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The private practice in Manhattan is expanding to include psychiatric house calls including care for Adolescents, Adults, Geriatrics, Family Therapy, and Psychopharmacology.

Tele-health options available for established patients.

Raymond Zakhari, NP is a board certified nurse practitioner in Family Practice and Family Psychiatr

The interface between medicine and psychiatry is the crack that many patients often fall through in terms of having their health care needs met. A small group of health care providers in the United States is uniquely qualified to care for patients with both mental health and primary care needs. This group of health care providers is double board certified in internal medicine/ family practice and psychiatry. That means they were equally trained in the traditional aspects of primary care as well as trained in the field of psychiatry. This health care provider can either be a physician or a nurse practitioner. If the provider is a physician they may be known as the Internist-Psychiatrist, and if the provider is a nurse practitioner they will be known as a Family Practitioner- and Family Psychiatric Mental Health Nurse Practitioner.

These two professions address the needs of people with mental health problems that impact a medical condition, as well as care for people with general medical concerns who develop a mental illness. They also have a great deal of experience in dealing with the adverse effects of psychotropic medications including diabetes, kidney trouble, and anemia. 

On average a patient with a serious mental illness such as bipolar disorder or schizophrenia can have a 10-20 year reduced life expectancy because of the barriers in accessing routine and preventative care, and the reduced adherence to treatment. People with mental illness can also suffer from the same conditions that affect the general population including heart disease, diabetes, and high blood pressure. Similarly it is not uncommon for a patient who has suffered a heart attack or stroke to become depressed or anxious to the degree that it impairs daily life functions. 

This holistic type of care which integrates primary care and mental health is an approach to care which seeks to optimize mental and physical well being with the added convenience of a one stop shop.  

What are your thoughts on getting your physical and mental health care from one clinician?

Most men hate going to the doctor. If you could design your ideal health encounter what would it include, and what would you like to see changed?  

Use the comments section to create your wish list. You may get what you are looking for.



Raymond Zakhari, NP  

How’s it hanging?   You may never be asked this question by your doctor, but I assure you it is one of the most important questions you should be asked at every visit.

Sexual dysfunction in men is often a barometer of overall health: problems with desire, arousal and climax can often indicate underlying heart disease, diabetes, obesity, thyroid conditions, depression, and anxiety, adverse effects of medication, substance abuse, nutritional deficiency, testosterone levels, circulation problems, and infections. So I will ask again: How’s it hanging? More importantly when was the last time you climaxed and are you satisfied with your level of desire, arousal and orgasm.

In an effort to treat you with dignity, modesty, privacy, and respect many doctors cut corners with a comprehensive physical exam, and ask leading questions with the hope that you will not report any problems so they can move on to the next person. In fact many physician groups are now reporting that an annual physical exam is worthless in terms of promoting health, and preventing death. They have even gone so far as to advise against you performing testicular self-exams, deemphasized prostate cancer screening all the while jumping on the bandwagon of low testosterone as the holy grail fountain of youth and virility.

Most men dread a visit to the doctor because it is often a cursory drive by physical that ends in a list of things they should not do. That, combined with the nearly universal all female ancillary staff, from the receptionist who insists we share the most intimate details of our lives as a prerequisite for an appointment, to the tech, seldom medical assistant, who records those same details in our records, all prior to even seeing the doctor for 10 minutes. Given the extremely personal nature of men’s health care and the potential for embarrassment, why is privacy and dignity so callously disregarded on a routine basis for male patients? How would female patients feel if their OB/GYN was accompanied by a male assistant or chaperon barely out of high school. This double standard needs to change for men to feel comfortable in seeking health-care. I’m convinced a significant percentage avoid needed medical care for this exact issue. These are difficult issues to admit even to yourself, more so with your wife, and then we’re expected to share the most intimate details of our lives with multiple female strangers.

Another reason men avoid formal health care is they don’t trust the doctor. They feel that in their compromised state of undress they will be sold a bill of goods.  The main reason for this is that many doctors do not have the time to explain the game plan and explore alternatives. The patient is left feeling bullied into a decision they may not have been prepared to make. Therein lays the rub. Unfortunately, we all reach that moment in life when have to face our fears. For that reason it is important to find a primary care provider you can trust so that you retain control over your health care rather than settling for the doc of the day when you are truly in need.

  • You wouldn’t drive your car for 100,000 miles without an oil change and a tune-up, and expect it to be fine, would you?
  • Erectile dysfunction may be an early marker of cardiovascular disease

Fortunately, there is an alternative. Metro Medical Direct offers personalized men’s health care in the comfort of your domain (home, office, or hotel). This practice was founded in 2009 to take the hassles out of going to the doctor. Imagine no ancillary staff, no paper gown, no endless unproductive waiting, and no condescending tongue thrashing of what you are doing wrong. Imagine a partner in care who acts as your coach. A mutually beneficial and therapeutic partner with whom you can speak freely and ask any question that comes to mind. Medical house calls and a virtual one stop shop in which you can text or video chat for those times when you do not actually need to be examined.

The Men’s Health service offers specialized primary and psychiatric care to optimize your overall health.

If you would like improved:

  • Sexual health, libido, stamina, erectile function , urinary stream
  • Cardiovascular health
  • Evaluation and management of testosterone deficiency
  • Psychological treatment and support
  • Couples therapy when sexual issues are paramount
  • Manual therapy for pelvic pain and prostatitis
  • Evaluation and management of bone health
  • General and mental health

Services are confidential, no third party insurance accepted,

appointments are evenings and weekends.

Request an appointment online call or text 917-484-2709


By Raymond Zakhari, NP

Many patients do not exactly know what the difference is between these various mental health care providers and hopefully this article will clarify the difference.  A psychotherapist is a term used to describe any mental health professional regardless of their training level. It refers to the talk therapy that occurs within the session. Simply stated a psychotherapist is anyone who practices psychotherapy.

So what is psychotherapy you may wonder?

Psychotherapy is a structured conversation with the intent of supporting a patient or client in making changes in the way they think or act in order to be congruent with their personal values system. The goal is to restore balance to the environment in which they live. The person who has this conversation with you is a psychotherapist. The title psychotherapist is not protected because it can be used by many different disciplines. So the titles of the disciplines that use the tool of psychotherapy are protected and subject to licensure and state laws.

So who can do psychotherapy?

 Usually people that claim to do psychotherapy are licensed professionals and they can be physicians, nurses, social workers, clergy, psychologists, and mental health counselors.

  • A psychiatrist is a physician either an MD or a DO. They have completed a residency in psychiatry after medical school for at least 3-4 years. They can order and interpret tests, prescribe medications, provide psychotherapy, and order a commitment to an institution.
  • A psychiatric nurse practitioner is a registered nurse who has completed either a masters or doctorate degree with a specialization in psychiatry. A psychiatric nurse practitioner is licensed to order and interpret tests, prescribe medication, and provide psychotherapy.  State laws vary regarding their ability to order a commitment to an institution, and the types of medications that can be prescribed.
  • A psychologist is a doctoral educated person who has either a PhD or a Psy.D. This person is usually an expert in diagnostic testing, in the field of mental health they are primarily the ones that adminsiter Neuro Psychological Tests and interpret them. In some states psychologists can prescribe medication. Most states do not allow psychologists to order physiological tests or imaging studies. Psychologists can provide psychotherapy.
  • Social Workers, Mental Health Counselors, Marriage and Family Therapists, and Clergy: all of these professionals can provide psychotherapy. These mental health professionals cannot order and interpret physiological tests, or prescribe medication. These professionals cannot order a commitment to an institution. These are the most abundant and most common providers of psychotherapy. They are sometimes referred to as simply therapists.

How do I combine both my family practice training and family psychiatry training in a medical house calls practice?

As a nurse practitioner, I am able to diagnose medical illnesses some of which may present as mental health problems.  I pay particular attention to the medical impact of psychological problems and the psychological impact of acute and chronic medical problems. I can also prescribe medications and order and interpret diagnostic tests.

I had a patient with difficulty breathing, who happens to be at home on a CPAP machine, she was frequently getting admitted to the hospital for difficulty breathing. After I evaluated the patient I was able to identify the underlying cause as panic attacks. This same patient subsequently became depressed because of her ailing health, and stopped eating. This led to problems with her blood pressure. Once I was able to diagnose the three problems that were affecting and perpetuating each other I was able to effectively treat the panic attacks, depression, and low blood pressure. This patient whom I had treated complained that these symptoms had progressed over the last 2 years and had not gotten better despite 5 hospitalizations and ICU admissions.  

The patient had been seeing a psychiatrist, pulmonologist, and neurologist. Because I was able to see the patient in her home I was able to physically assess her during the panic attack I was able to distinguish her feeling of respiratory distress from actual respiratory distress.  Also, because of my psychotherapy training I was able to help the family around her cope with the psychological impact of chronic illness, issues of their own mortality, the patients sense of powerlessness, and to explore the likelihood of the patient’s death. I instructed the caregivers and family members how to assess for true respiratory distress, and how to respond to a panic attack. The patient was never readmitted to the hospital again, and eventually died peacefully at home surrounded by family.  Afterwards I was able to provide grief counseling to the family members.

I hope this posting clarifies the differences between all the various mental health professionals that can provide psychotherapy. I also hope it assists you in choosing they type of psychotherapist to best meet your needs.  The most important indicator and predictor of a successful therapeutic outcome is not the type of professional you choose or even they type of talk therapy they provide. It is if you like them and feel they understand you. Mental health professionals call this the therapeutic alliance. More on this later—

Headaches can vary from mild to severe. The pain can feel sharp, dull, throbbing, or aching. The type, severity, and location of the pain depend on the cause of the headache.

Most headaches do not have a serious cause, and most be treated at home.
Here is some care advice that should help. (This is intended for general information, and is not intended to be specific to your situation. You should seek personal care from your primary care provider)

Types of Headaches:

Migraine Headache:
This type of headache is called a vascular headache. It can be mildly to severely painful. People who get migraines often describe them as throbbing or pulsing. A migraine headache is often felt on just one side of the head.
You may also vomit or have an upset stomach. Some people will have visual warning signs before they get migraines.

Muscle Tension Headache:
Most headaches are caused by muscle tension.
People say the headache feels like a tight band around their head. You may feel tension down into your neck and shoulders. These headaches can be made worse by emotional stress.
These headaches are painful. There are pain medications you can take to help the pain.

Pain Medicines:

Acetaminophen (Tylenol):
Regular Strength Tylenol: Take 2 pills (650 mg) every 4-6 hours. Each pill has 325 mg of acetaminophen.
Extra Strength Tylenol: Take 2 pills (1,000 mg) every 8 hours. Each pill has 500 mg of acetaminophen.
Do not take more than (3,000 mg) of this drug per 24 hour period

Ibuprofen (Motrin, Advil):
Motrin and Advil: Take 2 pills (400 mg) every 6 hours. Each pill has 200 mg of ibuprofen
A second choice is to take 3 pills (600 mg) every 8 hours. DO not take MORE than 1800mg in 24 hours.

Naproxen (Aleve):
Aleve: Take 1 pill (220 mg) every 8 hours. Each pill has 220 mg of naproxen.
A second choice is to take 2 pills (440 mg) every 12 hours. DO not. TAKE more than 880mg in 24 hours

Extra Notes:
Use the lowest amount of a drug that makes your pain feel better.
Your healthcare provider might tell you to take more than what is shown above. That is because your doctor knows you and your health problems.

Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription drugs. It might be in more than one drug you are taking. Be careful how much you take. Too much of this drug can hurt the liver.
Caution- Acetaminophen: Do not take it if you have liver disease.
Caution- Ibuprofen and Naproxen:
Do not take ibuprofen or naproxen if you are pregnant.
Do not take these drugs if you have stomach problems or kidney disease.
Do not take these drugs for more than 7 days without checking with your health care provider.
Read and follow all package instructions.

Migraine Medication: Take your prescription migraine medicine as soon as it starts.
Rest: Lie down in a dark, quiet place and try to relax. Close your eyes and try to relax your whole body.
Cold Pack: For pain, put a cold pack or cold wet washcloth on your forehead for 20 minutes.
Stretching: Stretch and massage any tight neck muscles.

Call Your Primary care provider If:
Headache lasts more than 24 hours or your symptoms worsen

Call 911 if you are falling asleep, feeling confused, having any weakness or numbness, or having slurred speech, this is the worst headache of your life, have a fever > 100.5 or believe you are having a life threatening emergency.

Raymond Zakhari, NP
Medical House Calls in New York City

You should establish a relationship with a primary care provider who is able to learn about your normal state of health and customize your care when you are ill.

It is estimated that one fourth to one third of patients transitioning in care will be re-hospitalized within 30 days due to preventable complications. The following risk factors have been identified as increasing the risk of hospital readmission within the first 30 days. The more risk factors the greater the likelihood the patient would benefit from a formal a transitional care plan and intensive primary care.

  • Age 80 or older
  • Moderate to severe functional deficits
  • An active behavioral and/or psychiatric health issue (diagnosed or not : most patients have not had a psychiatric evaluation)
  • Four or more active co-existing health conditions
  • Six or more prescribed medications (includes vitamins, supplements, and occasional pain medications)
  • Two or more hospitalizations within the past 6 months
  • A hospitalization within the past 30 days
  • Inadequate support system
  • Low health literacy
  • Documented history of non-adherence to the therapeutic regimen

Older adults are often hospitalized for a newly diagnosed condition or an exacerbation of a chronic condition. They are at an increased risk of re-hospitalization due to poorly managed transitions from home to hospital, and from hospital to home or other care settings.  Further complicating this situation is the condition of delirium which can be caused by a change in environment. Delirium can take several weeks to clear up particularly in an elderly patient with many medical problems. For older patients with multiple chronic conditions this “transition in care” is a point of great vulnerability along the continuum of care where many errors of omission and commission can occur.

The intensive primary care model is a patient-centered; nurse practitioner led interdisciplinary process that begins with an initial assessment of the patient’s potential needs prior to discharge. The primary aim is to help keep the patient at home safely. Patients are seen consistently and preventive to help detect subtle changes in condition that could result in a hospital admission. The nurse practitioner will attempt to streamline the medications that may be causing adverse effects leading to a decline in function. Intensive primary care is best suited for patients with multiple medical problems and or psychiatric co-morbidities that maybe increasing the risk of emergency room utilization. Emergency room utilization increases the risk of hospital admission in elderly people.

When a patient requires a transition of care from the hospital to home ongoing communication with the patient’s hospital care team and prospective care coordinator (loved one or professional care manager) help ensure a successful care transition while reducing the risk of readmission.

What should you expect from an intensive primary care evaluation?

In planning for a transition in care the patient’s medical record is reviewed and an assessment of the medical condition, and functional, social, cognitive capabilities is conducted to help assures that the comprehensive needs of the patient can be addressed. The patients, family member (professional care manager) are included in the process to help everyone understand and feel comfortable with the intended plan of care.  The process concludes with the coordination and implementation of services and transition to the patient’s home.

Intensive primary care does not require the patient be admitted to a hospital. Patients, family members, care managers can request the evaluation if they feel the medical condition is becoming increasingly complex. A good indicator that the condition is becoming increasingly complex:

  • Being prescribed increased amounts of medications
  • Being referred to numerous specialists
  • Being advised to have many diagnostic tests
  • You have had to utilize the emergency room more frequently
  •  You have been readmitted to the hospital more than once in the last 6 months.

If have a family member or are the care manager for a patient who has had to transition in care what lessons have you learned, and what advice would you pass on? Please share your comments so that together we can help each other.

Concierge medicine is rapidly gaining traction among People who are looking to establish a meaningful relationship with their primary care provider. Patients are yearning to experience a different kind of medical care – one where their a doctor spends quality time with them instead of rushing off to complete paperwork, or see the next person in a crowded waiting room of patients . A few years ago, doctors were always ready and able to drop everything and tend to the needs of their patients. “Family doctors” had a relationship based model of care, and made house calls.

Unfortunately, insurance companies and mounting government mandates have reduced health care to a list of codes, and endless forms. Patients are known by a string of numbers. Both doctors and patients are made to conform to the new regulations of the day. The traditionally practicing health care provider has a second full time job as a data entry clerk. Patient-focused services have eroded over time. Suddenly, the doctor-patient relationship is a business arrangement. Fast in, fast out. Drive by physical exams. Impersonal and fragmented delivery models. Increased ER utilization.

Do you find that your current annual physicals leave something to be desired? Are you sure that you know as much as you can about your health? If you are like most busy people here in New York, your annual physical does not provide you with full information about your health. Have you ever felt that your doctor could not provide you with the care you needed and have been rushed along? Are you tired of competing for your doctor’s attention? Are you fed up with calling to book an appointment and waiting on hold for hours, only to learn that the next available date isn’t for six months, and speaking to impersonal curt front of the house staff? If you’re one of the thousands of patients who has felt this way, it is likely because your doctor is one of the many overbooked Primary Care Providers/ Data Entry Clerks.

A Concierge Nurse Practitioner eliminates the need to chase your doctor and to try and fit yourself into his or her already overbooked slot. A concierge Nurse Practitioner deliberately plans enough time to talk to you as the most important member of your health care team. A Concierge Nurse Practitioner is willing to spend as much time as needed to uncover any potential issues with your health.

If you are ready to take control of your health care with a board certified primary care provider that has the time to focus on you, then you would greatly benefit from the expert care of a nurse practitioner. Concierge care allows you to experience relationship based primary care, and return to the good old days, of house calls, compassionate care, talk therapy, and a complete understanding of your diagnosis and treatment options. Join this movement to revitalize medical care, with a nurse practitioner that values your business and respects your time.

Prepared by:

Raymond Zakhari, NP founder of web based primary care medical house calls solutions that take the hassles out of going to the doctor.

When someone is looking for a geriatric care manager they are often left wondering exactly what is it that they are paying for? The Geriatric Care Manager can be as hands on or hands off as you would like. The easiest way to conceptualize the concept of a geriatric case manager is the following:  these are the available and responsible rent an adult child to care for the elderly person who is declining in function.

The Geriatric Care Manager will check in and facilitate the incidental activities of daily living (IADLs), make sure food is in the fridge, arrange for home attendants as needed, coordinate doctor appointments, arrange transportation, serve as a point of contact between concerned family members, health care providers and other parties as needed, and develop a therapeutic relationship with the client over time. They should be able to tell you if the living situation is safe or if a change is needed as well. 


Usually this person is paid on an hourly rate much like a lawyer which can range anywhere from $75-400 per hour. Often times a retainer is paid prior to starting the assessment.  A good way to help you get the most for your dollars spent is to prepare the following items listed below in a clear and easy to follow format before contacting a geriatric care manager otherwise you will have to pay for them to do it.

Financial and Legal Preparation:

  • Wills up to date in state of residency
  • Trusts considered
  • Durable Power of Attorney of person or HealthCare Proxy
  • Durable Financial Power of Attorney
  • Banking co-signatures
  • Asset/Income list – sources, contact info, acct #’s
  • Deeds available and up to date
  • Burial account set up
  • Funeral arrangements specified
  • Advance directives or Living Will discussed and/or written


  • Medicare status
  • Secondary health insurance
  • Medicaid coverage for health care or Skilled Nursing Facility care
  • Long-term care insurance

 Medical Care:

  • Primary Care Provider
  • Geriatric Consultation
  • Dementia evaluation
  • Vision, hearing, mobility, pain management at optimal levels
  • Substance abuse or psychiatric special needs
  • HIPPA or Release of Information forms on file with the MD and the Healthcare Proxy
  • List of prescriptions, diagnoses, physicians in the hands of pertinent people
  • Transportation to/from

Leisure and Socialization:

  • Transportation
  • Physical activity/recreation
  • Senior Center
  • Large print books
  • Pet care

Housing Issues:

  • Accessibility to stairs, bathroom, bedroom
  • Personal safety: wonder alerts, smoke detectors, spare keys

Equipment Needs/ Safety inspection:

  • Commode chair
  • Grab Bars
  • Shower chair
  • Mobility aids
  • Reaching tool
  • Visual or hearing aides

Discussion Points with Significant Others:

  • How to know when to stop driving?
  • Age in place preferences vs. relocation: How to know when it is time to move?
  • Care preferences, Advance Directives: how do you want to be cared for if frail or dying?
  • Financial Management, who will do it and how?

 Personal Attendants:

  • Medical Alert System
  • Home-delivered meals
  • Home safety inspection/modifications
  • Senior Transportation
  • Non-medical home companions
  • Adult day care
  • Respite care

Many of the above listed service are not covered by Medicare or Medicaid. Also, if the above service are going to be covered the patient has to abide certain rules i.e. medically homebound, or require personal care, or have a change in a medical condition that can be expected to benefit from rehab but not maintain current function etc. If these strict criteria are not met then these services will have to be privately paid.

The benefit of privately paying is it allows for the highest degree of flexibility in utilizing resources. It also helps facilitate a rapid implementation of resources and can bypass long waits for agency rendered services.

If you are interested in learning more about geriatric care management for residents living in Manhattan log on to and arrange an appointment.

The internet abounds with diagnostic criteria for what constitutes the diagnosis of diabetes. The criteria for diabetes has changed several times over the past few years with more and more people qualifying based on the newest criteria. If you have diabetes or pre diabetes or impaired glucose tolerance and are interested in some complimentary therapeutic options then this post is for you. Keep in mind none of these treatments are FDA approved and should not substitute for the advice of your primary care provider or health care professional.


The first and most effective treatment and preventative measure for diabetes is exercise: Ideally 30-60 minutes 6 days per week of a variety of activities that are enjoyable (walking, gardening, swimming, golf, tennis, weights, marital arts, dance water aerobics, tai chi, yoga etc.) The activity should be something that is regularly performed. It should be easy to fit into your lifestyle. Instead of starting intensely and burning out, try starting slowly and easily and maintaining for as long as possible. You should start to notice some results in about 2 weeks. Those positive effects will be improved sense of well-being, better sleep, and more energy. 


I am not going to ask you to count calories or carbs, but I will ask you to enjoy eating. The Mediterranean diet is a great place to start, but there is no need to become militant about it. If you enjoy something that is not officially on this diet then feel free to make room for it and to deliberately include it. The minute you make a food off limits the more likely you are to crave only it. The diet should also be high in fiber to create a feeling of fullness while also making gastric motility more efficient. High fiber can also slow the absorption of glucose which can help reduce sugar spikes and dips. 

Foods to include:

  • Oatmeal
  • nuts
  • bananas 
  • wild fatty fish
  • dark berries (blue, black and raspberry)


Consider order a size small or tall of your favorite foods and drinks, and think twice about over processed foods.

Weight loss: Yes, but I am not as hell bent on this as my colleagues are. Ideally you don’t want a muffin top or to have to squeeze into your pants. If that is what your doing then try to loose a few inches, and feel free to avoid the scale. 


Alpha-lipoic acid: 600- 1800 mg daily this is a potent antioxidant which also enhances glucose uptake, has been found to be helpful in people with peripheral neuropathy which is a common complication in people with uncontrolled diabetes. Some people may notice a skin rash or GI upset. Also people taking this may develop a thiamine deficiency so this should be supplemented as well.

Chromium: has been found to improve glucose control by facilitating uptake of glucose into the cells at doses of 200- 400 mg daily. It has also been found to reduce post meal blood sugars and glycosolated hemoglobin (the dreaded A1C), as well as insulin and cholesterol levels.  It is naturally found in wheat germ, whole grains, brewers yeast and meats. Be warned that this can be toxic when taking in doses of more than 1000 mg daily.

Omega-3 and Omega-6 Fatty Acids: this has been said to help with heart disease prevention, enhance insulin sensitivity. There is even a pharmaceutical product called Lovaza which has an indication for triglyceride control. These fatty acids naturally occur in flax seeds, salmon, mackerel, herring, halibut. The dose for beneficial effect is 1-4 grams daily.  Just a word of caution with respect to supplementing with this in a manner other than dietary intake: there may be an increased risk of cardiac rhythm abnormality which may be fatal in people with implantable cardioverter defibrillators.

Vanadium 100-300mg daily in animal studies has been shown to increase insulin sensitivity, and preserve pancreatic cells. In human studies it has been shown to reduce fasting blood glucose and reduce HbgA1C. This can cause some GI upset, and renal toxicity, a green discoloration of the tongue, fatigue and lethargy. Just because it is natural does not mean it is benign. If you have renal disease you may not want to use this supplement. 

Vitamin C: 1-2 grams daily has been shown to improve insulin resistance through its antioxidant capacity while reducing damage to beta cells by free radicals. There have been no prospective randomized control trials to demonstrate this theory there have been some population studies that show an inverse relationship to vitamin C levels and A1C.

Zinc is excreted in higher amounts in people with diabetes. That being said anyone taking a zinc supplement should also be taking a copper supplement. Zinc has been found to improve immune function and insulin sensitivity. It is naturally found in oysters, lean meat and dark meat of poultry, beans and almonds and leavened whole grains. Supplement form: 15- 20 mg daily. Be aware of mild GI upset, toxcicity, change in taste buds, and possible copper deficiency. 

Cinnamon has been shown to increase glucose metabolism and trigger insulin release and the usual dose is 1-6 grams daily. 

Ginger may help increase insulin sensitivity in patients with type 2 diabetes

All of these supplements should be used with great caution especially if you are already taking a prescription medication for diabetes as there maybe a compounded effect which could drop the blood sugar fatally low. You also maybe thinking that you do not want to take all of these extra pills. Try the following smoothie recipe which will provide you most of these nutrients from food sources which are always preferred to pill form. 

Diabetes Prevention Smoothie 

1 beet

1 carrot

1 apple

1 inch of ginger root

1 tablespoon of fresshly ground flaxseeds or chia seeds

5 oz of non-fat Greek yogurt

1 cup frozen dark berries

1 orange

3 tablespoons hemp seeds

2 Tablespoons of Honey (optional)

4 oz organic whole milk

Water and Ice as needed for a desired consistency. Use this smoothie to swallow your 1 gram cinnamon capsule in the morning. 

Also include 1-3 cups of black coffee through out the day. The benefits of black coffee are to numerous to count but the most recent findings suggest that those that drink it are less likely to develop diabetes and those that have it have better glycemic control. 

In addition to diet and exercise making time to deliberately relax each day, weekly massage, and making time for important relationships, learning to prioritize and establish boundaries can help reduce the chronic and acute stress that leads to disease promoting habits that could lead to conditions such as diabetes. 

Eat well, sleep well, love well and enjoy the health journey. 

The difference between traditional primary care and relationship based primary care is the later takes time to know the sort of patient that develops the disease. Whereas the former is treating the disease that has the patient. The relationship fosters the healing process rather than the treatment being thrust upon the diseased patient. If you are looking for relationship based primary care in Manhattan then request an appointment at Metro Medical Direct.