Dr. Tom Biernacki, DPM, FACFAS 
Quick answer: Testosterone levels in American men have declined an average of 1% per year since the 1980s — a generational trend not explained by aging alone — with population studies showing men in their 60s today have testosterone levels 15–20% lower than men the same age in the 1980s, while simultaneously a 2% per … Read more
Quick answer: Long COVID — persistent symptoms lasting 12 or more weeks after SARS-CoV-2 infection affecting an estimated 65 million people globally (Davis 2023, Nature Reviews Microbiology) — is now recognized as a multi-system condition with identifiable mechanisms including viral persistence, microclot-induced microvascular obstruction, reactivation of latent herpesviruses (particularly Epstein-Barr virus), immune dysregulation with CD8+ … Read more
Quick answer: The human gut microbiome — a community of approximately 38 trillion microbial cells harboring 150 times more genes than the human genome — regulates immune function, metabolism, neurotransmitter synthesis, inflammation, and even gene expression, with fecal microbiota transplantation (FMT) achieving 90% cure rates for recurrent Clostridioides difficile infection (versus 30% for antibiotics), and … Read more
Quick answer: Mitochondrial dysfunction — the failure of the cell’s energy-producing organelles — is now recognized as a central upstream driver of over 50 named diseases including type 2 diabetes, heart failure, Parkinson’s disease, Alzheimer’s disease, ALS, fibromyalgia, chronic fatigue syndrome, and cancer, with emerging evidence that mitochondrial biogenesis (the creation of new, healthy mitochondria … Read more
Quick answer: Heavy metal toxicity — from lead, mercury, arsenic, and cadmium — affects an estimated 8.4 million Americans at blood levels now recognized to cause cardiovascular disease, cognitive decline, and metabolic dysfunction, with the landmark TACT trial (2013, JAMA, n=1,708) demonstrating a 26% reduction in cardiovascular events with EDTA chelation therapy in post-MI patients … Read more
Quick answer: The CDC estimates 476,000 Americans are diagnosed with Lyme disease annually — yet 10–36% of treated patients develop Post-Treatment Lyme Disease Syndrome (PTLDS), a constellation of fatigue, cognitive impairment, and musculoskeletal pain persisting months to years after standard antibiotic therapy, with no FDA-approved treatment and substantial evidence pointing to biofilm persistence, immune dysregulation, … Read more
Quick answer: Hormone replacement therapy for women has been transformed by 20+ years of post-WHI evidence reassessment: the Women’s Health Initiative’s 2002 alarming findings applied to older women (average age 63) using synthetic conjugated equine estrogen + medroxyprogesterone acetate — not to bioidentical hormones or women in their 40s-50s using the “timing hypothesis” window. Modern … Read more
Quick answer: Adrenal dysfunction — encompassing HPA axis dysregulation, subclinical cortisol excess (functional hypercortisolism), cortisol insufficiency (burnout pattern), DHEA deficiency, and aldosterone dysregulation — is one of the most prevalent and under-recognized conditions in functional medicine practice. The 4-point salivary cortisol test with DHEA and the Cortisol Awakening Response (CAR) provides a comprehensive map of … Read more
Quick answer: Sleep is not rest — it is the most anabolically productive state of the 24-hour biological cycle, during which the glymphatic system clears 60% more neurotoxic waste (including amyloid-beta and tau), growth hormone peaks (accounting for 75% of daily GH secretion), immune memory consolidation occurs, adipokine homeostasis is restored, and cardiovascular risk protection … Read more
Quick answer: Obesity is not a failure of willpower — it is a complex neuroendocrine disease with a defended metabolic set point, driven by adipokine dysregulation, gut hormone resistance, hypothalamic inflammation, mitochondrial dysfunction, and profound genetic complexity (540+ identified genetic loci). The functional medicine approach to weight loss addresses the biological mechanisms driving set point … Read more