Top10FunctionalMedicineHomeRuns (notreally10butitsoundsgood)

Or Thingsthathelpyoutreatnearlyeverypersonwhowalksinyouroffice MarkHyman,MD September12,2011 Disclaimer:Thisisbasedonmypracticeandpersonalexperienceandshouldbeapplied atyourownrisk.Yourpatientsmaygetbetter,anditmaychangeyourthinkingforever aboutmedicine.Anditmayturnyourworldupsidedown.Thisdoesnotreflectthe viewsofIFMorthefacultyasawhole. DiagnosingtheMatrix:SeeMatrixQuizzesforPatientsforhelpindiagnosing imbalances. GettheMetametrixCaseStudyBook

CreatingBalanceintheMatrix

OptimizeNutrition
Focusonthenutrigenomicindex:Whole,real,fresh,lowglycemicloadfoods,as partofaplantbased,highfiber,phytonutrientrichdiet. Identifythemostprevalent,underdiagnosed,andclinicallyrelevantnutritional deficiencies: o Omega3fats(EPA/DHA14gramsaday) o VitaminD3(2000to5000Uday) o Impairedmethylation(B62550mg,MeB1210005000mcg,andfolate5 methylfolate12mg) o Magnesium(citrateorglycinate200400mgbid) o Zinccitrate(2060mgaday) Focusoninstitutinganappropriateaerobicexerciseprogram. AnythingthatcrampsorspasmsortwitchesisMgdeficiency. ForpeoplewithsluggishbowelsuseMgcitratetitrateto12easyBMaday dosemayvaryfrom150mgto2000mgormoreifdepleted;watchforloose bowelsthenreducedose. CheckRBCMgonQuest/Labcorpiflow,thepatientisinbigdeficitbutamild wontshowup.

TreatMagnesiumDeficiency

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TreatVitaminDDeficiency
Check25OHvitaminD(80%areinsufficient,whichislessthan45ng/dl). Ideallevelis50100ng/dl. Ifautoimmuneorinfection,check1,25OHvitaminD(willbehighwith inflammation). Iflow,thinkabsorptionissuesmalabsorptionalsocomeswithmanyother nutrientdeficiencies. Usehighdose,longterm5000UvitaminD3if<30ng/dl,2adayfor2months, thenrechecklevelevery6months.

MethylationandSulfation(Thiol)Chemistry
Learnhowtodiagnosemethylationandsulfationproblems(thiolchemistry)andtreat them Methylation Testhomocysteine(idealis68),serummethylmalonicacid(>250abnormal), andorganicacidsFIGLU,MMA,andB6markers. Eatgreensandbeans(thinkfoliageforfolate). MeB125000mcgslorim Folinicacid800mcgto5grams(or5MTHF) B6(Pyridoxyl5phosphate)50to200mg Trimethylglycine500mg2bidormore Sulfation TestusingLFTs(GGT)organicacids,GSHSNPs. Brassicas,greentea,alliums,watercress,cocoa,polyphenols NAC5001000mgbid rlipoicacid100mgbidto300mgbid Milkthistle140mg12bidormoreifabnormalLFT Se200400mcgqd ivGSH2grams23xaweekormoreiftoxicorchronicallyill(candorightafter Myerscocktail)

FixtheGut(Assimilation)WHENINDOUBTDOTHIS!!!
Startwitheliminationdiet(seebelow)forfoodsensitivities) Treatmentofgutdysfunction(dysbiosis) o Smallbowelbacterialovergrowth(SIBO) Rifaximin200mg2potidx7d o Yeastovergrowth Fluconazole100mgpoqdx30d
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 Nystatin500,000U2bidx30d Itraconazole200mgbidx30d o Parasitesandworms Alinia500mgpobidx6d(mostparasites)mayneedhigher doseandlongerduration(1000mgbidx14d) Albendazole200mg2bidfor3daysrepeatin2wks(formost worms) Fixaleakygut(Simple4Ror5Rprotocol) o Remove:Treatbugs(asabove)andallergens(eliminationdiet)first o Replace:Supportwithenzymes(12witheachmealmayneedeither plantoranimalenzymescanuseCreonifverybad) o Reinoculate:probioticsandprebiotics(fiber) o Repair:Nutrientandantiinflammatorysupportforguthealing(anti inflammatoryshakes,glutamine,quercitin,turmeric,GLA,Zn) TreatSmallIntestinalBacterialOvergrowthorSIBO(andYeast!) Symptomsofpostprandialbloatingarediagnostic. Canalsocoexistwithyeastconsiderhx:antibiotics,steroids,hormones,sugar intake,etc. TestingforSIBOOrganicacids:Indican,Dlactate,DHPPA;otherdysbiosis markers. Needtodoaneliminationdiet(basedonIgGorglutenanddairytostart)and lowfermentationdiet(lowingrainsandsugarsinitially). Probioticscanmakethemworseinitially. StartwithXifaxin(Rifaximin)200mg2tidfor1weeksomemayneedlonger term,repeatorchroniclowdosetreatment200mgaday. FollowbyDiflucan(fluconazole)100mgqdx34weeks. Useprobioticsaggressively50450billionunits.

CoolOffInflammation(DefenseandRepair)
Useallergyeliminationdiets(gluten,dairy,eggs+/corn,citrus,soy, nightshades,peanuts)seetoolkitorbookresourcesforeasyplanforpatients. Learnthewholespectrumofglutenrelateddisordersandtheirdiagnosisand treatment(seebelow). Thinkhiddeninfectionsviral,atypical(Mycoplasma,Chlamydia,Ureaplasma), tickborne(Lymeandcoinfections),dental(rootcanals),etc. Thinkmold.

FoodSensitivitiesandReactions
Thesearereal,varied,andchangeovertime,
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ChecktotalIgGantibodytesting(notIgG4only)theychangeovertimesome aretrueandsomeareconfounders(blockingantibodies);nowayofknowing really. Ifverysick,eliminateallfor12weeksthenreintroduceslowly;iflessilljust eliminating2+andgreaterisenough. Mostcommonallergies:gluten,dairy,eggs,yeast,oftensoy,andthenothersare specificandsomayneedtobetested.Canjustdoatrialof elimination/reintroductionseeToolKitforplanforpatients.

CeliacandGlutenSensitivity
Thinkglutenforanyonewhohasanyaninflammatory,allergic,digestive, autoimmune,mood,orcognitivedisorder,oranychronicillness CheckIgA,IgG,antigliadinantibodies,andtTGIgAandIgGandtotalIgAlevels. DeaminatedgliadintestingismoresensitiveandisdonebyLabcorp. ConsiderHLAgenotypingforDQ2/8ifsuspectproblembutantibodiesare equivocal. Beawareofinnate(cellmediated)vs.adaptive(antibodymediated)responses andoflatentceliacwithpositiveantibodiesbutnegativebiopsy. Give12weeksSTRICTeliminationuntilyouknowfullbenefit. Thinkotherallergieswhichgoalongwithitbecauseofleakygutdairy,eggs, yeast,etc. Ifsomeoneischronicallyillorresistanttotreatment,checkmoldandmyoctoxin IgA,IgM,andIgGantibodies. CheckVCStesting(www.survivingmold.com). CheckTGFbeta1,C4a(ifveryhighchronicinflammationandmoldlikely). Removefrommoldyenvironment. Environmentalengineerneedstoassessenvironmentandremediate. Detoxistoughrequiresacomprehensiveplan. Considercholestyramineandcharcoalbowelsneedtomove!

ThinkMold

BalanceHormones(Communication)
SeeMatrixQuizzesforDiagnosis Needcomprehensiveprogramtoaddressallaspectsofhormonaldysfunction Identifyandtreatinsulinresistanceanddyslipidemia o Testingisimportanttoassessdegreeofinsulinresistance. o 75gramglucoseloadwith1and2hourinsulinandglucose(nlins<5 fasting,<30at1and2hours;BS7090nlfasting,<120at1and2hours).
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o CheckcoexistingbiomarkersCRP,ferritin,fibrinogen,homocysteine, uricacid,LFTs,malehormones(lowtestosterone). o UsePGX(glucomannan)4qid5minacmealsandqhswith8ozH20(very effectiveviscousfiber). o LowGL,highphytonutrientdiet;proteininamandwitheachmeal;small frequentmealsforadvancedcasesnograinorfruitorsugarfor612 weeks. o MVI,EFA,D,Cr500mcg,alphalipoicacid300mgbid. AddressHPAaxisdysfunctionandadrenalinsufficiency AdrenalStressIndexsalivatest. Tryherbs(ginseng,rhodiola,Siberianginseng,licorice,ashwaganda,etc.). Glandularsmayhelp. Stressreductionyoga,massage,mediation,HeartMath,etc. Identifyandtreatthyroiddysfunction Seeresourcesforbooks,etc. TSH,freeT3,freeT4,TPOandantithyroglobulinasbaseline. TSH>2.5,FT3andFT4lowendnormalandorTPOorATGelevation shouldtriggertrialofthyroid. StartwithArmour15to30mgqam20minacmealsandrecheckq6wks tillstable20%mayneedothercombinationsofT4/T3. Identifyandtreatprogesterone,estrogenandtestosteroneimbalances Learnsimplehormonesupportseebelow. TryBethanyHaysscompoundedcocktailformenopause:Estradiol150 mg,Progesterone6grams,testosterone200mgin30ccpropyleneglycol apply1droptoforearmatnightandincreasebyonedropevery3days untilhotflashesresolveorbreasttendernessoccurs. ForPMStryMg,B6,taurine,Chineseherbformula;avoidsugar,etoh, dairy. Formentrytopicaltestosteroneprescriptionsorcompoundedor equivalentandmonitorlevels(oftenlowbecauseofinsulinresistance).

Biotransformation(Detoxification)
AlwaysidentifyheavymetaltoxicitybyDMPSorDMSAchallengeandwhole bloodHg,Pb,Ar. Learndietarystrategiestoupregulatedetox(phytonutrients,crucifers,garlic). Usenutrientsandherbstooptimizedetoxification(seeabove). Learnhowtooptimizemethylationandsulfation(seeabove). Getadvancedtrainingonheavymetaldetoxification.

HeavyMetalToxicity
Thinkmercuryifsomeischronicallyill.
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DooralDMPSchallengewith10mg/kgperamdose(max500mgand250mgfor kidsorelderly). Emptybladder,6hoururinecollectionanythingover50mcg/gr/crisveryhigh. Sendtolab. Lowerlevelscancauseimmunotoxicityandautoimmunity(considerMELISA testing). Preparepatientfordetoxificationbygeneralnutritionandhealthsupport. Repleteaminoacidspriortodetox(customizedblendsifpossiblebasedonAA testing). Chelationantioxidants,detoxdiet,saunas,exercise,liversupport(NAC,ALA, Se,thisilyn),Zn,Cu,etc.andDMSApo10mg/kgMTWeveryotherweekfor312 monthsalongwithbinder(modifiedcitruspectinoralingate). Repeatchallengeafter36months.

Energy(MitochondriaandRedox)
Learnhowtotakecareofmitochondriaandaddressredoxstatus. Learnhowtointerpretorganicacidanalysisthewhyandwhattodo? Learntousemitochondrialsupport. o Phospholipids,acetylLcarnitine,CoQ10,Dribose,Mg/Kaspartate,alpha lipoicacid,NADH,B2,B3,NAC..

PsychospiritualandRelationship
Developtheskillstocreateahealingrelationshipwiththepatient. Developtheskillstocreateahealingenvironmentwiththepatient. Addresspsychosocialissuesthatprovidethecontextforpatientslife/illness. Developresourcesformindbodymedicine(e.g.,yoga,meditation,biofeedback, HeartMath).

EssentialFunctionalMedicineTests

LearntheOrganicAcidTest
Studyinterpretationguidesfromlabsontheirtestssomehavepublishedbooks onlabtestingandassessment. Learnsupportoffat,CHOandenergymetabolism,Bvitamins,oxidativestress, NTfunction,detoxification,andgutdysbiosis CDSAorPCRtesting
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LearnStoolAnalysis

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Laboratories

Metametrix Genova DoctorsData(formetals) ImmunoLabs(IgGandIgEallergytesting) Liposcience(forNMRtestinglipids) Quest/Labcorp Igenex(fortickborneinfections) Neurosciences(forMELISA) DiagnosTechs(adrenalstressindex)

SupplementCompanies
Metagenics Prothera/Klaire PureEncapsulations DesignsforHealth Thorne ResearchedNutritionals

Seewww.drhyman.comformorearticles,resourcesandinformation.

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