1. © 2008, The Institute for Functional Medicine David S. Jones, MD President and Director of Medical Education Fundamentals of Functional Medicine: From Organ System to Systems Biology Dan Lukaczer, ND Associate Director of Medical Education Institute for Functional Medicine

2. © 2008, The Institute for Functional Medicine David Jones MD Dan Lukaczer ND

3. © 2008, The Institute for Functional Medicine Functional Medicine is personalized medicine that deals with primary prevention and underlying causes instead of symptoms for serious chronic disease

4. © 2008, The Institute for Functional Medicine THE UNMET NEED Holman H. JAMA. 2004;292:1057-1059. Chronic Disease: The Need for a New Clinical Education “It is axiomatic that medical education should prepare students well for the clinical problems they will face in their future practice. However, that is not happening for the most prevalent problem in health care today: chronic disease.” “It is axiomatic that medical education should prepare students well for the clinical problems they will face in their future practice. However, that is not happening for the most prevalent problem in health care today: chronic disease.” “Chronic disease replaced acute disease as the dominant health problem. Chronic disease is now the principal cause of disability and use of health services and consumes 78% of health expenditures.” “Chronic disease replaced acute disease as the dominant health problem. Chronic disease is now the principal cause of disability and use of health services and consumes 78% of health expenditures.”

5. © 2008, The Institute for Functional Medicine Stange KC. Ann Fam Med. 2006;4:98-100 “The Future of Family Medicine Report calls for a New Model of care that is grounded in timeless values of personalized, patient- centered care coupled with the application of new technologies and systems.” THE UNMET NEED

6. © 2008, The Institute for Functional Medicine ESSENTIAL COMPONENTS FOR FUNCTIONAL MEDICINE PRACTITIONER COGNITIVE SKILLS NEEDED: An analytical, iterative process of careful construction & clinical responseAn analytical, iterative process of careful construction & clinical response A disciplined methodology of organizing information for more comprehensive evaluation and treatment of chronic illnessA disciplined methodology of organizing information for more comprehensive evaluation and treatment of chronic illness Reframing of patient’s story to reflect antecedents, triggers & mediatorsReframing of patient’s story to reflect antecedents, triggers & mediators Integration of intellectual curiosity, academic rigor, and the use of pattern recognition to improve clinical judgmentIntegration of intellectual curiosity, academic rigor, and the use of pattern recognition to improve clinical judgment Facile in the use of the FM Matrix for organizing and understanding the indicators of dysfunctionFacile in the use of the FM Matrix for organizing and understanding the indicators of dysfunction

7. © 2008, The Institute for Functional Medicine PATIENT-CENTERED CLINICAL SKILLS Primacy of therapeutic partnership & patient empowermentPrimacy of therapeutic partnership & patient empowerment Eliciting and then retelling the patient’s story using the ATM (antecedents, triggers & mediators) modelEliciting and then retelling the patient’s story using the ATM (antecedents, triggers & mediators) model Understand the application of “readiness to change” models for establishing patient rapportUnderstand the application of “readiness to change” models for establishing patient rapport Use of appropriate functional medicine assessment procedures for clinical assessmentUse of appropriate functional medicine assessment procedures for clinical assessment Use of core therapeutics including: nutritional/dietary interventions, physical medicine, toxin avoidance and mitigation, mind-body-spirit interventions, bioenergetic treatments, appropriate use of drugs and surgeryUse of core therapeutics including: nutritional/dietary interventions, physical medicine, toxin avoidance and mitigation, mind-body-spirit interventions, bioenergetic treatments, appropriate use of drugs and surgery ESSENTIAL COMPONENTS FOR FUNCTIONAL MEDICINE PRACTITIONER

8. © 2008, The Institute for Functional Medicine THE UNMET NEED The need is for a new kind of CHRONIC CARE TEAM Physicians who approach disease from a systems biology perspective rather than organ system taxonomy Nutritionists/dietitians who can evaluate & educate patients for their nutritional status, cellular health and design nutritional programs Practitioners skilled in structural, exercise, and bioenergetics principles Biologic-Functional dentists skilled in non-toxic restoration of dental/oral function Pharmacists who can compound Rxs specific to the patient’s need Psychologists/mind-body-spirit practitioners skilled in training patients in techniques for achieving and maintaining wholeness Para-medical practitioners skilled in specific functional practices

9. © 2008, The Institute for Functional Medicine FUNCTIONAL MEDICINE: A Patient-Centered, Comprehensive Chronic-Care Model © 2007

10. © 2008, The Institute for Functional Medicine THE PRINCIPLES: A SCIENCE USING FIELD OF HEALTHCARE Biochemical individuality based on genetic and environmental uniqueness Patient centered versus disease centered Dynamic balance of internal and external factors Web-like interconnections of physiological factors Health as a positive vitality – not merely the absence of disease Promotion of organ reserve – healthspan Textbook of Functional Medicine: Chap 2

11. © 2008, The Institute for Functional Medicine At the heart of medicine lies the individual and each patient’s unique story… At the heart of medicine lies the individual and each patient’s unique story…

12. © 2008, The Institute for Functional Medicine That Story Is Typically Told As … Chief Complaint (CC) History of Present Illness (HPI) Past Medical History (PMH) Review of Organ Systems (RS) Family History (FH) Dietary History (DH) Medication and Supplement History Social, Lifestyle, and Exercise History Physical Exam Findings (PE) Laboratory and Imaging Evaluations Assessment and Diagnosis

13. © 2008, The Institute for Functional Medicine arrive quickly at the diagnosis. In conventional medicine, the primary aim is to arrive quickly at the diagnosis. acute-care setting; This emphasis on diagnosis is particularly critical in the acute-care setting; rapid diagnosis leads to rapid treatment. “lock down” Treatment in this setting must be prompt, as it is often designed to “lock down” and control physiology. chief complaint history of the present illness The chief complaint and history of the present illness become the critical aspects of the story; the rest of the patient’s story is often truncated when other information is seen as superfluous to reaching the diagnosis.

14. © 2008, The Institute for Functional Medicine In acute care, the patient’s story is squeezed down to the chief complaint and history of the present illness while the diagnosis increases in importance.

15. © 2008, The Institute for Functional Medicine Example #1 Chief Complaint: Wheezing Diagnosis: Acute Asthma Attack bronchodilatorscorticosteroids tightness in the chest sudden onset asthmatic history shortness of breath History of Present Illness oxygen

16. © 2008, The Institute for Functional Medicine The clinician proceeds directly to the diagnosis—naming the disease—in order to identify as quickly as possible a medication to treat that disease. Problems arise when the acute-care model is used to address chronic, long-term health issues.

17. © 2008, The Institute for Functional Medicine The Story Is Truncated Chief Complaint History of Present Illness Past Medical History Review of Organ Systems Family History Dietary History Medication and Supplement History Social, Lifestyle, and Exercise History Physical Exam Findings Laboratory and Imaging Evaluations Assessment DIAGNOSIS BY ORGAN SYSTEM

18. © 2008, The Institute for Functional Medicine THE RESULTS OF USING THE ACUTE CARE MODEL: Little attention is paid to the patient’s story beyond the chief complaint and history of the present illness. The patient’s whole story is not understood. Each major issue becomes a discrete diagnosis, dealt with in isolation from the others.

19. © 2008, The Institute for Functional Medicine Hypercholes-terolemia Statin Gastroesophageal Reflux Disease H2 blocker Depression SSRI Hypertension ACEinhibitor MigrainesTriptan Osteoarthritis NSAID Irritable Bowel Syndrome Dicyclomine … the result is a focus on treating each symptom complex as a separate and distinct “disease” with a separate and distinct treatment.

20. © 2008, The Institute for Functional Medicine Hypercholest-erolemia Statin Gastroesophageal Reflux Disease Reflux Disease H2 blocker Depression SSRI Hypertension ACEinhibitor MigrainesTriptan Osteoarthritis NSAID Irritable Bowel Syndrome Dicyclomine Each individual diagnosis becomes a distinct entity unto itself. The patient’s whole story never has a chance to be heard and understood in context.

21. © 2008, The Institute for Functional Medicine It is apparent that—in its rush to diagnose— conventional medicine is focused on the branches and leaves of the tree … CardiologyPulmonaryEndocrinology Gastroenterology Neurology Organ System Diagnosis Urology/Nephrology Hepatology Allergy Signs and Symptoms and not the trunk and roots 21st Century Medicine Systems Biology Diagnosis

22. © 2008, The Institute for Functional Medicine CardiologyPulmonaryEndocrinology Gastroenterology Neurology Organ System Diagnosis Urology/Nephrology Hepatology Allergy Signs and Symptoms Psychosocial Environmental Inputs Physical Exercise, Trauma Xenobiotics, Micro-organisms, Radiation Diet, Nutrients, Air/Water Mind and Spirit Genetic Predisposition Experiences, Attitudes, Beliefs

23. © 2008, The Institute for Functional Medicine CardiologyPulmonaryEndocrinology Gastroenterology Neurology Organ System Diagnosis Urology/Nephrology Hepatology Allergy Signs and Symptoms Psychosocial Environmental Inputs Physical Exercise, Trauma Xenobiotics, Micro-organisms, Radiation Diet, Nutrients, Air/Water 1. Communication - Outside the cell - Inside the cell 2. Bioenergetics/Energy Transformation 3. Replication/Repair/Maintenance/ Structural Integrity 4. Elimination of Waste 5. Protection/Defense 6. Transport/Circulation Fundamental Physiological Processes Mind and Spirit Genetic Predisposition Experiences, Attitudes, Beliefs

24. © 2008, The Institute for Functional Medicine CardiologyPulmonaryEndocrinology Gastroenterology Neurology Organ System Diagnosis Urology/Nephrology Hepatology Allergy Signs and Symptoms Psychosocial Environmental Inputs Physical Exercise, Trauma Xenobiotics, Micro-organisms, Radiation Diet, Nutrients, Air/Water 1. Communication - Outside the cell - Inside the cell 2. Bioenergetics/Energy Transformation 3. Replication/Repair/Maintenance/ Structural Integrity 4. Elimination of Waste 5. Protection/Defense 6. Transport/Circulation Fundamental Physiological Processes Mind and Spirit Genetic Predisposition Experiences, Attitudes, Beliefs Fundamental Clinical Imbalances 1.Immune and Inflammatory Imbalance 2.Redox Imbalance + Oxidative Stress + Mitochondropathy 3.Digestive/Absorptive and Microbiological Imbalance 4.Detox/Biotransformation/Excretory Imbalance 5.Structural /Membrane Imbalance 6.Hormonal and Neurotransmitter Imbalances 7.Psychological and Spiritual Imbalance

25. © 2008, The Institute for Functional Medicine Core Clinical Imbalances Hormonal and neurotransmitter imbalances Oxidation-reduction imbalances and mitochondropathy Detoxification and biotransformational imbalances Immune and inflammatory imbalances Digestive, absorptive, and microbiological imbalances Structural imbalances from cellular membrane function to the musculoskeletal system Mind-body/body-mind imbalances

26. © 2008, The Institute for Functional Medicine Psychological and Spiritual Equilibrium Hormone and Neurotransmitter Regulation Detoxification and Biotransformation Structural/Boundary and Membranes and Membranes Immune Surveillance and Inflammatory Process DigestionandAbsorption Oxidative/Reductive Homeodynamics These fundamental clinical imbalances are the underlying mechanisms of disease …

27. © 2008, The Institute for Functional Medicine ? ? ? Where does the symptom come from? That is, what are the antecedents and triggers? What keeps it going? That is, what are the mediators? And what can be done to change that dis-eased allostatic balance point the patient is locked into? That is, what are the underlying points of leverage where intervention can be most effective? In the functional medicine model, the patient’s full story is of central importance. Instead of a preoccupation with how to name the disease, the critical questions become:

28. © 2008, The Institute for Functional Medicine Triggers Affecting Antecedents (predisposing factors) Sending out signals as Mediators Creating Imbalance/Dis-ease Fundamental Approach

29. © 2008, The Institute for Functional Medicine Biological Mediators (cytokines, prostanoids, nitric oxide, kinins, hormones, neurotransmitters, free radicals) Antecedents (genetics, experiences, past illnesses, occupational exposure, nutrition, lifestyle) Triggers (microbes, allergens, trauma, toxins) Feed- forward cycle

30. © 2008, The Institute for Functional Medicine Psychological and Spiritual Equilibrium Hormone and Neurotransmitter Regulation Detoxification and Biotransformation Structural/Boundary and Membranes and Membranes Immune Surveillance and Inflammatory Process DigestionandAbsorption Oxidative/Reductive Homeodynamics These fundamental clinical imbalances are the underlying mechanisms of disease … The diagnosis becomes a systems biology assessment

31. © 2008, The Institute for Functional Medicine The Functional Medicine Story Is Developed with a Different Focus Chief Complaint (CC) History of Present Illness (HPI)  Antecedents, Triggers, and Mediators Past Medical History (PMH) Review of Organ Systems (RS) Family History (FH) Dietary History Medication and Supplement History Social, Lifestyle, and Exercise History Physical Exam Findings Laboratory and Imaging Evaluations Diagnosis by Organ System Disease DIAGNOSIS of Fundamental Clinical Imbalances (Systems Biology)

32. © 2008, The Institute for Functional Medicine ExercisePrescriptions Acupuncture Manipulative Therapies Phytonutrients Nutritionals: Vitamins & Minerals Nutraceuticals Yoga Drugs Surgery Counseling The expanded Functional Medicine Model permits the clinician to choose from an enlarged tool kit of therapies because the patient’s problems are seen from a perspective of underlying mechanisms of imbalance. Meditation Compounded, Personalized Prescriptions Personalized Diet Interventions

33. © 2008, The Institute for Functional Medicine Functional medicine should not be viewed as alternative medicine, but as a bridge to a more effective chronic-care model.

34. © 2008, The Institute for Functional Medicine Let’s Explore How to Use the Functional Medicine Matrix Model ®

35. © 2008, The Institute for Functional Medicine Functional Medicine ‘Expands the Accordion’ In Functional Medicine, the goal is to expand the patient’s story sufficiently to clarify the often multiple dysfunctions that must be addressed. For patients with chronic, complex illnesses, the ‘accordion file’ of the patient history is opened out to evaluate the important antecedents, triggers and mediators, and to clarify the underlying mechanisms of dysfunction

36. © 2008, The Institute for Functional Medicine In complex chronic disease there is often significant information buried in the story

37. © 2008, The Institute for Functional Medicine CardiologyPulmonary Endocrinology Gastroenterology Neurology Organ System Diagnosis Urology/Nephrology Hepatology Allergy Signs and Symptoms Fundamental Clinical Imbalances Hormonal and Neurotransmitter Imbalances Redox Imbalance + Oxidative Stress + Mitochondropathy Detox/Biotransformation/Excretory Imbalance Immune Imbalance Inflammatory Imbalance Digestive/Absorptive and Microbiological Imbalance Structural Integrity Imbalance 1. Communication - Outside the cell - Inside the cell Mind and Spirit Genetic Predisposition Experiences, Attitudes, Beliefs Psycho-social Physical Exercise Trauma Diet, Nutrients, Air/Water Xenobiotics Micro- organisms Radiation Environmental Inputs 2. Bioenergetics/Energy Transformation 3. Replication/Repair/Maintenance/ Structural Integrity 4. Elimination of Waste 5. Protection/Defense 6. Transport/Circulation Fundamental Physiological Processes

38. © 2008, The Institute for Functional Medicine Functional Medicine focuses on antecedents, triggers and mediators Antecedents are factors, genetic or acquired, that predispose to illness 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

39. © 2008, The Institute for Functional Medicine And the Core Clinical Imbalances These core clinical imbalances underlie the expression of disease These clinical imbalances form a pattern of dysfunction and are the result of underlying antecedents, triggers and mediators It is the recognition of these patterns that is the art and science of medicine

40. © 2008, The Institute for Functional Medicine Psychological and Spiritual Equilibrium Hormone and Neurotransmitter Regulation Detoxification and Biotransformation Structural/Boundary/ Membranes Immune Surveillance and Inflammatory Process Digestion and Absorption Oxidative/Reductive Homeodynamics _____________________ _____________________ _____________________ Antecedents (Predisposing) __________________ __________________ __________________ Triggering Events (Activation) __________________ __________________ __________________ The Patient’s Story Retold ____________________ ____________________ ____________________ Exercise Nutrition Status Beliefs & Self-Care SleepRelationships Date: ____ Name: ___________________ Age _____ Sex______ Chief Complaints: ___________________________ FUNCTIONAL MEDICINE MATRIX MODEL ™

41. © 2008, The Institute for Functional Medicine Case Study Progression Take a careful, ‘ expanded ’ case Assess signs and symptoms in the case and filter to appropriate clinical imbalances Evaluate for the most important antecedents, triggers and mediators Prioritize the clinical imbalances in the case (pattern recognition) From this prioritization, decide what further evaluation would be useful Explain and frame the story to the patient based upon the matrix; with antecedents, triggers, mediators and prioritizations

42. © 2008, The Institute for Functional Medicine 32 year old white male with a lifelong history of irritable bowel syndrome. Multiple work-ups as a child with little relief. 5 years ago he was diagnosed by stool exam with Blastocystis hominis and intestinal yeast. Treated with lactobacillus and Flagyl and reported significant improvement. (No follow-up lab performed) However, over the course of 6-12 months his digestive symptoms returned. Currently he experiences episodic gas, bloating, and intermittent diarrhea. Case Example Chief Complaint/History of PI

43. © 2008, The Institute for Functional Medicine Adult onset asthma started about 6 years ago. Prescribed multiple inhalers and antihistaminics with improvement. Relatively asymptomatic until the last 6 months during which he has had 3 asthmatic attacks unresponsive to bronchodilators. Placed on prednisone dose packs on three occasions. Currently mildly symptomatic. Multiple antibiotics as child for ear and throat infections. History of depression (and past treatment) but not currently on pharmacological treatment. Past Medical History

44. © 2008, The Institute for Functional Medicine Family History/Dietary History Family history : Paternal: asthma and chronic sinusitis Maternal: obesity Dietary history: Typical standard American diet (SAD): high in simple carbohydrates Often has fast food for lunch and dinner Drinks 3-5 cups of caffeinated beverages daily Does not eat fish or other significant sources of Omega 3 oils

45. © 2008, The Institute for Functional Medicine Prescriptive medications: Proventil prn Non prescriptive medications and supplements: Aspirin 2-3x weekly for headaches Tums 2-3x weekly for indigestion Supplement and Medication History

46. © 2008, The Institute for Functional Medicine Lives alone Works as a physician and has inconsistent and long work hours; little social life and few hobbies. No regular aerobic exercise. Occasionally uses a Stairmaster (1-2 times/weekly) for 30 minutes. No resistive training. Does not smoke or drink. No other recreational drug use. Lifestyle, Social, and Exercise History

47. © 2008, The Institute for Functional Medicine Physical Exam: 70” 175# BP 130/86 EENT: Nasal mucosa boggy and edematous. Slight erythema noted in posterior pharynx. Skin: dry in general, posterior arms have cobble-stone texture. Fingernails have multiple white spotting. Rest of physical exam is non-contributory Previous Laboratory : CBC, Chemistry panel within normal limits Physical Exam/ Laboratory Evaluation

48. © 2008, The Institute for Functional Medicine Clarify the most important antecedents, triggers and mediators in the case

49. © 2008, The Institute for Functional Medicine Assessing for Potential Antecedents, Triggers and Mediators Antecedents: Multiple antibiotics Genetic atopic propensity Triggers: Blastocystis hominis, Food sensitivity, Dysbiosis Mediators: Medications: Aspirin- increase in intestinal permeability Medication: Proventil-increase Detox load Adiposity-increased inflammatory mediators Depression-hormonal GI effects Nutritional insufficiencies: multiple effects on immune competence, intestinal permeability etc.

50. © 2008, The Institute for Functional Medicine Prioritize the clinical imbalances in the case (pattern recognition):

51. © 2008, The Institute for Functional Medicine Is Blastocystis a pathogen? Clinical Significance of Blastocystis hominis J Clin Micro 1989;Nov:2407-2409 Is Blastocystis a pathogen? Clinical Significance of Blastocystis hominis J Clin Micro 1989;Nov:2407-2409 Screening of a large population group for protozoa infection revealed that 515 were infected with the single protozoa Blastocystis hominis. However, only 239 (46%) were found to be symptomatic, suggesting differential pathogenicity. 43 of these symptomatic patients were treated with Metronidazole. All patients became asymptomatic with negative stools on follow-up.

52. © 2008, The Institute for Functional Medicine Does Blastocystis increase intestinal permeability? Protozoon infections and intestinal permeability. Acta Trop. 2002 Jan;81(1):1-5. Does Blastocystis increase intestinal permeability? Protozoon infections and intestinal permeability. Acta Trop. 2002 Jan;81(1):1-5. Thirty nine patients with protozoan infections were compared to ten healthy controls. Intestinal permeability (IP) was found to be increased in patients with protozoan infections compared with the control patients; specifically IP was increased in the Giardia and Blastocystis groups, although not in Entamoeba coli group. The increase in IP in patients with B. hominis suggests that it can be a pathogenic protozoal infection and have systemic consequences

53. © 2008, The Institute for Functional Medicine Healthy Gut Healthy Cell Junctions Junctions Healthy Villi/ Good Absorption

54. © 2008, The Institute for Functional Medicine Leaky Gut Damaged Villi / Poor Absorption Damaged Cell Junctions

55. © 2008, The Institute for Functional Medicine Altered Intestinal Permeability Poor Dietary Choices Stress & Emotions InfectionInfection LectinsLectins Systemic Disease Toxic Exposure Food Allergy MalnutritionMalnutrition DysbiosisDysbiosis Toxic Overload Elevated Total Toxic & Antigenic Burden Elevated Total Toxic & Antigenic Burden Low Stomach Acid Systemic Disease Leaky Gut - Pathophysiology

56. © 2008, The Institute for Functional Medicine Is intestinal permeability linked to asthma? Intestinal permeability is increased in bronchial asthma. Arch Dis Child. 2004 Mar;89(3):227-9. Thirty two asthmatic children, and 32 sex and age matched controls were assessed using the dual sugar (lactulose and mannitol) test. Intestinal permeability was increased in children with asthma, suggesting that the whole mucosal system may be affected. Previous reports have shown increased intestinal permeability in adult asthmatics.

57. © 2008, The Institute for Functional Medicine Psychological and Spiritual Equilibrium Hormone and Neurotransmitter Regulation Detoxification and Biotransformation Structural/Boundary/ Membranes Immune Surveillance and Inflammatory Process Digestion and Absorption Oxidative/Reductive Homeodynamics Antecedents (Predisposing) Triggering Events (Activation) The Patient’s Story Retold Exercise Nutrition Status Beliefs & Self-Care SleepRelationships Date: ____ Name: ___________________ Age _____ Sex______ Chief Complaints: ___________________________ FUNCTIONAL MEDICINE MATRIX MODEL ™ Food allergen Yeast sensitivity Zinc insufficiency EFA Insufficiency Excess adiposity Genetic propensity Multiple antibiotics Genetic atopic propensity Increased intestinal permeability secondary to? Dysbiosis Protozoa infection IBS trigger: B. hominis, Food sensitivity Asthma trigger: B. hominis, Food sensitivity Overweight, Depression Medications: Aspirin Nutritional insufficiencies: zinc, etc History of Depression, Little Social Life, Lives Alone Little Social Life, Lives Alone History of Depression Medications

58. © 2008, The Institute for Functional Medicine further evaluation to consider?

59. © 2008, The Institute for Functional Medicine Case Study Progression Reflecting back the patient’s story: Explain and frame the story back to the patient based upon the matrix. Start with the antecedents to the chief complaint(s) and review the important triggers and mediators that build on that story. Emphasize the main elements of the matrix in the story. The objective is to accurately and concisely reflect a story that a patient can understand.

60. © 2008, The Institute for Functional Medicine Psychological and Spiritual Equilibrium Hormone and Neurotransmitter Regulation Detoxification and Biotransformation Structural/Boundary/ Membranes Immune Surveillance and Inflammatory Process Digestion and Absorption Oxidative/Reductive Homeodynamics _____________________ _____________________ _____________________ Antecedents (Predisposing) __________________ __________________ __________________ Triggering Events (Activation) __________________ __________________ __________________ The Patient’s Story Retold ____________________ ____________________ ____________________ Exercise Nutrition Status Beliefs & Self-Care SleepRelationships Date: ____ Name: ___________________ Age _____ Sex______ Chief Complaints: ___________________________ FUNCTIONAL MEDICINE MATRIX MODEL ™ Food antibodies Yeast antibodies Bioelectrical impedance RBC Fatty Acids WBC zinc SNP assessment Amino Acid analysis O&P Lactulose Mannitol Digestive function

61. © 2008, The Institute for Functional Medicine Initial Intervention Comprehensive elimination diet Comprehensive elimination diet Non dairy/non gluten functional food containing: Non dairy/non gluten functional food containing: supplemental antioxidants supplemental antioxidants conditional essential nutrients for GI tract conditional essential nutrients for GI tract anti-inflammatory nutrients and phytonutrients anti-inflammatory nutrients and phytonutrients O&P X 3 O&P X 3

62. © 2008, The Institute for Functional Medicine 5 week follow-up Considerable improvement in IBS with a decrease in gas, bloating, and decreased frequency of episodic diarrhea. Considerable improvement in IBS with a decrease in gas, bloating, and decreased frequency of episodic diarrhea. Decreased asthmatic complaints. Decreased asthmatic complaints. Overall ≈ 50% improved Overall ≈ 50% improved Laboratory Results: Laboratory Results: O and P: O and P: Microscopy: Microscopy: Rare endolimax nana cysts and trophozoites Rare endolimax nana cysts and trophozoites Many Blastocystis hominis Many Blastocystis hominis EIA Giardia, Cryptosporidium, and Entamoeba negative EIA Giardia, Cryptosporidium, and Entamoeba negative

63. © 2008, The Institute for Functional Medicine “A therapeutic intervention is fitting the treatment to the individual. In that sense it is like tailoring … measuring and trying it on until you get a good fit…. You don’t always get it the first time.” Sid Baker, MD

64. © 2008, The Institute for Functional Medicine Continue on dietary and functional/medical food protocol. Add: Botanical anti-protozoal therapy: berberine, artemesia, and citrus seed extract in combination Botanical anti-protozoal therapy: berberine, artemesia, and citrus seed extract in combination Probiotics: lactobacillus and bifidobacteria in combination Probiotics: lactobacillus and bifidobacteria in combination 5 week follow-up

65. © 2008, The Institute for Functional Medicine Can probiotics affect intestinal permeability? Probiotics in the atopic march: highlights and new insights Dig Liver Dis. 2006 Dec;38 Suppl 2:S288-90. Probiotics positively affect the host by enhancing the microbial balance and therefore restore the normal intestinal permeability and gut micro ecology. In clinical trials probiotics appear to be useful for the treatment of various clinical conditions such as food allergy, AD and allergic rhinitis, It may be possible, in the future, to use probiotics in primary prevention of asthma.

66. © 2008, The Institute for Functional Medicine 12 week follow-up Asthma and IBS essentially asymptomatic Food reintroduction showed sensitivity to caffeine, chocolate, and eggs. Further consideration would include continuation of reinoculation and repair of gastrointestinal system and rotation diet. To discontinue functional/medical food and antiparasitic protocol. F/u O&P: negative

67. © 2008, The Institute for Functional Medicine “It is much more important to know what sort of person has a disease, than what sort of disease a person has.” Sir William Osler

68. © 2008, The Institute for Functional Medicine Psychological and Spiritual Equilibrium Hormone and Neurotransmitter Regulation Detoxification and Biotransformation Structural/Boundary/ Membranes Immune Surveillance and Inflammatory Process Digestion and Absorption Oxidative/Reductive Homeodynamics _____________________ _____________________ _____________________ Antecedents (Predisposing) __________________ __________________ __________________ Triggering Events (Activation) __________________ __________________ __________________ The Patient’s Story Retold ____________________ ____________________ ____________________ Exercise Nutrition Status Beliefs & Self-Care SleepRelationships Date: ____ Name: ___________________ Age _____ Sex______ Chief Complaints: ___________________________ FUNCTIONAL MEDICINE MATRIX MODEL ™