Summer is here!

Are you ready for cookouts, trips to the beach. . . and tick bites?

There are almost 100,000 cases of Lyme Disease in Massachusetts every year, and most of these occur in June, July and August.   A person usually becomes infected with Lyme Disease when they are bitten by a deer tick that stays attached for 4 to 5 days.  Most people with Lyme did not even know that they were bitten by a tick.

Preventing Tick Bites

  • Wear light colored clothing (long sleeves and pants are best, tucking pants into socks can help)
  • After spending time outdoors: rinse off in the shower, throw clothes in a hot dryer for at least 5 minutes, and check yourself for ticks.
  • Consider using a repellent containing DEET.

Apply it outdoors in a well-ventilated area.  Use the least concentrated version that works for your activity:  10% DEET works for about 2 hours, 20-30% DEET works for about 5 hours.  DEET is not recommended for use in infants or pregnant women.  There is a tiny risk of neurological problems if DEET is used in large amounts or frequently.

  • Consider using the insect repellent permethrin on clothes if you are at high risk. One application can remain on clothes for 2 weeks or more, even after several washes.  May be best to avoid use in children or pregnant women.
  • Citronella and lemon eucalyptus oil do not work well to repel ticks
  • Take care of your yard:

Remove old leaves, tall grass, and brush at the edge of the lawn.  A 3 foot zone of wood chips or gravel at the edge of the yard can help keep ticks away.  Cut grass often.  Stack wood neatly in a dry area to cut down on rodents.  Keep recreational areas like swing sets and decks away from the edge of the yard.  Fences can keep out wild animals that carry ticks.


  • Dr. Brown

Happy June solstice! It’s the first day of summer!

To help celebrate, we are offering a selection of healthy, organic tomato plants. They are in 3” pots, ready to be put in a garden or in a patio container.

Please stop by to choose a few of your favorites. They are located on our 2nd floor foyer.

Happy gardening from your Action Medicine, DPC team !

Type II Diabetes

Type II diabetes is running rampant in the United States. A big problem is that it is not diagnosed early enough. Most physicians don’t even check for it unless a person is obese and has an abnormally high random blood sugar.

Risk factors for Type II diabetes include a history of gestational diabetes, being overweight, being inactive, and a family history of diabetes. Symptoms can be excessive thirst, hunger, and urination.

As Americans get more and more overweight, the lab values have risen including the “normal“ blood sugar levels. At Action Medicine, DPC, we test fasting glucose, insulin, and C-peptide. This gives us the best opportunity to diagnose prediabetes short of doing a full three-hour glucose tolerance test with insulin levels. A regular glucose tolerance test is not enough because we need to test insulin levels at the same time. You can have a normal blood sugar but if you must have high insulin levels to keep it normal, you are insulin resistant, carbohydrate overloaded, and you are on your way to diabetes.

A study was done on several hundred Yale undergrads who were not overweight, but they did not exercise. 25% of the students tested positive for early diabetes and another 25% were prediabetic. Another 25% had high normal blood sugars. Action Medicine runs these tests on our patients during their yearly medical exam and lab work.

Please contact the office to schedule your annual physical, if needed.

~Dr. Mike and Action Medicine team

Synopsis of Unlocking the keto code by Dr Steven Gundry

As it turns out the ketogenic diet works by a biocellular process known as mitochondrial uncoupling. This process is facilitated through the gut when our bacteria manufacture post-biotics. This whole process builds more mitochondria which burn more energy and forces fat cells to release their calories.

There are three simple rules:

1) Consume some of your calories as medium chain triglycerides, MCT oil for example. Start with a tablespoon per day and try to increase it to three times a day gradually.

2) Utilize time restricted eating

3) Feed on fermented foods and fiber including cruciferous vegetables.

MCT oil can be added to beverages or consumed directly. They should ideally be non-GMO and organic. Start with a tablespoon a day in the morning and this will not break your fast. I also suggest 1 teaspoon of organic India psyllium in the morning as this is a resistant starch and it will tend to make you feel full. It will also help keep your bowel movements normal.

Time restricted eating ideally would be one meal a day (OMAD). People who are originally on a higher carbohydrate diet will have a hard time with time restricted eating initially. If this is the case, delay your first meal of the day as long as possible. Each week try to delay it a little longer until you get to about a six hour eating window, say 2 to 8. Do this Monday through Friday and be more lenient on weekends. Try to avoid grazing, and stay hydrated. Use the MCT oil and the psyllium in the morning and MCT oil in the afternoon. Drink black coffee or coffee with MCT oil powder. Drink black or green tea. Your meal should consist of grass fed and grass finished animals, wild caught fish, dairy from southern European cows, buffalo, sheep and goat and should be full fat. Cruciferous vegetables should be chopped before steaming and these include broccoli, cauliflower as well as other sulfur containing vegetables like onions, garlic, leeks, shallots, etc.

Feast on fermented foods and resistant starches. Sauerkraut, kombucha, miso paste, kimchi. Sweet potatoes, yams, plantains. Yogurt and cheeses from France, Italy and Switzerland. Goat and sheep dairy. Up to 6 ounces of red wine per day. Try to buy organic. Try a good quality vinegar such as Braggs in warm water as a beverage snack. Other high-fiber foods include artichokes, asparagus, leeks and chicory. Avoid sweets including fruit juices which are high in fructose. If you need to sweeten a dish, try swerve or Monk fruit sweeteners. Try and macadamia nut creamer.

For additional food selections go to DrGrundy.compdf-food list

Better yet, read the book as it has a bunch of good keto recipes

As always, if you have any questions, call, text or E-mail me.

  • Dr. Mike

Traditional Food Pyramid questioned

I attended a virtual conference a few weeks ago put on by an organization that I belong to called””.

At least 3/4 of Americans suffer from carbohydrate toxicity syndrome. This is because the “food pyramid “is upside down. We should be eating more protein in the form of meat, grass fed if available. We should also be eating good quality full fat dairy & avoiding low fat anything. Other good quality fats would be avocados and olive oil.

We should be doing our best to eat a very low or no carbohydrate diet. Low carb recommends that we definitely avoid highly processed carbohydrates that are found in foods like bread, pizza and pasta. These carbohydrates are extremely addictive and are often combined with sugar found in sugary cereals or fats as we find in pizza. They cause a rise in our insulin levels that makes us feel constantly hungry. This is why the average American eats eight times a day.

I suggest watching the free documentary film, “Fat Fiction” and check out Dr. Ken Berry on YouTube. The links are below.


Stay tuned for additional information from this conference.

~Dr. Mike & Action Medicine team

For our members, a new service offered

PRP ultrasoundAction Medicine, DPC has just taken a big step forward for our members. We have invested in a state of the art diagnostic ultrasound device.

Initially, it was purchased to help us do platelet rich plasma, PRP and stem cell joint injections. Within the first week, we were able to use it diagnostically in other areas. We used it to see a fractured toe, which verified our diagnosis and helped determine the treatment. We were able to look at the spleen of someone who had mononucleosis to reassure him that it was not enlarged. He can now go back to doing his workouts. We can use this device to look at the arteries and veins in the body. When someone has a swollen leg, we can determine if it is due to blood clots or not.

We are making efforts to enhance our services. Utilizing this new ultrasound device is offered at no additional charge for our members. Thank you for being a part of the Action Medicine, DPC family.

~Dr. Mike and Action Medicine team


I’d like to talk a little bit about fasting. My definition of fasting is no food consumption for at least 48 hours. Yes , you read this correctly  and are probably thinking “I could never do that “. I wish I had a nickel for every time I heard that phrase.

The reason people have a hard time going without eating is because they are carbohydrate addicted and therefore have carbohydrate toxicity. This involves high levels of insulin which keeps them hungry (Hangry) all the time. Once you do a water only fast past 36 hours, you use up your stored sugar .The feeling of being hungry diminishes .  You’re now in a state of ketosis where your body is burning fat rather than sugar.

You should focus on drinking plenty of water. Black coffee, tea and a good quality bone broth are also allowed. Try to do a two day fast to start. Each time you fast it gets easier. I personally have done three,  five day fasts and one seven day fast.

Most people lose 2 pounds a day but half of that is water weight which returns during refeeding. The result: you lose weight, you save money, enjoy more free time, feel better and you lose fat while maintaining muscle. It is a no brainer.

Studies have shown that if you do a five day fast twice a year, you will live an average of three years longer than others your age. When you fast or do the ketogenic diet, your risk of cancer and cardiovascular disease decreases. Cancer risk diminishes because precancerous cells and cancer cells need sugar to replicate. When sugar and insulin levels go down, your immune system can kill these abnormal cells more easily. Dr. Valter Longo and others are using fasting with more main stream treatment to fight and sometimes cure cancer patients. If this interest you, check out the links below.

~Dr. Mike and Action Medicine team






Yeah, yeah, I know. Those two statements don’t even go together… or do they? The holidays are here. We are eyeball deep in them. All around us, at home or work, are delicious things. Cookies! Cakes! Pies! (Yay Pie! Yay Pie!)

Unfortunately, after every holiday season, someone seems to sneak in my room and replace all my pants with other pants that LOOK EXACTLY THE SAME but are one size smaller. SO WEIRD. (Ok. This is what denial looks like, people). But seriously, keeping your waistline in check can be tricky during the time of abundance.

So, what can be done to help our body keep up with the extra intake of carbs? How about intermittent fasting. (Noo! Stay with me! Don’t stop reading now!)

Intermittent fasting can allow our body to recover from the heavy dosing of sugars and sweets we just consumed and dig into our reserves a bit to help rid some of the excess. Obviously, I’m massively simplifying this, but this blog isn’t a pathophysiology lesson. I actually wanted to focus on the experience of intermittent fasting from one of our patient’s firsthand experience with fasting for 2 consecutive days and eating a low carb/normal diet the 5 other days.

He/She shall remain anonymous due to HIPAA regulations; per our conversation here is the synopsis. It was reported that initially it was daunting. We are programmed to eat on a routine schedule since we are children, so breaking this pattern is difficult. Our patient had to figure out what to do with themselves when they got home.  However, after getting through the first day, the second was not as bad as they had thought. There was an issue when someone brought some delicious aromatic food to work, but otherwise, there was very little issue with feeling hungry.

There were some issues that occurred with loose stool. They found that after 36-48 hours of fasting their intestinal habits were out of the norm for them. Diarrhea symptoms also lasted a little after the fast had ended.  They also want to be very clear that when you do start eating, do so slowly. They recommend it is best to take it easy and start with bone broth and maybe a smoothie with protein powder. Overall, intermittent fasting was found to be a pretty easy way to control the amount of calories consumed in a week.

So, there you have it. It seems you can have your cake and eat it too after all…just on separate days.

While fasting is considered safe for most people, please consult with your doctor before initiating any type of timed eating/intermittent fasting diets.

~ Brooke Rieth, NP & Action Medicine team

We are including 2 recipes:

Bone broth,  from Nourishing Broth, Sally Morell

Ginger spice cookies, from Once Upon a Chef, Jenn Segal


Liquid Gold, Bone Broth

Emma Watterson, Hayes, Virginia

The turmeric in this recipe gives not only flavor but also a beautiful yellow color to

the broth: oregano adds a south-of-the-border taste.

Makes about 4 quarts



About 4 pounds chicken bones and pieces

2 to 4 chicken feet (optional)

¾ cup apple cider vinegar

About 4 quarts cold filtered water

1 large onion, ends cut off, quartered, with skin left on

1 head garlic, sliced in half (no need to peel it)

1 teaspoon ground turmeric

1 tablespoon dried oregano

Sea salt and freshly ground black pepper



-Place the chicken bones in stock pot with enough water to cover bones and vinegar over medium heat

-Bring to a bare simmer, uncovered.

-Add the onion, garlic, turmeric, and oregano

-Return to a simmer, then lower the heat to low.

-Cook at a bare simmer with the lid off or slightly askew for 4 to 6 hours, occasionally skimming scum from the top as needed and checking to ensure that the bones remain covered with water and adding more water as needed.

-Remove the bones and feet with tongs with a slotted spoon (when cooled, pick any

meat off the bones and use in soups, casseroles, and other dishes).

-Strain the stock through a fine-mesh strainer into 2-quart glass containers

-Allow to cool to room temp and store in fridge for 5 days or many months in freezer.

-Season individual servings with salt and pepper.


Old-Fashioned Ginger Spice Cookies

Soft and chewy with a crackled sugar crust, these ginger spice cookies have just the right balance of spices to please kids and adults alike.

Servings: 38 cookies
  • 2-1/3 cups all-purpose flour
  • 2 tsp baking soda
  • 1/4 tsp salt
  • 2 tsp ground ginger
  • 1 tsp ground cinnamon
  • 1/2 tsp ground allspice
  • 1/4 tsp ground cloves
  • 1/8 tsp freshly ground black pepper
  • 3/4 cup (1-1/2 sticks) unsalted butter, at room temperature
  • 1/4 cup plus 2 Tbsp granulated sugar
  • 1/4 cup plus 2 Tbsp packed light brown sugar
  • egg
  • 1/3 cup molasses, such as Grandma’s Original
  • 1/2 cup raw sugar (also called turbinado or demerara sugar), for rolling cookies


  1. In a medium bowl, whisk together the flour, baking soda, salt, ginger, cinnamon, allspice, cloves, and black pepper.
  2. In the bowl of an electric mixer fitted with the paddle attachment (or beaters), beat the butter and the granulated and light brown sugars until light and fluffy, about 2 minutes. Beat in the egg and molasses. Add the flour mixture and mix until combined. Chill the dough in the refrigerator until firm, a few hours.
  3. Meanwhile, preheat the oven to 350°F and set two racks in the centermost positions. Line two 13-by-18‑in baking sheets with parchment paper.
  4. Form tablespoons of dough into balls and roll in the raw sugar to coat generously. Arrange the dough balls about 2-1/2 in apart on the prepared baking sheets. Bake for 9 to 10 minutes, rotating the sheets from top to bottom and front to back midway through, until puffed and set. Let cool on the baking sheets for a few minutes, then transfer to a wire rack to cool completely. Store in an airtight container at room temperature for up to 3 days.
  5. Freezer-Friendly Instructions: The Cookie Dough can be Frozen for up to 3 Months: Roll the dough into balls, let set on a baking sheet in the freezer, then place in a sealable bag and press out as much air as possible. Bake as needed directly from the freezer. (Allow 1 to 2 minutes longer in the oven.) To Freeze After Baking: Let the cookies cool completely and store in an airtight container separating layers with parchment paper or aluminum foil. Before serving, remove the cookies from the container and let them come to room temperature.

Nutrition Information

  • Serving size: 1 cookie
  • Calories: 97
  • Fat: 4 g
  • Saturated fat: 2 g
  • Carbohydrates: 15 g
  • Sugar: 9 g
  • Fiber: 0 g
  • Protein: 1 g
  • Sodium: 70 mg
  • Cholesterol: 14 mg

This website is written and produced for informational purposes only. I am not a certified nutritionist and the nutritional data on this site has not been evaluated or approved by a nutritionist or the Food and Drug Administration. Nutritional information is offered as a courtesy and should not be construed as a guarantee. The data is calculated through an online nutritional calculator, Although I do my best to provide accurate nutritional information, these figures should be considered estimates only. Varying factors such as product types or brands purchased, natural fluctuations in fresh produce, and the way ingredients are processed change the effective nutritional information in any given recipe. Furthermore, different online calculators provide different results depending on their own nutrition fact sources and algorithms. To obtain the most accurate nutritional information in a given recipe, you should calculate the nutritional information with the actual ingredients used in your recipe, using your preferred nutrition calculator.

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