Fundamentals of Functional
Medicine:
From Organ System
to
Systems Biology
David S. Jones, MD
Dan Lukaczer, ND
President and Director of
Medical Education
Associate Director of
Medical Education
Institute for Functional Medicine
© 2008, The Institute for Functional Medicine
David Jones MD
© 2008, The Institute for Functional Medicine
Dan Lukaczer ND
Functional Medicine is
personalized medicine
that deals with primary
prevention and
underlying causes
instead of symptoms for
serious chronic disease
© 2008, The Institute for Functional Medicine
THE UNMET
NEED
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.”
“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.”
Holman H. JAMA. 2004;292:1057-1059.
© 2008, The Institute for Functional Medicine
THE UNMET
NEED
“The Future of Family Medicine Report calls
for a New Model of care that is grounded in
timeless values of personalized, patientcentered care coupled with the application of
new technologies and systems.”
Stange KC. Ann Fam Med. 2006;4:98-100
© 2008, The Institute for Functional Medicine
ESSENTIAL COMPONENTS FOR
FUNCTIONAL MEDICINE PRACTITIONER
COGNITIVE SKILLS NEEDED:
• An analytical, iterative process of careful
construction & clinical response
• A disciplined methodology of organizing
information for more comprehensive evaluation
and treatment of chronic illness
• Reframing of patient’s story to reflect antecedents,
triggers & mediators
• Integration 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
dysfunction
© 2008, The Institute for Functional Medicine
ESSENTIAL COMPONENTS FOR
FUNCTIONAL MEDICINE PRACTITIONER
PATIENT-CENTERED CLINICAL SKILLS
• Primacy of therapeutic partnership & patient
empowerment
• Eliciting 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 rapport
• Use 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 surgery
© 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
© 2008, The Institute for Functional Medicine
FUNCTIONAL MEDICINE:
A Patient-Centered,
Comprehensive
Chronic-Care Model
© 2008, The Institute for Functional Medicine
© 2007
THE PRINCIPLES:
A SCIENCE USING FIELD OF
HEALTHCARE

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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
© 2008, The Institute for Functional Medicine
At the heart
At the heartlies the
of medicine
of medicine lies the
individual and
each each
individual
and
patient’s unique story…
patient’s unique story…
© 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
© 2008, The Institute for Functional Medicine




In conventional medicine, the primary aim is
to arrive quickly at the diagnosis.
This emphasis on diagnosis is particularly
critical in the acute-care setting; rapid
diagnosis leads to rapid treatment.
Treatment in this setting must be prompt, as
it is often designed to “lock down” and
control physiology.
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.
© 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.
© 2008, The Institute for Functional Medicine
Example #1
Chief Complaint:
Wheezing
History of Present Illness
sudden
asthmatic
onset
history
tightness in shortness of
the chest
breath
Diagnosis:
Acute Asthma Attack
bronchodilators
© 2008, The Institute for Functional Medicine
corticosteroids
oxygen
Problems arise when the acute-care model is used to
address chronic, long-term health issues.

The clinician proceeds directly to the
diagnosis—naming the disease—in
order to identify as quickly as possible
a medication to treat that disease.
© 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
© 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.
© 2008, The Institute for Functional Medicine
Dicyclomine
NSAID
Irritable Bowel
Syndrome
Osteoarthritis
ACE
inhibitor
Hypertension
… the result is a focus on
treating each symptom
complex as a separate and
distinct “disease” with a
separate and distinct
treatment.
Hypercholesterolemia
Depression
Gastroesophageal
Reflux Disease
SSRI
H2 blocker
© 2008, The Institute for Functional Medicine
Migraines
Statin
Triptan
Dicyclomine
NSAID
Irritable Bowel
Syndrome
Osteoarthritis
ACE
inhibitor
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.
Hypertension
Depression
Gastroesophageal
Reflux Disease
Hypercholesterolemia
Statin
SSRI
H2 blocker
© 2008, The Institute for Functional Medicine
Migraines
Triptan
It is apparent that—in its rush to diagnose—
conventional medicine is focused on the
branches
Pulmonary
Cardiology
andEndocrinology
leaves of theUrology/Nephrology
tree …
Gastroenterology
Neurology
Organ System
Diagnosis
Hepatology
Allergy
Signs and Symptoms
and not the trunk and roots
21st Century Medicine
Systems Biology
Diagnosis
© 2008, The Institute for Functional Medicine
Cardiology
Pulmonary
Urology/Nephrology
Endocrinology
Hepatology
Gastroenterology
Organ System
Diagnosis
Neurology
Allergy
Signs and Symptoms
Mind and Spirit
Genetic Predisposition
Experiences, Attitudes, Beliefs
Psychosocial
© 2008, The Institute for Functional Medicine
Physical
Exercise,
Trauma
Diet, Nutrients,
Air/Water
Environmental Inputs
Xenobiotics,
Micro-organisms,
Radiation
Cardiology
Pulmonary
Urology/Nephrology
Endocrinology
Hepatology
Gastroenterology
Organ System
Diagnosis
Neurology
Allergy
Signs and Symptoms
Fundamental Physiological
Processes
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
Mind and Spirit
Genetic Predisposition
Experiences, Attitudes, Beliefs
Psychosocial
Physical
Exercise,
Trauma
Diet, Nutrients,
Air/Water
Environmental Inputs
© 2008, The Institute for Functional Medicine
Xenobiotics,
Micro-organisms, Radiation
Cardiology
Pulmonary
Urology/Nephrology
Endocrinology
Hepatology
Gastroenterology
Organ System
Diagnosis
Neurology
Allergy
Signs and Symptoms
Fundamental Clinical Imbalances
1.
2.
3.
4.
5.
6.
7.
Immune and Inflammatory Imbalance
Redox Imbalance + Oxidative Stress +
Mitochondropathy
Digestive/Absorptive and Microbiological
Imbalance
Detox/Biotransformation/Excretory Imbalance
Structural /Membrane Imbalance
Hormonal and Neurotransmitter Imbalances
Psychological and Spiritual Imbalance
Fundamental Physiological Processes
1. Communication
2. Bioenergetics/Energy
4. Elimination of Waste
Transformation
- Outside the cell
5. Protection/Defense
- Inside the cell 3. Replication/Repair/Maintenance/ 6. Transport/Circulation
Structural Integrity
Mind and Spirit
Genetic Predisposition
Psychosocial
© 2008, The Institute for Functional Medicine
Experiences, Attitudes, Beliefs
Physical Exercise,
Trauma
Diet, Nutrients,
Air/Water
Environmental Inputs
Xenobiotics,
Micro-organisms, Radiation
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
© 2008, The Institute for Functional Medicine
These fundamental clinical imbalances are
the underlying mechanisms of disease …
Immune
Surveillance
and Inflammatory
Process
Oxidative/Reductive
Homeodynamics
Digestion
and
Absorption
Detoxification
and
Biotransformation
Structural/Boundary
and Membranes
Hormone and
Neurotransmitter Regulation
Psychological
and Spiritual
Equilibrium
© 2008, The Institute for Functional Medicine
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:



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?
© 2008, The Institute for Functional Medicine
Fundamental Approach
Triggers
Affecting Antecedents
(predisposing factors)
Sending out signals
as Mediators
Creating Imbalance/Dis-ease
© 2008, The Institute for Functional Medicine
Antecedents
(genetics, experiences, past
illnesses, occupational exposure,
nutrition, lifestyle)
Triggers
(microbes, allergens, trauma, toxins)
Biological Mediators
(cytokines, prostanoids,
nitric oxide, kinins,
hormones,
neurotransmitters,
free radicals)
© 2008, The Institute for Functional Medicine
Feedforward
cycle
These fundamental clinical imbalances are
the underlying mechanisms of disease …
Immune
Surveillance
and Inflammatory
Process
Oxidative/Reductive
Homeodynamics
Digestion
and
Absorption
Detoxification
and
Biotransformation
Structural/Boundary
and Membranes
Hormone and
Neurotransmitter Regulation
Psychological
and Spiritual
Equilibrium
The diagnosis becomes a
systems biology assessment
© 2008, The Institute for Functional Medicine
The Functional Medicine Story Is
Developed with a Different Focus
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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)
© 2008, The Institute for Functional Medicine
Counseling
Exercise
Prescriptions
Phytonutrients
Compounded,
Personalized
Prescriptions
Meditation
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.
Drugs
Surgery
Personalized
Diet
Interventions
Yoga
Manipulative
Therapies
Acupuncture
Nutritionals:
Vitamins & Minerals
Nutraceuticals
© 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.
© 2008, The Institute for Functional Medicine
Let’s Explore How to Use the
Functional Medicine Matrix
®
Model
© 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
© 2008, The Institute for Functional Medicine
In complex chronic disease there is often
significant information buried in the story
© 2008, The Institute for Functional Medicine
Cardiology
Pulmonary
Endocrinology
Gastroenterology
Urology/Nephrology
Hepatology
Organ System Diagnosis
Neurology
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
Fundamental Physiological Processes
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
Mind and Spirit
Genetic Predisposition
Experiences, Attitudes, Beliefs
Psycho-social
© 2008, The Institute for Functional Medicine
Physical Exercise
Trauma
Diet, Nutrients,
Air/Water
Environmental Inputs
Xenobiotics Microorganisms Radiation
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
© 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
© 2008, The Institute for Functional Medicine
FUNCTIONAL MEDICINE MATRIX MODEL™
Immune Surveillance
and Inflammatory Process
Oxidative/Reductive
Homeodynamics
Detoxification and
Biotransformation
The Patient’s Story Retold
Digestion
Antecedents
and Absorption
(Predisposing)
_____________________
____________________
_____________________
____________________
_____________________
____________________
Hormone and
Neurotransmitter Regulation
Triggering Events
Structural/Boundary/
Membranes
(Activation)
__________________
__________________
__________________
__________________
__________________
__________________
Nutrition Status
Exercise
Sleep
Beliefs & Self-Care
Psychological
and Spiritual Equilibrium
Relationships
Date: ____ Name: ___________________ Age _____ Sex______ Chief Complaints: ___________________________
© 2008, The Institute for Functional Medicine
Case Study Progression
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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
© 2008, The Institute for Functional Medicine
Case Example
Chief Complaint/History of PI
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.
© 2008, The Institute for Functional Medicine
Past Medical History



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.
© 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
© 2008, The Institute for Functional Medicine
Supplement and
Medication History
Prescriptive medications:

Proventil prn
Non prescriptive medications and
supplements:

Aspirin 2-3x weekly for headaches

Tums 2-3x weekly for indigestion
© 2008, The Institute for Functional Medicine
Lifestyle, Social, and
Exercise History

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.
© 2008, The Institute for Functional Medicine
Physical Exam/
Laboratory Evaluation
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
© 2008, The Institute for Functional Medicine
Clarify the most important
antecedents, triggers and
mediators in the case
© 2008, The Institute for Functional Medicine
Assessing for Potential
Antecedents, Triggers and Mediators

Antecedents:



Triggers:


Multiple antibiotics
Genetic atopic propensity
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.
© 2008, The Institute for
Functional Medicine

Prioritize the clinical
imbalances in the case
(pattern recognition):
© 2008, The Institute for Functional Medicine
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.
© 2008, The Institute for Functional Medicine
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
© 2008, The Institute for Functional Medicine
Healthy Gut
Healthy
Villi/ Good
Absorption
Healthy Cell
Junctions
© 2008, The Institute for Functional Medicine
Leaky Gut
Damaged
Villi / Poor
Absorption
Damaged
Cell
Junctions
© 2008, The Institute for Functional Medicine
Leaky Gut - Pathophysiology
Poor Dietary Choices
Stress & Emotions
Infection
Lectins
Systemic Disease
Altered
Intestinal
Permeability
Food Allergy
Malnutrition
Elevated Total
Toxic & Antigenic
Burden
Dysbiosis
Low Stomach Acid
Toxic Exposure
© 2008, The Institute for Functional Medicine
Toxic Overload
Systemic Disease
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.
© 2008, The Institute for Functional Medicine
FUNCTIONAL MEDICINE MATRIX MODEL™
Immune Surveillance
and Inflammatory Process
Oxidative/Reductive
Homeodynamics
Food allergen
Yeast sensitivity
Zinc insufficiency
EFA Insufficiency
Excess adiposity
Genetic propensity
Digestion
and Absorption
Increased intestinal
permeability secondary to?
Dysbiosis
Protozoa infection
Structural/Boundary/
Membranes
Nutrition Status
Detoxification and
Biotransformation
Medications
The Patient’s Story Retold
Hormone and
Neurotransmitter Regulation
Antecedents
(Predisposing)
Multiple antibiotics
Genetic atopic propensity
History of Depression
Triggering Events
(Activation)
IBS trigger: B. hominis, Food sensitivity
Asthma trigger: B. hominis, Food sensitivity
Overweight, Depression
Medications: Aspirin
Nutritional insufficiencies: zinc, etc
Exercise
Sleep
Beliefs & Self-Care
Psychological
and Spiritual Equilibrium
History of Depression,
Little Social Life, Lives Alone
Relationships
Date: ____ Name: ___________________ Age _____ Sex______ Chief Complaints: ___________________________
© 2008, The Institute for Functional Medicine
further evaluation to consider?
© 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.
© 2008, The Institute for Functional Medicine
FUNCTIONAL MEDICINE MATRIX MODEL™
Immune Surveillance
and Inflammatory Process
Food antibodies
Yeast antibodies
Bioelectrical impedance
RBC Fatty Acids
WBC zinc
SNP assessment
Digestion
and Absorption
O&P
Lactulose Mannitol
Digestive function
Structural/Boundary/
Membranes
Oxidative/Reductive
Homeodynamics
Detoxification and
Biotransformation
The Patient’s Story Retold
Antecedents
(Predisposing)
_____________________
____________________
_____________________
____________________
_____________________
____________________
Hormone and
Neurotransmitter Regulation
Amino Acid analysis
Triggering Events
(Activation)
__________________
__________________
__________________
__________________
__________________
__________________
Nutrition Status
Exercise
Sleep
Beliefs & Self-Care
Psychological
and Spiritual Equilibrium
Relationships
Date: ____ Name: ___________________ Age _____ Sex______ Chief Complaints: ___________________________
© 2008, The Institute for Functional Medicine
Initial Intervention
• Comprehensive elimination diet
• Non dairy/non gluten functional food
containing:
• supplemental antioxidants
• conditional essential nutrients for GI tract
• anti-inflammatory nutrients and
phytonutrients
• O&P X 3
© 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.
Decreased asthmatic complaints.
Overall ≈ 50% improved
Laboratory Results:
•
O and P:
• Microscopy:
•
•
Rare endolimax nana cysts and
trophozoites
• Many Blastocystis hominis
EIA Giardia, Cryptosporidium, and
Entamoeba negative
© 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
© 2008, The Institute for Functional Medicine
5 week follow-up
Continue on dietary and
functional/medical food protocol.
Add:
• Botanical anti-protozoal therapy:
berberine, artemesia, and citrus seed
extract in combination
• Probiotics: lactobacillus and
bifidobacteria in combination
© 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.
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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.
© 2008, The Institute for Functional Medicine
12 week follow-up
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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
© 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
© 2008, The Institute for Functional Medicine
FUNCTIONAL MEDICINE MATRIX MODEL™
Immune Surveillance
and Inflammatory Process
Oxidative/Reductive
Homeodynamics
Detoxification and
Biotransformation
The Patient’s Story Retold
Digestion
Antecedents
and Absorption
(Predisposing)
_____________________
____________________
_____________________
____________________
_____________________
____________________
Hormone and
Neurotransmitter Regulation
Triggering Events
Structural/Boundary/
Membranes
(Activation)
__________________
__________________
__________________
__________________
__________________
__________________
Nutrition Status
Exercise
Sleep
Beliefs & Self-Care
Psychological
and Spiritual Equilibrium
Relationships
Date: ____ Name: ___________________ Age _____ Sex______ Chief Complaints: ___________________________
© 2008, The Institute for Functional Medicine