Clinical Integration and Functional Medicine Matrix Model Integration and Functional Medicine Matrix Model Monique Class, ... Sleep Disorder ... (inadequate sleep and Sleep apnea)

Clinical Integration and Functional

Medicine Matrix Model

Monique Class, ARNP

Applying Functional Medicine in Clinical Practice London, England

October 2015

Biotransformation & Elimination

Energy

Communication

Defense & Repair

Structural Integrity

Assimilation Antecedents

Triggering Events

The Patient’s Story Retold

Personalized Lifestyle Factors

Nutrition & Hydration

Physiology and Function: Organizing the Patient’s Clinical Imbalances

Mediators/Perpetuators Spiritual

Sleep & Relaxation

Name:____________________________ Date:___________ CC:_____________________________________ © Copyright 2011 Institute for Functional Medicine

Transport

Stress & Resilience

Family History:

• Depression

• Hypothyroidism

• Diabetes II

Mother’s

pregnancy: SAD

and smoker

Major life stressors: • Single mother • Divorce • Job • Isolation Extra weight

Chronic antibiotics 3 Children born between 25-29 Mother dying from BrCA. Divorce Major Job change

In the past but too tired now

Poor sleep hygiene, reads in bed, falls asleep but then wakes frequently, takes naps; un-refreshed.

Diverse diet but she does have significant carb cravings (candy etc.)

Divorce Single mother Job change

Lives alone No hobbies Uses Facebook casually to stay in touch with children

Carb Cravings Hurried eating Long Hx. of IBS Chronic ABX use early in life Bottle Fed

Possible exposure to toxins as a nurse/instructor Sensitive to scents/perfume Depressed Mood NSAIDs for HA Fluoxitine for Depression Acne

Severe fatigue Un-refreshing sleep Depressed Mood

Hashimoto’s? Adiposity=inflammation

IBS symptoms 3 children in short order NSAIDs=Increased IP

Divorce Single mother

Job change

Hypothyroidism Post? Menopause Hx. of Dysmenorrhea Acne

Hyperlipidemia

Nutrition, A Deep Dive

PFC-MVP Biomarkers

Your Functional Medicine Prescription

Nutrition

Assessments

PFC-MVP

Biomarkers

Gather

Organise

Re-Tell

Order/Prioritise

Initiate

Functional

Nutrition

Therapeutic

Interventions

The ABCDs of

Nutrition Evaluation

Food Is…

Food Is…

Food Is…

Food is information.

We are not our genes.

We are the expression of our genes.

Food Is…

Food is connection.

We are who our friends are.

We are what our friends eat.

Food Is…

Food is medicine.

“Let food be your medicine and

medicine be your food.”

- Hippocrates

Plant

Plan

Preparation

Portion

Pleasure

Phytonutrient Spectrum Patient Education Resources

©2015 The Institute for Functional Medicine

Personalising

the IFM Food Plans

Considerations for Personalising

the Food Plans

• Choose Food List Based on Features

• Provide Tailored Food List

– Consider Macronutrient Percentages

– Targeted Calories when Appropriate

– Provide Serving Allowances

– Remove Triggering Foods

• Discuss Therapeutic Foods

• Provide Practical Tools such as Weekly Menu

Plan, Recipes, and Shopping List


the Food Plans











the Food Plans










Functional Nutrition Food Plans

Medical History ABCDs of Nutrition Evaluation

Anthropometrics

Biomarkers and Labs

Clinical Indications from NPE

Diet and Lifestyle Review

Matrix Review

Chief Complaints

Conditions

Timeline and ATMs

Medication Review

Choosing a Food Plan

Taking a Tour

through the

Food Plans • Ideal Patient

Population

• Food Plan Features

• Introduction to the

Food Plan List

• Comprehensive

Guide

• Suite resources

The Core Food Plan



Anthropometrics

Biomarkers and Labs



Matrix Review

Chief Complaints

Conditions

Timeline and ATMs

Medication Review


Profile for when to use the Core

Food Plan

Gather/GOTOIT

Core Food Plan

Chief Complaint and

Medical History

Weight Gain / Weight loss

Fatigue

Conditions Non-specific

Medical History Seeking Healthy Diet, All

Ages, Athletic, Pregnancy,

Overweight, Underweight

ATMs

Anthropometrics Non-specific

Biomarkers & Labs Normal screening values

Clinical Indicators from

Nutrition Physical Exam

Non-specific

Diet and Lifestyle Inadequate nutrients

Prepared food

Matrix Patterns Non-specific


x x

The Elimination Diet



Anthropometrics

Biomarkers and Labs



Matrix Review

Chief Complaints

Conditions

Timeline and ATMs

Medication Review


Identifies Food Triggers

Reduces Inflammation

Repairs Intestinal Permeability

Phytonutrients to Heal the Gut

Reduces Toxic Burden

No Calorie Restriction

Promotes Body Awareness to Foods

Profile for

when to use

Gather/GOTOIT

Elimination Diet

Chief Complaint and

Medical History

GI sxs-bloating, indigestion, Joint pain, Muscle aches

Immune dysregulation, Fatigue

Conditions

Gastrointestinal

• Irritable Bowel Syndrome

• Intestinal Permeability

Immune/Inflammation

• Auto-immune Diseases

• Asthma

• Atopy &Skin Inflammation

• Myalgias and Arthralgias

Mood Disorders

• Depression

Medical History Allergies, Atopy, Asthma, GI Distress, Pain and Fatigue,

AI Diseases.

ATMs Antibiotics, Multiple infections, Trauma, Stress, Familial

allergies, Mother with Group B strep, Acid Blocking

Medication, Maternal use of PPI during pregnancy

Anthropometrics Increased BMI, Increased ECW/ICW

Biomarkers & Labs Inc.. IgG or IgE food reactions, Celiac, Autoantibodies,

Dysbiosis.



Dry Skin, thin eyebrows, Fluid retention, and skin

inflammation.

Diet and Lifestyle Food Triggers, Allergy Exposures. Excess reliance on

one food.

Matrix Patterns Assimilation

Biotransformation

Communication/Defense and Repair


The next step…

Reintroduction of foods


Food Reintroduction



Anthropometrics

Biomarkers and Labs



Matrix Review

Chief Complaints

Conditions

Timeline and ATMs

Medication Review



Profile for

when to use

Gather/GOTOIT

Cardiometabolic Food Plan

Chief Complaint and

Medical History

Elevated Blood Sugar, Increased Blood

Pressure, Increased Waist Line, Fatigue

Conditions Obesity, Metabolic Syndrome, Type 2

Diabetes, Essential Hypertension, Dyslipidemia

Medical History Metabolic Syndrome, Type 2 Diabetes,

Hypertension, Dyslipidemia, Obesity

ATMs Family History, T2DM, CVD, HTN, Obesity,

Sedentary Lifestyle, Sleep Disorder (inadequate

sleep and Sleep apnea)

Anthropometrics Inc..: BMI, WC, WHR, Fat, Blood Pressure

Biomarkers & Labs Inc..: HgbA1C, FBS, insulin, hs-CRP, Trigs

Decr.: HDL



Inc..: WC and WHR

Skin tags, acanthosis nigricans, peripheral

neuropathy.

Diet and Lifestyle Excess simple sugar, high CHO intake, GI

foods, low protein, excess alcohol, elevated

trans fats.

Matrix Patterns Structural Integrity

Transport

Defend and Repair/Communication

Arteriosclerosis Thromb Vasc Biol. 2012 September; 32(9): 2052–2059.

Fatty Liver

Obesity

Type 3 Diabetes

Cardiovascular Disease

Immune Dysfunction

Endothelial Dysfunction

Beta-cell Dysfunction

Lipotoxicity Osteoporosis


Modified Mediterranean Approach

Mediterranean Diet

• The most well-studied dietary approach • Over 3800 articles on PubMed (as of 8/17/15) • Over 1400 articles for its connection to

cardiovascular disease (as of 8/17/15)

Taken from The Practitioners Guide to Personalizing the IFM Food Plans

Macronutrient Distribution for 40/30/30 Approach

©2015 The Institute for Functional Medicine Taken from The Practitioners Guide to Personalizing the IFM Food Plans


THE CARDIOMETABOLIC

FOOD PLANS

with Caloric Targets

Low glycemic index and

glycemic load

Targeted calories

Eating regular times

High in fibre

Low in simple sugars

Balanced Quality Fats

Condition-specific

phytonutrients

PLACEHOLDER FOR CMS FOOD PLAN


Core Food Plan Elimination Diet Cardiometabolic

Chief Complaint and Medical History

Weight Gain / Weight loss Fatigue

GI sxs-bloating, indigestion Joint pain Muscle aches Immune dysregulation Fatigue

Elevated Blood Sugar Increased Blood Pressure Increased Waist Line Fatigue

Conditions

Non-specific Gastrointestinal • Irritable Bowel Syndrome • Intestinal Permeability

Immune/Inflammation • Auto-immune Diseases • Asthma • Atopy &Skin Inflammation • Myalgias and Arthralgias

Mood Disorders • Depression

Obesity Metabolic Syndrome Type 2 Diabetes Essential Hypertension Dyslipidemia

Differentiating Food Plans

Allows you to Personalise all other

food plans

Clinical Nutrition Findings

Core Food Plan Elimination Diet Cardiometabolic

Medical History Seeking Healthy Diet, All Ages, Athletic,

Pregnancy, Overweight, Overweight,

Underweight.

Allergies, Atopy, Asthma, GI Distress,

Pain and Fatigue, AI Diseases.

Metabolic Syndrome, Type 2 Diabetes,

Hypertension, Dyslipidemia, Obesity

ATMs Antibiotics, Multiple infections, Trauma,

Stress, Familial allergies, Mother with

Group B strep, Acid Blocking

Medication, Maternal use of PPI during

pregnancy

Family History, T2DM, CVD, HTN,

Obesity, Sedentary Lifestyle, Sleep

Disorder (inadequate sleep and Sleep

apnea)

Anthropometrics Non-specific Increased BMI, Increased ECW/ICW Inc.: BMI, WC, WHR, Fat, Blood

Pressure

Biomarkers & Labs Normal screening values Inc.. IgG or IgE food reactions, Celiac,

Autoantibodies, Dysbiosis.

Inc.: HgbA1C, FBS, insulin, hs-CRP, Trigs

Decr: HDL

Clinical Indicators from Nutrition

Physical Exam

Non-specific Dry Skin, thin eyebrows, Fluid retention,

and skin inflammation.

Inc.: WC and WHR

Skin tags, acanthosis nigricans,

peripheral neuropathy.

Diet and Lifestyle Inadequate nutrients

Prepared food

Food Triggers, Allergy Exposures. Excess

reliance on one food.

Excess simple sugar

High CHO intake, GI foods, low protein,

excess alcohol, elevated trans fats.

Matrix Patterns Non-specific Assimilation

Biotransformation

Communication/Defense and Repair


Transport

Defend and Repair/Communication

Food Plans

Get together with a member

Of your group:

• Which of the 3 featured Food Plans could you implement within your patient base?

• What challenges or resistance could you imagine with your patients if you recommend these Food Plans?


Let’s Go Back to the Case,

What Functional Nutrition

Tools Would You Give Her?

54 year old white female

• CC: long term fatigue x 15 years

• Irritable Bowel Syndrome x 40 years

• Depression x 24 years

• Chemical Sensitivity x 19 years

• Hypothyroidism x 6 years

• Hyperlipidemia & High Triglycerides x 5 years

• Hypertension x 5 years

• Also reports long term history of Weight Gain, Memory Changes, Emotional Lability, and Headaches

D

Pre

con

cep

tio

n

Current Concerns

Antecedents

Triggers or Triggering Events

Signs, Symptoms or Diseases Reported

Pre

nat

al

Bir

th

7-10 14-18

30 54

Depression, Headaches Insomnia & ‘Brain Fog’ Resistant Weight Loss

48

Chronic Antibiotic use for 2+ years;

25-29

HTC, Dyslipidemia, Increased trigs,

& Hypothyroidism

LMP

52 1-3

Chronic OM

3 Children born; at ages of 25, 27, 29

Colic

IBS, Abd Pain

Dysmenorrhea, Acne

37-39 42

40

Major Life Stressors

• Diet • Smoking

47

“Chemical Sensitivity”

35

Severe Fatigue Began

Exposure?

FHx.: • Depression • Hypothyroidism • Diabetes (dad) • HTN (dad) • Breast CA (mom)


D

Pre

con

cep

tio

n

Current Concerns

Antecedents

Triggers or Triggering Events

Signs, Symptoms or Diseases Reported

Pre

nat

al

Bir

th

7-10 14-18

30 54

Depression, Headaches Insomnia & ‘Brain Fog’ Resistant Weight Loss

48

Chronic Antibiotic use for 2+ years;

25-29

Dx: Dyslipidemia, Increased trigs,

& Hypothyroidism

LMP

52 1-3

Chronic OM

3 Children born; at ages of 25, 27, 29

Colic

IBS, Abd Pain

Dysmenorrhea, Acne

37-39 42

40

Major Life Stressors

• Diet • Smoking

47

“Chemical Sensitivity”

35

Severe Fatigue Began

Exposure?

FHx.: • Depression • Hypothyroidism • Diabetes (dad) • HTN (dad) • Breast CA (mom)


Energy

Communication

Defense & Repair



Triggering Events






Sleep & Relaxation


Transport

Stress & Resilience

Family History:

• Depression

• Hypothyroidism

• Diabetes II

Mother’s

pregnancy: SAD

and smoker





Diverse diet but she does have significant carb cravings (candy etc..)







IBS symptoms 3 children in short order NSAIDs=Increased IP Hypertension Visceral Adiposity


Job change


Hyperlipidemia Hypertriglyceridemia

Hypothyroidism Post? Menopause Hx. of Dysmenorrhea Acne Insulin Resistance


x


x

x


Energy

Communication

Defense & Repair



Triggering Events






Sleep & Relaxation


Transport

Stress & Resilience

Family History:

• Depression

• Hypothyroidism

• Diabetes II

Mother’s

pregnancy:

SAD and

smoker





Diverse diet but she does have significant carb cravings (candy etc..)









Job change




x

x


x x x

Why Not Start with the Elimination Diet ?


x

x

x



Macronutrient Ratio?


x

x

x x



Caloric Target?


Which Areas of the Matrix

Would You Consider

Key Points of Leverage?


Energy

Communication

Defense & Repair



Triggering Events






Sleep & Relaxation


Transport

Stress & Resilience

Family History:

• Depression

• Hypothyroidism

• Diabetes II

Mother’s

pregnancy: SAD

and smoker














Job change




What does stress do?

It messes with the Matrix!

Summary: Stress and the Matrix

It is pro-inflammatory and causes immune dysregulation.

Stress and the Immune System

Stress and the Energy Node

Stress is a source of oxidative stress and diminishes mitochondrial

function but it is reversible!

Stress and Detoxification Stress impairs Detoxification and increases toxic burden through

poor dietary choices.

Stress and Transport

Stress increases BP and Increases Carotid Artery Intima Thickness

Stress and Communication Stress causes alterations in the HPATG axis

Stress and Structural Integrity Stress decreases bone density in postmenopausal women

Stress and Assimilation Stress causes increased intestinal permeability



Energy

Communication

Defense & Repair



Triggering Events






Sleep & Relaxation


Transport

Stress & Resilience

Family History:

• Depression

• Hypothyroidism

• Diabetes II

Mother’s

pregnancy: SAD

and smoker














Job change




In your Toolkit


Energy

Communication

Defense & Repair



Triggering Events






Sleep & Relaxation


Transport

Stress & Resilience

Family History:

• Depression

• Hypothyroidism

• Diabetes II

Mother’s

pregnancy: SAD

and smoker














Job change






Energy

Communication

Defense & Repair



Triggering Events






Sleep & Relaxation


Transport

Stress & Resilience

Family History:

• Depression

• Hypothyroidism

• Diabetes II

Mother’s

pregnancy: SAD

and smoker














Job change




Lets us now consider

each node of the Matrix

Biotransformation &

Elimination

Energy

Communication

Defense & Repair



Relationships

Modifiable Personal Lifestyle Factors


Mental

Spiritual

Name:____________________________ Date:___________ CC:_____________________ © Copyright 2014 Institute for

Functional Medicine

Emotional

Transport

Retelling the Patient’s Story

FUNCTIONAL

MEDICINE MATRIX

Stress

Nutrition

Exercise &

Movement

Sleep & Relaxation

Mediators/Perpetuators

Triggering Events

Antecedents

Stool Analysis

Digestion/Absorption

Digestive enzyme levels/fibers, Bile acids

Immunology/Inflammation

Calprotectin, Lactoferrin, Fecal sIgA

Metabolic and Microbiome

Parasites: O&P, EIA,

Bacteria, yeast: culture and sensitivity,

SCFAs

5Rs

Remove-Elimination Food Plan,(Oligoantigenic diet),

pathogenic organisms

Replace-digestive enzymes, HCl, Bile Salts, Fiber,

Bromelain

Reinoculate-Probiotics, Prebiotics, Synbiotics

Repair-Glutamine, Zinc, Vit. A,D,E, plantain, EPA/DHA

Rebalance-relaxation, mindful eating, Psychotherapy, Stress

management

Assimilation/Structural

Integrity

Assessment

• Are symptoms frankly associated with food/eating? From what we now

know, could those symptoms possibly be associated with food?

• Does the patient have high scores in the MSQ sections for

“digestive tract” and “weight” sections?

• Are there medications or surgeries that may impair digestion and/or

absorption

• Assessing the patient’s diet, is it deficient/insufficient?

Inflammatory? Hurried, emotional eating?

Interventions

Questions to Ask

Biotransformation &

Elimination

Energy

Communication

Defense & Repair



Relationships



Mental

Spiritual


Functional Medicine

Emotional

Transport


FUNCTIONAL

MEDICINE MATRIX

Stress

Nutrition

Exercise &

Movement

Sleep & Relaxation


Triggering Events

Antecedents

Assessment

Signs of inflammation:

• Allergic shiners, boggy mucosa, pain, congestion

Labs:

• Autoantibodies

• Increased levels of inflammatory mediators such as histamine and various cytokines

and Interleukins.

• AA:EPA ratio >3

• Elevated hs-CRP, Leukocytosis

• Elimination Diet Food Plan

• Avoid Triggers

• EFAs: EPA/DHA

• Alpha-Lipoic acid, NAC,

• Antioxidants

• Probiotics

• Botanicals/phytonutrients:

• Quercitin, Scute, Curcumin, Ginger, Catechins, Devil’s

Claw

• Boswellia, Ginkgo, Licorice, Grape Seed Extract

Questions to Ask: • Does the patient have an Inflammatory diet such as high fried, processed,

high simple sugar, high GL?

• Does the patient have a highly antigenic diet? (Gluten, Milk etc..)

• Has the patient had environmental exposure to potentially inflammatory

triggers? (smoking, pesticides, solvents, alcohol)

• Is there a traumatic event in the patient’s Timeline?

Interventions

Defense &

Repair

Biotransformation &

Elimination

Energy

Communication

Defense & Repair



Relationships



Mental

Spiritual


Functional Medicine

Emotional

Transport


FUNCTIONAL

MEDICINE MATRIX

Stress

Nutrition

Exercise &

Movement

Sleep & Relaxation


Triggering Events

Antecedents

Communication/Transport

Assessment

NCEP ATP III:

Increased waist circum., Inc.. Blood Pressure, Elevated FBS, Elevated

Triglycerides, Decreased HDL

Visceral Adiposity, Bio impedance Analysis, Hyperinsulinemia

Dysglycemia

• Elevated Inflammatory markers such as hs-CRP.

• Elevated A1C.

• Insulin resistance

• Elev TG/HDL (>=3)

• Apo B/Apo A-1 > 0.8

• Cardiometabolic Food Plan

• Exercise Prescription

• Essential Fatty Acids

• Blood Glucose Log

• Stress Management

• Correct Nutritional Insufficiencies

• Insulin sensitizing phytonutrients: Cr, Mg,

Vit D, catechins, cinnamon

Questions to Ask:

• Is there a pattern of dysinsulinemia and dysglycemia?

• Is there a family or personal history of Cardiovascular or

Cardiometabolic disease?

• Is there a history or suspicion of sleep apnea or other sleep

disturbances?

• High saturated fat/high sugar/high GL?

Interventions

Biotransformation &

Elimination

Energy

Communication

Defense & Repair



Relationships



Mental

Spiritual


Functional Medicine

Emotional

Transport


FUNCTIONAL

MEDICINE MATRIX

Stress

Nutrition

Exercise &

Movement

Sleep & Relaxation


Triggering Events

Antecedents

More Communication/Transport

Assessment

Abnormal findings in sex steroid

hormones or Thyroid/Adrenal

hormone levels.

• TSH, T4, fT4, rT3

• Estrogen fractions, PROG, Test,

SHBG

• Cortisol and DHEA

Clinical evidence of abnormal

endocrine function (even with

apparently “normal” levels).

Fasting Blood Glucose and Insulin

SNPs in Detoxification pathways.

Questions to Ask:

• Are there seemingly vague and broad-spectrum symptoms?

• Is there a history of removal or injury to any endocrine

organ?

• Is the patient taking any hormones of any kind, or

medications that affect hormones?

• Is there un-refractory fatigue?

• Cardiometabolic Food Plan

• Optimize bowel function

• Aromatase inhibitors: Anastrazole, green tea,

mushrooms, curcumin, chrysin, crucifers,

resveratrol, omega-3s.

• Treat insulin resistance and obesity

• Hormone replacement

Interventions

Biotransformation &

Elimination

Energy

Communication

Defense & Repair



Relationships



Mental

Spiritual


Functional Medicine

Emotional

Transport


FUNCTIONAL

MEDICINE MATRIX

Stress

Nutrition

Exercise &

Movement

Sleep & Relaxation


Triggering Events

Antecedents

Assessment

• Evidence of Dysbiosis

• SNPs that impair detoxification

• Toxic exposure questionnaire implies a past or ongoing

exposure.

• Direct measurement of toxins.

• Impaired hepatic function: GGT.

• Toxic Metals (hair, stool, blood, urine)

• Minimize exposure to toxins

• Maximize Organic foods, Fresh foods

• Judicious intake of fish and shellfish

• Avoid amalgam fillings

• Optimize bowel function

• Antioxidants

• Consume Sea and Cruciferous vegetables

• Clean air with plants/devices

• Use natural cosmetics

• Adequate Exercise & Sauna

• D-glucaric Acid, NAC, Alpha-Lipoic Acid, Taurine

• Botanicals/phytonutrients

• Berberine, Globe Artichoke, Turmeric, Milk thistle,

Dandelion

Questions to Ask:

• Is there exposure in the patient’s history? Home? Work? Hobby?

Childhood?

• Is the patient “sensitive” to perfumes etc.?

• Are the patient’s TEQ-20 and MSQ suspicious for toxicity?

Interventions

Biotransformation

Biotransformation &

Elimination

Energy

Communication

Defense & Repair



Relationships



Mental

Spiritual


Functional Medicine

Emotional

Transport


FUNCTIONAL

MEDICINE MATRIX

Stress

Nutrition

Exercise &

Movement

Sleep & Relaxation


Triggering Events

Antecedents

Energy

Assessment

Questions to Ask:

• Is the patient experiencing: prolonged inflammation? An

increased need for detoxification? Or increased stress?

• Is there a toxic exposure (increases the need for cellular

energy and potentially inhibits it’s production)?

• Chronic shallow breathing?

Total Antioxidant Capacity (TAC); GSH:GSSG; Cysteine:Cystine

Antioxidant Enzymes:

• Superoxide Dismutase

• Glutathione Peroxidase

• Catalase

Oxidative Damage:

• Lipid peroxides, oxidized LDL

• HgbA1c, AGEs

• 3-Nitrotyrosine

• 8-OH Deoxyguanosine

NAC, vitamin C, Vitamin E

Milk Thistle

Pyridoxyl-5-Phosphate

CoQ10, Lipoic Acid

Curcumin and Cayenne, Carotene

Methylation factors (B-Vitamins), EGCG, Resveratrol

Adequate Protein and Mineral co-factors

Interventions

What are the next steps?

Diagnostically?

Therapeutically?

rack assessments, note the effectiveness of the therapeutic

approach, and identify clinical outcomes at

each visit—in partnership with the patient

“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


Unconscious

Incompetence Conscious

Incompetence

Discovery Learning

(You don’t know what you

don’t know.)

(You know what you need

to do but you don’t have

the skills to do it.)

(You know what to do and

how to do it and it flows

naturally from you.)

Conscious

Competence Unconscious

Competence

Disciplined Effort Skilled Application

(You know what you

should do, and how to do

it, but it takes a lot of

conscious effort.)

Both you and your patient are on a Journey


General Challenges in Follow-up

• What do you do when the patient doesn’t

improve?

• What do you do if they do?

• Following up on a lifestyle program

• Following up on a dietary program


General Challenges in Follow-up

• Navigating symptom control vs. long term

resolution

• Giving the patient too much change vs. not

enough

– Doing too much vs. doing too little


Follow up with our Patient

What do you do if your initial treatment approach of…

– An elimination diet, probiotics, and glutamine for the gut

– Omega 3 fatty acids and B-complex for depression

– Nutritional support for the thyroid

– Magnesium for headaches

– Stress reduction techniques and sleep hygiene

Did not work, or did not work well enough?


Follow up with our Patient

What lab would you get?

What else would you do?


Functional Nutrition Biomarkers


Taking a Functional Medicine History

Using a Timeline and Matrix

Take the time to complete

Your Own Timeline

“Perhaps the most basic skill of the physician is the ability to have comfort with uncertainty; to recognise with humility the uncertainty inherent in all situations; to be open to the ever-present possibility of the surprising, the mysterious and even the holy; and to meet people there.”

Rachel Naomi Remen

Documents

Clinical Integration and Functional Medicine Matrix Model Integration and Functional Medicine Matrix Model Monique Class, ... Sleep Disorder ... (inadequate sleep and Sleep apnea)