The Functional Medicine Approach to Patient Care Scott Antoine, DO, FACEP Vine Healthcare, LLC.

The Functional Medicine Approach to Patient Care Scott Antoine, DO, FACEP Vine Healthcare, LLC

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

Functional Medicine Also known as: Functional and Integrative Medicine, Holistic Medicine, Systems Medicine

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

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

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

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

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

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

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

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

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

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

Causes of Mortality (Kenya)

Causes of Mortality (USA)

Change in BMI (USA)

Change in Blood Glucose (USA)

Risk Factors

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

How Sick is Sick? Number of Chronic ConditionsPercentage of Medicare Spending 5+68% 412% 310% 26% 13% 01%

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

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

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?

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

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

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.

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**

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

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

Single Nucleotide Polymorphisms (SNPs)

SNPs and Cancer Risk

SNPs and Drug Interactions

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

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

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

The Homocysteine Cycle Folat e THF 5,10-CH 2 -THF 5-CH 3 -THF MTHFR B 12 CH 3 -B 12 Methionine Homocysteine

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%

Basic Principles of Functional Medicine 5.Underlying Causes of Disease (continued) C.Epigenetics (the effect the exposome has on your genome and genetic expression)

Epigenetics

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.

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

Basic Principles of Functional Medicine Epigenetics + Loss of Functional Reserve =

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

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

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

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

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)

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

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

Nutrigenomics at Work

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)

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

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

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)

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

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

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

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

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

The Normal Intestine

Leaky Gut

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

Triggering of The Immune System by GI Barrier Disruption

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

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

Healthy Food!

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

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!

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

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

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

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?

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%>)

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

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

What Does Gluten Do?

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

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

What About Dairy?

Our Track Record

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

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

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

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The Functional Medicine Approach to Patient Care Scott Antoine, DO, FACEP Vine Healthcare, LLC.

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Transcript of The Functional Medicine Approach to Patient Care Scott Antoine, DO, FACEP Vine Healthcare, LLC.