experienced significant weight loss when combined with a healthy diet and exercise. Potential Benefits. Contrave may not only help you lose weight but also improve your overall health. Weight loss can lead to a reduced risk of obesity-related conditions such as heart disease and type 2 diabetes. Safety Considerations. It's essential to use Contrave under the guidance of a qualified healthcare professional. They will assess your individual health needs, medical history, and potential side effects to ensure your safety. Contrave is typically prescribed to individuals with a body mass index (BMI) above a certain threshold and who have struggled to lose weight through other methods. It is not suitable for everyone, and your doctor will determine if it's right for you. Lifestyle Changes. While Contrave can be a valuable tool, it should be combined with a balanced diet and regular exercise for the best results. Your healthcare provider will work with you to create a personalized weight loss plan. Take the First Step. If you're ready to take control of your weight and improve your health, consult with a healthcare professional today. They can evaluate your situation, discuss whether Contrave is right for you, and guide you on your journey to a healthier and happier life. Remember, it's essential to prioritize patient safety and ensure that the medication is used responsibly and under proper medical supervision. Always consult with a healthcare professional before starting any weight loss medication or program. In conclusion, Contrave offers a multifaceted approach to weight loss and weight management. Its dual mechanism of action, proven effectiveness, and potential for improving overall health make it a valuable option for individuals struggling to achieve their weight loss goals. However, it's crucial to consult with a healthcare professional to determine whether Contrave is appropriate for your specific circumstances, as it may not be suitable for everyone and should always be used under medical supervision. Contrave is available from our in-house pharmacy. At a substantial discount to the patient, it is probably the most affordable modern weight loss medication available. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Tricks of the trade often come from feedback from the Patient. This one is a winner, inexpensive and came from one of my most loyal and pleasant patients! With its potent antibacterial properties, Manuka honey offers benefits that may improve wound healing, provide cough relief, and many other such claims. Manuka honey is native to New Zealand. Viral upper respiratory tract infections (URI) will cause nasal congestion and post nasal drip. This will irritate the throat, tonsils, uvula and cause cough. The cough itself can cause sore throat. Using a cough suppressant is sometimes helpful but topical relief can help you get some well-needed rest and do so without causing additional troubles. Generally, I use Halls Cough and Cold lozenges. They keep well wrapped in my pocket. If left out, the packaging can stick to the lozenge making it harder to use. This makes a good first line OTC product. One of my patients saw me open one of the Hall's drops, and offered me one of her Manuka products. (Many thanks, if you get a chance to read this.) It changed my approach to self-treatment. The Manuka lozenge adds a little 'kick' to the process by soothing the throat mechanically and may give you a slight antiviral effect to help things heal. The good news is that they work together. Manuka is made from honey, a very special honey, and has the potential of affecting blood sugar. Diabetics should use with due caution. Neither of these products is addictive, of course, and both are inexpensive. I buy my cough drops in the large jar, above. With a family with young grand children, somebody is usually a little sick, so we stay well stocked. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Start Savings TODAY Health Savings Accounts (HSAs) have gained popularity in the United States as a tax-advantaged way for individuals and families to save and pay for healthcare expenses. These accounts come with several advantages and disadvantages, which are important to consider when evaluating their suitability for your financial situation and healthcare needs. If you have even a modest amount of money that you can set aside for the future, consider using the HSA. While it may seem like a modest amount of money to set aside, incrementally it can be substantial by the time you reach retirement. It costs very little in administrative fees to use most brokerage firms. The advantage is that any unused contributions roll over to the next year, and the years that follow, growing with time. Insurance companies generally take any unused funds at the end of the year, and keep them. Advantages of HSAs: Tax Benefits: One of the primary advantages of HSAs is the tax benefits they offer. Contributions made to an HSA are tax-deductible, and any interest or investment gains within the account are tax-free. Triple Tax Advantage: HSAs offer a triple tax advantage, as contributions are tax-deductible, earnings are tax-free, and withdrawals for qualified medical expenses are tax-free. This makes HSAs a powerful tax-advantaged savings tool. Flexible Use: Funds in an HSA can be used for a wide range of qualified medical expenses, including doctor's visits, prescription medications, dental care, and even some over-the-counter items. The flexibility in spending is a significant advantage. Portability: HSAs are portable, meaning you can take the account with you if you change jobs or insurance plans. This allows you to continue using the funds for healthcare expenses in different situations. Roll-over: Unlike Flexible Spending Accounts (FSAs), HSA funds roll over from year to year, so there's no "use it or lose it" requirement. This provides long-term savings potential. Disadvantages of HSAs: High Deductible Requirement: To be eligible for an HSA, you must be enrolled in a High Deductible Health Plan (HDHP). These plans come with higher deductibles, which can be a disadvantage if you have significant healthcare expenses. Limited Contribution Amounts: There are annual contribution limits for HSAs. While they have increased over the years, they may not be sufficient to cover all medical expenses, especially for those with chronic conditions. Not for Everyone: HSAs may not be suitable for individuals with high healthcare needs or low income, as they may struggle to fund the account adequately or face financial strain from the high deductible. Penalties for Non-Qualified Expenses: If you withdraw funds from your HSA for non-qualified expenses before age 65, you'll face a 20% penalty, in addition to paying income tax on the withdrawal. This can deter misuse but may also limit access to your savings. Investment Risk: While HSAs can be invested in stocks, bonds, or mutual funds for potential growth, there's also the risk of losing money due to market fluctuations. Some individuals may prefer more stable savings options. Complex Rules: HSAs come with rules and regulations that can be confusing for some people. It's essential to understand the eligibility criteria, contribution limits, and qualified expenses to make the most of the account. If you enroll in Social Security you will be automatically enrolled in Medicare Part A, which will disqualify you from contributing to an HSA. Using a brokerage firm for your Health Savings Account (HSA) has certain advantages over going through an insurance company. Here are some of the key benefits: Investment Options: Brokerage HSAs typically offer a wider range of investment options compared to HSAs provided by insurance companies. With a brokerage HSA, you can invest in a variety of assets such as stocks, bonds, mutual funds, and exchange-traded funds (ETFs). This can potentially lead to higher returns on your HSA funds compared to a traditional savings account offered by an insurance company. Greater Control: When you use a brokerage HSA, you have more control over how your HSA funds are invested. You can tailor your investment strategy to your risk tolerance and financial goals, which can be beneficial if you have a longer investment horizon and want to maximize the growth of your HSA. Lower Fees: Brokerage HSA accounts often have lower fees compared to HSAs offered by insurance companies. These lower fees can result in more of your contributions being invested and growing over time, rather than being used to cover administrative costs. Flexibility: Brokerage HSAs offer flexibility in terms of investment choices, and you can manage your investments to suit your financial objectives. This can be particularly advantageous for individuals who are comfortable making investment decisions and want to grow their HSA funds over the long term. Diversification: With a brokerage HSA, you can diversify your investments across different asset classes, reducing risk and potentially improving the performance of your HSA. Diversification can be challenging to achieve in a traditional HSA savings account provided by an insurance company. Potential for Higher Returns: By investing your HSA funds in a brokerage account, you have the potential to earn higher returns over time, which can help your HSA grow faster and cover more of your healthcare expenses in the future. While brokerage HSAs have their advantages, it's important to consider a few potential disadvantages as well: Risk: Investing in a brokerage HSA carries investment risk, which means that your HSA funds can fluctuate in value. If the market experiences downturns, you may lose money, which can be a disadvantage for individuals who prefer a more conservative, low-risk approach. Expertise Required: Managing investments in a brokerage HSA requires some level of investment knowledge and experience. If you are not comfortable with investment decisions or don't have the time to manage your investments, you may prefer the simplicity of an insurance company HSA. Fees and Costs: While brokerage HSA fees can be lower than insurance company fees, they still exist. You should be aware of these fees and how they can impact your overall returns. Administrative Complexity: Brokerage HSAs can be more administratively complex than traditional HSA savings accounts. You'll need to monitor your investments, make asset allocation decisions, and potentially deal with tax reporting requirements. NOTE: With many insurance company sponsored HSA's, it is a 'use it or lose it' proposition. Any money you do not spend by being frugal goes back to the insurance company. With a bank or broker, any unused funds remains in the account and hopefully grows over the years. It remains with you, to be used for health related problems, or it becomes part of your estate. In summary, HSAs offer significant tax advantages and flexibility for those who can manage the high deductible requirement and are willing to invest time in understanding the rules. However, they may not be suitable for everyone, particularly those with high healthcare expenses or limited income. Evaluating your financial situation and healthcare needs is crucial in determining whether an HSA is the right choice for you. David S. Klein, MD, FACA, FACPM 1917 Boothe Circle Longwood, Florida 32750 Tel: 407-679-3337 Fax: 407-678-7246

Bronchitis is a common respiratory condition characterized by inflammation of the bronchial tubes, which are the air passages that connect the windpipe (trachea) to the lungs. It can be caused by viral or bacterial infections, as well as exposure to irritants like cigarette smoke, air pollution, or dust. My case followed a severe infection caused by a bacterium, Mycoplasma Pneumoniae. The inflammation in the bronchial tubes results in increased mucus production, leading to symptoms such as a persistent cough, chest discomfort, and difficulty breathing. There are two main types of bronchitis: acute bronchitis and chronic bronchitis. Acute bronchitis is often short-lived and typically caused by viral infections, like the common cold or the flu. It can resolve on its own or with supportive care. On the other hand, chronic bronchitis is a more long-term condition usually associated with smoking or prolonged exposure to irritants, or following pulmonary infections, bacterial, viral and/or fungal. Treatment for bronchitis depends on the underlying cause. In cases of acute bronchitis, treatment typically focuses on managing symptoms and includes rest, hydration, and over-the-counter medications to alleviate cough and fever. For chronic bronchitis, the primary approach is to quit smoking if applicable, and healthcare providers may prescribe medications to open the airways and reduce inflammation. In either case, it's essential to consult a healthcare professional for a proper diagnosis and guidance on managing the condition effectively. Antibiotics may be indicated, selection is guided by sputum culture, but more precisely with Respiratory PCR testing. What is sputum? Sputum is a term used to describe the mucus or phlegm that is coughed up from the respiratory tract, including the bronchial tubes, and expelled from the mouth. In the context of bronchitis, sputum plays a significant role as it is one of the hallmark symptoms of the condition. When a person develops bronchitis, the bronchial tubes become inflamed, and the body responds by producing excess mucus as a protective mechanism. This mucus can be clear, white, yellow, green, or even blood-tinged, depending on the severity and the underlying cause of the bronchitis. The color and consistency of sputum can provide valuable information to healthcare providers when diagnosing bronchitis. For example, yellow or green sputum is often associated with bacterial infections, while clear or white sputum may indicate a viral cause. Blood-tinged sputum could be a sign of more severe irritation or inflammation in the airways. Monitoring changes in sputum can help healthcare professionals determine the progression of the condition and guide treatment decisions. Sputum analysis, along with other clinical assessments, aids in tailoring the most appropriate treatment plan, whether it involves antibiotics for bacterial bronchitis, antiviral medications for viral bronchitis, or bronchodilators and anti-inflammatory drugs to relieve symptoms and reduce inflammation. Clearing that pesky mucus from the lungs. First things first, get the junk out! The Flutter Valve for Mucous Clearance What is an asthmatic without the obligatory 'inhaler.' Used by physicians for many decades, these portable devices have delivered life-saving medications at the moment that the medication is needed. Sprayed directly into the mouth, timed precisely with inspiration, and after significant practice, the asthmatic might get it right. The Incentive Spirometer for Increasing Depth of Breathing There is a simple device, remarkably inexpensive, that takes much of the worry out of timing the 'squeeze.' Teaching a child to do it right is very difficult, expensive if you consider the waste of medicine that is involved in 'practicing.' The Philips Respironics Optichamber makes it very easy to administer the bronchodilator and increases the amount of medication delivered to the lungs by around 60%. I have patients that are able to get by with one puff instead of two on their Ventolin, saving more than a few dollars by reducing the frequency of inhaler refill.Sel The 'Spacer' for an Inhaler to Increase Efficiency of Asthmatic Inhalers I found that you can get these with a detachable mask, something that might be worth having around, but it works very well if you place the mouthpiece directly in your mouth. The Inhaler, mine is Ventolin (albuterol, Ventolin is the better of the generics) attaches on the opposite side of the chamber. Attach your inhaler mouthpiece to the opening in the spacer. Shake the inhaler, before each use. Exhale and just as you begin to inhale slowly, you actuate the inhaler into the chamber. Precise timing is not essential as it is without the Spacer. This device is equipped with a high volume whistle that fires if you inhale 'too fast.' Perfect feedback, actually. The need for self help became obvious after my first hospitalization for pneumonia: My First Impression I was admitted in January 2023 with asthmatic respiratory failure after a two week long bout of pneumonia (Mycoplasma Pneumoniae.) I had been doing well, I thought, working full time in the clinic. One Thursday afternoon, however, I was escorted out of the office and ended up in the hospital. Antibiotics, oral steroids and 3 days later, I had a discussion with the respiratory therapist who was giving me my nebulizer treatments. He looked at my inhalers and asked: "Hey, Doc, where are your spacers?" Well, it is not my field of expertise, but I know better now. The spacer makes the inhaler work like a champ. The Test Being a bit skeptical, I needed to be convinced. The RT suggested that I try two puffs without the spacer, and see how well I'm breathing. He was withholding the nebulizer, I might add. Then, he told me to take one 'hit' on with the spacer. I did as I was told, and moments later, the effect was unlike any I had previously experienced with the albuterol. I did not take a second inhalation, as it was entirely unnecessary. The principal advantage to the spacer is efficiency. The principal disadvantage is bulk. It does not fit neatly in my trouser pocket. It is the Essential Accessory for the Asthmatic. The spacer increases the efficiency of the inhaler by 40 to 60% The device is probably a reasonable device to carry in a purse, folio or whatever the garment that men are seen carrying through the airports. I bought three of them, leaving one at the office, one in my bathroom and one in my car. I have been a physician for 42 years, and I rarely pick up pearls of wisdom as I did from that Respiratory Therapist. It is now a frequently used piece of armamentarium in the treatment of my patients with asthma and chronic bronchitis. I provided a link to an Amazon page where you can see the instructions for use. I chose not to use the spacer-facemask, for my own situation. David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute 1917 Boothe Circle Longwood, Florida 32750