Functional Medicine Functional The Systemized Approach ...
Transcript of Functional Medicine Functional The Systemized Approach ...
2008© 2010
Functional Medicine The Systemized Approach to Fibromyalgia
Functional Medicine The Systemized Approach
Using a Case study of Fibromyalgia
© 20102
Be open minded, but not so open minded that your brains fall out.
Groucho Marx
© 201016 © 20106
Functional Medicine Key Components
➢ A Continuum of Health & Wellness ➢ Balance ➢ Biochemical Individuality
➢ Personalized Treatment
➢ InterConnection
Dean Ornish, MD 2010
FIBROMYALGIA
© 20106
Functional Medicine Key Components
➢ A Continuum of Health & Wellness ➢ Balance ➢ Biochemical Individuality
➢ Personalized Treatment
➢ InterConnection
Balance
Balance© 201010
Functional Medicine Key Components
➢ A Continuum of Health & Wellness ➢ Balance ➢ Biochemical Individuality
➢ Personalized Treatment
➢ InterConnection
© 201013
“You”
“Phenotype”
© 201015
Functional Medicine Key Components
➢ A Continuum of Health & Wellness ➢ Balance ➢ Biochemical Individuality
➢ Personalized Treatment
➢ InterConnection
© 201017
Personalized Medicine
• Integrating the cutting edge, science-based tools of diagnostic medicine • Looking ‘upstream’ to assess and treat the underlying causes of illness • Individually tailored therapies to restore health and improve function.
© 201018
Personalized Diagnostics
To create an understanding of balance in the human body we look @: • Hormones, chemicals, minerals, metabolites • Body fluids (blood, urine, stool, saliva, DNA) • Inter-relationship of these compounds in optimally healthy people
We compare an individual with the optimized norm and give recommendations to bring the person to balance.
© 201019
Personalized Treatment• Risk assessment, not disease detection
• Early changes in biochemical balance are evaluated and treated (vitamins, minerals, nutrition, lifestyle changes, drugs, etc.) before the onset of disease
• Identify and correct imbalance in an individual – “powerful medicine” at the heart of personalized medicine
Hea
lth
Stat
us
© 201022
Time
EVENTS
The Prevention Process
HEALTH
SYMPTOMS
DIS–EASE
© 201023
Functional Medicine Key Components
➢ A Continuum of Health & Wellness ➢ Balance ➢ Biochemical Individuality
➢ Personalized Treatment
➢ InterConnection
© 201025
The Web of InterConnections . . . Defense & Repair
Energy Regulation
Biotransformation
Transportation
Assimilation
Structural Imbalance
Communication
Biotransformation & Elimination (e.g., Toxicity, Detoxification)
Energy(e.g., Energy Regulation, Mitochondrial Function)
Communication (e.g., Endocrine, Neurotransmitters, Immune messengers)
Defense & Repair (e.g., Immune, Inflammation, Infection/Microbiota)
Structural Integrity (e.g., from Subcellular Membranes to Musculoskeletal Structure)
Assimilation (e.g., Digestion, Absorption, Microbiota/GI, Respiration)
Antecedents (Predisposing Factors- Genetic/Environmental)
Triggering Events (Activators)
The Patient’s Story Retold
Exercise &Movement
Nutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators (Contributors)
e.g., cognitive function, perceptual patterns
e.g., emotional regulation, grief, sadness, anger,
etc.
e.g., meaning & purpose, relationship with something greater
Sleep & Relaxation Stress & Resilience Relationships &Networks
Spiritual
Transport (e.g., Cardiovascular, Lymphatic System)
Personalized Lifestyle Factors
Endo-toxicity Defense & Repair
Energy Regulatione.g., emotional
ToxicityBiotransformation & Elimination (e.g., Toxicity, Detoxification)
Energy (e.g., Energy Regulation, Mitochondrial Function)
Exercise & Movement
Fundamental Lifestyle FactorsNutrition & Hydration
Physiology and Function: organisingthe Patient’s Clinical Imbalances Assimilation (e.g., Digestion, Absorption, Microbiota/GI, Respiration)
e.g., cognitive function, perceptual patterns
regulation, grief, sadness, anger, etc.
Sleep & Relaxation
Name:____________________________Date:___________CC:_____________________________________
Stress & Resilience Relationships & Networks
Structural Integrity
Communication
The Patient’s Story Retold
Antecedents
Family History of CVD, T2DM, Depr, Dementia, Cancer
Triggering Events (Activators)
•Stress •Sugar
Modifiable Lifestyle Factors for Clinicians Using the Functional Medicine Model
e.g., meaning & purpose, relationship with something greater
Spiritual
Transport
•High GI/GL Foods •Sedentary Behavior
Mediators/Perpetuators •Visceral Adipose •Inflammation •Insulin•Cortisol •Toxins
3
Functional Medicine Systemized Approach
GO TO IT
O T TG
Gather Oneself & Information Organize on Timeline & Matrix Tell the Patient’s Story Order of your Priorities Initiate Assessment and Care Track Progress
O I
Definitions:
• Timeline: a form used to plot all information from prebirth to
current status
• Matrix: a form used to gain a quick perspective of all imbalances
• 7 Biological Systems: are systems that make up the physiological
functioning of the body
• Antecedents: are factors, genetic, orn acquired that predispose an
individual to an illness or pattern
• Triggers: are factors that provoke the symptoms and signs of illness
• Mediators: are factors, biochemical or psychosocial that contribute
to pathological changes and dysfunctional responses
Case Study: Joan (Fibromyalgia)
SUMMARY • Age 45 female caucasian
• Long history of fatigue, anxiety, lethargy, multiple tender points, depression, achy
stiff joints and muscles.
• Dx: 10 yrs ago with fibromyalgia
• Medications: Cymbalta, Lyrica (feels drowsy most of the time)
• 3 Teenage Kids
• High stress
• Enjoyed exercise in early adulthood then slowly less until none by age 34
• Multiple antibiotics in teens and 30’s
• Increased weight, initially around hips then waist too, now 185 lbs
• Insomnia worse last few years, difficulty falling asleep
• Family hx: Mother Ra in 40’s, diabetes age 35; Father colon cancer age 58
• Mercury Amalgams
Prec
once
ptio
n
Pren
atal
CurrentConcerns
Antecedents
Triggers or TriggeringEvents
Signs, Symptoms or Diseases Reported
Birth
7-10
Multiple antibiotics
13-15
Severe Acne
3545
Asthma; Increased depression and Fatigue Resistant Weight LossHeadaches
40
Achy muscles joint, Dx FibromyalgiaIncreased stress Severe Fatigue Developed
Chronic Antibiotic use for years; 2wks of every month and a half
3 Children born; at ages of 25, 27, 29
22-30
Dx: Dysbiosis & Hypothyroidism
LMP
43
Mother: dx diabetes RAFather: Colon cancer
Biotransformation & Elimination
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Energy
MATRIX
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Fatigue, lethargy, Chronic Muscle pain Organic acidsMATRIX
Gather Case Study: Joan - MSQ & Organic acids
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Nutrition PE & Lab RequestAnthropometrics
Biomarkers and Functional Labs (POMFAB)
Clinical Indicators from Nutrition Physical Exam
Diet and Lifestyle Assessment
Defining Body Composition: Pattern Recognition
OVER Weight
Gynoid Obesity
overfat OVER SAT Subcutaneous
Adipose Tissue
overfat OVER VAT
Visceral Adipose Tissue
Android Obesity
Using Waist CircumferenceCountry/Ethnic Group GenderEthnic South/Central America South Asians‐Chinese, Malay, Asian‐ Indian.
Male
Waist Circumference‐Increased Health risk>90 cm >35.5 inches
Chinese, Japanese
Europids, Sub‐Saharan African, Eastern Mediteranean, Middle East(Arab) populations
Female Male Female Male
>80 cm>90 cm>80 cm>94 cm
>31.5 inches>35.5 inches>31.5 inches>37 inches
USA
Female Male Female
>80 cm>102 cm>88 cm
>31.5 inches>40 inches>35 inches
Alberti KGMM, P. Zimmet P, Shaw J : Metabolic syndrome—a new world‐wide definition. A Consensus Statement from the International Diabetes Federation Diabet. Med. 23, 469–480 (2006)
Body Composition Assessment
Fat Mass % Male FemaleAge 20‐39 8‐13 17‐21Age 40‐59 11‐16 19‐23Age 60‐79 13‐18 24‐31
Male FemaleBMI‐ Overweight
>25 >25
Obese >30 >30
US‐non ethnic Male FemaleWaist Circumference >40 in
102 cm>35 inches 88 cm
Waist/Hip >0.9 >0.8
JOAN: 185 lbs BMI: 35 Waist: 40inches Hip: 45 Inches WHR: 0.9 Fat %: 38
Gather Case Study: Joan - ANTHROPOMETRICS
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Fatty acid profile MSQ 114 Low Omega 3 index High ox stress ( lipid peroxidase)
Genes Polymorphisms which render individuals with different susceptibilities
Function Shifts physiologic state into “alarm” reaction characterized by inflammatory process
Symptoms of Inflammation
-osis becomes -itis with increasing severity
©2017 The Institute for Functional Medicine
NF‐κB binds to DNA, leading to activation
of…..
Leukotrienes Prostaglandins
NF‐κB Activated
Inflammatory Trigger
CyclooxygenaseLipoxygenase
TNF, IL1, IL6
Biologics Rituximab
Etanercept, Etc.
Less inflammatory eicosanoids
Less inflammatory eicosanoids
Flax, walnut, canola, soy, chia, hemp
Sunflower, safflower, peanut, most vegetable oils
Borage, black currant seed, evening primrose
Animal fat, dairy, shellfish
Linoleic acid (LA) 18:2n‐6
Alpha‐linolenic acid (ALA) 18:3n‐3
Delta‐6‐desaturase (Inhibited by age.
alcohol)
Delta‐6‐elongase
Delta‐5‐desaturase (up‐
regulated by insulin)
Beta Oxidation
Eicosatetraenoic acid 20:4n‐3
Eicosapentaenoic acid (EPA) 20:5n‐3
Docosapentaenoic acid 22:5n‐3
Docosahexaenoic acid (DHA)
22:6n‐3
Docosapentaenoic acid 22:5n‐6
Adrenic acid 22:4n‐6
Arachidonic acid (AA)
20:4n‐6
Gamma‐linolenic acid (GLA)
18:3n‐6
Dihomo‐gamma‐ linolenic acid 20:3n‐
6
Stearidonic acid 18:4n‐3
Delta‐5‐elongase
Cold water fish, wild game, enriched eggs
Omega 6 Familyvegetable oils, grains
Omega 3 FamilyCold water fish, flax oil
Inhibition
Less inflammatory eicosanoids
Lipoxins (anti‐inflammatory)
More inflammatory eicosanoids
Cold water fish, wild game, enriched eggs, algae
Retro conversion
Retro conversion
Gather Case Study: Joan - Genetics & Organic acids Gather Case Study: Joan - Genetics & Organic acids
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Fatty acid profile MSQ 114 Low Omega 3 index High ox stress ( lipid peroxidase)
High MSQ 114 Genetic deletions Low glutathione
Types of Reactions
PHASE ICytochrome P450 enzymes:
Oxidation Reduction Hydrolysis
Water‐ Soluble
Compound
PHASE IIGlucuronosyl Transferase (UGT) Sulfo‐transferases (SULT) Amino Acid Conjugation Glutathione Conjugation Acetylation Methylation
Parent Compound
Activated Intermediate
Imbalanced Detoxification
Phase I CYP P450 Phase II
Conjugation
Damage to DNA, RNA, Proteins
Reactive IntermediateNon‐Polar Xenobiotic Inert Water‐
Soluble Metabolite
Gather Case Study: Joan - Genetics & Organic acids
Gather Case Study: Joan - Genetics & Organic acids
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Fatty acid profile MSQ 114 Low Omega 3 index High ox stress ( lipid peroxidase)
High MSQ 114 Genetic deletions Low glutathione
Dysbiosis Constipation GERD Organic acids High Elastase
Mother: RA, diabetes
Father: Cancer
3rd child birth
Loss of father
Stress Insomnia Sedentary High simple sugar diet
Insomnia 10 hrs sleep Not refreshed
None Skips breakfast Low protein / high carb 3 cups coffee
Takes B vitamin
High
NO relaxation tech
Marriage rated fair Has good friends Good relation with Mother
Energy
Transport
Defense and Repair
Structural Integrity
Communication
Detoxification & Biotransformation
Assimilation
Properly Functioning
Gastrointestinal Ecosystem
DIG
IN
Digestion / Absorption
Intestinal PermeabilityGut microbiota / DysbiosisImmune Modulation/Inflammation
Nervous System
Key Functional Roles & Aspects of the Gut
Impairments in Digestion and Absorption
• Inadequate mastication • Hypochlorhydria • Pancreatic insufficiency • Bile insufficiency • Brush Border Injury
Brush Border injury
Gather Case Study: Joan - MSQ & Organic acids
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Fatty acid profile MSQ 114 Low Omega 3 index High ox stress ( lipid peroxidase)
High MSQ 114 Genetic deletions Low glutathione
Dysbiosis Constipation GERD Organic acids High Elastase
Mother: RA, diabetes
Father: Cancer
3rd child birth
Loss of father
Stress Insomnia Sedentary High simple sugar diet
Insomnia 10 hrs sleep Not refreshed
None Skips breakfast Low protein / high carb 3 cups coffee Takes B vitamin
High
NO relaxation tech
Marriage rated fair Has good friends Good relation with Mother
Suppressed 24 hr cortisol Light sleeper Irritability Depression
Gather Case Study: Joan - Stress Q & Salivary 24 hr Cortisol
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Fatty acid profile MSQ 114 Low Omega 3 index High ox stress ( lipid peroxidase)
High MSQ 114 Genetic deletions Low glutathione
Dysbiosis Constipation GERD Organic acids High Elastase
Mother: RA, diabetes
Father: Cancer
3rd child birth
Loss of father
Stress Insomnia Sedentary High simple sugar diet
Insomnia 10 hrs sleep
Not refreshed
None Skips breakfast Low protein / high carb 3 cups coffee
Takes B vitamin
High
NO relaxation tech
Marriage rated fair Has good friends Good relation with Mother
Suppressed 24 hr cortisol Light sleeper Irritability Depression
Apo E4 Poor lipid profile
Total Toxic Load
Gather Case Study: Joan - Genetics & Mercury Amalgams
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Fatty acid profile MSQ 114 Low Omega 3 index High ox stress ( lipid peroxidase)
High MSQ 114 Genetic deletions Low glutathione
Dysbiosis Constipation GERD Organic acids High Elastase
Mother: RA, diabetes
Father: Cancer
3rd child birth
Loss of father
Stress Insomnia Sedentary High simple sugar diet
Insomnia 10 hrs sleep
Not refreshed
None Skips breakfast Low protein / high carb 3 cups coffee Takes B vitamin
High
NO relaxation tech
Marriage rated fair Has good friends Good relation with Mother
Suppressed 24 hr cortisol Light sleeper Irritability Depression
Apo E4 Poor lipid profile
Gather Case Study: Joan - Self Care questionnaire
Gather Case Study: Joan - Sleep questionnaire
Tips for getting a goodnight’s sleep! 1. Maintain a regular sleep schedule. 2. Establish a regular, relaxing bedtime routine. 3. Create a sleep-conducive environment. 4. Sleep on a comfortable mattress and pillows. 5. Finish eating at least 2-3 hours before bedtime. 6. Exercise regularly. 7. Avoid caffeine, nicotine and alcohol close to bedtime. 8. Keep a sleep diary!
National Sleep Foundation
(www.sleepfoundation.org)
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Fatty acid profile MSQ 114 Low Omega 3 index High ox stress ( lipid peroxidase)
High MSQ 114 Genetic deletions Low glutathione
Dysbiosis Constipation GERD Organic acids High Elastase
Mother: RA, diabetes
Father: Cancer
3rd child birth
Loss of father
Stress Insomnia Sedentary High simple sugar diet
Insomnia 10 hrs sleep
Not refreshed
None Skips breakfast Low protein / high carb 3 cups coffee Takes B vitamin
High
NO relaxation tech
Marriage rated fair Has good friends Good relation with Mother
Suppressed 24 hr cortisol Light sleeper Irritability Depression
Apo E4 Poor lipid profile
Exercise and Staying in Motion…
Walking / Jog for 30 min 3 times per week. Specific Autonomic Stretching routine 20 min before bed 3 per week 15 min Body weight program working large muscle groups
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Fatty acid profile MSQ 114 Low Omega 3 index High ox stress ( lipid peroxidase)
High MSQ 114 Genetic deletions Low glutathione
Dysbiosis Constipation GERD Organic acids High Elastase
Mother: RA, diabetes
Father: Cancer
3rd child birth
Loss of father
Stress Insomnia Sedentary High simple sugar diet
Insomnia 10 hrs sleep
Not refreshed
None Skips breakfast Low protein / high carb 3 cups coffee
Takes B vitamin
High
NO relaxation tech
Marriage rated fair Has good friends Good relation with Mother
Suppressed 24 hr cortisol Light sleeper Irritability Depression
Apo E4 Poor lipid profile
Biotransformation & Elimination (e.g., Toxicity, Detoxification)
Energy (e.g., Energy Regulation, Mitochondrial Function)
Communication (e.g., Endocrine, Neurotransmitters, Immune messengers)
Defense & Repair (e.g., Immune, Inflammation, Infection/Microbiota)
Structural Integrity (e.g., from Subcellular Membranes to Musculoskeletal Structure)
Assimilation (e.g., Digestion, Absorption, Microbiota/GI, Respiration)
Antecedents (Predisposing Factors- Genetic/Environmental)
Triggering Events (Activators)
The Patient’s Story Retold
Exercise & Movement Nutrition &Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators (Contributors)
e.g., meaning & purpose, relationship with something greater
e.g., cognitive function,perceptual patterns
e.g., emotional regulation, grief,
sadness, anger, etc.
Sleep & Relaxation
Name:____________________________Date:___________CC:_____________________________________
Spiritual
Circulation (e.g., Cardiovascular, Lymphatic
System Fluid Balance)
Personalized Lifestyle FactorsStress & Resilience Relationships & Networks
Elimination diet To Maintainance Detox Food Plan
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Fatty acid profile MSQ 114 Low Omega 3 index High ox stress ( lipid peroxidase)
High MSQ 114 Genetic deletions Low glutathione
Dysbiosis Constipation GERD Organic acids High Elastase
Mother: RA, diabetes
Father: Cancer
3rd child birth
Loss of father
Stress Insomnia Sedentary High simple sugar diet
Insomnia 10 hrs sleep
Not refreshed
None Skips breakfast Low protein / high carb 3 cups coffee Takes B vitamin
High stress with teenagers
NO relaxation tech
Highly strung personality
Marriage rated fair Has good friends Good relation with Mother
Suppressed 24 hr cortisol Light sleeper Irritability Depression
Apo E4 Poor lipid profile
Balance
Balance
JOAN:
FREE MEDITATION APPS: OMVANA
USE IN BED INSTEAD OF TV / FACEBOOK
Initiate Case Study: Joan - Restoration Prescription
Biotransformation & Elimination
ENERGY
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Relationships & Networks Exercise & Movement
Personalized Lifestyle FactorsNutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators
Mental
Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________
Emotional
Transport
Stress & Resilience
Increased BMI Waist / hip circumference Incr fat % Incr BMI Cell membrane
Fatigue, lethargy, Chronic Muscle pain Organic acids
Fatty acid profile MSQ 114 Low Omega 3 index High ox stress ( lipid peroxidase)
High MSQ 114 Genetic deletions Low glutathione
Dysbiosis Constipation GERD Organic acids High Elastase
Mother: RA, diabetes
Father: Cancer
3rd child birth
Loss of father
Stress Insomnia Sedentary High simple sugar diet
Insomnia 10 hrs sleep
Not refreshed
None Skips breakfast Low protein / high carb 3 cups coffee Takes B vitamin
High stress with teenagers
NO relaxation tech
Highly strung personality
Marriage rated fair Has good friends Good relation with Mother
Suppressed 24 hr cortisol Light sleeper Irritability Depression
Apo E4 Poor lipid profile
Healthy Relationships
(e.g., Energy Regulation,
Biotransformation & Elimination (e.g., Toxicity, Detoxification)
Communication (e.g., Endocrine, Neurotransmitters, Immune messengers)
Defense & Repair (e.g., Immune, Inflammation, Infection/Microbiota)
Structural Integrity (e.g., from Subcellular Membranes to Musculoskeletal Structure)
Assimilation (e.g., Digestion, Absorption, Microbiota/GI, Respiration)
Antecedents (Predisposing Factors- Genetic/Environmental)
Triggering Events (Activators)
The Patient’s Story Retold
Exercise & Movement Nutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators (Contributors)
e.g., meaning & purpose, relationship with something greater
e.g., cognitive function, perceptual patterns
regulation, grief, sadness, anger, etc.
Sleep & Relaxation
Name:____________________________Date:___________CC:_____________________________________© Copyright 2011Institute for Functional Medicine
Stress & Resilience Relationships & Networks
Spiritual
Transport (e.g., Cardiovascular, Lymphatic System)
Personalized Lifestyle Factors
e.g., emotional EnergyMitochondrial Function)
Case Study: Joan (Fibromyalgia)
SUMMARY PLAN OF CARE • Focus to restore mitochondrial health ( reassess using organic acids at 6 months)
• Reduce MSQ to below 30 ( from 114), reassessed every 30 days
• Elimination diet Plus 5R Program
• Sleep hygiene optimization
• Exercise routine customized to Functional Metabolic Threshold
• Relaxation techniques: ANS stretch routine and meditation app prior to bed
• Mercury amalgams removed
• Supplements to support gut health, inflammation, oxidative stress, mitochondrial
health, detox and methylation
• Gratitude journal
• Manual therapy, ANS techniques, acupuncture, myofascial release techniques
• Low dose DMSA (250mg) to remove mercury and lead initiated after MSQ under 50 and
gut health optimal (monitored by FM physician)
• No more meds
Cellular Energy andMitochondrial Function
Cellular Energy andMitochondrial Function
Lipoic Acid
SUPPORTING THE MITOCHONDRIAL ETC
Organic acids: Real time mitochondrial function
Gather Case Study: Joan - 6 months later
Structural Integrity
NO
Increased WC?
Increased BIA Fat%?
YES
Abnormal High BMI?
YES
Dx:OverFatYESYES
Gut/Detox/HPATGG dysfunctions?
Assessing Body Composition
YES
NO YES
NO
Increased WHR?
TLC Nx/ Rx
NO
Increased WC or WHR?
YES
NO
Increased BIA Fat%?
NO
NO
Increased WHR?
Increased BIA Fat%?
Metabolically Obese (OverVAT)
YESNO
Ideal Skinny Fat or Possible High Gynoid Metabolically Muscle MassObesity/ Obese or Athlete overSAT
Gynoid Possible HighObesity/ Muscle Mass overSAT or Large
Skeletal Frame
Increased BIA Fat%?
Dx:Overweight/Obese
MetSyn?
Dx:OverVAT
YES
Android Obesity (OverVAT)
YES
END