functional medicine and nutritional genomics - American Association ...

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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 40 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
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS Minerals: All the nutrient elements are low-normal, except selenium. Mineral absorption requires an acidic environment. (see table below) Amino Acid- Plasma Lysine 114 - low normal Methionine 10 - low Tryptophan 23 - low Results 95% Reference Range 94-277 12-47 30-75 Isoleucine 39 29-111 Leucine 99 59-197 Valine 172 128-373 Phenylalanine 29 - low Histidine 39 - low Threonine 37 - low Arginine 25 - low normal 36-85 52-108 57-208 25-140 Taurine 37 32-149 Glycine 118 - low normal 73-177 41 Mineral- RBC Potassium 1380 - low normal Magnesium 18 - low normal Zinc 4.5 - low normal Copper 291 - low normal Manganese 26 - low normal Chromium 1.6 - low normal Selenium 0.21 - low normal Result 95% Reference Range 1099- 2492 18-40 4.2-9.3 275-534 22-43 1.3-7.5 0.15-0.41 2012
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