functional medicine and nutritional genomics - American Association ...

AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS
fundamental clinical imbalance are essential to
address the modern plague of diabesity.
The causes of diabesity are not the same for
every person. For some, diabesity may be simply
a result of poor diet. For others, it may be due
to environmental toxins, chronic inflammation,
digestive imbalances, chronic stress, or even food
sensitivities. This is why we must take a
comprehensive approach to understanding,
diagnosing, and treating these fundamental clinical
imbalances that drive diabetes, insulin resistance,
and most chronic diseases.
Functional Medicine Approach to Diabesity: Case
Studies
Obesity (diabesity) is a complex, multi-factorial,
multi-gene disorder with dynamic web-like
physiological imbalances affecting gene expression
and phenotype. A systemic approach directed at
removing the impediments to optimal function
(diet, toxins, allergens, infections, stress) and
providing the ‚ingredients‛ for optimal health
(whole foods, micronutrients, light, air, water,
movement, rhythm, sleep, connection, community,
meaning and purpose) based on the model of
Functional medicine xcviii provides a roadmap for
diagnosis and treatment of the underlying clinical
imbalances at the root of obesity and chronic
disease. The functional clinical imbalances are
influenced by the environment including diet and
nutritional status on core functional systems -
hormonal/metabolic, immune/inflammatory,
digestive, detoxification, mitochondrial energetics
and redox status, structural and psycho-spiritual.
These diagnostic and treatment principles are
illustrated in the following cases.
Case 1: Inflammation, Obesity and Diabetes
S.R. is a 67-year-old woman with a 10-year
history of type 2 diabetes. Her weight was 233
pounds with a BMI of 36 and waist to hip ratio
0.91. Her past medical history was significant for
hypertension, angina, reflux, rheumatoid arthritis
and lupus, hypothyroidism, chronic allergies and
sinusitis, and depression. Her medications
included metformin, benazepril, fluoxetine,
pravastatin, bio-identical hormone replacement,
50
cetrizine, lansoprazole, levothyroxine, naproxen, a
multivitamin glucosamine, and calcium with D.
She is a widow who lives alone and is estranged
from her family. She is a recovering alcoholic with
a history of childhood sexual abuse. Her diet
consisted predominately of refined carbohydrates
including bread, pasta, muffins and ice cream.
She does no exercise. Her medical symptom
questionnaire (MSQ) was 86.
Functional diagnostic assessment revealed
hyperinsulinemia of 23 (nl < 5), glucose of 140
mg/dl and HbA1c of 6.8. Her high sensitivity
C-reactive protein was elevated at 10.6 (nl <
1) and her sedimentation rate was 20. Her antinuclear
antibodies were 1:80 speckled pattern.
On a statin her total cholesterol was 198 mg/dl,
LDL-C 119 mg/dl, HDL-C 54 mg/dl and
triglycerides 199 mg/dl. She had a fatty liver
with an elevated gamma glutamyl transferase
(GGT) of 40. Organic acid analysis revealed
impaired fatty acid and carbohydrate metabolism,
and mitochondrial dysfunction as well as impaired
detoxification and dysbiosis with small intestinal
bacterial overgrowth (SIBO).
Treatment consisted of low glycemic load, high
fiber, phytonutrient rich, allergen elimination (gluten
and diary), whole foods plant based diet and
moderate exercise of 30 minutes of walking daily.
Digestive imbalances were treated by stopping
NSAID, proton pump inhibitor, herbal antimicrobials,
probiotics, glutamine and an antiinflammatory
rice based medical food for treating
dysbiosis. Oral estrogen was changed to vaginal
to reduce fat deposition and inflammation. Antidepressant
was changed from fluoxetine to
buproprion to improve appetite control. In addition
to her multivitamin, she was treated with
coenzyme Q10 and alpha lipoic acid (antioxidants
and mitochondrial co-factors) as well as Bcomplex
and milk thistle for fatty liver and
enhanced detoxification. After 2 years of
treatment, she lost 45 pounds. Her medical
symptoms score (MSQ) reduced from 86 to 6.
Her C-reactive protein reduced from 10.6 to 2.8,
total cholesterol from 198 to 171, triglycerides
from 199 to 88, and HDL-C increased from 57
to 65. Her insulin reduced from 23 to 11,
fasting glucose from 140 to 103 and hemoglobin
A1c from 6.8 to 5.7 and GGT from 40 to 17.
2012