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The Emergence of Autoinflammatory Syndromes

by Thomas G. Guilliams, PhD

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Most clinicians are familiar with autoimmune disease mechanisms. Typically, these define situations where effectors within the adaptive immune system (i.e., immunoglobulins or T-cell receptors) bind inappropriately to a host molecule which subsequently recruits an immune response against those tissues. Processes of self-tolerance, whereby naïve B and T lymphocytes are exposed to self-antigen in a controlled environment, are used to find cells producing cross-reactive antibodies or T-cell receptors so they can be eliminated before they circulate in the body.
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The question in cardiometabolic disease is not what are you eating, but who are you feeding?

by Todd R. LePine, MD

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Cardiometabolic disease is rampant in the United States and our current approach to treating it is broken. For years, doctors and patients have been taught that cholesterol is the underlying cause of heart disease. The American Heart Association has recommended a low-fat, low-cholesterol diet based on the guidelines of the USDA food pyramid. Unfortunately, following this pathway has led to increased obesity and diabetes, thanks to a calorie intake of mostly sugar and high glycemic carbohydrates.
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MTHFR: Treating Genes or Patients?

by Thomas G. Guilliams, PhD

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In the discussion about nutrition, genetics and genomics, invariably the topic of methylation and genes related to methylation will find their way into the discussion. Chief among the genes mentioned in such conversations is MTHFR, the gene encoding one of the key enzymes responsible for “re-charging” the activated form of folate (5-MTHF), called methylenetetrahydrofolate reductase, along with a few of its well-known polymorphisms (e.g., C677T). If you have been following the MTHFR discussion over the past few years, you know how complex and confusing it has become.
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Mapping the Cardiometabolic Patient Journey

by Shilpa P. Saxena, MD

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Mapping the Cardiometabolic Patient Journey
As of 2015, the combined prevalence of diabetes and prediabetes was 45.4% among adults in the United States. Approximately 11% have diabetes and 33.9% have prediabetes, representing 84.1 million people who could develop type 2 diabetes within five years, according to the CDC in the 2017 National Diabetes Statistics Report.
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Cardiovascular Disease: New Clinical Options for Expanding the Therapeutic Target, Part 3

by Jeffrey Bland, Ph.D., FACN, CNS and Thomas G. Guilliams, Ph.D.

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A New Pleiotropic Path
From early ideas about dietary fat, to a complex array of genetic risk factors and biomarkers, the arc of scientific discovery is pointing to cardiovascular disease being a pleiotropic condition. It follows, then, that one agent against a cluster of diseases will not produce favorable outcomes. The old “a pill for an ill” model will be outdated.
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Cardiovascular Disease: New Clinical Options for Expanding the Therapeutic Target, Part 2

by Jeffrey Bland, Ph.D., FACN, CNS and Thomas G. Guilliams, Ph.D.

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Vector of Truth: Medical Research is an Arc of Discovery
Anyone who devotes their career to scientific research is likely a seeker of truth. But this can sometimes mean taking the road less traveled. Even in medicine, it can be tempting to take the path of not seeking the hard and difficult questions about a disease, but to seek the expedient answers.
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Cardiovascular Disease: New Clinical Options for Expanding the Therapeutic Target, Part 1

by Jeffrey Bland, Ph.D., FACN, CNS and Thomas G. Guilliams, Ph.D.

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Functional medicine can sometimes clash with the broader healthcare industry, which focuses on treating specific systems or diseases. In functional medicine, practitioners offer a more holistic and preventative approach to care, often recommending lifestyle, diet, and nutritional supplements. However, the norms of pharmaceutical research don’t necessarily translate into effective supplement research. Moreover, nutritional supplements often fall into gray areas in drug regulation, making the safe and effective use of supplements difficult for many functional medicine clinicians.
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The Gym Inside Your Door

by Ralph LaForge, MSc

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The Gym Inside Your Door program was initially developed to increase daily physical activity in prediabetic and diabetic Alaska Natives in 2007, but has since gained widespread use in primary and secondary prevention programs. Diverse forms of physical activity have been shown to improve health outcomes and reduce risk for cardiometabolic disease. One means of prescribing exercise is by recommending specific physical activities by their frequency, duration and relative intensity. Read more


Exercise: The Ultimate Anti-Inflammatory

by Jonathan Cannizzo, MSc

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Do you talk about the importance of nutrition and prescribe a personalized diet to every patient, regardless of health status, who walks into your clinic? Of course, you do. Every functional medicine clinician understands the importance of nutrition. What you eat matters. It plays a role in your long-term health, wellness and ability to prevent chronic disease. No one would argue that. Now, let me ask you this: Do you talk about the importance of physical activity and prescribe a personalized exercise program to every patient, regardless of health status, who walks into your clinic? Read more


Beyond Bacteria: How Antibiotics Impact Mitochondria

by Angela Lucterhand, DC

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According to the Centers for Disease Control and Prevention (CDC), at least 30% of antibiotics prescribed in the outpatient setting are unnecessary—meaning no antibiotic was needed at all. With that, would it shock you to know that five out of six people are prescribed an antibiotic in outpatient care? Read more


Managing the Exposome

by Thomas G. Guilliams, Ph.D.

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Two related fields of study, both owing to the emerging science of genetics and genomics, are beginning to help us discover the role toxins play in human health and disease. The first is toxicogenetics, which describes how the genetic differences between certain individuals allow for varying susceptibility to different toxins. Since there are hundreds of different enzymes involved in our detoxification pathways, many individuals carry gene variants (polymorphisms) that allow for more efficient conversion and removal of toxins than others. Those individuals with slower detoxification pathways for a given toxin will show signs of toxicity at much lower doses than those with normal detoxification capacity. These differences often complicate “cause-and-effect” studies in large populations that carry over into the clinic. That is, just because a large epidemiological trial does not find a statistically significant relationship between exposure to a particular toxin and a particular health outcome (the average of all genetic variants), does not mean that such a relationship does not exist in the genetically-susceptible patient. Read more


Be Worth It! Value Your Care and Improve the Financial Wellbeing of Your Patients

by Jeff Gladd, MD

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This post correlates to a presentation delivered by Dr. Gladd at The Evolution of Cardiology Functional Forum (March 2017). Click here to view the presentation.

The most common criticism of direct-pay practices is that the services are too expensive and only accessible by patients with the means to afford them. As practitioners, we can all agree that health care should not cost an arm and a leg, but are we advocating for the financial wellness of our patients as much as their physical wellness? If we believe the services and guidance we provide are worth it, then we must become health care “financial advisors” and demonstrate how our care can be worth it to our patients. The first step is identifying challenges in the current health care system. Read more


How to Keep Patients from Sabotaging Their Exercise Programs

by Jonathan Cannizzo, MSc

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A recent publication in PeerJ documented compelling evidence that exercise might not be the key to controlling body weight. This study found that over a three-year period, total weight gain was greater among participants who met the physical activity guidelines of two and a half hours a week, compared to those who did not. Read more


How to Make Your Practice Stand Out in a Crowded Field

by Mark J. Tager, MD

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No matter the terminology—Integrative, Functional, Holistic, Wellness or Anti-Aging—a growing cadre of clinicians are now competing for the cash dollars of patients seeking a more personalized, root-cause health care experience. Don’t just take my word for it; let’s do the math: In this case, a simple LinkedIn search (February 2017) shows the following number of practitioners: Read more


Group Visits? My Patients Love Them and So Do I!

by Randi Mann, WHNP-BC, APNP, NCMP

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It's my hope that this article inspires you to offer Group Visits to your patients. With the tools, support and coaching offered by the Lifestyle Matrix Resource Center, I know every practitioner can do this!!Read more


3 Steps to Eradicating Cardiometabolic Disease

by Shilpa P. Saxena, MD

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Cardiovascular and cardiometabolic disease continue to devastate the lives of patients, families, communities and the US healthcare system at large. The sad truth is, a solution already exists. If healthcare systems could figure out how to implement therapeutic lifestyle change, nearly 80% of the world’s medical problems would either be prevented or reversed. Over the last 10 years, I have seen this solution play out in my office and other Functional and Integrative offices around the world. So, why isn’t this already happening? Three things: 1) Provider training, 2) Patient engagement, and 3) Cost. Read more


Understanding the Pathology of Autoimmunity Through the Prism of the Gut

by Kara Fitzgerald, ND

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Dr. Alessio Fasano catapulted the understanding of GI involvement in immune diseases to center stage with his seminal research on zonulin and intestinal permeability. Notably, his 2008 Scientific American piece got the attention of almost every clinician I know. When his concepts were introduced at the Institute of Functional Medicine’s Annual International Conference that year, we were collectively awestruck that a scientist finally, solidly, put on the map what we, as integrative and functional clinicians, have observed clinically for years. Read more


What Can You Learn From a Salivary Hormone Test?

by Christopher Mote, DO, DC.

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You know whether your patient has high cortisol, normal cortisol, or low cortisol—so what? Cortisol and DHEA can be high, low or within range and be perfectly appropriate depending on the patient’s physiologic condition. How do these markers change your medical decision-making? Read more


Re-assessing the Notion of “Pregnenolone Steal”

by Thomas G. Guilliams, Ph.D.

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When clinicians measure salivary cortisol and DHEA (DHEA-S) to assess stress and HPA axis function, it is common to find DHEA levels below the reference range in a number of individuals. A common explanation for the depletion of DHEA and other hormones (e.g., progesterone, testosterone) due to chronic stress is the phenomenon known as “pregnenolone steal.” This notion basically states that since all steroid hormones use pregnenolone (derived from cholesterol) as a precursor, the elevated secretion of cortisol caused by acute or chronic stress will inevitably result in less available pregnenolone to serve as a precursor for the production of DHEA and other down-stream hormones. Read more


Exercise Adherence Starts with an Exercise Prescription

by Jonathan Cannizzo, MSc

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The statement, “Exercise is an important part of lifestyle medicine,” seems rather obvious. Studies indicate relative risks for cardiovascular disease are up to three times higher for inactive persons as compared to active. In fact, physical inactivity is as harmful as other conventional risk factors, such as blood pressure and cholesterol levels, in predicting chronic disease. Yet, only 10% of Americans meet the recommended level of 150 minutes of exercise per week. Read more


Dysbiosis or Adaptation: How Stable is the Gut Microbiome?

by Thomas G. Guilliams, Ph.D.

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One of the greatest paradigm shifts in medicine over the past few decades has been the unfolding discoveries revealing the metabolic influence of the human microbiome, especially that which resides within the gastrointestinal tract. Indeed, it is difficult to find a medical discipline that is not actively investigating the potential role played by the gut microbiome in human health and disease. Read more


The Twofold Path to Practice Success

by Mark J. Tager, MD

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Every health care business has a major goal. You want to get noticed, known, and remembered so you can attract the types of patient you’d like to treat. In the process of caring for your patients, you must also create an experience that meets or exceeds their expectations. The better the patient experience, the more likely you will gain a good reputation and be the recipient of positive referrals. Read more


Assessing Immune Dysfunction: What You Need to Know

by Kara Fitzgerald, ND

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Inflammation is the body’s natural, protective response to a harmful stimuli, be it a pathogen, an injury, a noxious compound, damaged tissue or cellular debris and more. A remarkably elegant and complex symphony of immune cells and associated compounds are released that quickly and powerfully contain the offending agent(s) and restore order. Our immune system is ever-active, constantly monitoring and clearing potential dangers with astonishing efficacy. Read more


The Real Solution to the Health Care Crisis

by Terry Wahls, MD

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As we all know, our health care system is in crisis. The media constantly bombard us with this message. However, while I agree with this assessment, I have a different opinion than the media on the nature of and solution to this crisis.

Much of the arguing centers on the Affordable Care Act. Politicians from both sides seem to be locked in a vigorous debate about whether this piece of legislation, now law, is helpful or harmful to the American people, and what we must do about it right now. Careers hang in the balance. A lot of money is at stake. But where, I ask, is the discussion that really matters as we talk about health care? Where is the discussion of health? Read more


Care: The Secret Sauce to a Successful Clinic

by Jeffery Gladd, MD

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I get this question a lot when speaking to practitioners about starting their own micropractice, “Why would patients pay me?”

Do you wonder how someone would pay cash for your services? Do you think you need to offer fancy testing and really involved therapies in a high-end office space?

In my opinion, it is difficult to successfully run a medical practice dedicated to health promotion and take insurance. A direct-pay practice that lives outside of the squeeze and time crunch of insurance will have you loving work and enjoying your life. Many find this daunting, but realize the rewards, not all of them financial, are great. I find picking my kids up from school a couple days a week rewarding. I find three-day weekends rewarding as well. Read more


Age-Associated Changes Impacting Immune Function

by Thomas G. Guilliams, Ph.D.

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Newborns have an immature immune system and are vulnerable to infectious agents. The immune system begins to mature with appropriate interaction with antigens and is enhanced by the changing microflora of the gut throughout adolescence and adulthood. Of course, aging affects all the systems of the body, and the immune system is no exception. The changes in immune system function that result from aging have been well characterized and are known as immunosenescence. Read more


Clinical, Operational and Financial Benefits of Group Visits

by Shilpa P. Saxena, MD

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Statistics continue to highlight the snowballing burden of complex, chronic disease as the ‘Achilles heel’ of our healthcare system’s future. More and more healthcare providers are realizing that the most effective solution is centered around lifestyle change and behavior modification. Unfortunately, implementation of successful lifestyle modification amongst a population of patients overseen by trained clinicians in supportive institutions has been problematic in the typical medical office, to say the least. Fortunately, a progressive form of relief called lifestyle-based group visits (LBGV) is positioned to rescue the time-starved, well-intentioned clinician. Read more


Exercise: So Simple and Yet So Hard to Do

by Murray Ardies, Ph.D.

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Exercise is like eating: Patients think they are doing a lot better at it than they actually are. They may head to the gym after a long workday or commit to going for a run each morning, but the road to an unhealthy lifestyle is paved with good intentions. Hurdles to achieving healthy exercise habits are real, but they can be overcome with the right knowledge and diligence. Read more


Canary in the Coal Mine: AMD and the Lifestyle Synergy Model

by Thomas G. Guilliams Ph.D.

Figure 1: Basic Anatomy of the Eye and Retina. The retina is the light sensitive tissue lining the back of the eye, responsible for converting visual light into electrical impulses which exit the eye via the optic nerve and travel to the visual cortex of the brain. The macula is a pigmented area responsible for high visual acuity, it is also known as the macula lutea (“yellow spot”) due to the concentration of macular pigments at this location. The fovea is the center of the macula; here the inner layers of the retina are displaced for greater visual acuity – as indicated by the dip in the diagram. The inset image depicts the highly ordered cell layers of the retina showing each of the cells. See text for details about each cell.



Since doing my initial research for The Original Prescription, in which I discuss the benefits of lifestyle synergy, I keep running into more and more data confirming the overall health benefit of multiple “signals” coming from a variety of lifestyle decisions. Read more


What You Need to Know Before Running Another Adrenal Profile

by Christopher Mote, DO, DC



One of my earliest clinical mentors used to tell me, “Who we are and how we practice once we are three years out of school/training is who we will be for the rest of our clinical practice.”Read more


Improving Metabolic Health, One Active Day at a Time

by Sean Newsom, PhD



Do you prescribe regular exercise for your patients with metabolic diseases? Of course you do. You want the best health outcomes for your patients and you know that regular exercise can be a remarkably effective intervention for the prevention and treatment of numerous cardiometabolic diseases and weight management issues. But do you know how much exercise is required to induce metabolic benefits? Even more importantly, do your patients adhere to your exercise prescription? Read more


Be Present to Have More Presence

by Mark J. Tager, MD



Presence. The healthcare marketing and social media gurus will tell you that you can’t have enough of it. They even tell us that increasing your presence can be automated and systematized. It’s easy: Turn on the machine, get more followers, enjoy the results of greater influence. For healthcare practitioners, especially physicians, it’s a very seductive message. he prospect of gaining more online followers appeals to our achievement addicted, success scoring, comparison-creating nature. These are attitudes and behaviors that were reinforced in our upbringing and training. Don’t get me wrong. I’m in favor of you getting more Twitter, Facebook and LinkedIn followers.Practice and marketing management companies provide a valuable service in this regard. Read more


A Clinician’s Perspective on Evaluating Stress

by Christopher Mote, DO, DC



As I eagerly opened the repeat test results for two patients and me, I expected the salivary adrenal profile would demonstrate improved function in the form of healthier hormone levels. After all, the subjects in this initial testing were had symptomatic improvement. It was not slight, but significant reduction in fatigue, sleep problems, concentration, etc. There was every reason to expect our success would be confirmed. It was with great disappointment that I read results for each of us that were nearly identical to the initial testing. No improvement was demonstrated on any of the tests. How could that be? Read more


Is it Adrenal Fatigue? Reassessing the Nomenclature of HPA Axis Dysfunction

by Thomas G. Guilliams Ph.D.



Sometimes, when we endeavor to understand and describe complicated medical topics, there is a temptation to find a simple explanation to cut through the complexity. These explanations can help bridge the knowledge gap for a while, but as our knowledge-over-simplified explanations actually become a hindrance to helping clinicians and patients understand the important mechanisms and solutions related to chronic conditions. The use of terms like “adrenal fatigue” and “adrenal exhaustion” to summarize the complex dysfunctions related to the stress response is one such explanation. Though these terms have helped dispel the notion that only extreme issues related to adrenal function (Addison’s disease or Cushing’s disease) are of clinical importance, and have become surrogate descriptions for stress-related outcomes, they should now be replaced by more accurate and medically appropriate terms, like HPA axis dysfunction, adrenal insufficiency, or where applicable, hypocortisolism. Read more.

 


Mind-Altering Microbes: How your gut microbiome may influence your mood

by Jill Carnahan, M.D.

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While we have certainly heard that appetite and digestion are controlled by the enteric nervous system (also known as “the master control panel in your gut”), who would’ve thought that the gut might also control your emotions and mood? It’s no wonder the old sayings, like “I’ve got a gut feeling about this,“ “That movie was gut-wrenching, “ or “Come on, gut it out!” ring so true. In fact I’d venture to say when we are trusting our intuition we associate it with having a “gut feeling” about something. Read more.


Managing a Stressed Practice

by Shilpa P. Saxena, M.D.

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The term “stress,” as it is currently used, was coined by Hans Selye in 1936 who defined it as “the non-specific response of the body to any demand for change.” Selye’s theories attracted considerable attention in basic medical sciences; however, stress soon became a popular buzzword that completely ignored Selye’s original definition, even until today. Some people used the word to describe a known unpleasant trigger or situation to which they were subjected. For others, stress was their reaction to this in the form of physical or emotional symptoms. Read more.

 

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