Transcript of The Functional Medicine Approach to Patient Care Scott Antoine, DO, FACEP Vine Healthcare, LLC.
- Slide 1
- The Functional Medicine Approach to Patient Care Scott Antoine,
DO, FACEP Vine Healthcare, LLC
- Slide 2
- Objectives To provide a definition of Functional Medicine To
provide a definition of Functional Medicine To define the need for
a paradigm shift in healthcare and the role of Functional Medicine
in that shift To define the need for a paradigm shift in healthcare
and the role of Functional Medicine in that shift To show that
Functional Medicine is Osteopathic Medicine To show that Functional
Medicine is Osteopathic Medicine To outline the Functional Medicine
approach to patient evaluation and treatment To outline the
Functional Medicine approach to patient evaluation and
treatment
- Slide 3
- Functional Medicine Also known as: Functional and Integrative
Medicine, Holistic Medicine, Systems Medicine
- Slide 4
- The 4 Ps of Functional Medicine Personalized - genetic and
environmental variations drive individual treatments Personalized -
genetic and environmental variations drive individual treatments
Predictive - tailored health strategies based upon a personalized
map of health risks with traditional and novel biomarkers
Predictive - tailored health strategies based upon a personalized
map of health risks with traditional and novel biomarkers
Preventive - proactive vs. reactive approaches which shift from
illness to wellness, from disease treatment to functional
enhancement Preventive - proactive vs. reactive approaches which
shift from illness to wellness, from disease treatment to
functional enhancement Participatory - empowers and engages the
patient Participatory - empowers and engages the patient
- Slide 5
- Ultimately. Functional Medicine is about balance: Removes what
is NOT supposed to be in the system Removes what is NOT supposed to
be in the system Adds (or maintains) what IS supposed to be in the
system Adds (or maintains) what IS supposed to be in the
system
- Slide 6
- Osteopathic Medicine DOs practice a "whole person" approach to
medicine. Instead of just treating you for specific symptoms or
illnesses, they regard your body as an integrated whole DOs
practice a "whole person" approach to medicine. Instead of just
treating you for specific symptoms or illnesses, they regard your
body as an integrated whole Osteopathic physicians focus on
preventive health care Osteopathic physicians focus on preventive
health care --From the website of the American Osteopathic
Association
- Slide 7
- Academic Interest in Functional Medicine Institute of
Functional Medicine (IFM) Basic and advanced courses in Functional
Medicine Basic and advanced courses in Functional Medicine
Attendees from 60 academic centers and residencies including:
Attendees from 60 academic centers and residencies including:
Albert Einstein (NY), Duke, Johns Hopkins, Harvard, UCLA, Penn,
UNC, Des Moines Osteopathic, Lake Erie College of Osteopathic
Medicine
- Slide 8
- Corporate and Government Interest Medical insurers such as
CIGNA are considering pilot programs using Functional Medicine
Medical insurers such as CIGNA are considering pilot programs using
Functional Medicine VA is exploring research in Functional Medicine
VA is exploring research in Functional Medicine Supported by 12
Senators, Medicare has expressed interest in pilot programs for
intensive lifestyle change programs Supported by 12 Senators,
Medicare has expressed interest in pilot programs for intensive
lifestyle change programs
- Slide 9
- Traditional Approach to the Patient Encounter The patient
presents with symptom(s) The patient presents with symptom(s) A
history of the chief complaint is taken A history of the chief
complaint is taken Pertinent past medical history is obtained
Pertinent past medical history is obtained A physical examination
is performed A physical examination is performed A differential
diagnosis is made and testing is performed A differential diagnosis
is made and testing is performed A named disease may or may not be
found A named disease may or may not be found Medicine is given to
treat the disease or lessen symptoms Medicine is given to treat the
disease or lessen symptoms
- Slide 10
- Traditional Approach to the Patient Encounter Relies on
deductive reasoning and reductionism Relies on deductive reasoning
and reductionism Name it and blame it Name it and blame it A drug
for each bug A drug for each bug A pill for each ill A pill for
each ill Sherlock Holmes and the Clue analogy Sherlock Holmes and
the Clue analogy Works well for acute illness or injury Works well
for acute illness or injury
- Slide 11
- You Have a Flat Tire Call a specialist Call a specialist Look
at the tire Look at the tire Decide if it is a nail, sidewall
damage, etc Decide if it is a nail, sidewall damage, etc Fix the
problem and (hopefully) stop the leak Fix the problem and
(hopefully) stop the leak This is an acute care situation This is
an acute care situation
- Slide 12
- Several Problems Tire is flat Tire is flat Brakes are bad
Brakes are bad Hole in the muffler Hole in the muffler Need a bunch
of specialists Need a bunch of specialists If we fix these 3
problems, is the car in good shape ? If we fix these 3 problems, is
the car in good shape ? This is the chronic illness model This is
the chronic illness model
- Slide 13
- The Burden of Chronic Illness Data compiled in the World Health
Organization Non-Communicable Disease (NCD) Country Profile report
(2011) Data compiled in the World Health Organization
Non-Communicable Disease (NCD) Country Profile report (2011)
Described mortality causes for 193 member states to the WHO
Described mortality causes for 193 member states to the WHO Data
compiled for causes and risk factors Data compiled for causes and
risk factors
- Slide 14
- Causes of Mortality (Kenya)
- Slide 15
- Causes of Mortality (USA)
- Slide 16
- Change in BMI (USA)
- Slide 17
- Change in Blood Glucose (USA)
- Slide 18
- Risk Factors
- Slide 19
- The Burden of Chronic Disease March 14, 2002 Study NEJM by R.
Sinha et al (Vol 346 (11);802-810) showed that: March 14, 2002
Study NEJM by R. Sinha et al (Vol 346 (11);802-810) showed that: 55
obese children (4-10 years old) --25% had impaired glucose
tolerance 55 obese children (4-10 years old) --25% had impaired
glucose tolerance 112 obese teens (11-18 years old) -21% had
impaired glucose tolerance. Four were diagnosed with type II DM 112
obese teens (11-18 years old) -21% had impaired glucose tolerance.
Four were diagnosed with type II DM Recent estimates indicate that
1/3 of people born in 2000 will eventually be diabetic Recent
estimates indicate that 1/3 of people born in 2000 will eventually
be diabetic
- Slide 20
- How Sick is Sick? Number of Chronic ConditionsPercentage of
Medicare Spending 5+68% 412% 310% 26% 13% 01%
- Slide 21
- The Problem We are treating chronic illness with the acute care
model We are treating chronic illness with the acute care model
Patients are broken into organ systems (GI, Cardiac..) Patients are
broken into organ systems (GI, Cardiac..) There is a failure to
recognize web-like interactions of multiple comorbidities,
antecedents, and triggers, in chronically-ill patients There is a
failure to recognize web-like interactions of multiple
comorbidities, antecedents, and triggers, in chronically-ill
patients Consequences Consequences Polypharmacy leading to
non-compliance and adverse drug reactions Polypharmacy leading to
non-compliance and adverse drug reactions Coordination of care
among specialists may be difficult Coordination of care among
specialists may be difficult Duplication of tests and therapies
Duplication of tests and therapies The fire may be out, but the
embers are still smoldering The fire may be out, but the embers are
still smoldering
- Slide 22
- How Could Your Car be Restored? Comprehensive inspection
(unique to your car) Comprehensive inspection (unique to your car)
Examine each system from the inside, look for problems (take it all
apart), and look for connections Examine each system from the
inside, look for problems (take it all apart), and look for
connections Add what is missing and needed Add what is missing and
needed Get rid of what does not belong and causes problems Get rid
of what does not belong and causes problems Keep up maintenance and
buy good gas Keep up maintenance and buy good gas This is
Functional Medicine This is Functional Medicine
- Slide 23
- Basic Principles of Functional Medicine 1.The Continuum of
Wellness Pre-Diabetes Pre-Diabetes Pre-Hypertension
Pre-Hypertension Pre-Dementia Pre-Dementia Are these all separate
diseases or are they just pit-stops along a continuum from optimal
wellness to illness? Are these all separate diseases or are they
just pit-stops along a continuum from optimal wellness to
illness?
- Slide 24
- Basic Principles of Functional Medicine In August 2009, after
six years of planning, Johns Hopkins University School of Medicine
rolled out the Genes to Society Curriculum. This novel curriculum
rejects the notion that there is "normal" or "abnormal" in
medicine. Rather, everyone is on a continuum. The curriculum takes
a systems approach to understanding all levels of the human being -
from genes, molecules, cells, and organs of the patient on one end,
to the familial, community, societal, and environmental components
at the other end. The GTS curriculum integrates all of these
variables to help students understand why patients present the way
they do. In August 2009, after six years of planning, Johns Hopkins
University School of Medicine rolled out the Genes to Society
Curriculum. This novel curriculum rejects the notion that there is
"normal" or "abnormal" in medicine. Rather, everyone is on a
continuum. The curriculum takes a systems approach to understanding
all levels of the human being - from genes, molecules, cells, and
organs of the patient on one end, to the familial, community,
societal, and environmental components at the other end. The GTS
curriculum integrates all of these variables to help students
understand why patients present the way they do.
http://www.hopkinsmedicine.org/som/admissions/md/curriculum/g
ts.html
- Slide 25
- Basic Principles of Functional Medicine 2.Wellness is a
positive vitality and not merely the absence of disease 3.The
decline of ICD-9 (and 10) and the emergence of models of systems
medicine 4.Recognition of a web-like interconnectivity of bodily
systems
- Slide 26
- Basic Principles of Functional Medicine The NIH Roadmap.
Science, vol 302, Oct 2003, Elias Zerhouni New Pathways to
Discovery. This theme addresses the need to understand complex
biological systems. Future progress in medicine will require
quantitative knowledge about the many interconnected networks of
molecules that comprise cells and tissues, along with improved
insights into how these networks are regulated and interact with
each other.
- Slide 27
- Basic Principles of Functional Medicine 5.Underlying Causes of
Disease A.The Exposome Toxins (drugs, chemicals, radiation, EMF)
Toxins (drugs, chemicals, radiation, EMF) Nutrition (as a toxin)
Nutrition (as a toxin) Stress Stress Allergens Allergens Infections
Infections Trauma Trauma **Damage is from direct mechanical
effects, gene interaction, or metabolic effects**
- Slide 28
- The Exposome What is the exposome? Success in mapping the human
genome has fostered the complementary concept of the "exposome".
The exposome can be defined as the measure of all the exposures of
an individual in a lifetime and how those exposures relate to
health. An individuals exposure begins before birth and includes
insults from environmental and occupational sources. Understanding
how exposures from our environment, diet, lifestyle, etc. interact
with our own unique characteristics such as genetics, physiology,
and epigenetics impact our health is how the exposome will be
articulated. Source: The Centers For Disease Control (CDC)
website
- Slide 29
- Basic Principles of Functional Medicine 5.Underlying Causes of
Disease (continued) B.The Genome (genetic variation) Inherited
(Familial) differences Inherited (Familial) differences SNPs
(Single Nucleotide Polymorphisms)- must occur in at least 1% of the
population SNPs (Single Nucleotide Polymorphisms)- must occur in at
least 1% of the
populationhttp://ghr.nlm.nih.gov/handbook/genomicresearch/snp
http://www.cancer.gov/cancertopics/understandingcanc
er/geneticvariation
- Slide 30
- Single Nucleotide Polymorphisms (SNPs)
- Slide 31
- SNPs and Cancer Risk
- Slide 32
- SNPs and Drug Interactions
- Slide 33
- Facts About SNPs Occur about 1 time per 1000 base pairs Occur
about 1 time per 1000 base pairs Make up the bulk of the 3 million
variations found in the genome Make up the bulk of the 3 million
variations found in the genome One third or more effect
coenzyme-binding sites for vitamins or nutrients and therefore have
a role in disease or dysfunction * One third or more effect
coenzyme-binding sites for vitamins or nutrients and therefore have
a role in disease or dysfunction * * B Ames. Cancer Prevention and
Diet: help from single nucleotide polymorphisms. Proc Natl Acad Sci
USA 1999;96(22):12216-18
- Slide 34
- SNPs and Nutrients Our analysis of metabolic disease that
affects cofactor binding, particularly as a result of polymorphic
mutations, may present a novel rationale for high-dose vitamin
therapy, perhaps hundreds of times the normal dietary reference
intakes (DRI) in some cases..* Our analysis of metabolic disease
that affects cofactor binding, particularly as a result of
polymorphic mutations, may present a novel rationale for high-dose
vitamin therapy, perhaps hundreds of times the normal dietary
reference intakes (DRI) in some cases..* *B Ames. High dose vitamin
therapy stimulates variant enzymes with decreased coenzyme binding
affinity (increased Km): relevance to genetic disease and
polymorphisms. Am J Clin Nutr. 2002;75:616-658
- Slide 35
- MTHFR A Case in Point Methelenetetrahydrofolate reductase
Methelenetetrahydrofolate reductase Responsible for donating a
methyl group to B12 which then converts homocysteine to methionine
Responsible for donating a methyl group to B12 which then converts
homocysteine to methionine SNP results in thermolabile enzyme which
is 50% less active than normal SNP results in thermolabile enzyme
which is 50% less active than normal Increased homocysteine results
Increased homocysteine results
- Slide 36
- The Homocysteine Cycle Folat e THF 5,10-CH 2 -THF 5-CH 3 -THF
MTHFR B 12 CH 3 -B 12 Methionine Homocysteine
- Slide 37
- MTHFR A Case in Point Homocysteine and Ischemic Heart Disease :
Results of a Prospective Study With Implications Regarding
Prevention Arch Intern Med. 1998;158(8):862-867 229 men without CAD
who went on to die of CAD 229 men without CAD who went on to die of
CAD Matched to 1126 men of similar age Matched to 1126 men of
similar age Continuous dose-response relationship. Higher
homocysteine = more CAD Continuous dose-response relationship.
Higher homocysteine = more CAD ML Silaste, et al, Polymorphisms of
key enzymes in homocysteine metabolism, affect diet responsiveness
of plasma homocysteine in healthy women. J Nutr 2001;131:2643-47
Group of patients with MTHFR and Methionine Reductase SNPs Group of
patients with MTHFR and Methionine Reductase SNPs Low folate vs.
high folate diet (similar homocysteine at baseline) Low folate vs.
high folate diet (similar homocysteine at baseline) High folate
group had 18% reduction in homocysteine. Low folate group reduced
11% High folate group had 18% reduction in homocysteine. Low folate
group reduced 11%
- Slide 38
- Basic Principles of Functional Medicine 5.Underlying Causes of
Disease (continued) C.Epigenetics (the effect the exposome has on
your genome and genetic expression)
- Slide 39
- Epigenetics
- Slide 40
- Epigenetics
- Slide 41
- Epigenetics Diabetes and Epigenetics 100% of the increase in
prevalence of type II diabetes and obesity in the U.S. during the
latter half of the 20 th century must be attributed to a changing
environment interacting with genes, since 0% of the human genome
changed during this time period.. FW Booth, et al. Waging war on
modern chronic diseases: primary prevention through exercise
biology. J Appl Physiol. 2000; 88:774-87.
- Slide 42
- Basic Principles of Functional Medicine 5.Underlying Causes of
Disease (continued) D.Loss of Functional Reserve (will affect your
response to the exposome) MC Creditor. Hazards of Hospitalization
of the Elderly. Annals of Internal Medicine. 1993;
118(3):219-223
- Slide 43
- Basic Principles of Functional Medicine Epigenetics + Loss of
Functional Reserve =
- Slide 44
- Basic Principles of Functional Medicine 5.Underlying Causes of
Disease (continued) E.Deficiency States Hydration Hydration
Proteins Proteins Carbohydrates Carbohydrates Fats Fats Vitamins
Vitamins Cofactors and enzymes Cofactors and enzymes
- Slide 45
- Basic Principles of Functional Medicine The Macro/Micro Paradox
Symptoms are experienced at the macro or whole body level (nausea,
diarrhea, allergies, etc.) Symptoms are experienced at the macro or
whole body level (nausea, diarrhea, allergies, etc.) Causes of
symptoms (and abnormal function) occur at the micro level, often
with individual chemical reactions and processes Causes of symptoms
(and abnormal function) occur at the micro level, often with
individual chemical reactions and processes
- Slide 46
- Basic Principles of Functional Medicine The Macro/Micro Paradox
These micro changes may create whole system malfunction, even
though they may not seem related These micro changes may create
whole system malfunction, even though they may not seem related
Drugs directed at symptom relief (stop the diarrhea or heartburn)
rarely fix the underlying pathology Drugs directed at symptom
relief (stop the diarrhea or heartburn) rarely fix the underlying
pathology
- Slide 47
- Basic Principles of Functional Medicine The first component of
this challenge is to recognize that inadequate intakes of specific
nutrients may produce more than one disease, may produce diseases
by more than one mechanism, and may require several years for the
consequent morbidity to be sufficiently evident to be clinically
recognizable as disease. Because the intakes required to prevent
many of the long-latency disorders are higher than those required
to prevent the respective index diseases, recommendations based
solely on preventing the index diseases are no longer biologically
defensible. RP Heaney, Long-latency deficiency disease: insights
from calcium and vitamin D. Am J Clin Nutr 2003;78:9129
- Slide 48
- Basic Principles of Functional Medicine B. Ames. The Metabolic
Tune-Up: Metabolic Harmony and Disease Prevention. J. Nutr. 133:
1544S1548S, 2003. (University of California, Berkeley and Childrens
Hospital and Research Center at Oakland)
- Slide 49
- Basic Principles of Functional Medicine TO RECAP: 5.Underlying
Causes of Disease A.The Exposome B.The Genome (Genetic Variation)
C.Epigenetics D.Loss of Functional Reserve E.Deficiency States
- Slide 50
- Basic Principles of Functional Medicine 6.Nutrigenomics (the
epigenetics of food and nutrients) Advanced by Linus Pauling
Advanced by Linus Pauling Nutrients modulate physiologic processes
at the molecular level Nutrients modulate physiologic processes at
the molecular level This modulation gives rise to the phenotype of
health or disease This modulation gives rise to the phenotype of
health or disease There has been a growing recognition that both
macronutrients and micronutrients can be potent dietary signals
that influence metabolic programming of cells and have and
important role in the control of homeostasis M Muller, S Kersten.
Nutrigenomics: goals and strategies. Nat Rev Genet. 2003;
4:315-322
- Slide 51
- Nutrigenomics at Work
- Slide 52
- Basic Principles of Functional Medicine The Seven Core Clinical
Imbalances 1.Assimilation (Digestive, Absorptive, Microbiological
Balance) 2.Defense and Repair (Inflammation and Immune Function)
3.Energy (Oxidation/Reduction and Mitochondropathy)
4.Biotransformation and Elimination (Detoxification)
- Slide 53
- Basic Principles of Functional Medicine The Seven Core Clinical
Imbalances (contd) 5.Communication and Circulation (Hormonal and
Neurotransmitter Balance) 6. Structural Integrity (Cellular
Membrane Function to the Musculoskeletal System) 7.Mind/Body
Imbalances Notice there are 7 areas to address rather than the
12,000 diseases in ICD-9 or the 155,000 in ICD-10
- Slide 54
- Functional Medicine Approach A timeline history is taken
(including prenatal events) A timeline history is taken (including
prenatal events) Medical history, diet, and lifestyle factors are
incorporated into a complete life history Medical history, diet,
and lifestyle factors are incorporated into a complete life history
A physical examination is performed A physical examination is
performed Laboratory testing is performed relative to the
complaints AND to assess the general state of the patients
individual bodily functioning and toxicity Laboratory testing is
performed relative to the complaints AND to assess the general
state of the patients individual bodily functioning and toxicity
Genetic testing may be performed to look for specific disease risk
or modifications of dietary intake needed Genetic testing may be
performed to look for specific disease risk or modifications of
dietary intake needed Food sensitivity testing is often performed
Food sensitivity testing is often performed
- Slide 55
- Functional Medicine Approach Finally, a 2 step process to
individualized treatment of the patient occurs: 1.REMOVE what does
not belong in the body (bad foods, allergens, toxins, pathogens,
heavy metals) 2.RESTORE (add) what the body needs to thrive
(healthy foods, vitamins, minerals, botanicals, sleep, restoration,
healthy relationships, spiritual health)
- Slide 56
- The GI Tract Did You Know? The intestine is the PRIMARY immune
organ in the body---it contains almost 70% of the immune cells in
the body The intestine is the PRIMARY immune organ in the body---it
contains almost 70% of the immune cells in the body The intestine
produces 70% of all neurotransmitters The intestine produces 70% of
all neurotransmitters The small intestine contains as many neurons
as the spinal cord The small intestine contains as many neurons as
the spinal cord Balance in this system is vital for overall health
and disorder here produces many total body effects Balance in this
system is vital for overall health and disorder here produces many
total body effects
- Slide 57
- The GI Tract A microbiome of organisms (some good, some bad) A
microbiome of organisms (some good, some bad) A barrier to keep
toxins out and facilitate digestion A barrier to keep toxins out
and facilitate digestion A nervous system independent of your brain
which controls its function A nervous system independent of your
brain which controls its function
- Slide 58
- The GI Tract It is affected by What comes into the intestine
What comes into the intestine Toxins (GMOs, Pesticides, HFCS,
additives and preservatives) Toxins (GMOs, Pesticides, HFCS,
additives and preservatives) Inflammatory foods / allergens
Inflammatory foods / allergens High glycemic load foods High
glycemic load foods The health of the intestinal barrier The health
of the intestinal barrier What lives in the intestine What lives in
the intestine Normal bacteria Normal bacteria Yeast / pathologic
bacteria / viruses / parasites Yeast / pathologic bacteria /
viruses / parasites
- Slide 59
- Symptoms of Disordered GI Function Gastrointestinal
Gastrointestinal Nausea, vomiting, diarrhea, constipation, weight
loss. Nausea, vomiting, diarrhea, constipation, weight loss.
Abdominal pain, bloating, IBS, Crohns, Ulcerative Colitis, colon
cancer Abdominal pain, bloating, IBS, Crohns, Ulcerative Colitis,
colon cancer Immune Immune Frequent infections, bacterial
overgrowth, yeast overgrowth, lupus, rheumatoid arthritis Frequent
infections, bacterial overgrowth, yeast overgrowth, lupus,
rheumatoid arthritis Hematologic (blood cells) Hematologic (blood
cells) Anemia Anemia Decreased white blood cell count Decreased
white blood cell count
- Slide 60
- Symptoms of Disordered GI Function Cardiovascular
Cardiovascular High cholesterol and triglycerides, high blood
pressure, coronary vessel blockages High cholesterol and
triglycerides, high blood pressure, coronary vessel blockages
Dermatologic (skin) Dermatologic (skin) Rashes, hives, psoriasis
Rashes, hives, psoriasis Endocrine Endocrine Diabetes, metabolic
syndrome, decreased libido, abnormal periods, PMS Diabetes,
metabolic syndrome, decreased libido, abnormal periods, PMS
Neurologic / Psychiatric Neurologic / Psychiatric Migraines,
depression, anxiety, insomnia, fatigue, dementia, ADHD,
schizophrenia, brain fog Migraines, depression, anxiety, insomnia,
fatigue, dementia, ADHD, schizophrenia, brain fog
- Slide 61
- The Normal Intestine
- Slide 62
- Leaky Gut
- Slide 63
- Leaky Gut Consequences Impaired absorption of vitamins, amino
acids, minerals Impaired absorption of vitamins, amino acids,
minerals Increased chance of abnormal bacteria and yeast overgrowth
Increased chance of abnormal bacteria and yeast overgrowth Abnormal
or insufficient GI production of vital hormones and
neurotransmitters Abnormal or insufficient GI production of vital
hormones and neurotransmitters Triggering of the Immune system
Triggering of the Immune system
- Slide 64
- Triggering of The Immune System by GI Barrier Disruption
- Slide 65
- Controlling GI Damage Stress Stress Environmental toxins
(Pesticides, drugs, ETOH) Environmental toxins (Pesticides, drugs,
ETOH) Heavy metals Heavy metals And--- a Wonder Drug And--- a
Wonder Drug
- Slide 66
- Question: The Ideal Drug Name the drug which is inexpensive,
readily available, easy to use, and can treat a wide variety of
disorders with virtually no side effects. It has been shown to have
the ability to turn off cancer causing genes and turn on cancer
fighting genes
- Slide 67
- Healthy Food!
- Slide 68
- Healthy Foods Organic and grass-fed (or free-range) lean meats
Organic and grass-fed (or free-range) lean meats Small/wild fish
Small/wild fish Fresh organic vegetables with high fiber Fresh
organic vegetables with high fiber Fresh organic fruits Fresh
organic fruits Non-GMO foods Non-GMO foods Minimally processed
Minimally processed
- Slide 69
- Unhealthy Foods Meats and produce produced with pesticides,
hormones, antibiotics, and GMOs Meats and produce produced with
pesticides, hormones, antibiotics, and GMOs High Fructose Corn
Syrup. (It may be corn-sugar, but it will still kill you) High
Fructose Corn Syrup. (It may be corn-sugar, but it will still kill
you) Refined (especially white) sugar and grains Refined
(especially white) sugar and grains Any processed food Any
processed food Beware if more than 5 ingredients! Beware if more
than 5 ingredients!
- Slide 70
- Food Allergies The difference between food sensitivities and
allergies The difference between food sensitivities and allergies
Testing methods Testing methods Increased gut permeability may show
an allergic response to many foods due to sensitization by
particles exposed to the immune system Increased gut permeability
may show an allergic response to many foods due to sensitization by
particles exposed to the immune system
- Slide 71
- Most Common Pro-inflammatory/Allergenic Foods Gluten Gluten
Dairy Dairy Corn Corn Soy Soy Egg Egg Peanuts/other nuts
Peanuts/other nuts All are held as part of an elimination diet All
are held as part of an elimination diet
- Slide 72
- Gluten The protein gliaden is found in wheat and other grains
The protein gliaden is found in wheat and other grains 30% of
Northern Europeans carry the HLA DQ8 gene or DQ2 gene for celiac
disease 30% of Northern Europeans carry the HLA DQ8 gene or DQ2
gene for celiac disease 1% of the population (1 in 100) have celiac
disease. Many are undiagnosed 1% of the population (1 in 100) have
celiac disease. Many are undiagnosed Even in the absence of the
genetic predisposition or celiac antibodies, many people are gluten
sensitive Even in the absence of the genetic predisposition or
celiac antibodies, many people are gluten sensitive
- Slide 73
- Gluten Sensitivity-Why Now? Gluten has been in wheat for
thousands of years Gluten has been in wheat for thousands of years
Are we just better at diagnosing it? Are we just better at
diagnosing it? Is the incidence rising? Is the incidence rising? If
there is more gluten sensitivity, why now? If there is more gluten
sensitivity, why now?
- Slide 74
- Gluten Sensitivity In an article by Dr. Joseph Murray published
in 2009 in the Journal Gastroenterologyon Celiac Disease:
(Gastroenterology Volume 137, Issue 1, July 2009) 9133 healthy
young adults between 1948 and 1954 had antibody tests done 9133
healthy young adults between 1948 and 1954 had antibody tests done
12768 health young adults compared in 2009 12768 health young
adults compared in 2009 The undiagnosed patients in the early study
had a 4x greater risk of death The undiagnosed patients in the
early study had a 4x greater risk of death The amount of
undiagnosed patients in the recent 2009 study was 4.5 times higher
than the earlier study (400%>) The amount of undiagnosed
patients in the recent 2009 study was 4.5 times higher than the
earlier study (400%>)
- Slide 75
- Gluten Sensitivity Scope Likely 1.8 million people actually
have Celiac Likely 1.8 million people actually have Celiac 1.4
million of these patients do not know it 1.4 million of these
patients do not know it Some estimate it may be 6% of the
population Some estimate it may be 6% of the population
- Slide 76
- Why The Change? Our gut has a much higher toxin load
(pesticides, processed foods, additives) Our gut has a much higher
toxin load (pesticides, processed foods, additives) Wheat has been
genetically engineered to be more hearty. This has saved many from
starvation, but some believe that it has made the gluten more
irritating or has raised the gluten content Wheat has been
genetically engineered to be more hearty. This has saved many from
starvation, but some believe that it has made the gluten more
irritating or has raised the gluten content
- Slide 77
- What Does Gluten Do?
- Slide 78
- Up-regulates the inflammation response Up-regulates the
inflammation response Increased free radicals (make you age)
Increased free radicals (make you age) Thyroid dysfunction Thyroid
dysfunction Hormonal disorders and infertility Hormonal disorders
and infertility Forms neuroactive peptides gluten exorphins which
affect cognitive function and increase symptoms in autistic
children Forms neuroactive peptides gluten exorphins which affect
cognitive function and increase symptoms in autistic children
Activates the Immune System Activates the Immune System
- Slide 79
- Should Your Patient Be Gluten Free? It is a personal decision.
Should have family buy-in It is a personal decision. Should have
family buy-in Definitely a smart first step if they have digestive
issues Definitely a smart first step if they have digestive issues
Not everyone may respond poorly to gluten exposure. Some may
detoxify well. Impossible to tell who will Not everyone may respond
poorly to gluten exposure. Some may detoxify well. Impossible to
tell who will Some studies have shown when patients were placed on
a gluten free diet versus standard diet in a blinded fashion, the
gluten free cohort had less digestive complaints after 6 weeks Some
studies have shown when patients were placed on a gluten free diet
versus standard diet in a blinded fashion, the gluten free cohort
had less digestive complaints after 6 weeks Cutting down vs.
stoppingThe tack example Cutting down vs. stoppingThe tack
example
- Slide 80
- What About Dairy?
- Slide 81
- Our Track Record
- Slide 82
- Slide 83
- Slide 84
- Keeping Your GI Tract Healthy/Repairing Damage Specific Diets S
tandard A merican D iet (sad it is) S tandard A merican D iet (sad
it is) Elimination Diet (oligo-antigenic diet) Elimination Diet
(oligo-antigenic diet) Mediterranean diet- Abundant Plants foods,
fresh fruit as dessert, olive oil as principle fat, cheese and
yogurt for dairy, low meat, moderate wine consumption Mediterranean
diet- Abundant Plants foods, fresh fruit as dessert, olive oil as
principle fat, cheese and yogurt for dairy, low meat, moderate wine
consumption Paleolithic Diet Paleolithic Diet
- Slide 85
- Standard Supplements Multivitamin Multivitamin Vitamin D
Vitamin D Calcium Calcium Co-Q10 Co-Q10 Vitamin A Vitamin A B12 and
Folate B12 and Folate Fish Oil (DHA and EPA) Fish Oil (DHA and EPA)
Vitamin E Vitamin E Vitamin C Vitamin C Magnesium Magnesium
Curcumin Curcumin Probiotics Probiotics
- Slide 86
- Based Upon Clinical Situation Pharmacologic agents
Pharmacologic agents Specialty referral Specialty referral
Detoxification and Methylation support Detoxification and
Methylation support Counseling Counseling The Exercise Prescription
The Exercise Prescription Stress reduction and spiritual health
Stress reduction and spiritual health
- Slide 87
- www.vinehealthcare.com