functional medicine and nutritional genomics - American Association ...

AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS
Urine is another specimen type that is easy to
collect. There are more than 100 different tests
that can be done on urine. Urinary organic acids
are frequently used by functional and integrative
clinicians to reveal nutritional and metabolic
impairments. Organic acids include markers of
oxidative damage, neurotransmitter breakdown
products, intestinal microbial activity, and may
identify impairments related to specific nutrients
[13, 14]. Organic acids are metabolic
intermediates that may be able to be used to
evaluate the function of metabolic pathways.
Canada’s government has started the Human
Metabolome project www.metabolomics.ca, which is
the next step following the U.S. Human Genome
project. The Human Metabolome project is a
significant tool in the use of metabolomics.
Metabolomics is a new-born cousin to genomics
and proteomics.[15]
Salivary assessments are another tool used in
integrative and functional medicine; they are used
to evaluate stress markers, antibodies, drugs and
hormones [16]. While conventional laboratory
assessment is used to diagnose Cushing’s
syndrome, functional laboratory tests are used to
evaluate adrenal function. Salivary measurements
of cortisol and dehyroepiandrosterone (DHEA) can
help to evaluate level of demand of cortisol. An
increased level of cortisol and a decreased
DHEA-S, or a decrease in the DHEA-S/cortisol
ratio can be an indicator of chronic stress or
increased fight or flight. Integrative clinicians would
then use varying interventions to help ameliorate
the stress-induced fatigue [17].
Integrative and functional clinicians additionally rely
on stool testing to identify over-all gastrointestinal
function. The tests can evaluate status of
beneficial or predominant bacteria, SCFAs,
pathogens, parasites, yeast/fungi, digestive
enzymes and immune status [18-21]. Stool tests
are easily collected by the patient; newer DNA
tests make only a single sample necessary and
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are considered more accurate. The stool test can
be a great addition for patients undergoing a
colonoscopy for specific GI symptoms. In patients
who are found to have a clean colonoscopy, the
assessment done in a stool test often helps to
guide further clinical treatment. The case study
below illustrates such a case.
Case Study
RT is a 58 year old female who presented with
fatigue. The patient noted she had been taking an
OTC PPI (proton pump inhibitor) for acid reflux
for several years. Diet and health history
evaluations found that the patient ate adequate
amounts of protein, vitamins and minerals.
Conventional laboratory tests revealed the patient
had a low albumin, vitamin B12, ferritin and
hemoglobin. Functional laboratory testing showed
low and low-normal levels of individual amino
acids and minerals. Stool testing also identified
low fecal elastase 1, a marker of impaired
exocrine pancreatic function. Adequate stomach
acid is needed for the breakdown and digestion of
proteins into amino acids, as well as minerals and
B12. Inadequate stomach acid can lead to
impaired absorption. The IOM currently
recommends older adults take extra B12 because
stomach pH becomes higher as people age.
Significant Laboratory Results
Hemoglobin 10 % - low and considered a marker
of anemia
Albumin– 2.8 g/100ml – indicates poor nutritional
state – from inadequate protein intake
Plasma amino acids: The majority are low:
methionine, tryptophan, phenylalanine, histidine and
threonine are below the reference interval. (see
table below)
2012