A Tough Experience and a Child Watching Recently, a young child came into our office with fever and a sore throat. The child was well appearing, testing did not identify a bacterial cause, and the clinical picture suggested a viral infection. Later, after another symptom developed, a frightened parent sought care in an emergency department. By the following day, the family was back in our office and what began as a routine childhood illness had evolved into something much m

Cholesterol Lipid Hypothesis Part 3 How Does Atherosclerosis Actually Begin? So far in this series, I have put forth several hypotheses that may cause controversy and that raise questions about how we traditionally think about cardiovascular disease and its treatment. I am comfortable with that. The purpose of this series is not to tell readers to disregard established guidelines or their physician's recommendations. It is to stimulate a deeper conversation about

Nicholas Kelly RD - in his words. More Than a Diagnosis: Nicholas Kelly's Story Nicholas Kelly has lived with cystic fibrosis since infancy, but this conversation is ultimately not a story about cystic fibrosis. It is a story about what happens when illness becomes part of a person's life without being allowed to become the definition of that life. This distinction is critical. Nicholas's journey began with something remarkable: his mother refused to accept that every

Cholesterol Lipid Hypothesis Part 2 Cholesterol, Immunity, and the Gut The hypothesis: Cholesterol and the lipoproteins that carry it, including LDL and HDL, are inherently useful and necessary. Problems arise when these systems become chronically unbalanced through genetics, lifestyle, inflammation, or some combination of all three. From last week: the carrier lipoproteins LDL and HDL are ancient components of our innate immune system with important roles in host def

Kairos is the ancient Greek idea of the right or opportune moment, not chronological time passing on a clock, but the moment when circumstances align and possibility opens. The key: possibility - never a guarantee. From a parent’s perspective, kairos is both always and never. The right time to parent is always. Every conversation, disappointment, triumph, mistake, scraped knee, failed test, broken friendship, and unexpected curiosity contains the possibility of becoming

Cholesterol Story Part I Back by popular demand, we’re running the Advanced Labs Boot Camp again! Join us for a practical deep dive into basic and advanced laboratory testing: how to move beyond simply identifying what is “high” or “low” and instead use laboratory data to interrogate metabolism, inflammation, immune function, nutrient status, and overall physiology. We’ll connect the dots between routine labs and advanced biomarkers, focusing on pattern recognition, clinica

Literature Review 1) From Molecular Psychiatry, Dr. Lai and colleagues have found more evidence connecting maternal inflammation and neurobehavioral changes in offspring. In a maternal immune activation model, the investigators followed excitatory cortical neurons developmentally and found altered DNA methylation and transcription around birth at Tbr1 regulatory sites, abnormal deep-layer neuronal electrophysiology, and dysregulation of several high-confidence ASD genes.

The Story We Cannot See For those that have not read Theo of Golden, do so. Quite an incredible read. There is a moment in Theo of Golden when Allen Levi introduces us more deeply to Ellen, a woman whose circumstances make it easy for the world to place her into a category. Homeless. Poor. Troubled. Someone living at the margins. But then we learn her story. And suddenly that category becomes inadequate. Worse, inappropriate. That is one of the quiet gifts of a beau

AI and Thought Full disclosure: I am a major fan of AI as it will democratize knowledge and lift up the general capacity of the world unlike anytime in human history. There are risks, to be sure. Alas, nothing great in human history was brought to bear without risk. Noah Hariri brings so much thought to bear as it relates to Artificial Intelligence and human growth. He has a must listen to you tube video entitled: The next 50 years: humanity, AI, power | Yuval Noah Harari

Sivers and Literature Leading Life "Last week someone asked why I prefer books. My immediate answer was that I love their quiet, non-commercial nature. No ads. No hype. Just quiet wisdom with deep rewards for a focused mind. But today I realized something more profound: Each of my biggest life-changing moments came from a single sentence deep inside a book." (Sivers D. 2026) I still prefer to hold a book in my hands, the weight of it, the rough-hewn pages beneath my fin

Pregnancy Changes the Story in a Mother’s Brain Something remarkable happens to a woman's brain during pregnancy. And I'm not talking about "pregnancy brain", forgetting where you left your keys or walking into the kitchen and wondering why you went there. These changes are much deeper than that. Dr. Hoekzema, a Neuroscientist, and colleagues followed women from before conception through pregnancy and into the postpartum period, using brain imaging to watch the transfor

The Story Your Brain Decides to Tell Two people walk into the same room. One has been told that she is there to make new friends. The other has been told that she is there to determine whether the people in the room can be trusted. Same room. Same people. Same conversations. But perhaps not the same experience. That is the fascinating implication of emerging neuroscience exploring how the brain constructs the story of our lives. We tend to imagine that our senses

Breakfast and Lunch Ideas Breakfast options:  Greek yogurt bowl: Plain Greek yogurt, blueberries or strawberries, walnuts, chia seeds, and cinnamon. Oatmeal upgrade: Steel-cut or rolled oats with berries, ground flaxseed, walnuts, cinnamon, and a spoonful of almond or peanut butter. Avocado toast: Whole-grain toast topped with avocado, tomato, pumpkin seeds, and a side of berries. Breakfast smoothie: Unsweetened milk or kefir, berries, spinach, chia or flaxseed, and unsw

Back To School Thoughts As summer winds down and the school year starts, our attention naturally turns to backpacks, school supplies, new clothes, sports schedules, and carpools. But getting ready for school is about much more than checking items off a list. It is about helping our children return to the classroom with the physical, mental, and emotional foundation they need to thrive. A few simple changes now can make the transition much easier. 1) Start With S

Literature Review 1) In this JAMA paper, "Of the 1173 participants (median age, 74 years experienced greater than or equal to 2 conditions by the end of follow-up (316 of 385 [82%], 327 of 385 [85%], and 350 of 403 [87%], respectively, among lifestyle, metformin, and placebo groups). The risk of multimorbidity was lower among lifestyle compared with placebo participants after adjustment for relevant covariates. There was no difference between participants in the metform

The Hardest Part of Medicine Isn't Making the Diagnosis Last week I wrote that one of the most healing words in the English language may be "no." I believed it when I wrote it. After today, I believe it even more. Today was one of the hardest days I've experienced in medicine in a long time. I drove home with a heaviness that is difficult to describe. Not because a child died. Not because I faced an impossible diagnosis. Not because science failed me. Not because of t

1) In this Nature paper, the authors engineered an enzyme capable of converting Nε-carboxymethyllysine (CML), a common advanced glycation end product (AGE), back into its native amino acid, lysine. Rather than relying on the body to degrade and replace damaged proteins, this approach directly repairs a key form of age-related protein damage. "AGE accumulation contributes to the stiffening and loss of elasticity observed in aging tissues by crosslinking collagen and inhibiting

The Healing Power of Saying No Why the path to health often begins with restraint! Every major faith tradition discovered something long before neuroscience or evolutionary biology could explain it. Growth often begins with restraint. During Lent, people give something up, not because chocolate, wine, or social media are inherently evil, but because saying no creates space. Space for awareness. Space for clarity. Space to notice how often our impulses quietly run the show

An issue on everyone's mind lately is the parasite Cyclospora. The good news is that, for the overwhelming majority of healthy people, this is more of an unpleasant gastrointestinal illness than a dangerous infection. Cyclosporiasis is an intestinal infection caused by the protozoan parasite Cyclospora cayetanensis, acquired almost exclusively by ingesting contaminated fresh produce or water. Humans are the only known reservoir. Unlike many enteric pathogens, the parasite'

The Medscape/Pediatric News article by Christine Bahls, "The Rise of Early-Onset Diabetes: A Looming Crisis," frames youth-onset type 2 diabetes as one of the most significant emerging pediatric health threats. Rather than viewing diabetes as an isolated endocrine disorder, the article emphasizes it as the downstream consequence of profound changes in childhood metabolism, nutrition, and environment. We are seeing this reality play out weekly in our clinic. We are diagnosing