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Dr. Vivian DeNise and
Chef Elisa Haggarty
   A holistic medical center
   Full-service




                                www.patientsmedical.com
   Discover health, rediscover vitality
   Focus on the root cause
   Integrate modern medicine, holistic
    practices, and natural supplements




                                      www.patientsmedical.com
   Our goal
     Promote healing and prevent disease




                                        www.patientsmedical.com
Physicians collaborate to approach each
            patient holistically.




                               www.patientsmedical.com
Result:
Gain health and nutritional wisdom that can
       be applied for years to come.




                                www.patientsmedical.com
Founder, Dr. Warren Levin
began practicing his ground-breaking holistic
             protocols in 1974.




                                 www.patientsmedical.com
   Conditions Treated
       Chronic Fatigue Syndrome
       Multiple Sclerosis
       Osteoarthritis (OA)
       Rheumatoid Arthritis (RA)
       Diabetes
       Heart disease
       Crohn’s disease, IBS, IBD
       Alzheimer’s disease
       Lyme disease
       Thyroid disease
       Auto-immune diseases
       Many other secondary medical conditions
                                                  www.patientsmedical.com
   Staff
     Medical Doctors
      ▪ Internal Medicine
      ▪ Family Practice
      ▪ Gynecology
      ▪ Osteopathy
      ▪ Oncology
      ▪ Alternative Pain Management
      ▪ Pediatrics
     Nutrition
     Kinesiology
     Reflexology and Reiki
     Oriental Medicine and Acupuncture
     Homeopathy
                                          www.patientsmedical.com
Integrative Medicine




                       www.patientsmedical.com
Please tell us what
you liked and what
 you would like to
see from us in the
       future!




                      www.patientsmedical.com
Introducing our speakers:

 Vivian DeNise, DO
 ABAARM, FAARM
 Integrative Internal Medicine
 Holistic Pediatrics




                                 www.patientsmedical.com
 Completed her medical degree
  at New York College of
  Osteopathic Medicine
 Certified in Integrative Medicine
  with the American Academy of
  Anti-Aging Medicine (A4M)


                                      www.patientsmedical.com
   Specialties include
       Balancing Adrenal Function
       Detoxification
       Hormonal Imbalances
       Nutritional Deficiencies
       Thyroid Disorders
       Weight Loss
       Gastro-Intestinal Problems
       Women’s and Men’s Wellness
       Pediatrics
       And many more!



                                     www.patientsmedical.com
   Allergies
   Anxiety
   Arthritis
   Asthma
   Cancer
   Chronic fatigue
   Chronic pain
   Depression
   Fibromyalgia
   Headache & migraine
   Hypertension
   Immune dysfunction
   Infertility
   Irritable bowel syndrome
   Osteoporosis
   Stress disorders
   Weight gain
   Weight loss


                               www.patientsmedical.com
Introducing our speakers:

       Elisa Haggarty of Culinary Farmacy
Certified Holistic Health Coach &Natural Foods Chef




                                     www.patientsmedical.com
   Received Professional
    Holistic Health Coaching
    training at The Institute for
    Integrative Nutrition
   Training at The Natural
    Gourmet Institute



                                    www.patientsmedical.com
   Studied over 100 different
    dietary theories
   Uses food, stress
    management and other
    techniques to help women
    live an abundantly rich life!



                                    www.patientsmedical.com
www.patientsmedical.com
www.patientsmedical.com
… but you may not know why.
Or how to start feeling good again.




                             www.patientsmedical.com
Our philosophy is to determine the root cause
of the symptom, so that we can help you get
               back on track.




                                  www.patientsmedical.com
www.patientsmedical.com
www.patientsmedical.com
www.patientsmedical.com
Feeling the need to sleep.




                        www.patientsmedical.com
Lack of energy and motivation usually
in response to:
  physical exertion
  emotional stress
  lack of sleep
  boredom
  “other”
                            www.patientsmedical.com
Fatigue can be a single symptom, a
  cluster of symptoms or a clinical
 syndrome such as chronic fatigue
        syndrome or cancer.



                           www.patientsmedical.com
Symptoms of fatigue can be divided
into 3 separate categories:
 Physical
 Cognitive
 Emotional



                           www.patientsmedical.com
 Reduced activity
 Low energy
 Tiredness
 Decreased physical endurance
 Increased effort with physical tasks and
  with overcoming activity
 General weakness
 Heaviness, slowness, or sluggishness
 Non Restorative sleep
 Sleeplessness

                                  www.patientsmedical.com
   Decreased concentration
   Decreased attention
   Decreased mental
    endurance
   Slowed thinking




                              www.patientsmedical.com
 Decreased motivation or initiative
 Decreased interest
 Feeling overwhelmed
 Bored or “low”
 Aversion to effort




                                www.patientsmedical.com
All these symptoms can overlap making it
    difficult to disentangle the complex
             of “co-morbidities”.




                               www.patientsmedical.com
Environmental          Diseases          Occupational


                                         Vitamin and
Psychological          Fatigue           Mineral Deficiencies




         Medications              Physical


                                             www.patientsmedical.com
Endocrine     Infectious




Neurologic                    Rheumatologic




       Heart Disease    Cancer




                                              www.patientsmedical.com
 Diabetes
 Hypoglycemia
 Hypothyroidism
 Adrenal Fatigue

                    www.patientsmedical.com
A phenomenon due to oxidative stress and
mitochondropathy
  Oxidative stress occurs at the cellular level
  Imbalance between free radicals and anti-
   oxidants




                                          www.patientsmedical.com
   Infectious
     Chronic Fatigue Syndrome
     Fibromyalgia
     Lyme Disease
     Hepatitis C
     HIV / AIDS




                                 www.patientsmedical.com
 Fatigue must be present for ≥ 6 months
 A decrease of functional activity and somatic symptoms and
  pain not attributable to a specific diagnosis or disease
 In addition at least 4 of the following must be present
     Sore throat
     Impaired memory or cognition
     Un-refreshing sleep
     Post-exertional fatigue
     Tender glands
     Aching stiff muscles
     Joint pain
     Headaches

                                              www.patientsmedical.com
   Central Nervous and Hormonal Imbalance
     Imbalance in neurotransmitters
     Cortisol Deficiency
     Disturbance of Circadian Rhythms
   Infections
   Immune System Abnormalities
     Allergies


                                   www.patientsmedical.com
Is defined as chronic
 diffuse pain in absence of
inflammatory or structural
       musculoskeletal
abnormalities. In addition,
 fatigue, sleep and mood
   disturbances are also
           present.

                              www.patientsmedical.com
www.patientsmedical.com
4 Major Categories
1. Physical Stress
2. Chemical Stress
3. Thermal Stress
4. Emotional Stress




                      www.patientsmedical.com
1.   Overworking or shift work
2.   Lack of sleep / insomnia
3.   Athletic over-training




                                 www.patientsmedical.com
   40 million people in the US have some kind of problem with
    sleep
   Accounts for more than 50% of doctor visits each year
   Affects 25-40% of all children and adolescents




                                                www.patientsmedical.com
 Chronic stress
 Caffeine
 Carbohydrates before
  bed
 Restless Leg Syndrome
  (RLS)
 Sleep Apnea
 Alcohol or Drug Abuse



                          www.patientsmedical.com
Not only causes fatigue but also
 Deficits in memory
 Decreased concentration
 Depressive mood
 Irritability
 Decreased libido or Erectile Dysfunction
  (ED)

                                www.patientsmedical.com
In one study, Severe Fatigue was reported by
 11% of Adolescents in the 11-14 year old age
 17% of the 13-16 year olds




                                     www.patientsmedical.com
 Environmental pollutants such as
   Insecticides and Pesticides
   Heavy Metal Poisonings such as
     Mercury, Aluminum
 Food Additives and allergies
 Vitamin and Mineral Deficiencies
 Medically prescribed drugs


                                     www.patientsmedical.com
 Eating fish or shellfish
 Dental work such as Mercury amalgams
 Breathing contaminated vapors or skin
  contact with: antiseptics, bactericides,
  batteries, cosmetics, fabric softeners,
  floor wax and polish, paints, tattoo inks,
  perfumes, etc.

                                 www.patientsmedical.com
Aspartame = AsparticAcid + phenylalanine +
 methanol

Accounts for > 75% of adverse reactions to food
 additives reported to FDA.




                                   www.patientsmedical.com
   Numbness           Visual disturbances
   Muscle spasms      Hearing loss
   Weight gain        Palpitations
   Rashes             Headaches/migraines
   Depression         Dizziness
   Fatigue            Seizures
   Irritability       Nausea
   Tachycardia
   Insomnia
                                www.patientsmedical.com
Some common
deficiencies include
 Iron deficiency (anemia)
 B12 deficiency




                             www.patientsmedical.com
B12 deficiency may cause
   Muscle weakness
   Fatigue
   Tingling of extremities
   Mental Fogginess
   Memory Problems
   Mood Swings
   Feeling of apathy
   Lack of motivation
                              www.patientsmedical.com
Lack of Vitamin B5 (Pantothenic Acid) can lead
   to adrenal exhaustion and ultimately to
      destruction of the adrenal glands.




                                   www.patientsmedical.com
   Caffeine
   Synthetic Estrogen
    supplementation*
   Sleeping pills



*Synthetic estrogen is NOT the same as Bio-Identical
Hormone Replacement Therapy.
                                         www.patientsmedical.com
   Brewer’s Yeast
   Calf Liver
   Chicken Liver
   Peanuts
   Split Peas
   Pecans


                     www.patientsmedical.com
   The adrenal glands are the second biggest
    store of Vitamin C in the body.
   If there is an insufficient amount of Vitamin C,
    there will be insufficient amounts of adrenal
    hormones made, leading to immune
    deficiencies.



                                        www.patientsmedical.com
   Statins such as Lipitor, Crestor deplete CoQ10
   Oral contraceptives
   Antidiabetics such as the Sufonylureas,
    Biguanides, Metformin
   Anti Hypertensives: Hydralazine, Thiazides, B
    blockers, Clonidine, Methyl dopa
   Psychotropics: Phenothiazines, Tricyclic
    Antidepressants, Haloperidol

                                      www.patientsmedical.com
   Meloncholic depression is associated with
    hypercortisolism secondary to CRH
   Atypical Depression is associated with
    pathologic reduction of mediators and a
    decrease in the hypothalamic CRH




                                     www.patientsmedical.com
www.patientsmedical.com
www.patientsmedical.com
Your
 Resiliency
 Energy
 Endurance
 Your Very Life



      …depends on your adrenal health.
                                 www.patientsmedical.com
www.patientsmedical.com
Secretes
 Epinephrine (adrenaline)
 Norepinephrine


    These are secreted in crisis situations.




                                    www.patientsmedical.com
Zona
reticularis
  DHEA (S)
   Zona
   fasiculata
   Cortisol

    Zona
    glomerulosa
    Aldosterone

           www.patientsmedical.com
Hypothalamus   -
               CRH



               Anterior
               Pituitary   ACTH


                              Adrenal
                              Cortex                Cortisol
                                        www.patientsmedical.com
    Essential for maintaining blood sugar levels
    in the proper balance
    Powerful anti-inflammatory
    Decreases the effect of white blood cells
    Direct effect on the heart and blood pressure
    Influences behavior, mood, excitability
    Regulation of adrenal sex hormones


                                      www.patientsmedical.com
 Difficulty in awakening in the morning
 Lack of energy
 Increased energy to do everyday tasks
 Decreased sex drive
 Decreased ability to handle stress
 Increased time to recover from illness, injury or
  trauma
 Light headed when standing up quickly
 Mild depression
 Less enjoyment or happiness with life

                                           www.patientsmedical.com
   Increased PMS
   Symptoms increase if meals are skipped or
    inadequate
   Thoughts less focused, more fuzzy
   Memory less accurate
   Decreased tolerance
   Don’t really wake up until 10:00AM
   Afternoon low between 3:00 and 4:00PM
   Feels better after evening meal
   Decreased productivity
                                         www.patientsmedical.com
   A careful history and physical from a
    physician
   Blood Tests
   Salivary tests




                                      www.patientsmedical.com
www.patientsmedical.com
www.patientsmedical.com
www.patientsmedical.com
   Proper amount of sleep
   Proper nutrition including a lot of fresh
    vegetables, fruits, nuts and legumes
   Meditation, Yoga, prayer etc. for stress relief
   Mild to moderate exercise




                                        www.patientsmedical.com
   Vitamin C       Cordyceps
   B complex       CoQ10
   Ashwaganda      Lipoic Acid
   Carnitine       N-acetylcysteine
   Rhodiola        Omega 3
   Ginseng



                              www.patientsmedical.com
We’ll address questions about Dr.
 DeNise’s fees and insurance policies
           towards the end,
but now is the time to ask your adrenal
          fatigue questions!


                             www.patientsmedical.com
www.patientsmedical.com
“Let food be thy medicine and medicine be thy food”
Hippocrates

                                         www.patientsmedical.com
• Health started for me with a
  bout of depression and anxiety.
• I learned to question the advice
  given to me and the
  prescriptions handed to me.
• No one in the medical community
  inquired about my diet- my
  lifestyle.
• I encourage you to find out what
  works for YOU and never doubt      www.culinaryfarmacy.com
  that food has an amazing
  capacity to heal us.
                                           www.patientsmedical.com
   Individual Heath Coaching Programs
   4 Week Sugar Boot Camp
   Health Supportive Cooking Classes
   Workshops/Cooking Demos
   10 day Whole Foods Winter Detox

*Ingredients to success: whole foods cooking,
local, seasonal, fresh, plant based, cleansing
and mind set shifts
                                   www.patientsmedical.com
   Food has a profound capacity to both cause
    sickness or promote health.
   Everyday, 3 times a day, and over 1,095
    times a year we have the ability to change
    the expression of our genes.
   The most essential component of health, is
    restoring energy…the naturally occurring
    energy that our adrenal glands provide.


                                    www.patientsmedical.com
www.patientsmedical.com
   SUGAR
   Consuming foods you are allergic/sensitive too
    (corn, yeast, wheat/gluten, dairy, eggs, soy, alco
    hol are the top offenders)
   Stimulants (coffee, chocolate or cacao)
   Refined and processed foods = nutrient zappers
   Stress
   Toxic environments



                                         www.patientsmedical.com
Ingredients
  2 heaping tablespoons of cashew butter (can
   use almond butter)
  1 tbs tahini
  1 heaping tablespoon of carob powder
  1 tablespoon of coconut oil
  1 tbs coconut nectar or natural sweetener
  3/4 cup coconut flakes
  dash of Himalayan sea salt
  2 tablespoon of hemp seeds or flax seeds
  Cinnamon to taste
  1/4 cup sesame seeds for coating
                                     www.patientsmedical.com
All you need is a food
  processor, or high
  speed blender 



       www.patientsmedical.com
 Regulating blood sugar with balanced meals
  it the key to adrenal health.
 My formula for optimal blood sugar success
  (on the plate)
 FAT, FIBER & PROTEIN = stable blood sugar
  and less adrenal stress

Fat: tahini, coconut oil
Fiber: hemp seeds, flax seeds, sesame seeds
Protein: almond/cashew butter, hemp & flax
seeds                                www.patientsmedical.com
 Don’t believe the hype that fat is bad or even
  that saturated fats will lead to coronary heart
  disease.
 Fat does not make you fat (hint…sugar is the
  most common culprit in weight gain).
 Fats, and especially saturated fats are essential
  for blood sugar balance and hormone
  regulation.
 Fat breakdown & assimilation happens in the
  small intestine (gut) and so it takes the longest
  to digest.
                                     www.patientsmedical.com
   Is a Medium Chain Fatty Acid which help to
    inhibit the growth of yeast (candida) and they
    not stored as fat in the body.
   MCFA’s create heat or thermogenesis in the
    body and boost metabolism.
   MCFA’s help boost immunity. It has Lauric
    acid and is found in breast milk.
   MCFA’s are needed for proper utilization of
    the essential fatty acids! They work in tandem!
   The heart draws on the MCFA’s in times of
    stress.
                                     www.patientsmedical.com
 A really great alternative
      to chocolate. Why avoid
      raw cacao you ask?
     Cacao is a stimulant-
      containing theobromine
      which is a relative of
      caffeine.

•       When rejuvenating the adrenals, we want to remove stimulants

•       Carob is stimulant free, high in calcium, magnesium, Vit. A and D.

                                                       www.patientsmedical.com
 Both very high in Omega 3 fatty acids
  which are anti-inflammatory.
 Both have dietary fiber (flax more so) and
  both have protein.
 Using hemp and flax seeds helps make
  your meals/snacks more nutrient dense.




                                 www.patientsmedical.com
 Your adrenal glands keep you hydrated. If
  you are constantly thirsty- that is a sign you
  are off balance and you have weak adrenals.
 Salt (unrefined Himalayan or Celtic) helps to
  rehydrate your cells, electrifies your cells and
  contain countless trace minerals.




                                      www.patientsmedical.com
   If you want to take control of your health,
    naturally- all you have to do is ask.
   I am offering each of you a free one hour
    health breakthrough consultation!
   Find out how to create your unique
    culinary farmacy !



                                   www.patientsmedical.com
It’s time to nourish your adrenal glands!
Value?
 Renewed sense of health
 Improved energy and mental clarity
 Boost immunity
 Become a culinary master of clean eating
 Kick cravings
 Feel more rested, balanced, leaner 


                                www.patientsmedical.com
What you get!
 Accountability and expert guidance
 Access to a private Facebook group for support
 10 day Meal Plan (guess work taken care of!)
 Resources Packet shopping list and reminders
 3 online tele-seminars (recorded mp3 files)
 Options for taking the detox at your pace
 Video food demonstrations
 Recommended supplement list
 Top 5 ways to detoxify beyond food

                                     www.patientsmedical.com
Normal Registration rate $197
          For YOU: $147
          Tonight: $127

Nourish your adrenals without the stimulants,
sugar, and decrease inflammation by removing
    allergens like: wheat/gluten/soy/dairy!
                                  www.patientsmedical.com
www.patientsmedical.com
www.patientsmedical.com
Questions?
Ask me now!




              www.patientsmedical.com
Get started TODAY by
  scheduling your
 appointment with
     Dr. DeNise.

Use your coupon today!



                         www.patientsmedical.com
Please tell us what
you liked and what
 you would like to
see from us in the
       future!




                      www.patientsmedical.com
www.patientsmedical.com
Balance Your Hormones – Balance Your Life!
Dr. Harris explains how hormone imbalance can make your
sick, tired and CRAZY! Learn how all-natural Bio-Identical
     Hormones work and why she recommends them.
            Wednesday, February20th at 6:30pm




                                           www.patientsmedical.com
Come See Our Holistic Ophthalmologist
      Dr. Ayman Matta will be seeing patients on
        Friday, February 22nd in the afternoon.
See one of our staff members for details and scheduling.




                                          www.patientsmedical.com
Just for MEN: Boost Your Mojo Naturally
Dr. DeNise and Nutritionist/Personal Trainer, Judy Penta
explain how to improve your focus, physique, libido and
 energy without dangerous OTC or prescription drugs.
            Tuesday, March 19th at 6:30pm




                                          www.patientsmedical.com
Are You Suffering from Hair Loss?
  Get a free hair/scalp evaluation and
  stem cell therapy consultation with
         Dr. Paul A. Dreschnack
        By Appointment Only




                                  www.patientsmedical.com
Dr. Rashmi          Dr. Kamau Kokayi,                              Dr. Marcia A. Harris
                                                   Dr. Stuart Weg,                                  Dr. Vivan DeNise,
     Gulati, Medical     Holistic and Chinese                             Holistic GYN and
                                                   Alternative Pain                                Integrative Internal
        Director               Medicine                                   Internal Medicine
                                                    Management                                     Medicine and Peds




Dr. Eileen DiFrancesco                          Dr. Paul A. Dreschnack                            Dr. Victor I. Rosenberg
                         Dr. Gino Bottino                                Dr. L. Deanna Howard
 Psychopharmacology                                 Plastic Surgery                                   Plastic Surgery
                         Holistic Oncology                                    Holistic GYN
                                                                                            www.patientsmedical.com
www.patientsmedical.com
www.patientsmedical.com
To get more information or to schedule an
               appointment,
          call 212-679-9667 or
  email media@patientsmedical.com




                                www.patientsmedical.com

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How to Beat Adrenal Fatigue Naturally

  • 1. Dr. Vivian DeNise and Chef Elisa Haggarty
  • 2. A holistic medical center  Full-service www.patientsmedical.com
  • 3. Discover health, rediscover vitality  Focus on the root cause  Integrate modern medicine, holistic practices, and natural supplements www.patientsmedical.com
  • 4. Our goal  Promote healing and prevent disease www.patientsmedical.com
  • 5. Physicians collaborate to approach each patient holistically. www.patientsmedical.com
  • 6. Result: Gain health and nutritional wisdom that can be applied for years to come. www.patientsmedical.com
  • 7. Founder, Dr. Warren Levin began practicing his ground-breaking holistic protocols in 1974. www.patientsmedical.com
  • 8. Conditions Treated  Chronic Fatigue Syndrome  Multiple Sclerosis  Osteoarthritis (OA)  Rheumatoid Arthritis (RA)  Diabetes  Heart disease  Crohn’s disease, IBS, IBD  Alzheimer’s disease  Lyme disease  Thyroid disease  Auto-immune diseases  Many other secondary medical conditions www.patientsmedical.com
  • 9. Staff  Medical Doctors ▪ Internal Medicine ▪ Family Practice ▪ Gynecology ▪ Osteopathy ▪ Oncology ▪ Alternative Pain Management ▪ Pediatrics  Nutrition  Kinesiology  Reflexology and Reiki  Oriental Medicine and Acupuncture  Homeopathy www.patientsmedical.com
  • 10. Integrative Medicine www.patientsmedical.com
  • 11. Please tell us what you liked and what you would like to see from us in the future! www.patientsmedical.com
  • 12. Introducing our speakers: Vivian DeNise, DO ABAARM, FAARM Integrative Internal Medicine Holistic Pediatrics www.patientsmedical.com
  • 13.  Completed her medical degree at New York College of Osteopathic Medicine  Certified in Integrative Medicine with the American Academy of Anti-Aging Medicine (A4M) www.patientsmedical.com
  • 14. Specialties include  Balancing Adrenal Function  Detoxification  Hormonal Imbalances  Nutritional Deficiencies  Thyroid Disorders  Weight Loss  Gastro-Intestinal Problems  Women’s and Men’s Wellness  Pediatrics  And many more! www.patientsmedical.com
  • 15. Allergies  Anxiety  Arthritis  Asthma  Cancer  Chronic fatigue  Chronic pain  Depression  Fibromyalgia  Headache & migraine  Hypertension  Immune dysfunction  Infertility  Irritable bowel syndrome  Osteoporosis  Stress disorders  Weight gain  Weight loss www.patientsmedical.com
  • 16. Introducing our speakers: Elisa Haggarty of Culinary Farmacy Certified Holistic Health Coach &Natural Foods Chef www.patientsmedical.com
  • 17. Received Professional Holistic Health Coaching training at The Institute for Integrative Nutrition  Training at The Natural Gourmet Institute www.patientsmedical.com
  • 18. Studied over 100 different dietary theories  Uses food, stress management and other techniques to help women live an abundantly rich life! www.patientsmedical.com
  • 21. … but you may not know why. Or how to start feeling good again. www.patientsmedical.com
  • 22. Our philosophy is to determine the root cause of the symptom, so that we can help you get back on track. www.patientsmedical.com
  • 26. Feeling the need to sleep. www.patientsmedical.com
  • 27. Lack of energy and motivation usually in response to:  physical exertion  emotional stress  lack of sleep  boredom  “other” www.patientsmedical.com
  • 28. Fatigue can be a single symptom, a cluster of symptoms or a clinical syndrome such as chronic fatigue syndrome or cancer. www.patientsmedical.com
  • 29. Symptoms of fatigue can be divided into 3 separate categories:  Physical  Cognitive  Emotional www.patientsmedical.com
  • 30.  Reduced activity  Low energy  Tiredness  Decreased physical endurance  Increased effort with physical tasks and with overcoming activity  General weakness  Heaviness, slowness, or sluggishness  Non Restorative sleep  Sleeplessness www.patientsmedical.com
  • 31. Decreased concentration  Decreased attention  Decreased mental endurance  Slowed thinking www.patientsmedical.com
  • 32.  Decreased motivation or initiative  Decreased interest  Feeling overwhelmed  Bored or “low”  Aversion to effort www.patientsmedical.com
  • 33. All these symptoms can overlap making it difficult to disentangle the complex of “co-morbidities”. www.patientsmedical.com
  • 34. Environmental Diseases Occupational Vitamin and Psychological Fatigue Mineral Deficiencies Medications Physical www.patientsmedical.com
  • 35. Endocrine Infectious Neurologic Rheumatologic Heart Disease Cancer www.patientsmedical.com
  • 36.  Diabetes  Hypoglycemia  Hypothyroidism  Adrenal Fatigue www.patientsmedical.com
  • 37. A phenomenon due to oxidative stress and mitochondropathy  Oxidative stress occurs at the cellular level  Imbalance between free radicals and anti- oxidants www.patientsmedical.com
  • 38. Infectious  Chronic Fatigue Syndrome  Fibromyalgia  Lyme Disease  Hepatitis C  HIV / AIDS www.patientsmedical.com
  • 39.  Fatigue must be present for ≥ 6 months  A decrease of functional activity and somatic symptoms and pain not attributable to a specific diagnosis or disease  In addition at least 4 of the following must be present  Sore throat  Impaired memory or cognition  Un-refreshing sleep  Post-exertional fatigue  Tender glands  Aching stiff muscles  Joint pain  Headaches www.patientsmedical.com
  • 40. Central Nervous and Hormonal Imbalance  Imbalance in neurotransmitters  Cortisol Deficiency  Disturbance of Circadian Rhythms  Infections  Immune System Abnormalities  Allergies www.patientsmedical.com
  • 41. Is defined as chronic diffuse pain in absence of inflammatory or structural musculoskeletal abnormalities. In addition, fatigue, sleep and mood disturbances are also present. www.patientsmedical.com
  • 43. 4 Major Categories 1. Physical Stress 2. Chemical Stress 3. Thermal Stress 4. Emotional Stress www.patientsmedical.com
  • 44. 1. Overworking or shift work 2. Lack of sleep / insomnia 3. Athletic over-training www.patientsmedical.com
  • 45. 40 million people in the US have some kind of problem with sleep  Accounts for more than 50% of doctor visits each year  Affects 25-40% of all children and adolescents www.patientsmedical.com
  • 46.  Chronic stress  Caffeine  Carbohydrates before bed  Restless Leg Syndrome (RLS)  Sleep Apnea  Alcohol or Drug Abuse www.patientsmedical.com
  • 47. Not only causes fatigue but also  Deficits in memory  Decreased concentration  Depressive mood  Irritability  Decreased libido or Erectile Dysfunction (ED) www.patientsmedical.com
  • 48. In one study, Severe Fatigue was reported by  11% of Adolescents in the 11-14 year old age  17% of the 13-16 year olds www.patientsmedical.com
  • 49.  Environmental pollutants such as  Insecticides and Pesticides  Heavy Metal Poisonings such as Mercury, Aluminum  Food Additives and allergies  Vitamin and Mineral Deficiencies  Medically prescribed drugs www.patientsmedical.com
  • 50.  Eating fish or shellfish  Dental work such as Mercury amalgams  Breathing contaminated vapors or skin contact with: antiseptics, bactericides, batteries, cosmetics, fabric softeners, floor wax and polish, paints, tattoo inks, perfumes, etc. www.patientsmedical.com
  • 51. Aspartame = AsparticAcid + phenylalanine + methanol Accounts for > 75% of adverse reactions to food additives reported to FDA. www.patientsmedical.com
  • 52. Numbness  Visual disturbances  Muscle spasms  Hearing loss  Weight gain  Palpitations  Rashes  Headaches/migraines  Depression  Dizziness  Fatigue  Seizures  Irritability  Nausea  Tachycardia  Insomnia www.patientsmedical.com
  • 53. Some common deficiencies include  Iron deficiency (anemia)  B12 deficiency www.patientsmedical.com
  • 54. B12 deficiency may cause  Muscle weakness  Fatigue  Tingling of extremities  Mental Fogginess  Memory Problems  Mood Swings  Feeling of apathy  Lack of motivation www.patientsmedical.com
  • 55. Lack of Vitamin B5 (Pantothenic Acid) can lead to adrenal exhaustion and ultimately to destruction of the adrenal glands. www.patientsmedical.com
  • 56. Caffeine  Synthetic Estrogen supplementation*  Sleeping pills *Synthetic estrogen is NOT the same as Bio-Identical Hormone Replacement Therapy. www.patientsmedical.com
  • 57. Brewer’s Yeast  Calf Liver  Chicken Liver  Peanuts  Split Peas  Pecans www.patientsmedical.com
  • 58. The adrenal glands are the second biggest store of Vitamin C in the body.  If there is an insufficient amount of Vitamin C, there will be insufficient amounts of adrenal hormones made, leading to immune deficiencies. www.patientsmedical.com
  • 59. Statins such as Lipitor, Crestor deplete CoQ10  Oral contraceptives  Antidiabetics such as the Sufonylureas, Biguanides, Metformin  Anti Hypertensives: Hydralazine, Thiazides, B blockers, Clonidine, Methyl dopa  Psychotropics: Phenothiazines, Tricyclic Antidepressants, Haloperidol www.patientsmedical.com
  • 60. Meloncholic depression is associated with hypercortisolism secondary to CRH  Atypical Depression is associated with pathologic reduction of mediators and a decrease in the hypothalamic CRH www.patientsmedical.com
  • 63. Your  Resiliency  Energy  Endurance  Your Very Life …depends on your adrenal health. www.patientsmedical.com
  • 65. Secretes  Epinephrine (adrenaline)  Norepinephrine These are secreted in crisis situations. www.patientsmedical.com
  • 66. Zona reticularis DHEA (S) Zona fasiculata Cortisol Zona glomerulosa Aldosterone www.patientsmedical.com
  • 67. Hypothalamus - CRH Anterior Pituitary ACTH Adrenal Cortex Cortisol www.patientsmedical.com
  • 68. Essential for maintaining blood sugar levels in the proper balance  Powerful anti-inflammatory  Decreases the effect of white blood cells  Direct effect on the heart and blood pressure  Influences behavior, mood, excitability  Regulation of adrenal sex hormones www.patientsmedical.com
  • 69.  Difficulty in awakening in the morning  Lack of energy  Increased energy to do everyday tasks  Decreased sex drive  Decreased ability to handle stress  Increased time to recover from illness, injury or trauma  Light headed when standing up quickly  Mild depression  Less enjoyment or happiness with life www.patientsmedical.com
  • 70. Increased PMS  Symptoms increase if meals are skipped or inadequate  Thoughts less focused, more fuzzy  Memory less accurate  Decreased tolerance  Don’t really wake up until 10:00AM  Afternoon low between 3:00 and 4:00PM  Feels better after evening meal  Decreased productivity www.patientsmedical.com
  • 71. A careful history and physical from a physician  Blood Tests  Salivary tests www.patientsmedical.com
  • 75. Proper amount of sleep  Proper nutrition including a lot of fresh vegetables, fruits, nuts and legumes  Meditation, Yoga, prayer etc. for stress relief  Mild to moderate exercise www.patientsmedical.com
  • 76. Vitamin C  Cordyceps  B complex  CoQ10  Ashwaganda  Lipoic Acid  Carnitine  N-acetylcysteine  Rhodiola  Omega 3  Ginseng www.patientsmedical.com
  • 77. We’ll address questions about Dr. DeNise’s fees and insurance policies towards the end, but now is the time to ask your adrenal fatigue questions! www.patientsmedical.com
  • 79. “Let food be thy medicine and medicine be thy food” Hippocrates www.patientsmedical.com
  • 80. • Health started for me with a bout of depression and anxiety. • I learned to question the advice given to me and the prescriptions handed to me. • No one in the medical community inquired about my diet- my lifestyle. • I encourage you to find out what works for YOU and never doubt www.culinaryfarmacy.com that food has an amazing capacity to heal us. www.patientsmedical.com
  • 81. Individual Heath Coaching Programs  4 Week Sugar Boot Camp  Health Supportive Cooking Classes  Workshops/Cooking Demos  10 day Whole Foods Winter Detox *Ingredients to success: whole foods cooking, local, seasonal, fresh, plant based, cleansing and mind set shifts www.patientsmedical.com
  • 82. Food has a profound capacity to both cause sickness or promote health.  Everyday, 3 times a day, and over 1,095 times a year we have the ability to change the expression of our genes.  The most essential component of health, is restoring energy…the naturally occurring energy that our adrenal glands provide. www.patientsmedical.com
  • 84. SUGAR  Consuming foods you are allergic/sensitive too (corn, yeast, wheat/gluten, dairy, eggs, soy, alco hol are the top offenders)  Stimulants (coffee, chocolate or cacao)  Refined and processed foods = nutrient zappers  Stress  Toxic environments www.patientsmedical.com
  • 85. Ingredients  2 heaping tablespoons of cashew butter (can use almond butter)  1 tbs tahini  1 heaping tablespoon of carob powder  1 tablespoon of coconut oil  1 tbs coconut nectar or natural sweetener  3/4 cup coconut flakes  dash of Himalayan sea salt  2 tablespoon of hemp seeds or flax seeds  Cinnamon to taste  1/4 cup sesame seeds for coating www.patientsmedical.com
  • 86. All you need is a food processor, or high speed blender  www.patientsmedical.com
  • 87.  Regulating blood sugar with balanced meals it the key to adrenal health.  My formula for optimal blood sugar success (on the plate)  FAT, FIBER & PROTEIN = stable blood sugar and less adrenal stress Fat: tahini, coconut oil Fiber: hemp seeds, flax seeds, sesame seeds Protein: almond/cashew butter, hemp & flax seeds www.patientsmedical.com
  • 88.  Don’t believe the hype that fat is bad or even that saturated fats will lead to coronary heart disease.  Fat does not make you fat (hint…sugar is the most common culprit in weight gain).  Fats, and especially saturated fats are essential for blood sugar balance and hormone regulation.  Fat breakdown & assimilation happens in the small intestine (gut) and so it takes the longest to digest. www.patientsmedical.com
  • 89. Is a Medium Chain Fatty Acid which help to inhibit the growth of yeast (candida) and they not stored as fat in the body.  MCFA’s create heat or thermogenesis in the body and boost metabolism.  MCFA’s help boost immunity. It has Lauric acid and is found in breast milk.  MCFA’s are needed for proper utilization of the essential fatty acids! They work in tandem!  The heart draws on the MCFA’s in times of stress. www.patientsmedical.com
  • 90.  A really great alternative to chocolate. Why avoid raw cacao you ask?  Cacao is a stimulant- containing theobromine which is a relative of caffeine. • When rejuvenating the adrenals, we want to remove stimulants • Carob is stimulant free, high in calcium, magnesium, Vit. A and D. www.patientsmedical.com
  • 91.  Both very high in Omega 3 fatty acids which are anti-inflammatory.  Both have dietary fiber (flax more so) and both have protein.  Using hemp and flax seeds helps make your meals/snacks more nutrient dense. www.patientsmedical.com
  • 92.  Your adrenal glands keep you hydrated. If you are constantly thirsty- that is a sign you are off balance and you have weak adrenals.  Salt (unrefined Himalayan or Celtic) helps to rehydrate your cells, electrifies your cells and contain countless trace minerals. www.patientsmedical.com
  • 93. If you want to take control of your health, naturally- all you have to do is ask.  I am offering each of you a free one hour health breakthrough consultation!  Find out how to create your unique culinary farmacy ! www.patientsmedical.com
  • 94. It’s time to nourish your adrenal glands! Value?  Renewed sense of health  Improved energy and mental clarity  Boost immunity  Become a culinary master of clean eating  Kick cravings  Feel more rested, balanced, leaner  www.patientsmedical.com
  • 95. What you get!  Accountability and expert guidance  Access to a private Facebook group for support  10 day Meal Plan (guess work taken care of!)  Resources Packet shopping list and reminders  3 online tele-seminars (recorded mp3 files)  Options for taking the detox at your pace  Video food demonstrations  Recommended supplement list  Top 5 ways to detoxify beyond food www.patientsmedical.com
  • 96. Normal Registration rate $197 For YOU: $147 Tonight: $127 Nourish your adrenals without the stimulants, sugar, and decrease inflammation by removing allergens like: wheat/gluten/soy/dairy! www.patientsmedical.com
  • 99. Questions? Ask me now! www.patientsmedical.com
  • 100. Get started TODAY by scheduling your appointment with Dr. DeNise. Use your coupon today! www.patientsmedical.com
  • 101. Please tell us what you liked and what you would like to see from us in the future! www.patientsmedical.com
  • 103. Balance Your Hormones – Balance Your Life! Dr. Harris explains how hormone imbalance can make your sick, tired and CRAZY! Learn how all-natural Bio-Identical Hormones work and why she recommends them. Wednesday, February20th at 6:30pm www.patientsmedical.com
  • 104. Come See Our Holistic Ophthalmologist Dr. Ayman Matta will be seeing patients on Friday, February 22nd in the afternoon. See one of our staff members for details and scheduling. www.patientsmedical.com
  • 105. Just for MEN: Boost Your Mojo Naturally Dr. DeNise and Nutritionist/Personal Trainer, Judy Penta explain how to improve your focus, physique, libido and energy without dangerous OTC or prescription drugs. Tuesday, March 19th at 6:30pm www.patientsmedical.com
  • 106. Are You Suffering from Hair Loss? Get a free hair/scalp evaluation and stem cell therapy consultation with Dr. Paul A. Dreschnack By Appointment Only www.patientsmedical.com
  • 107. Dr. Rashmi Dr. Kamau Kokayi, Dr. Marcia A. Harris Dr. Stuart Weg, Dr. Vivan DeNise, Gulati, Medical Holistic and Chinese Holistic GYN and Alternative Pain Integrative Internal Director Medicine Internal Medicine Management Medicine and Peds Dr. Eileen DiFrancesco Dr. Paul A. Dreschnack Dr. Victor I. Rosenberg Dr. Gino Bottino Dr. L. Deanna Howard Psychopharmacology Plastic Surgery Plastic Surgery Holistic Oncology Holistic GYN www.patientsmedical.com
  • 110. To get more information or to schedule an appointment, call 212-679-9667 or email media@patientsmedical.com www.patientsmedical.com

Editor's Notes

  1. Fatigue is one of the most frequent symptoms bringing patients into the doctor’s office today, sometimes leading to multiple visits without relief and the patient leaving feeling helpless and hopeless. Often times it is misdiagnosed as depression. Your fatiguenot only affects you but your work but more importantly your health and your family, the result can be devastating.
  2. This is how you feel as you are about to get ready to go to sleep
  3. It can be a single symptom such as I am tired, or a cluster of symptoms such as I am tired, I feel stressed out, I feel depressed.
  4. People will develop a variety of different complaints depending on which of the body’s functions have been compromised and the general areas of susceptibility which they have inherited or acquired. It is unlikely the same combination of symptoms will be seen twice. The bodies reaction to stress is different in different people.
  5. For example: your tired, you can’t get through your workout the way you use to , you have aches and pains. When you try to go to sleep you can’t and even if you do you still get up as if you didn’t sleep.
  6. Often referred to as “brain fog”, you can’t get through daily things like reading the newspaper or an article the way you use to , you forget what your are doing, you have slow word recall you have mind chatter
  7. You can be depressed or overwhelmed, everything seems to be an effort. You may no longer care about people and situations that use to bring you pleasure. Loved ones or coworkers may presume that the person is lazy or lacks motivtion, but we will see later in the presentation that nothing could be further from the truth, in fact the people with severe fatigue must drive themselves much harder.
  8. The causes of fatigue also overlap and at times are difficult to sort out thus Making diagnosis difficult. Without a knowledgeable physician treatment can be reduced to the patient being given a prescription for an antidepressant and told to seek therapy. In fact sometimes this treatment will help for a short time until the patient no longer responds. Traditional medicine encourages the doctor to just up the dose. Perhaps it is depression but it could also be from anemia, or toxic exposure if you are a car mechanic or work in a salon. Perhaps you are deficient in Vitamin D3 like 3 out of 4 Americans. We will see that some medications have this as a common side effect. The possibilites are endless, so it is my hope to give you some helpful insight.
  9. Neurologic diseases include:Parkinson’s,Alzheimers, Epilepsy, MSRhuematological diseases include Rhuematoid arthritis
  10. It’s interesting to note that we frequently see hypoglycemia occurring in the adolescent age group due to their tremendous rate of metabolism and growth.
  11. Fatigue is a central component of most diseases. Therefore it is essential to minimize your oxidative stress by increasing your antioxidants such as Vitamin C, CoQ10, eating organic foods and drinking clean water.
  12. Most wooden playground equipment is treated with arsenic!
  13. One theory of CFS is that there is activation of the immune system that causes an increase of inflammatory mediators. Inflammatory mediators work at the mitochondrial level to alter cell signaling, which causes a reduction of ATP (which is the energy source) in the mitochondria thus enhancing mitochondrial oxidative stress and producing severe fatigue.In a study published in Archives of General Psychiatry Jan. 2009, Heim and Nater found that childhood trauma is associated with a 6 fold increase in chronic fatigue syndrome.
  14. Theories include an imbalance in neurotransimitters. Theses are chemicals made primarily in the brain that allows nerve cells to talk to each other, they can be excitatory or inhibitory and to make it even more confusing sometimes they can act as both depending on the situation :so some of these are abnormally high serotonin, decreased dopamine which have been associated with addictions and cravings or an imbalance of norepinephrine which causes lack of energy, focus, motivation and mood. Although I told you that most of the neurotransmitters are produced in the brain, norepinephrine one of them that is made in the adrenal glands primarily and this will become important later in our talk.Infections have included:Lyme, candida, herpes type6 Human T cell virus, EBV, measles, coxsackie B, CMV and parvo. 80% of all cases start with flu-like symptoms. In the US outbreaks are often found in clusters such as within the same household , workplace or community.The majority of patients with CFS have allergies to foods, pollen, metals(nickel,mercury). In theory these allergens begin to trigger the cascade of immune abnormalities.
  15. Ok now we have gone over only some of the major diseases, so lets move on to other causes of fatigue. There are 4 major stress categories that play an enormous role in fatigue.
  16. People who are involved in a weekly rotating shift have magnified stress because their bodies never have a chance to adjust to the new circadian rhythm produced by each sleep change. People on alternating shifts with less than three weeks between shift changes are continually hammering their adrenal glands. Every time the wake/sleep cycle is altered it takes several days to weeks to establish a new normal pattern for this cycle. It is known that shift work decreases one’s Serotonin level which leads to fatigue and depression.Lack of sleep can be caused by a variety of reasons such as stress, restless leg syndrome, sleep apnea or drug abuse. In addition athletes are one of our most underserved populations in American medicine. It is not uncommon for the doctor to just assume an athlete is in great health. However, over exercising especially for endurance athletes cause them lose their performance capacity. Studies have been published showing mutations in the mitochondrial DNA in muscle biopsies from athletes with sustained fatigue are consistent with those of patients with CFS.
  17. It is interesting to note that 50% of all accidents caused by falling asleep at the wheel involves teenagers.
  18. Carbs before bed keeps blood sugar high
  19. The fatigue was either attributed to over exercising or being highly sedentary such as playing video games. Today many of our children are over extended. I have had children in my practice that were on hockey teams on the ice at 5 am because that was the only time the team could get ice time. These are not olympic hopefuls, there just regular kids . Many children play more than one sport often taking up 6 -7 days a week! Add this on top of the high demands of school work and you have a very fatigued child.
  20. 630,000 children are born each year with elevated levels of mercury. 1 in 12 women of child bearing age have enough mercury to put her unborn at risk. Sulfur containing antioxidant enzymes are readily destroyed by heavy metals. One such enzyme is adenylcyclase which catalyzes the synthesis of cAMP from ATP. Remember ATP is the energy source. cAMP is a cofactor for enzymes in the adrenal cortex. Mercury accumulates in the adrenal glands and disrupts adrenal function. It causes a defect in adrenal steroid biosynthesis by inhibiting the activity of 21a-hydroxylase, thus causing lowered plasma levels of corticosterone and elevated concentrations of progesterone and DHEA. Because patients are incapable of synthesizing cortisol there’s a compensatory rise in ACTH leading to adrenal hyperplasia. In turn the adrenal glands by their accelerated activity to produce steroids to the point that production begins to dimish and the glands will atropy or stop working
  21. First a few words about allergies, the adrenal glands are implicated in most types of allergies. Most allergies involve an inflammatory process and one of the major anti inflammatories in the body is cortisol. Frequently, the allergen is merely the straw that breaks the camels back. The allergen would not cause the person any trouble if he had an adequate level of his own adrenal production of the anti inflammatory glucocorticoids aka cortisol
  22. Diseases that can be triggered or worsened include CFS, Fibromyalgia, Brain Tumors, MS, Epilepsy, Parkinsons , Alzhiemers, Lymphoma, Birth Defects, Diabetes, Cancer
  23. Symptoms often include muscle weakness fatigue, lack of energy, tingling in extremities, mental fogginess, memory problems mood swings feelings of apathy and lack of motivation
  24. Brewer’s yeast, calf liver, chicken liver, peanuts, split peas , pecans are some sources of B5. Note synthetic estrogen either for oral contraceptives or replacement therapy is very different from bio identical hormone replacement therapy.
  25. Who doesn’t have emotional stress, we worry about our spouses, our children, parents. Relationships today seem to be more transient and lacking commitment. We worry about the economy and the days ahead. Depression can fall into 2 categories Meloncholic depression is characterized by insomnia, early morning awakening, anorexia, rumination of guilt, personal unworthiness and pessimism. Atypical depression is characterized by hypersomnia, weight gain, increased appetite, severe lethargy and fatigue. There are 30 million Americans on antidepressants, that is 1 in 10 people.
  26. Adrenal fatigue occurs when the amount of stress overextends the capacity of the body to compensate and recover from that stress or combined stresses. It was first recognized by Dr. Hans Selye in 1936 and was called the general adaptation syndrome.
  27. First lets discuss what the adrenal glands are and what they do. They are 2 small triangular shaped glands that sit on top of the kidneys . They are considered the “anti-stress” glands of the body. But in traditional medicine it is often the forgotten gland.
  28. Your adrenal glands respond to every kind of stress in the same way whatever the source.
  29. During a crisis they work together to dilate bronchi (air passages in the lungs), and blood vessels to the muscle, which brings more blood and oxygen to the tissues in need of it, increases heart beats and strength of contraction, and cause other physiologic changes to help the body respond to stressful situations via “flight or fight”. For example if your driving your car and another driver cuts in front of you what helps you react is your epinephrine and cortisol
  30. Aldosterone is the major hormone controlling the sodium and potassium levels, and thus fluid balance, within your bloodstream, cells and interstial fluids. Sometimes this lead patients to crave salt.Cortisol controls or greatly influences the metabolism of fats, proteins, and carbohydrates to maintain blood glucose within a narrow optimal range and keep it there even under stressful conditions. Cortisol along with DHEA are primarily responsible to make Estrogen, progesterone and testosterone after menopause. Does this sound like an umimportant gland to you?
  31. Ok so now we see the importance of the adrenals in acute stress and stresses be it diseases, physical, chemical, thermal or emotional. Adrenal fatigue can evolve over months to many years, but it occurs when the adrenal glands decrease their output of the steroids, leaving the body open to aging and disease.
  32. People tend to show a tendency toward increased fears, anxiety and depression, at times having confusion, difficulties in concentration and acute memory recall. They have less tolerance and more irritability.
  33. There may be dizziness when standing up, due to a drop in blood pressure. Other symptoms that aren’t always recognized is that of musculoskeletal pain. It is not uncommon due to muscle weakness that we often see patients with sacro-iliac pain, low back pain, knee pain or foot and ankle weakness or aching calves. There may be one of these or there may be all.
  34. Just a word about this graph this shows that the normal cortisol pattern is high in the morning to get you ready to start your day, it actually increases right before you awake. This is the pattern we would expect to see in adrenal crisis.
  35. This is a pattern of a person just starting to experience adrenal fatigue. Getting up in the morning isn’t so bad but they seem to crash around noon and drag through the rest of the day
  36. This is what you would expect for a person with extreme adrenal fatigue, they have a very difficult time dragging themselves out of bed in the morning. They get a second wind about 6 pm and then have a hard time falling asleep and so the vicious cycle begins.
  37. In CFS there has been unusually low levels of aceylcarnitine. Increased doses of vitamin C and B complex can be gotten through Intravenous drips.