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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS 75). A 2-hour glucose insulin response test revealed normal fasting insulin (5 micro IU/mL -- - normal < 5) but severe hyperinsulinemia at 1 and 2 hours post glucose load (242 micro IU/mL and 84 micro IU/mL --- normal < 30 micro IU/mL). His fasting glucose was 74 mg/dL, his 1-hour glucose was 184 mg/dL and his 2-hour glucose was 93 mg/dL. Immune and inflammatory evaluation revealed elevated IgG antigliadin antibodies of 16 U/mL (nl < 11) with normal IgA antigliadin and tissue transglutaminase antibodies. He had elevated IgG antibodies to wheat, dairy, and yeast. His high sensitivity C-reactive protein was normal at 0.3 mg/L. His quinolinate was significantly elevated indicating cytokine disruption of the enzymatic conversion of tryptophan to serotonin. Moderate elevation of dysbiosis markers on urinary organic acids indicated digestive imbalances. Detoxification markers showed low levels of sulfate and alpha-hydroxybutyrate indicating glutathione deficiency. Mitochondrial evaluation on organic acids revealed deficiencies of carnitine, riboflavin, lipoic acid, coenzyme Q10, magnesium, and lipoic acid. What story do this history, exam and functional laboratory assessment tell? We asked two simple questions: what did this young man need to get rid of that was impeding his health, and what did he need to get or receive that he was missing? And then from asking how this affected his core clinical physiologic systems we learn the following. The Core Clinical Imbalances: Networks of Dysfunction He was nutritionally depleted of vitamin D (seasonal depression v,vi and impaired immunity vii ), as well as deficient in omega 3 fats (depression viii and acne), B12 ix and B6 x (depression and fatigue), B vitamins (chelosis, B vitamin deficiency markers on organic acids), and zinc based on his impaired immunity, acne, and white spots on his 30 nails. His hormones and neurotransmitters were out of balance with a history of anxiety and depression. He had a low body temperature (95.5 F), elevated thyroid antibodies and low free T3 (depression, morning fatigue, hyperlipidemia, insulin resistance xi ), and he was severely hyperlinsulinemic (acne, xii depression, xiii weight gain, carbohydrate cravings) and had dyslipidemia with a low HDL, high triglycerides and high LDL (from insulin resistance). His immune imbalances included elevation of IgG anti-gliadin antibodies (fatigue, depression, xiv hypothyroidism, xv acne) and IgG antibodies xvi to dairy, wheat and yeast. His canker sores supported the diagnosis of gluten intolerance. xvii Digestive imbalances were supported by his history of long-term antibiotic use and dysbiosis markers on organic acids. Mitochondrial dysfunction was inferred from his fatigue xviii and confirmed by significant abnormalities of fat, carbohydrate and Kreb cycle metabolites. Deficiency of sulfate and abnormal glutathione markers indicated impaired detoxification and oxidative stress. Removing Impediments, Replacing What’s Missing Based on these clinical markers we simply removed impediments to health – gluten, IgG food allergens, antibiotics, and treated yeast overgrowth with fluconazole. We removed processed, junk food and refined carbohydrates from his diet. Then we replaced what was missing that he needed to thrive: a whole foods, low glycemic load, high phytonutrient, allergen free diet, thyroid hormone (Armour thyroid), a multivitamin and mineral, vitamin D, zinc, methylation factors (5methylfolate, pyridoxine, sublingual B12), mitochondrial support (coenzyme Q10, carnitine, lipoic acid), omega 3 fatty acids, detoxification support (N-acetylcysteine), probiotics, protein kinase modulators xix from hops to improve insulin sensitivity, as well as whole soy protein, and plant sterols to improve lipid metabolism. 2012
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS His clinical response included improved energy, depression, and cold intolerance. His acne, cankers sores and chelosis resolved. He lost 15 pounds in the first two months of treatment and eliminated his carbohydrate cravings. So what can we say about his ‚diagnosis‛? Was the cause of his symptoms ‚depression‛, ‚acne vulgaris‛, and ‚hyperlipidemia‛? Did he need antidepressants, antibiotics and statins? Or perhaps he was suffering from a few underlying causes, which triggered imbalance and patterns of dysfunction in his core physiologic systems (gluten, IgG food allergies, poor diet, yeast overgrowth from antibiotic use)? And was he missing a few ‚ingredients‛ or raw materials needed to thrive (thyroid hormone, whole foods, omega 3 fats, vitamin D, zinc, methylation support (B6, B12, folate), mitochondrial nutrients and probiotics to restore normal gut flora? Complexity in chronic illness is the norm, but navigating therapy is relatively simple. Using a comprehensive history, exam and reframing diagnostic evaluation to identify impediments to health, assess function, and imbalance rather than pathology is a better compass for finding our way through the 21-century puzzle of chronic illness. The next era of research might focus on the clinical application of systems biology and generate new models of investigation and data analysis. Our current reductionistic analysis in clinical medicine based on the randomized controlled trial prevents study of multi-interventional approaches. Clinical practice must piece together research into discrete interventions (nutrients, phytonutrients, hormones, lifestyle treatment, and so on). Clinical experience can inform research and research clinical practice in fertile cycle. But at the bedside there are Inherent limitations for translation of research into clinical protocols. What guides us each day is the art of blending science, theory, and experience into what we hope is the best treatment for our patients. Mark Hyman has dedicated his career to identifying and addressing the root causes of chronic illness through a groundbreaking whole- 31 systems medicine approach known as Functional Medicine. He is a family physician, a four-time New York Times bestselling author, and an internationally recognized leader in his field. Through his private practice, education efforts, writing, research, advocacy and public-policy work, he strives to improve access to Functional Medicine, and to widen the understanding and practice of it, empowering others to stop managing symptoms and instead treat the underlying causes of illness, thereby also tackling our chronic-disease epidemic. Dr. Hyman is Chairman of the Institute for Functional Medicine, and was awarded its 2009 Linus Pauling Award for Leadership in Functional Medicine. He is on the Board of Directors of The Center for Mind-Body Medicine, and a faculty member of its Food As Medicine training program. He is also on the Board of Advisors of Memhet Oz’s HealthCorps, which tackles the obesity epidemic by ‚educating the student body‛ in American high schools about nutrition, fitness and mental resilience. He is a volunteer for Partners in Health with whom he worked immediately after the earthquake in Haiti and continues to help rebuild the health care system there. He was featured on 60 Minutes for his work there. Dr. Hyman has testified before the White House Commission on Complementary and Alternative Medicine, and has consulted with the Surgeon General on diabetes prevention. He has testified before the Senate Working Group on Health Care Reform on Functional Medicine, and participated in the White House Forum on Prevention and Wellness in June 2009. Dr. Hyman was nominated by Senator Tom Harkin for the President’s Advisory Group on Prevention, Health Promotion and Integrative and Public Health, a 25-person group to advise the Administration and the new National Council on Prevention, Health Promotion and Public Health. With Drs. Dean Ornish and Michael Roizen, Dr. Hyman crafted and helped to introduce the Take Back Your Health Act of 2009 into the United States Senate, to provide for reimbursement of lifestyle treatment of chronic disease. He continues to work in Washington on health reform, recently testifying before a Congressional hearing 2012
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