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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS Intervention Spread out 4 meals and 2 snacks per day Spread protein intake through-out the day Decrease intakes of processed and fast foods Keep a food/symptom diary Supplementation: � Discontinue PPI (proton pump inhibitor) stop eating 2-3 hours before bed � Short term use of free-form amino acid supplements (morning and afternoon dosing) � Digestive enzymes with meals (not snacks) � Consider a shot glass of apple cider vinegar after large meals to lower stomach acid � Good quality multi-vitamin mineral supplement � Iron supplement with vitamin C Follow-up: The patient felt better after 10 days of treatment, and back to normal after 3 months. The patient stopped the free-form amino acids and apple cider vinegar shots with large meals after 6 weeks. She continued with the digestive enzyme and iron supplement. She worked to make sure she got adequate protein sources and spread out her protein intakes. It is not uncommon for patients to eat good diets but due to impaired digestion, age or medication not have adequate nutrient status. Elizabeth Redmond is the current Professional Advancement Chair and incoming Chair Elect of the Dietitians In Integrative and Functional Medicine (DIFM) a practice group of the Academy of Nutrition and Dietetics www.IntegrativeRD.org. Additionally she was a member of Standards of Practice (SOP) and Standard Of Professional Practice (SOPP) working group for DIFM, as well as a board member of the credentialing application. Dr. Redmond received her Master of Medical Science in Clinical Nutrition from Emory University in Atlanta, and her doctorate in Nutrition from the University of Georgia. She has worked in public health, research, and private practice. Her research interests have included dietary effects of cancer, 42 and diabetes translation, though she has worked, written and spoken on a variety of nutrition subjects. She currently works at Metametrix Laboratory as the Education Coordinator, and has a private practice in Atlanta, GA. Her private practice focuses on clinician education and mentoring, Contact Elizabeth Redmond at eredmond@metametrix.com or 678-638-2954. Website: www.RedmondRules.com References: 1. Ford, D., et al., American Dietetic Association: standards of practice and standards of professional performance for registered dietitians (competent, proficient, and expert) in integrative and functional medicine. J Am Diet Assoc, 2011. 111(6): p. 902-913 e1-23. 2. Richard Lord, J.A.B., ed. Laboratory Evaluations for Integrative and Functional Medicine Second Edition. 2008, Metametrix Institute: Duluth, GA. 3. Ames, B.N., Optimal micronutrients delay mitochondrial decay and age-associated diseases. Mech Ageing Dev, 2010. 131(7-8): p. 473-9. 4. Ames, B.N., Prevention of mutation, cancer, and other age-associated diseases by optimizing micronutrient intake. J Nucleic Acids, 2010. 5. Ames, B.N., Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage. Proc Natl Acad Sci U S A, 2006. 103(47): p. 17589-94. 6. Belanger-Quintana, A., et al., Up to date knowledge on different treatment strategies for phenylketonuria. Mol Genet Metab, 2011. 7. Fiege, B. and N. Blau, Assessment of tetrahydrobiopterin (BH4) responsiveness in phenylketonuria. J Pediatr, 2007. 150(6): p. 627-30. 8. Nalin, T., et al., Optimized loading test to evaluate responsiveness to tetrahydrobiopterin (BH(4)) in Brazilian patients with 2012
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS phenylalanine hydroxylase deficiency. Mol Genet Metab, 2011. 9. Anjema, K., et al., The 48-hour tetrahydrobiopterin loading test in patients with phenylketonuria: Evaluation of protocol and influence of baseline phenylalanine concentration. Mol Genet Metab, 2011. 10. Singh, R.H. and M.E. Quirk, Using change in plasma phenylalanine concentrations and ability to liberalize diet to classify responsiveness to tetrahydrobiopterin therapy in patients with phenylketonuria. Mol Genet Metab, 2011. 11. Harris, W.S. and D.M. Klurfeld, Twentiethcentury trends in essential fatty acid intakes and the predicted omega-3 index: evidence versus estimates. Am J Clin Nutr, 2011. 93(5): p. 907-8. 12. Harris, W.S., The omega-3 index: clinical utility for therapeutic intervention. Curr Cardiol Rep, 2010. 12(6): p. 503-8. 13. Janeckova, H., et al., Targeted metabolomic analysis of plasma samples for the diagnosis of inherited metabolic disorders. J Chromatogr A, 2011. 14. Lankinen, M., et al., Metabolomic analysis of plasma metabolites that may mediate effects of rye bread on satiety and weight maintenance in postmenopausal women. J Nutr, 2011. 141(1): p. 31-6. 15. Muti, P., et al., Omics underpins novel clues on VDR chemoprevention target in breast cancer. OMICS, 2011. 15(6): p. 337-46. 16. DHEA. Monograph. Altern Med Rev, 2001. 6(3): p. 314-8. 17. Head, K.A. and G.S. Kelly, Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep. Altern Med Rev, 2009. 14(2): p. 114-40. 18. Mariat, D., et al., The Firmicutes/Bacteroidetes ratio of the human microbiota changes with age. BMC Microbiol, 2009. 9: p. 123. 19. Topping, D.L. and P.M. Clifton, Short-chain fatty acids and human colonic function: roles of resistant starch and nonstarch polysaccharides. Physiol Rev, 2001. 81(3): p. 1031-64. 20. Leeds, J.S., K. Oppong, and D.S. Sanders, The role of fecal elastase-1 in detecting 43 exocrine pancreatic disease. Nat Rev Gastroenterol Hepatol, 2011. 8(7): p. 405-15. 21. Pyle, G.G., et al., Low-dose gluten challenge in celiac sprue: malabsorptive and antibody responses. Clin Gastroenterol Hepatol, 2005. 3(7): p. 679-86. 2012
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