Functional Medicine in Primary Care

Free Preview: My Journey: …22 years ago, laying on the floor, sick and exhausted, I promised, to help others. AND now, I vow to respectfully educate. I hope this book will teach healthcare providers who want to be compassionate, understanding healers- a way to approach the complexity of individual diagnoses. And for you, the patient, I’m going to be the one that gives you the benefit of the doubt. I will not allow you to malinger, I will not allow you to use your illness as an excuse- it will not become an identifiable part of who you are- because it IS NOT who you are, it’s part of your history, it’s part of your experience, and it’s part of your journey. Introduction: It’s really not farfetched – the idea of optimal function and patient improvement. Why are we settling for mediocre in our practices? … This is how I feel we can overcome or survive physician burnout. So, how can we practice medicine as it currently outlined and have a TRUE patient satisfaction rate greater than 60%?... …However, in the meantime, until a functional medicine healthcare model is accepted and covered by insurance, I feel I can offer a solution for the current medical model. As an alternate solution to a cash-based practice of primary care. I propose a blended FUNCTIONAL PRIMARY CARE approach for insurance-based practitioners. Of course, this model can benefit ANY provider to offer a more fulfilling, daily patient-practitioner interaction. REGARDLESS of the field of specialty, I hope the information in this manuscript will help transform your practice into a rewarding experience for all involved. “In standard primary care practice, we are lucky to get 15 minutes with each patient.” I, as do all physicians, understand the importance of the patient’s story, but as I have said, in the current model we are limited by time. So, how do we solve this??? FUN FACT: 19 minutes with a patient is the average reported Initial primary care visit and patients regularly announce the time they were speaking was less than 5 minutes. (BioMed Central T. Nathan) My solution … Case examples: FUN FACT: For UTIs cranberry cocktail is not helpful!!! Cranberry concentrate, the kind that makes you pucker, is what has been proven to help reduce the risk of urinary tract infection, not treat an ongoing infection because the proanthocyanins interfere with the bacteria’s ability to adhere to the bladder wall. (American Journal of Obstetrics and Gynecology 2015) Another example, a little less simplistic, but a common complaint- is fatigue. My first recommendation for these patients is to … To add to the complexity, not only does stress/perceived stress/and HPA function, play a role in optimal thyroid function, but so do genetics- particularly in conversion …. “polymorphism Thr92Ala in DIO2 is related to lower serum FT3 levels after thyroidectomy, and the D2-Ala mutant reduces T4 to T3 conversion in cell cultures”. FUN FACT: The most recent AACE and ATA guidelines support treatment of mild subclinical hypothyroidism in patients with evidence of atherosclerotic cardiovascular disease and heart failure or in the presence of risk factors associated with these disorders (6). …Some of my favorite herbal support for viral etiologies include olive leaf, Ocimum basilicum (sweet basil), and cat’s claw, garlic. 8.Clin Exp Pharmacol Physiol. 2005 Oct; 32(10):811-6. Antiviral activities of extracts and selected pure constituents of Ocimum basilicum. Chiang LC1, Ng LT, Cheng PW, Chiang W, Lin CC. Vitamin D – In the last 5 years learned I had the VDR polymorphism (genetic mutation, mentioned below -see chapter on genetic for more info) which interferes with the uptake of vitamin D into the cell. I recall when I started vitamin D in 2009, at high doses my skin rash improved. As I mentioned earlier in the thyroid section, vitamin D, is vital for immune regulation and it is also an excellent area of action for inflammatory disorders - making optimization especially important in all autoimmune disorders, brain and bone health and even mental health. This is, in my opinion, an area primary care practitioners can easily make an impact. From the Chronic fatigue section: Once we optimize the patient’s endocrine function (see thyroid/HPA section) and lifestyle/nutritional changes have been made, we ought to consider the other etiologies of fatigue. Reflect on the history. This is where an excellent questionnaire will come into play. Rule out other basic possible causes of fatigue - thyroid, depression, etc. If the history lends itself to possible infectious etiology “had mono...never recovered” or “my glands swell here and there, then I suffer with bouts of fatigue… Worse than my other fatigue”- then consider CFS secondary to infectious etiology (s). EBV and CMV IgM, IgG antibodies should be checked and used as a guide. Leading CFS researcher, Dr. Jose Montoya, recommends checking EBV, CMV titers. Several cytokines were found to be elevated in Dr. Montoya’s research… I suggest also, testing genetics, in my experience, a SOD2 SNP – I always think mitochondrial insufficiency! ATP is our energy and mitochondria are our powerhouses! Tying into this mitochondrial/ATP connection is nutrient deficiencies – especially those related to the Kreb and TCA cycle. Studies have shown, concentrations of organic acids related to the TCA cycle and energy metabolism, such as citrate, isocitrate and malate, are significantly lower in CFS patients thus suggesting and supporting the likelihood of less than optimal ATP output. [4] The Kreb cycle nutrient requirements include many, specific vitamins and minerals to help metabolize fats, carbohydrates and protein to create energy. If you can do a panel inclusive of all fat- and water-soluble nutrient metabolites, amino acids, and antioxidants then by all means do. If limited by resources or need to be conscious of patient cost, I suggest, test a serum CoQ10, RBC glutathione, RBC Magnesium and Manganese, and if you are able, add vitamins B1, B2, B3. Also, important to note- some people have genetic mutations of NQO1 which if abnormal may impede the conversion of CoQ10 into ubiquinol. [10] ….But I must comment- please do not take the “little is good more must be better...” attitude! This book was written to refresh the provider, allowing for positive health outcomes. And for the patient, to restore health and promote active participation in your wellness. Read more to see how Dr Herbst provides guidelines and data to help support diagnosis and treatment for optimal function.