The Kaplan Center for Integrative Medicine is a place known for its compassion, innovation, and truly personalized care. As many of you know, I am no longer practicing at the Kaplan Center. It has been one of the greatest honors of my career to care for such thoughtful, resilient, and inspiring patients.
In past newsletters, I’ve mentioned that I travel each year to Ecuador for a medical mission called Project Nido. Shortly after arriving there in August, I began to experience abdominal pain that required emergency surgery. Unfortunately, my condition became complicated by sepsis, DIC, and liver and kidney failure. I was medically evacuated to Miami, where I spent three weeks in a coma, followed by two more months recovering at hospitals in Miami and Virginia.
I am now home and focused on healing over the next several months with the help of my family and friends. I am thankful for my life, but this experience has been humbling and difficult, as I’ve had to relearn how to do very basic things. Working with therapists, I am learning how to eat, swallow, walk, and even speak— as my vocal cords were damaged while I was intubated.
I continue to reflect on my time with patients in moments when I get frustrated with my own recovery. Whether managing complex medications or relearning simple tasks like using scissors, I often think of my patients’ courage, dedication, and determination to balance their pill boxes, therapies, and daily lives while navigating chronic illness. You all have truly inspired me!
I also wanted to share that Project Nido 2025 was a success! The team treated more than 500 patients in one week, continuing the mission to bring compassionate care to underserved communities.
As I close this chapter of my time with the Kaplan Center in order to focus on recovering my health, I am comforted to know that the patients who I have served during my time with the center will continue to be in good hands in their health and wellness journeys.
Thank you again for allowing me to be part of your care and your healing process.
With warmth and appreciation,
Nidhi Reva, MPH, PA-C
Once upon a time it was thought that the health of our gut was only dictated by what we ate and that any problems originating in the gut stayed in the gut. Fast forward to today where research has shown that those two ideas are almost completely inaccurate. Not only is our digestive system far more complex than once understood, but we now know that there are many factors beyond diet that profoundly affect our gut health; and because the gut plays a central role in immune function, metabolism, hormone regulation, and even brain health, its balance is directly tied to our long-term vitality. In other words, a healthy gut is not just about feeling better today—it’s one of the most important investments we can make in our future well-being.
The gut microbiome is made up of trillions of tiny microorganisms. When the gut becomes unbalanced and harmful bacteria outnumber beneficial strains, it can trigger a cascade of health issues throughout the body. Key factors that influence the make up of our microbiome include diet, sleep, stress, medications, environmental exposures, and lifestyle.
Digestive symptoms such as gas and bloating may be the first warning signs of an imbalance, but when left unaddressed, other more serious conditions can manifest—such as autoimmune disorders, mood disorders, chronic joint and muscle pain, or cardiovascular disease. By restoring and nurturing a healthy balance of gut bacteria, we not only see an improvement of symptoms, but we enhance immune resilience, emotional well-being, metabolic function, and digestion—all essential pillars of healthy aging and key contributors to long-term vitality and longevity.
Restoring gut balance
1. Increase your fiber intake
A simple but effective step. Nutrition experts say adults should consume at least 25 grams of fiber each day for regulating digestion (it’s thought that most Americans eat only 16 grams a day on average). Fiber also acts as a prebiotic, serving as a food source for many strains of beneficial gut bacteria. Apples, avocados, bananas, potatoes, lentils, and oats are just a few examples of fiber-rich foods.
2. Consider gut-friendly diets: Low-FODMAP diet
Common diets for individuals with conditions like Irritable Bowel Syndrome (IBS) include the low-FODMAP diet, a specific carbohydrate exclusion diet. Those with IBS may experience symptoms such as cramping, diarrhea or bloating after consuming certain carbohydrates that are hard to digest; the low-FODMAP diet eliminates these carbohydrates. A 2017 study in the Journal Gastroenterology & Hepatology reviewed existing research and found that 50% to 86% of people with IBS responded well to a low-FODMAP diet.
However, before starting any gut-friendly diet, it is important to remember that diets like FODMAP come with mixed results. They work well for some individuals while having no impact on others. It is always advised to speak to a physician or nutritionist about any major changes to your diet.
3. Stay active
Regular exercise has positive effects on the gut microbiome. Whether it’s running, walking, yoga or going to the gym, any exercise is good. Recent studies suggest that exercise can enhance the number of good bacteria in the gut.
4. Add food diversity to your diet
A healthy microbiome is one that’s diverse. That means the microbiome is populated with a range of food items: asparagus, artichokes, radishes, leeks, and particularly fermented foods like: sauerkraut, kefir, kimchi and miso. A 2016 study in the Journal Molecular Metabolism notes that the more diverse the diet, the more diverse the microbiome and the more adaptable it will be to changes.
5. Dealing with stress? Consider cognitive behaviour therapy
The term “butterflies in your stomach” refers to having a nervous feeling in the stomach during certain situations. Although it’s not meant to be taken literally, there is a lot of truth to the statement as it links our feelings to digestion. Anger, anxiety, sadness — all of these feelings (and others) can trigger symptoms in the gut. This is where Cognitive Behavioral Therapy (CBT) might help. CBT is one of the most common forms of psychotherapy. It is a form of talk therapy that explores the way that your thoughts and emotions impact your behavior and health. The therapy can help teach relaxation to reduce stress, and promote relaxation which can in turn reduce gut symptoms.
6. Limit the amount of processed food you eat
Highly processed foods can throw the microbiome off balance. Replace canned foods, soft drinks and packaged snack foods with natural, whole foods.
7. Probiotics
Early studies have suggested that imbalances in intestinal bacteria can cause “arthritis, diarrhea, autoimmune illness, B12 deficiency, chronic fatigue syndrome.” Probiotics may help correct that imbalance. Probiotics are defined as live microorganisms that may have health benefits when consumed or applied to the body. While this is still an emerging field of study, researchers have found that certain strains of probiotics can help reduce inflammation in people with certain diseases. You can find probiotics in yogurt and fermented foods.
8. Cut back on NSAIDs.
Regular use of non-steroidal anti-inflammatory drugs medications (NSAIDs) such as Ibuprofen or Aspirin can cause a massive disruption of the gut flora. NSAIDs simultaneously reduce pain and prevent healing, and because the lining of the intestines is repaired and replaced every 3 to 5 days, the mechanism of NSAIDs dangerously interrupts and blocks that process.
By incorporating some of the simple daily practices mentioned above, you can restore microbial balance to your gut and strengthen the foundations of lifelong vitality. A healthier gut today truly sets the stage for healthier aging tomorrow!
If you have health and nutrition goals you’re still striving to meet, our Team is here to help. Call us at 703-532-4892 to schedule an appointment!
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
Mid-life is when both women and men often experience changes in mood, sex drive and energy levels. Many tend to think it is “normal” or “a phase,” but it may actually be hormonal imbalance. While this phase is more common with women in and before menopause, science shows that men experience hormonal imbalance and its side effects, as well.
As there is no single solution that works for everyone, it is best to be tested and have an individualized approach prescribed for you, with options for natural remedies, as well as other treatments.
Female Hormonal Fluctuation
Perimenopause, the time leading up to menopause, gets little attention, but should. It is characterized by night sweats, irritability, and can cause havoc for over a decade before women experience menopause—heavy and/or sporadic periods, hot flashes and, ultimately, menstrual cessation. There are a number of natural hormonal balancing remedies, such as herbs, that can provide significant relief from perimenopause symptoms with little or no risk (e.g. Chaste Tree Berry and Shepard’s Purse). When herbs and supplements cease to offer relief, hormone replacement therapy (HRT) can relieve many of those unpleasant symptoms. Recent guidelines support starting hormone replacement therapy earlier than waiting for full menopause, which is one year with no period. This alleviates the uncomfortable symptoms of hot flashes and sleep disturbance, and protects against the inevitable loss of bone mass with loss of estrogen.
Hormone Replacement Therapy and Bio-Identical Hormones
It is important to have a specialist review your entire medical history and condition prior to considering HRT, as it is not without risks. A family history of breast cancer, stroke or heart disease may make this type of therapy inadvisable. Those specific risks may not be a concern with “bioidentical” or “natural hormones.” This is the approach we favor most, based on its safety. A bioidentical hormone mimics the body’s natural state, and has been synthesized from a natural botanical source. We prefer that these hormones be administered transdermally, so that the hormones bypass the liver and go directly through the skin and into the bloodstream, then onto the target cells (e.g., the brain, skin, vagina).
Male Hormonal Imbalances DO Impact Social/Work Life
It isn’t only women who experience serious disruptions to their work or lives; men are greatly affected as well, although it is generally less publicized. Men manifest some symptoms similar to women, however, the fluctuations in men are often fleeting. Unfortunately when hormonal imbalance affects men’s bodies, moods, and concentration, it is seldom noticed.
Just as with women, hormones in men tend to fluctuate more with age. Imbalances in men and women may cause bone loss, depression, irritability, weight gain, and weight or muscle loss; but men may also experience impotence or erectile dysfunction. Testosterone Pellet Therapy is an effective, convenient, and safe method to raise low testosterone levels for both men and women with benefits that enhance multiple areas of health. Pellets provide an even and consistent dose of testosterone and only need to be administered every 5-6 months. Testosterone can aslo be given by gel, patch, compound creams, or injection.
At the Kaplan Center, we take everything – all medical and natural options – into consideration to create a personalized treatment plan. If you are experiencing any of the symptoms described above and would like to regain a more stable, symptoms-free life, call 703-532-4892.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
From Compassionate Care to Personal Healing: A Letter to My Patients
/in News/by Kaplan CenterThe Kaplan Center for Integrative Medicine is a place known for its compassion, innovation, and truly personalized care. As many of you know, I am no longer practicing at the Kaplan Center. It has been one of the greatest honors of my career to care for such thoughtful, resilient, and inspiring patients.
In past newsletters, I’ve mentioned that I travel each year to Ecuador for a medical mission called Project Nido. Shortly after arriving there in August, I began to experience abdominal pain that required emergency surgery. Unfortunately, my condition became complicated by sepsis, DIC, and liver and kidney failure. I was medically evacuated to Miami, where I spent three weeks in a coma, followed by two more months recovering at hospitals in Miami and Virginia.
I am now home and focused on healing over the next several months with the help of my family and friends. I am thankful for my life, but this experience has been humbling and difficult, as I’ve had to relearn how to do very basic things. Working with therapists, I am learning how to eat, swallow, walk, and even speak— as my vocal cords were damaged while I was intubated.
I continue to reflect on my time with patients in moments when I get frustrated with my own recovery. Whether managing complex medications or relearning simple tasks like using scissors, I often think of my patients’ courage, dedication, and determination to balance their pill boxes, therapies, and daily lives while navigating chronic illness. You all have truly inspired me!
I also wanted to share that Project Nido 2025 was a success! The team treated more than 500 patients in one week, continuing the mission to bring compassionate care to underserved communities.
As I close this chapter of my time with the Kaplan Center in order to focus on recovering my health, I am comforted to know that the patients who I have served during my time with the center will continue to be in good hands in their health and wellness journeys.
Thank you again for allowing me to be part of your care and your healing process.
With warmth and appreciation,
Nidhi Reva, MPH, PA-C
8 Steps to a Healthier Gut—and a Longer, Healthier Life
/in Digestive Issues, Inflammation, Wellness/by Kaplan CenterOnce upon a time it was thought that the health of our gut was only dictated by what we ate and that any problems originating in the gut stayed in the gut. Fast forward to today where research has shown that those two ideas are almost completely inaccurate. Not only is our digestive system far more complex than once understood, but we now know that there are many factors beyond diet that profoundly affect our gut health; and because the gut plays a central role in immune function, metabolism, hormone regulation, and even brain health, its balance is directly tied to our long-term vitality. In other words, a healthy gut is not just about feeling better today—it’s one of the most important investments we can make in our future well-being.
The gut microbiome is made up of trillions of tiny microorganisms. When the gut becomes unbalanced and harmful bacteria outnumber beneficial strains, it can trigger a cascade of health issues throughout the body. Key factors that influence the make up of our microbiome include diet, sleep, stress, medications, environmental exposures, and lifestyle.
Digestive symptoms such as gas and bloating may be the first warning signs of an imbalance, but when left unaddressed, other more serious conditions can manifest—such as autoimmune disorders, mood disorders, chronic joint and muscle pain, or cardiovascular disease. By restoring and nurturing a healthy balance of gut bacteria, we not only see an improvement of symptoms, but we enhance immune resilience, emotional well-being, metabolic function, and digestion—all essential pillars of healthy aging and key contributors to long-term vitality and longevity.
Restoring gut balance
1. Increase your fiber intake
A simple but effective step. Nutrition experts say adults should consume at least 25 grams of fiber each day for regulating digestion (it’s thought that most Americans eat only 16 grams a day on average). Fiber also acts as a prebiotic, serving as a food source for many strains of beneficial gut bacteria. Apples, avocados, bananas, potatoes, lentils, and oats are just a few examples of fiber-rich foods.
2. Consider gut-friendly diets: Low-FODMAP diet
Common diets for individuals with conditions like Irritable Bowel Syndrome (IBS) include the low-FODMAP diet, a specific carbohydrate exclusion diet. Those with IBS may experience symptoms such as cramping, diarrhea or bloating after consuming certain carbohydrates that are hard to digest; the low-FODMAP diet eliminates these carbohydrates. A 2017 study in the Journal Gastroenterology & Hepatology reviewed existing research and found that 50% to 86% of people with IBS responded well to a low-FODMAP diet.
However, before starting any gut-friendly diet, it is important to remember that diets like FODMAP come with mixed results. They work well for some individuals while having no impact on others. It is always advised to speak to a physician or nutritionist about any major changes to your diet.
3. Stay active
Regular exercise has positive effects on the gut microbiome. Whether it’s running, walking, yoga or going to the gym, any exercise is good. Recent studies suggest that exercise can enhance the number of good bacteria in the gut.
4. Add food diversity to your diet
A healthy microbiome is one that’s diverse. That means the microbiome is populated with a range of food items: asparagus, artichokes, radishes, leeks, and particularly fermented foods like: sauerkraut, kefir, kimchi and miso. A 2016 study in the Journal Molecular Metabolism notes that the more diverse the diet, the more diverse the microbiome and the more adaptable it will be to changes.
5. Dealing with stress? Consider cognitive behaviour therapy
The term “butterflies in your stomach” refers to having a nervous feeling in the stomach during certain situations. Although it’s not meant to be taken literally, there is a lot of truth to the statement as it links our feelings to digestion. Anger, anxiety, sadness — all of these feelings (and others) can trigger symptoms in the gut. This is where Cognitive Behavioral Therapy (CBT) might help. CBT is one of the most common forms of psychotherapy. It is a form of talk therapy that explores the way that your thoughts and emotions impact your behavior and health. The therapy can help teach relaxation to reduce stress, and promote relaxation which can in turn reduce gut symptoms.
6. Limit the amount of processed food you eat
Highly processed foods can throw the microbiome off balance. Replace canned foods, soft drinks and packaged snack foods with natural, whole foods.
7. Probiotics
Early studies have suggested that imbalances in intestinal bacteria can cause “arthritis, diarrhea, autoimmune illness, B12 deficiency, chronic fatigue syndrome.” Probiotics may help correct that imbalance. Probiotics are defined as live microorganisms that may have health benefits when consumed or applied to the body. While this is still an emerging field of study, researchers have found that certain strains of probiotics can help reduce inflammation in people with certain diseases. You can find probiotics in yogurt and fermented foods.
8. Cut back on NSAIDs.
Regular use of non-steroidal anti-inflammatory drugs medications (NSAIDs) such as Ibuprofen or Aspirin can cause a massive disruption of the gut flora. NSAIDs simultaneously reduce pain and prevent healing, and because the lining of the intestines is repaired and replaced every 3 to 5 days, the mechanism of NSAIDs dangerously interrupts and blocks that process.
By incorporating some of the simple daily practices mentioned above, you can restore microbial balance to your gut and strengthen the foundations of lifelong vitality. A healthier gut today truly sets the stage for healthier aging tomorrow!
If you have health and nutrition goals you’re still striving to meet, our Team is here to help. Call us at 703-532-4892 to schedule an appointment!
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
References
https://www.hopkinsmedicine.org/health/wellness-and-prevention/fodmap-diet-what-you-need-to-know#
https://my.clevelandclinic.org/health/treatments/22466-low-fodmap-diet
https://www.health.harvard.edu/staying-healthy/ibs-a-low-fodmap-diet-may-help
https://www.bmj.com/content/361/bmj.k2179
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357536/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837298/#
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1727292/
Mid-Life Irritability & Fatigue Improved by Hormonal Balancing
/in Hormone Health, Treatments/by Lisa Lilienfield, MDMid-life is when both women and men often experience changes in mood, sex drive and energy levels. Many tend to think it is “normal” or “a phase,” but it may actually be hormonal imbalance. While this phase is more common with women in and before menopause, science shows that men experience hormonal imbalance and its side effects, as well.
As there is no single solution that works for everyone, it is best to be tested and have an individualized approach prescribed for you, with options for natural remedies, as well as other treatments.
Female Hormonal Fluctuation
Perimenopause, the time leading up to menopause, gets little attention, but should. It is characterized by night sweats, irritability, and can cause havoc for over a decade before women experience menopause—heavy and/or sporadic periods, hot flashes and, ultimately, menstrual cessation. There are a number of natural hormonal balancing remedies, such as herbs, that can provide significant relief from perimenopause symptoms with little or no risk (e.g. Chaste Tree Berry and Shepard’s Purse). When herbs and supplements cease to offer relief, hormone replacement therapy (HRT) can relieve many of those unpleasant symptoms. Recent guidelines support starting hormone replacement therapy earlier than waiting for full menopause, which is one year with no period. This alleviates the uncomfortable symptoms of hot flashes and sleep disturbance, and protects against the inevitable loss of bone mass with loss of estrogen.
Hormone Replacement Therapy and Bio-Identical Hormones
It is important to have a specialist review your entire medical history and condition prior to considering HRT, as it is not without risks. A family history of breast cancer, stroke or heart disease may make this type of therapy inadvisable. Those specific risks may not be a concern with “bioidentical” or “natural hormones.” This is the approach we favor most, based on its safety. A bioidentical hormone mimics the body’s natural state, and has been synthesized from a natural botanical source. We prefer that these hormones be administered transdermally, so that the hormones bypass the liver and go directly through the skin and into the bloodstream, then onto the target cells (e.g., the brain, skin, vagina).
Male Hormonal Imbalances DO Impact Social/Work Life
It isn’t only women who experience serious disruptions to their work or lives; men are greatly affected as well, although it is generally less publicized. Men manifest some symptoms similar to women, however, the fluctuations in men are often fleeting. Unfortunately when hormonal imbalance affects men’s bodies, moods, and concentration, it is seldom noticed.
Just as with women, hormones in men tend to fluctuate more with age. Imbalances in men and women may cause bone loss, depression, irritability, weight gain, and weight or muscle loss; but men may also experience impotence or erectile dysfunction. Testosterone Pellet Therapy is an effective, convenient, and safe method to raise low testosterone levels for both men and women with benefits that enhance multiple areas of health. Pellets provide an even and consistent dose of testosterone and only need to be administered every 5-6 months. Testosterone can aslo be given by gel, patch, compound creams, or injection.
At the Kaplan Center, we take everything – all medical and natural options – into consideration to create a personalized treatment plan. If you are experiencing any of the symptoms described above and would like to regain a more stable, symptoms-free life, call 703-532-4892.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
Updated on November 13, 2025.