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Why You Need to Monitor Magnesium in Your Patients

Magnesium is the fourth most common mineral in the body and an essential component of hundreds of daily enzymatic processes that occur across multiple organ systems. The risk of inadequate intake is high, so supplementation may be helpful.

The Master Antioxidant: Bioavailability of Oral Glutathione Supplementation

Though there are many ways to support our antioxidant status and overall immune health, oral glutathione supplementation has been clinically demonstrated to be bioavailable.

Promising New Weight Loss Research: Can Specialized Polyphenols Provide the Spark Your Patients Need?

Combat obesity with natural plant polyphenols! Discover how hibiscus, lemon verbena, and green coffee bean extract enhance metabolism, curb appetite and promote weight loss to help your patients overcome the energy gap and achieve long-term weight-loss success.

Collagen: Beyond Beauty

Supplemental collagen is for more than just healthy hair, skin and nails. Learn about the science behind collagen's multifaceted functions for musculoskeletal, gastrointestinal, immune, cardiovascular, EENT and oral health.

Ketogenic Diets for Cardiometabolic Outcomes: What Is the Evidence?

A growing body of research has been published regarding the keto diet’s effect on cardiometabolic measures, but practitioners should be aware of the following considerations before encouraging patients to implement versions of the keto diet.

36 Great Ideas from Cardiometabolic Function: The Intersection Among Neurology, Endocrinology, and Immunology

Key takeaways from the April 2023 Personalized Lifestyle Medicine Institute conference, Cardiometabolic Function: The Intersection Among Neurology, Endocrinology, and Immunology.

Why Your Detox Protocol Needs a Broad-Spectrum Binder

Your patients need your help to stop the harsh cycle of toxin recirculation. By incorporating a comprehensive detox protocol that includes these two broad-spectrum binders, you can remove a wider variety of toxins and help your patients feel better faster.

Tips for Supporting Elimination Pathways

How many of your patients have tried a detox that just didn’t work out as well as they planned? If they stuck to the protocol but felt worse than when they started, we have tips for supporting their elimination pathways and Phase 3 detoxification.

How Mold and Mycotoxins Affect Immune Health

Mold and mycotoxin exposure can contribute to inflammatory issues and autoimmune disease in your patients. Fortunately, there are tests available to determine if mold or mycotoxin exposure is contributing to their symptoms, which may then require environmental rather than dietary intervention.

Improving Energy with Mushrooms

Many studies have shown that edible and medicinal mushrooms have antifatigue properties. This article focuses on the research demonstrating the benefits of Cordyceps and reishi mushrooms for your patients with chronic fatigue or other energy-related issues.

Reprogramming Inflammation and the Immune Response

When we discuss inflammation and inflammatory diseases, it is important to consider not just the cause of inflammation but whether the body is able to turn off the inflammatory response to prevent chronic inflammation. Fortunately, there are ways to support these mechanisms in your patients.

Dysautonomia: A Growing Clinical Concern

The symptoms of dysautonomia can be so varied and seemingly disconnected that recognizing dysautonomia in the clinical setting can be challenging. When treating your dysautonomia patients, it is essential to address the root causes and support the body's healing process with adaptogenic herbs.

Endothelial Glycocalyx Damage: The Lead Measure of Cardiovascular Disease

The endothelial glycocalyx (eGCx) serves many cardiovascular health functions. When treating cardiovascular conditions, such as diabetes and high blood pressure, consider the importance of the glycocalyx for vascular wellness. Read more to learn how to support glycocalyx health.

Making Sense of Medicinal Mushrooms and Their Impacts on Immune Function

Medicinal mushrooms offer an adaptive, intelligent approach to modulate and strengthen immune function. Different species contain unique key constituents, such as beta-glucans and triterpenoids, that are beneficial for immune health.

NAFLD as a Key Factor in the Cardiometabolic Continuum

Non-alcoholic fatty liver disease (NAFLD) is often asymptomatic, leading to delays in diagnosis and negative impacts on overall cardiometabolic health. Learn more about the nine modifiable NAFLD risk factors and consequences, and discover the top nutrients to support your patients.

Using Phospholipids to Ignite Mitochondrial Function

Phosphatidylcholine is the most abundant phospholipid in the mitochondrial membrane, making it a crucial component to keep mitochondria firing on all cylinders. 

An Emerging Clinical Conundrum: Patients with "Resistant"-Type Microbiome Patterns

Functional medicine practitioners who prescribe probiotics need to consider some recent findings regarding their patients’ colonization patterns.

Uric Acid: The Body’s Physiological Alarm Bell?

Elevated uric acid levels, or hyperuricemia, are associated with cardiometabolic disorders, including hypertension, diabetes, non-alcoholic fatty liver disease and kidney disease. The following dietary, lifestyle and supplement interventions can help optimize your patients' uric acid levels.

The Cell Danger Response and Chronic Disease Progression

Discover the top nutrients to support the health of your patients with chronic conditions based on the latest research on the cell danger response, the mitochondria, and cellular membranes from Robert Naviaux, MD, PhD.

Mitochondria: The Forgotten Cause of Cardiovascular Disease

Mitochondrial dysfunction is associated with the development of some of the most common cardiac conditions we manage as practitioners—atherosclerosis, ischemia-reperfusion injury, hypertension, diabetes, cardiac hypertrophy, heart failure and arrhythmia.

Fundamental Principles for Building Immune Strength

Pharmaceuticals and pharmacological immunomodulating agents are often reactionary approaches to building immune system strength. For true resilience, patients must build the ten foundational principles of immune health.

Mitochondrial Disease: Key Indicators That Might Be Overlooked

Mitochondria are negatively impacted by HPA axis and metabolic stressors, certain medications, and poor lifestyle habits, so measuring the health of mitochondria is necessary to treat chronic conditions like autoimmunity, mitochondrial disease, or cardiometabolic disease.

8 Best Practices for Healthy Detoxification

In this follow-up post to last week's blog on supporting Phase I and Phase II liver detoxification, we're going over the important considerations when creating a detox treatment plan for your patients.

Detox or Die: How to Help Your Patients Detoxify in a Modern World

Detoxification is a multi-step process that occurs in multiple organ systems but especially in the liver. Support your patients' liver detoxification pathways and hormone balance with these foods and nutrients.

The HPA Axis: A System Beyond the Stress Response

The HPA axis is responsible for more than just stress response and chronic disease. It is one of the most critical surveillance systems in the body, designed to coordinate metabolic resources with metabolic needs.

Berberine Offers Multifaceted Benefits for Your Patients

Berberine is typically recognized for its antimicrobial or antifungal properties, but may better be considered a “microbial modulator” because of the distinctive relationship it has between the microbiome and overall metabolic health.

Nrf2 Activation: A Key Regulator of Detoxification

The Nrf2 pathway is one of the important genomic regulators protecting the cell from environmental stressors by managing the antioxidant and detoxification processes within most cells.

A Clinician's Perspective on Evaluating Stress

Lifestyle changes should be your top priority when forming patient care plans for stress management and evaluating the success of treatment based on test results. When these fail to improve patient outcomes, other root causes may be at play.

Case Study: Fibromyalgia

A fibromyalgia patient case study, including a thorough background on the syndrome for clinicians as well as treatment strategy and protocol recommendations.

4 Consequences of Stress on Gut Health & Tips for Repair

Although stress is ubiquitous, there are ways to guide patients in managing it, including how it impacts their gut health.

Cellular Hypothyroidism: What You Need to Know About Normal TSH in Symptomatic Patients

Thyroid-stimulating hormone (TSH) test results are not the tell-all of thyroid function. What happens if the TSH is within range, but the patient still reports hypothyroid-like symptoms?

PPI Overuse and Nutrient Depletion: Give Your Patients the Support They Need

PPIs are among the most widely prescribed drugs worldwide and are seldom used judiciously for short-term treatment. Instead, patients are often placed on PPIs indefinitely without regard for the long-term consequences.

Time It Right: When You Should Educate Acute Pain Patients

Providing patient education is imperative. For patients experiencing pain, this must be carefully and intentionally delivered and timed to accommodate that individual's capacity, depending on where they are in their journey.

3 Targeted Therapies to Help Your Patients Overcome Anxiety

It's normal to feel anxious, worried and fearful from time to time due to the complicated lives we live. Anxiety is a natural part of life. But if anxiety occurs more than just occasionally, it can become harmful to our emotional wellbeing and overall health.

Cardiometabolic Differences: EPA vs. DHA

Studies show both mechanistic and clinically-relevant differences between the fatty acids, EPA and DHA, which potentiates targeted therapeutic uses for either EPA or DHA.

MTHFR: Treating Genes or Patients?

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.

4 Non-Traditional Warning Signs of Metabolic Syndrome

Metabolic syndrome (MetS) is a cluster of metabolic and cardiovascular (CV) risk factors, including visceral adiposity, hyperglycemia, dyslipidemia and hypertension, contributing to CV mortality.

Turmeric: The "Golden First-Line Therapy" for Joint Health

Results of a 2017 double-blind, placebo-controlled, three-arm study showed safety and efficacy of both the low and high doses of the turmeric complex extract for patients with osteoarthritis.

3 Natural, Therapeutic Options to Support Kids Struggling with Stress

Stress is experienced by all ages, not just by adults. A child's life may be perceived by most as carefree and happy because their only job at this time in their life is to play and learn. It's not surprising however, that kids do indeed experience a certain degree of stress even though they don't have the same responsibilities as adults, such as bills to pay and mouths to feed.

Beat Fatigue with Phosphatidylcholine for Mitochondrial Health

The integrity of mitochondrial membranes is critical to cell function and energy metabolism. Recent clinical trials assessing patients with chronic fatigue have shown the benefits of membrane lipid replacement with phosphatidylcholine.

Research Update: Binding Capacities for Serum-Derived Bovine Immunoglobulins

Dysfunction of the intestinal microenvironment is the primary therapeutic application of the lifestyle medicine movement. While diet and lifestyle are foundational, certain rare supplements can also support treatment efforts.

Is Birth Control or Hormone Replacement Making Your Patients Tired and Depressed?

Many prescription drugs, including birth control and hormones, cause drug-induced nutrient depletion (DIND). The Standard American Diet is insufficient to provide adequate nutrients, let alone the deficiencies caused by DIND.

Blood Sugar Stability: A Key to Longevity

If there is a disease process that best demonstrates the differences between the conventional and integrative approach, it must be type 2 diabetes and its various comorbidities and complications

Polyphenols: The New Prebiotic Frontier

Prebiotics are nutrients that induce the growth or activity of beneficial bacteria in the gut. Prebiotic fibers induce microbial fermentation in the distal small bowel and large intestine.

The Gut-Heart Connection, Risk Assessment and Intervention

Many factors can increase the risk of developing heart disease, including inactivity, toxic burden and being overweight or obese. But there’s an important factor that may often be overlooked: gut health.

Integrate Multiple Approaches to Provide More Comprehensive Healthcare

Whichever medical discipline we choose should be leveraged as a cornerstone of our approach to healthcare. To offer more comprehensive healthcare, it is beneficial to adopt different and additional tools.

Omega-3 Index: An Actionable Nutrient Status Biomarker

O3I is a biomarker of omega-3 nutrient status, which is proven to be a remarkable measure of overall health risks and closely tied to food-derived and supplemental omega-3 intake.

Top Nutrient Protocols for Acute Injury Recovery

In this article, we cover three broad recommendations for acute pain and inflammation as well as those for tissue and collagen repair.

Elephant in the Room: Stigma Against Offering Supplements

A whole tribe of lifestyle medicine practitioners have been utilizing supplements and know that it has clinical benefits. Benefiting financially is OK as long as you are helping your patient.

36 Great Ideas from Mastering the Implementation of Personalized Lifestyle Medicine

On May 13-14, 2022 hosted healthcare practitioners at Mastering the Implementation of Personalized Lifestyle Medicine: Advances in Clinical Functional Immunity. Here are the highlights.

Helping Your Patients Optimize Exercise for Weight Loss

Physicians can leverage language around exercise to lower patients' risks and achieve weight loss goals. Here is how.

Osteoimmunology: The Emerging Bone-Immune Connection

Bone tissue is largely considered an inert mineral reservoir that provides a framework for locomotion and physical strength. However, if we drill down into the origins of bone cells, we find that the interconnected bone and immune cells' crosstalk plays a key role in not only bone mineral metabolism and bone remodeling but inflammatory signaling that can contribute to bone loss. In this article, we will review osteoimmunological interactions and nutraceutical options that are emerging as novel bone health options.

Dairy Sensitivities and Intolerances: Using the Right Digestive Enzymes

Patients with IBS or IBD often have a dairy intolerance, sensitivity or combination of both. An effective dairy enzyme blend is a great adjunct to the care to help patients manage uncomfortable GI symptoms associated with dairy intolerance and sensitivity.

Case Study: Mold Illness

A 33-year-old male presented with a 20-year history of chronic eczema, chronic athlete’s foot, mild asthma and moderate seasonal allergies.

Collagen and Lyme: Why This Connection is Key for Tissue Repair

Lyme is the most common vector-borne disease in the United States, according to the CDC, and it’s primarily caused by a bacteria called Borrelia burgdorferi.

Key Considerations for Rotating Probiotics

The microbiome is a complex ecosystem in which a diversity of species is required for a healthy GI environment.

5 Safe & Effective Nutrients for Vulnerable Populations During COVID-19

Supporting the immune system with supplements often includes stimulatory herbs such as echinacea, andrographis, and elderberry. And these herbs are often coupled with high-dose foundational nutrients like...

GERD: Weighing the Benefits and Risks of Treatment Options

Take a moment to reflect how many of your patients experience heartburn or prolonged coughing. More than likely, it may be too many to count. And chances are if these patients are experiencing symptoms more than a couple times a week...

Microtrauma: The Little Things Matter

It was a typical Monday morning. I walked into one of our treatment rooms and encountered a fit, 53-year-old female patient in severe pain. She had severe right cervical pain that radiated into her right arm and hand. Her debilitating pain drastically...

A New Approach to Overcoming Performance Anxiety at Work

It’s perfectly normal to experience some degree of anxiety before delivering a presentation, or something equally stressful. According to a 2018 survey conducted by the American Psychiatric Association (APA), 68% of people felt a combination of...

Nailing and Scaling the 80/20 Rule in Cardiometabolic Disease Treatment

If you talk to non-clinicians in the health care industry, you might not be surprised to find they are unimpressed with the average clinician’s understanding of business philosophy. Who would blame us clinicians? We focus on patient care, and the most...

Why Your Patients Need Full-Spectrum Turmeric

Is there anything that turmeric, that golden fairy dust, can't do?! It is a pleiotropic, multifaceted botanical that does so much to reduce inflammation in the body. So far, research has emphasized one turmeric component: curcumin. This ingredient is often touted as a star phytonutrient, with more than 3,000 preclinical studies highlighting its benefits. With all these trials, curcumin has gained a credible reputation of mitigating inflammation and preventing diseases. But one of the biggest conundrums of curcumin is bioavailability, and some delivery systems, like liposomes and phytosomes, intentionally move curcumin past the gut to increase its bioavailability.

4 Tips to Help Your Patients Fend Off the Winter Blues

Shorter days and cold weather may interfere with your patients' normal circadian rhythm. For example, if you live in the northern United States, you may experience a greater health impact due to staying indoors more during the winter, as this can lead to less exposure to natural light. Additional factors during this time of year include less physical activity, stress of the holidays and juggling finances.

Collagen for Skin Health: Is It Healthy or Hype?

There's no doubt that your patients have either asked you about collagen or have started taking it on their own. As their health expert, it can be challenging to keep up with the latest trends and separate marketing hype from the actual efficacy of a product. Many clinicians want to know if there is science that supports collagen for skin health. In this post, we'll start with the basics of collagen and then get below the surface of research to give you the most up-to-date information on this popular supplement.

Folate Supplements: Differences and Benefits

The Food and Nutrition Board (FNB) developed dietary folate equivalents (DFEs) to reflect the higher bioavailability of supplemental folic acid compared to that of food folate. The intake recommendations for folate are provided in the recommended dietary allowance (RDA) as micrograms (mcg) of DFEs.

Fasting and Cardiometabolic Disease: What Practitioners Need to Know

Fads come and go in the health and wellness space. When it comes to fasting, expect this one to stick around for the long-term. Unlike harmful diuretic weight loss pills, cabbage juice dieting, or the Thigh Master, fasting comes in many forms to fit the unique needs of the patient. These include fasting mimicking diets, intermittent fasting, weekly 24-hour fasts, alternate day fasting and more aggressive, extended fasts that require medical supervision.

Can COVID-19 Trigger Autoimmunity?

If we look back to late 2019 and early 2020, the medical community was beginning to understand autoimmunity differently, as a growing epidemic with deep roots in environmental triggers. Much of the tremendous rise of the wellness industry can be attributed to the increasing number of Americans finding themselves chronically ill secondary to a dysfunctional immune system. My own research to that time was dedicated to uncovering how that dysfunction is specifically triggered by factors in the environment.

Protection Your Patients Need for the Holidays: Effective Approaches to Neutralize Gluten

As the holiday season approaches, eating patterns are often unpredictable. Whether it is eating out at a restaurant or going over to a family member's house for dinner, unexpected foods may present themselves at unexpected times. Sure, your patients can be educated to identify and dodge problem foods that provide digestive troubles. Yet it is often overlooked how "safer" foods are prepared.

Feedback: Why Patients Need It, When to Use It and How to Give It

If someone asked one of your new patients (between three to six months of care) how their care has been progressing, what would they say? Would they be able to talk about their subjective improvements, like energy levels, and how those relate to improvements in other categories, such as body composition goals, inflammatory markers, lipid levels and common diabetic parameters?

Preconception, Prenatal and Postnatal Optimization: Nutritional Strategies for Patients in Their Childbearing Years

The role of epigenetics on fetal and human development is of paramount importance to all of us as healthcare practitioners and parents. Toward the end of World War 2, after the battle at Arnhem, in what was known as the "Hongerwinter" (hungry winter), the Nazi's surrounded and cut off supplies to an area in the Netherlands. It was a tragic experiment on the long-term effects of famine. From December 1944 until Germany surrendered in May 1945, food was rationed to under 1,000 dietary calories per day and dropped as low as 580 calories per day in the height of winter.

Strontium: Still a Viable Therapy for Bone Health

Strontium (Sr) is an alkali earth metal, with characteristics very similar to that of calcium; though having an atomic weight nearly double that of calcium. First discovered in the 18th century, this trace element is found in ground water, ocean water and in various foods such as leafy green vegetables and some seafood. The ability for Sr to naturally accumulate in the bones of animals after being fed small doses was first published in 1870. However, it wasn't until the 1950s that human studies were first published.

Novel Therapeutics to Help Soothe and Strengthen the Gut Epithelium

Back-to-school season is here and both teachers and students are exposed to bugs, toxins and other antigens that may work their way into the GI tract and cause health woes. Alongside reinforcing healthy lifestyle habits, we as practitioners are compelled to offer the most comprehensive protection to our patients, which includes supporting a healthy gut epithelium.

The Immune System, Inflammation and Musculoskeletal Health

The musculoskeletal (MSK) system is the focus of attention in many of our practices, with pain and function being the focal point of attention. I would love to broaden this scope of thinking to include the concept of immune health and inflammation, and how they are influenced by the MSK system. Part of the reason I'm shining a light on this topic is that in recent decades, the focus has narrowed on just pain and function, but there is so much more to these intricately linked systems.

The Homocysteine Playbook: Why Should You Test, And What to Do If Elevated

As a functional integrative medicine practitioner, you know all about homocysteine, and how this non-essential amino acid is connected to methylation and a common genetic mutation of the MTHFR SNP. Methylenetetrahydrofolate reductase (MTHFR) is the rate-limiting enzyme in the methyl cycle, and it is encoded by the MTHFR gene. Methylenetetrahydrofolate reductase catalyzes the conversion of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate, a co-substrate for homocysteine remethylation to methionine.

An Integrative Approach to Autoimmune Disease

Fifty million Americans suffer from at least one autoimmune condition. Comparatively, only 12 million suffer from cancer and 25 million from heart disease. This statistic cannot be explained with genetics, as genes don't change or evolve that quickly. That points heavily to the idea that the environment in which we exist has changed drastically, and it is forcing us to live incongruently with what epigenetically creates health.

Back to School Nutrition: Strategies to Help Parents Fill Gaps in Kids' Diets

As we get ready to get back to school during this difficult time of a partially treated pandemic, parents will be faced with one additional problem: How do we get kids to eat delicious and nutritious meals without breaking the bank or their parents' psyche?

Berberine and the Gut Microbiota: A Bidirectional Relationship

There are many phytonutrients that have a bidirectional relationship with the gut microbiome. That is, the nutrient affects the types and/or metabolic activities of the gut microbiota, and the activities of the gut microbiota affect the bioactivity of the phytonutrient, typically through metabolism to more bioavailable and/or more bioactive compounds. The popular phytonutrient compound, berberine, is a classic example of this bidirectional relationship.

These Are the Cardiovascular Risk Assessments You Need for Better Clinical Outcomes

In functional medicine, we are in no short supply of tests. Given the opportunity, many clinicians would love nothing more than to run copious amounts of blood, saliva, urine, and stool samples to assess every aspect of their patients' health. But the issue is that the cost of testing alone could reach thousands of dollars, and at that price, you better have a good reason why each test was chosen and how each will lead to better treatment.

The Quercetin Paradox: The Secret to Preventing Toxic Quercetin Metabolites

Dose may be one part of what determines whether a substance is a medicine or poison, but quercetin in particular serves well as an example of how both dose and metabolism are determining factors in achieving the desired clinical outcome safely and effectively.

Is Your Practice Poised to Be the Future of Medicine?

The triumph of health care will hinge on health professionals reinventing the way in which we work with a patient, with a population, and often overlooked, with each other. We have seen how large conventional multi-disciplinary models are challenged getting to know one patient; conversely, we can admit it is equally challenging for one provider to have all the knowledge needed to provide total care to any one patient or population.

The Clinical Benefits of DPA in Fish Oil

As functional medicine providers, we know that omega-3 fatty acids in fish oil have many benefits. The health benefits include inflammatory balance, cardiovascular fitness, brain health, and normal growth and development. We have learned that these benefits come from EPA and DHA. However, new research shows that many of the benefits attributed to EPA or DHA may actually be from a lesser-known omega-3, docosapentaenoic acid or DPA.

Health Benefits of Collagen: A Practitioner's Perspective

It is the start of a busy Wednesday morning and I walk into treatment room #2. One of my long-time patients is sitting on the treatment table, beaming at me, and says, "Doc, that stuff you gave me last month just rocked my socks!" Not quite knowing how to take that statement, I inquired, "Umm, how do you mean?" They replied, "My chronic knee pain is significantly better, and that deep hip pain is now well enough for me to sleep through the night!"

The What, When and Why of Using Probiotics as Targeted Therapies

For any practitioner who uses probiotics in their practice, there isn't a clear-cut guide on the what, when and why of using probiotics for different conditions. Worldwide, over-the-counter consumption of probiotic supplements has increased in recent years. Notwithstanding, clinical studies for many probiotic strains and formulations have had conflicting results. New stool testing modalities, like 16s-RNA PCR and whole-genome sequencing, have helped assess gut colonization by probiotics, strain-level activity, interactions with resident flora, effects on the host, and the potential useful medical indications of specific strains. Regardless, trying to design test-guided probiotic formulations based on shot-gun sequencing of a stool specimen is still not exact science, as I have seen in patients who have tried customized probiotics through companies, like Sun Genomics, not achieve the intended results one would expect through "customization."

Using Virtual Group Visits to Enhance Patient Success

The American Academy of Family Physicians asserts that group visits are an effective method for enhancing patients' self-care of chronic conditions, increasing patient satisfaction, and improving outcomes. Group visits (AKA shared medical appointments) occur when multiple patients are seen in a group setting for follow-up care or management of chronic conditions (e.g., diabetes group visit). A lifestyle-based group visit, furthermore, incorporates the power of functional and lifestyle medicine into this innovative appointment format.

3 Remarkable Benefits of Hyaluronic Acid

Many people have heard of hyaluronic acid in beauty products, but few are familiar with this ingredient as a dietary supplement. We'll explore a few evidence-based benefits of hyaluronic acid (HA) as a supplement with some of the best uses based on the latest science.

The Complex Relationship Between IBS and SIBO

The symptoms of SIBO (e.g., bloating, abdominal distension/ pain/discomfort, diarrhea, fatigue, weakness, etc.) overlap considerably with those of irritable bowel syndrome (IBS), and many clinicians consider these conditions to be commonly associated. However, epidemiological research shows that the relationship between the two conditions is not well understood, is controversial, and varies considerably depending upon the diagnostic criteria used to define SIBO (and IBS). In fact, the large variance in the frequency of SIBO in IBS subjects mirrors that found in healthy controls.

3 Key Foundational Nutrients with Pleiotropic Effects

As functional medicine providers, we go beyond traditional medicine and root out underlying causes of health issues as well as attempt to restore normal physiological function and homeostasis. Often during this quest, we recommend nutraceuticals to support recovery. While the physiological effects of nutraceuticals are well-documented, the effects of nutrition at the genetic level are often overlooked. This knowledge can be incredibly useful when managing a variety of patient cases. Here are three examples of nutrients that have pleiotropic effects on the body...

COVID-19 & Autoimmunity: What We Know Now

In 2020, the medical discussion was dominated by the diagnosis and treatment of COVID-19, and rightfully so-this has been an unprecedented health challenge and crisis. With the first year behind us and vaccines now available, many want to put the pandemic in the past, and resume health care and life the way it was before. I've been guilty of this myself at times, but unfortunately, we are only just beginning our battle with COVID-19.

Implications of Cytolethal Distending Toxins Bring New Perspective for Natural SIBO Treatment

For the functional medicine practitioner, it is not a rare occurrence when a patient presents to your office with uncomfortable gastrointestinal symptoms such as bloating, abdominal pain, diarrhea and/or constipation. These are common complaints that present across most GI cases. But what happens when the patient doesn't show improvement, and even small diet changes still present with gas, bloating, diarrhea and food intolerances? Patients like these are frustrating, especially if you have tried numerous approaches, like an elimination diet, with unsuccessful results, and you cannot pinpoint the cause of their symptoms. If this is the case, you may want to consider small intestinal bacterial overgrowth (SIBO).

Treatment Strategies to Support Patients with Low Gut Motility

Many functional integrative medicine practitioners would agree that a fundamental principal of their practice is to pinpoint the root cause of dysfunction in order to truly help patients. Yet, this is not always easy to do, and some patients can be more frustrating than others. Such is true for patients with small intestinal bacterial overgrowth (SIBO), especially if numerous approaches to remove unwanted bacteria in the small intestine provide unsuccessful results.

3 Ways to Naturally Treat Histamine Sensitivities

Let's start by stating the obvious here: COVID-19 has brought forth a cocktail of health issues! Apart from the blatant immune system problems, we also have a rise in metabolic dysfunction-think "Quarantine 15." To add more, while most people are cocooned in their homes and spending a lot more time indoors, there is an increased amount of exposure to indoor antigenic materials. So, it should be no surprise when you see patients with histamine-associated symptoms outside of the usual spring season.

Living Well on the Road Ahead: Vitamin D and COVID-19

Vitamin D is a pro-hormone with ubiquitous effects throughout the body. It has been shown to have a multitude of benefits, including bone health, innate and adaptive immune function, and vascular health, yet we live in country where, depending on the source you consider, 40-70% of the population is vitamin D deficient and people are routinely told to limit sun exposure.

Strategies for Helping Patients Reduce Stress and Improve Immune System Function

Stress in appropriate amounts can be beneficial for the body to function better and stay healthy.1 As much as stress is a normal component of daily life, stress in abundance leads to illness and eventually chronic disease conditions.2 In this post, we will define stress, explain how it affects immunity and provide long-term strategies for reducing stress.

Building Wellbeing and Resilience in Your Patients in 2021

The year 2020 will go down in history as an extraordinary year for all of us. In fact, this year will likely be remembered as the biggest experiment ever done on mankind. For many years to come, researchers will examine how societal norms, human behavior, medications, and underlying conditions affected not only COVID-19 outcomes, but a host of ancillary illnesses. We are likely to see studies on depression in adolescents, domestic violence, elder neglect, and failure to adhere to medical advice.

Helping Patients Combat Stress with Targeted Nutrition

Your patients' stress stems from many different sources,1 and there is no one-size-fits-all approach to mitigating it. Nutrition is a powerful tool that, when implemented strategically, can help restore key nutrients depleted by chronic stress. In addition, nutrition can help build resiliency to feelings of overwhelm and anxiety, especially when paired with lifestyle interventions. Read on to learn the most common nutrients depleted by stress and clinical strategies to replenish them.

The Innate Immune System is More Adaptive Than You Think

A few weeks back I spoke at the Microbiome 2.0 Symposium, part of the Personalized Lifestyle Medicine Institute's Mastering the Implementation of Personalized Lifestyle Medicine series. This was one of the first live events that I have attended since March of 2020! I was tasked with teaching on a variety of topics, but my first lecture focused on the gut-immune interface. As part of this lecture, I included a few slides designed to remind the clinician audience how the immune system interprets self from non-self, or more specifically, harmful vs. non-harmful encounters.

How to Make Spore-Forming Probiotics a Successful Part of Your SIBO Treatment Protocol

Small intestinal bacterial overgrowth (SIBO) is a rising area of focus in functional medicine. As microorganism levels in the small intestine increase, so does microbial activity, like fermentation. With these type of patients in practice, you may have seen that even healthy diets can cause gas, bloating, and intolerance to certain foods and probiotics. Such gastrointestinal complaints have been attributed to sensitivity, but the reason may be microbial imbalance in the small intestinal environment. As you know, the health of the gut relies on a balanced microbiota. Spore-forming probiotics can contribute to that balance by having a positive influence specifically in the small intestine, promoting organism diversity and immune protection.

Improve Patients' Quality of Life with Lifestyle Interventions for IBS

Almost everyone experiences these symptoms at some point. But when they are a daily reality, these symptoms become a significant burden in patients' lives. Patients often feel isolated and limited in their day-to-day activities; they don't know where to turn. As practitioners, we must try to understand the frustration these patients are experiencing and recognize that our expertise in pinpointing the root cause of symptoms will be the key to helping these patients. Examples like these are classic cases of irritable bowel syndrome (IBS).

4 Resilience Strategies for Busy, Stressed-Out Practitioners

Promoting health and vitality is something we all know how to do, yet life can sometimes conspire against us. We get caught in time crunches, food deserts, insomnia vortices and other places where making smart, healthy choices is not always easy, or for that matter, a priority. Yet maintaining good health requires work, a strategy and the occasional checkup and test. Life itself can act as a healing catalyst if we learn how to use it.

4 Ways to Help Metabolic Syndrome Patients Avoid a Lifetime of Medications

Let's face the facts: If you see human patients, you're seeing patients with metabolic dysfunction. Even children, who should be resilient and thriving, are showing signs of metabolic dysfunction. Think back to the average patient walking through your doors (or on your virtual appointment calendar). It's rare to not see at least one or two aspects of metabolic syndrome.

The #1 Thing You Can Do to Help Your Patients Get Stress Under Control

As a health care provider, you regularly see patients managing varying levels of stress. This stress comes from external and internal sources, meaning emotional stress, as well as infections or other physiological dysfunction. The number-one challenge I see with patients and a primary internal stressor is blood sugar regulation.

Using Bergamot in Your Lipid-Lowering Strategy

In 2021, we are in no short supply of supplements that can support healthy cholesterol and improve lipid measurements. Many are backed by stacks of research including mechanistic studies, human randomized controlled trials, and some even have thousands of years of historical use in Ayurvedic and Traditional Chinese Medicine. It seems a lack of options is not the issue here. Rather, many clinicians are reluctant to or frustrated with incorporating supplements into a treatment plan, especially when it contradicts current guidelines.

New Ways to Implement Functional Medicine Programs in 2021

There has never been a better time for functional medicine.The population of the modern world has a weight around its ankle named chronic disease, and we have been walking the pandemic plank for the better part of 2020.As a health care practitioner with an abundance of passion and sharp clinical knowledge, you see the writing on the wall. You know your patients need a personalized functional medicine plan with a foundation of lifestyle medicine.Knowing this and attracting actual patients to your practice are two separate things, however. Unfortunately, this hurdle often leaves many providers at the starting line stuck in pre-contemplation.

Benefits of Spore-Forming Probiotics

In the past two decades, there have been few areas of research that have expanded as greatly as that which explores the importance of the human microbiome(s), especially the nuanced relationship between the bacteria in the GI tract and their human host. It is not uncommon to see papers published, weekly, showing the potential connection between metabolic activity within the gut microbiome and some important human pathophysiology.

The Emergence of Autoinflammatory Syndromes

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...

The 4 Best Phytonutrients for Arthritis

Inflammation is the most common target for arthritis symptom management. However, to get to the root cause and ultimately improve outcomes, the target must incorporate the microbiome and consider systemic inflammation. Diverse pleotropic phytonutrients not only relieve local inflammation caused by the degradation of cartilage, but also enhance microbiome diversity and the gut epithelium, which helps reduce systemic inflammation. Here are the top phytonutrients I recommend for my arthritis patients:

Cardiometabolic Lifestyle Medicine: Real People with Real Success

While I enjoy writing technical posts, my passion lives with sharing patient stories as clinical education. In our provider world, we call these "case studies," but to me, it's so sterile-sounding. These are real people-parents, siblings, children-unique individuals who all have a life they literally hand to us so it can be optimized and juiced for everything it's worth. So, without further ado, I introduce you to Ken!

What's the Deal with Cortisol? Assessing Patients Using the Cortisol Awakening Response (CAR)

The circadian rhythm influences many factors in the human body, including sleep-wake cycles, hormone production and release, hunger and satiety, mood, digestion, the immune system, and body temperature. As such, any dysfunction within this process increases the risk for long-term sequelae and chronic disease.

19 Great Ideas from Simplexity Medicine 2.0: Quantifying Patient Resilience

On July 9, 2020, the Personalized Lifestyle Medicine Institute, in collaboration with Ortho Molecular Products, convened hundreds of healthcare practitioners to Simplexity Medicine 2.0: Quantifying Patient Resilience. The virtual, live conference was a great opportunity for functional medicine practitioners, as it helped them connect and learn from a faculty of experts sharing their insight on building and measuring health resiliency. In the climate of COVID-19, this topic was timely and valuable to healthcare practitioners seeing patients on the front lines of the pandemic. Attendees also learned about ways to continue transitioning their practices to meet the needs of patients during the pandemic, including telemedicine and group visits.

The Future of Health is Virtual-Are You Ready?

The coronavirus has skyrocketed the demand for health care while simultaneously amputating its main arm of delivering the care itself. People desperately want to see trained professionals; however, they are equally afraid to see them in-person. And because face-to-face individual appointments had been the comfortable and seemingly secure way of seeing patients pre-COVID-19, many smaller medical offices are suddenly disoriented and struggling to figure out how to pivot to remain solvent these days.

How to Keep Patients from Sabotaging Their Exercise Programs

A recent publication in PeerJ documented compelling evidence that exercise might not be the key to controlling body weight.

Functional Medicine Therapies for the Burned-Out Brain

In my last post, I introduced the concept of chronic stress causation as a broader scope than previously recognized in medicine. We also learned about the three likely culprits of chronic stress, which cause symptoms of anxiety, depression, sleeplessness, fatigue, poor memory and concentration, and chronic pain. In this post, I want to provide you a paradigm, or road map, for non-prescriptive treatments that support the stress response and reduce or resolve symptoms for nearly everyone who implements them.

The 3 I's of Building a Strong Gut-Immune Axis

In practice, it can be a challenge to break down complex medical concepts and articulate them simply to our patients. This is especially true when we begin to talk about the connection between gut and immune function. In the world of functional medicine, we find our patients to be a lot more engaged and wanting to learn these complex concepts in a more digestible way. And so, to provide quality information in smaller bites, I often speak about the 3 I's of building gut-immune health as a way to understand the importance of the types of nutrients we use together in order to enhance this synergistic relationship After all, 70% of our immune system is found within the digestive tract. In this post, I will lay out the 3 I's and include corresponding solutions to glue it all together.

A Paradigm for EvaluatingAnxiety and Mood Disorders

Large segments of the global population suffer the effects of a burned-out brain and subsequent symptoms of anxiety, depression, sleeplessness, fatigue, poor memory and concentration, and chronic pain. Functional medicine clinicians have long referred to this constellation of symptoms as "adrenal fatigue," but by refocusing on the true dysfunction, the hypothalamus and its inability to organize a proper stress response, we can help patients overcome their anxiety and mood disorders.

Mitochondria: 3 Ways to Help YourPatients Improve Cellular Energy

We all know what it feels like to feel under the weather: drained energy, lethargy, full-body aches, drowsiness, brain fog-sound familiar? They're the results of the immune system at work fighting off illness, and it goes without saying that the immune system demands a lot of energy to do its job. Mitochondria, the main metabolic engine, are abundant in immune cells to help meet those energy demands.

4 Ways to Mitigate Heart DiseaseRisk During COVID-19

Heart disease is still the most significant mortality threat to Americans today. But now, cardiometabolic experts are asking this epigenetic question: How will the dramatic COVID-19-related changes to our daily lifestyles affect our patients' risks for cardiovascular disease?

17 Great Ideas fromSimplexity Medicine: Health Care Reimagined

On April 16, 2020, the Personalized Lifestyle Medicine Institute, in collaboration with Ortho Molecular Products, convened more than 4,600 healthcare practitioners to Simplexity Medicine: Health Care Reimagined. The virtual, live conference was a silver lining amid all the uncertainty surrounding COVID-19, an opportunity for functional medicine practitioners to connect and learn from a faculty of experts sharing their insight on the virus and its effects. Attendees also learned about ways to transition their practices to a virtual model using the Virtual Practice Pivot Program.

How to Start a GroupExercise Program in Your Practice

"Exercise is medicine." This is probably one of the most to-the-point and impactful pieces of advice you can give your patients. The improvements exercise imparts on health, including rate of healing and decreased pain, are so significant that we are doing our patients a disservice if we neglect to encourage exercise in all its forms.

How to Build Resilience inYour Patients and Your Practice

What does a typical day look like in your practice? Do you find yourself moving from one patient crisis to the next, all day long? You work with patients for several months to help them move the needle on their health and then poof! they disappear until the next crisis occurs.

Microbiome Availability & How Botanicals Interact with the Gut

There has been a lot of buzz around "bioavailability" lately, especially as it concerns dietary supplement ingredients like fish oil, CoQ10, and phytonutrients like curcumin and resveratrol. However, much of what is marketed as having increased bioavailability rarely translates into meaningful therapeutic improvements, especially when it comes to phytonutrients.? This is primarily because phytonutrient research has mostly followed the same path used for developing drugs, which focuses on single compounds discovered through in vitro activity screening methods.

This Will Make You Rethink How You're Treating Chronic Stress

When our patients have symptoms of fatigue, weight gain, dry skin, hair loss and constipation, we evaluate the thyroid with lab testing. When our patients have symptoms of bloating and gas, nausea, heartburn, alternating constipation and diarrhea, a common approach is to order a stool test and assess alterations in enzymes, the microbiome or "leaky gut." And when our patients have symptoms of reduced libido, hot flashes, vaginal dryness, emotional lability and anxiety, it makes sense to check their hormone levels. But are these truly functional approaches?

6 Reasons You're Not Implementing Group Visits (And How to Overcome Them)

Group medical visits, also called shared medical appointments, are provider-patient medical encounters in which a group of people are seen together in a concurrent session. Although the individual face-to-face appointment continues to be the prevailing model of patient care, by default mostly, there is growing evidence that suggests group visits are indeed effective, and furthermore, provide benefits above and beyond an individual encounter.

Glutathione: The Master of All Antioxidants

Antioxidants and detoxification are more than just marketing buzzwords. With health care professionals talking more and more about the importance of detoxification, almost everyone understands that antioxidants play a crucial role in this process and in optimizing overall health. There is significant clinical data that indicates a good detoxification protocol is a must for individuals with chronic illnesses. This patient type in particular needs to reduce their toxic burden as a first step in their healing process.

Statins, Bergamot & Lifestyle Medicine

Statins have been the cornerstone of heart disease prevention in the conventional medical model for a long time. However, there is a growing resistance to using this prescription among patients. More and more, our culture is questioning the slippery use of pharmaceuticals as the panacea for the complex, chronic disease epidemics of our time, and statins are at the forefront of this shift.

The Term "Adrenal Fatigue" Should be Abandoned

Sometimes, when we endeavor to understand and describe complicated medical topics, there is a temptation to find a simple explanation to cut through that complexity. Sometimes these simple explanations can help bridge the knowledge gap for a while, but as our knowledge grows, those explanations lose some of their original usefulness (i.e., "good" and "bad" cholesterol). In many cases, those oversimplified explanations actually become a hindrance to helping clinicians and patients understand the important mechanisms and solutions related to their chronic conditions.

Case Study: Peripheral Neuropathy

Chronic pain is a widespread, incapacitating and expensive condition. In the United States alone, an estimated 126 million adults reported some type of pain in the previous three months, with 25.3 million adults (11.2%) reporting daily (chronic) pain and 23.4 million (10.3%) describing intense pain.1 Chronic pain costs the United States an estimated $560 to $635 billion annually.1

The 4 Key Stressors and Nutritional Support Protocols for Rebuilding Stress Resiliency

In functional medicine, we focus on finding the root cause of health issues to help our patients achieve lasting recovery and relief from their symptoms. In cases of chronic stress, it is important to dig deeper into what stressors may be affecting the body; here are four key stressors to consider when assessing chronic stress patients:

6 Strategies for Rebuilding Healthy Circadian Rhythms

If resilience is the body's ability to return to homeostasis following a stress of our physiology, what does it look like when we lose resiliency?

Rebuilding Stress Resiliency

Resilience is defined as the ability to recover quickly from difficulties, toughness, or the ability of an object to spring back into shape; elasticity. As it pertains to the human body, resiliency is the ability to return to homeostasis following a stressor. While there are numerous physiologic mechanisms that provide resilience in our bodies, perhaps the most important is the hypothalamus.

Getting to YES: How to Enroll More Patients Into Care

In the previous two posts, I discussed the importance of niching down to make it easier for your ideal patients to recognize your expertise and relevance, and how to employ lead magnets to build your email list and then nurture your prospective patients to know, love and trust you enough to take the next step.

Getting to YES: How to Nurture Your Prospects to Know, Love & Trust You

In my last post, I discussed the importance of niching down to make it easier for your ideal patients to recognize your expertise and relevance.In this post, I'll highlight how to develop preeminence in your community, so that your audience considers you the go-to choice before they even take up any of your precious time.

Getting to YES: How to Attract More of Your Ideal Patients

Imagine Thomas Edison only tinkering in his workshop, but never telling the world about inventing the lightbulb...crazy, right?Yet that's exactly what many health care practitioners do, thinking that their clinical expertise alone should be enough to attract new patients!

How to Know When It's Time to Start Group Visits in Your Practice

No matter your medical discipline, if you can facilitate behavior change in your patients, you will see incredible results. It is simply the most powerful force in reversing chronic illness. Practitioners are looking for the most effective ways to facilitate behavior change in their patients, and a proven strategy is the Group Visit practice model. Researching this practice model or tuning into the Evolution of Medicine Podcast's Group Visit Series will tell you that Group Visits are innovating the way we practice medicine.

3 Patient Cases that Always Benefit from Nutritional Protocols

Your day begins as soon as you set foot in your office. Ten patient messages await your attention; an insurance denial on a patient's MRI beckons from your desk; one of your staff, who manages patient services and scheduling...

Functional Medicine Approaches to Treating Urinary Tract Infections

The second-most common human infection is one that people barely speak about. Urinary tract infections, also known as bladder infections, impact 10-20% of women at least once a year, and the typical treatment intervention is prescription antibiotics. Middle-aged women presenting with chronic conditions like autoimmunity, dysbiosis and hormone dysfunction are common patients in functional medicine, so taking antibiotics regularly could pose an issue for them. When optimizing microbiome health, immune tolerance and hormone production, it is crucial that bacteria are given the opportunity to thrive, and antibiotic use poses a threat to that opportunity. With that said, if urinary tract infections are one of the most common infections physicians see, and we are attempting to avoid unnecessary antibiotic use, what functional medicine approaches do we have?

The Role of Stress and Nutrient Availability in Circadian Metabolism

In the last several years, I dove into the research exploring the intersection between circadian rhythm and the HPA axis. As most of you probably know, normal cortisol production follows a predictable circadian output, which rises sharply upon awakening (the cortisol awakening response, or CAR) and then drops quickly over the next few hours, gradually declining and reaching its nadir late at night. What many may not know is that glucocorticoid receptors (i.e., cortisol receptors), found in almost every tissue, are vital in helping to maintain peripheral circadian rhythm, which can greatly influence cellular metabolic function.

The Breakfast of Functional Medicine Champions

When I first began my foray into functional medicine, I was pleasantly surprised to hear of this thing called functional foods. As someone who doesn't like to eat solids for breakfast, who loves the concept of eating but feels it gets in the way of more pressing matters, and who surely needs some daily nutrient therapy for existing and future medical issues, I found functional foods deserved that heavenly operatic "Ahhhhhh" when I began enjoying all the benefits they provided me in my day-to-day life.

Simplifying SIBO: Case Study + Treatment Plan

You have a new patient coming in to see you. As you peruse her intake forms, you see she has already been treated for small intestinal bacterial overgrowth (or SIBO, for short) several times, and she comes in complaining of recurring symptoms.

Resetting Circadian Rhythms of the HPA Axis

After nearly 20 years of clinical practice, I have found one concept makes all the difference between partial and significant clinical effectiveness: understanding and harnessing the power of circadian rhythms.

Pain, Addiction and the Opioid Crisis: A Fresh Perspective for a Growing Epidemic

From the pages of medical journals to the worried minds of family members watching loved ones suffer, the opioid crisis continues to permeate our society. Whether in chiropractic, allopathic or physical therapy offices, clinicians must focus on bringing awareness and solutions to patients concerned about physical pain and the very-real risk of addiction.

Strategies to Move Patients from Acute Injury to Long-Term Wellness

If patients are experiencing low back pain, they're not alone. About 80% of adults experience low back pain at some point in their lifetimes, and it is one of the most common reasons patients seek out medical care. Most causes of low back pain are not acute broken bones or traumatic accidents, but subacute/overuse injuries in which increased mechanical stress accumulates and degenerates body tissues over time, resulting in tissue failure. Any injury, whether categorized as a micro or macrotrauma, results in biomechanical dysfunction and is commonly characterized by both pain and inflammation.

4 Ways to Make Your Functional Medicine Clinic More Profitable

Profitability: A concept few want to talk about and just about all of us are concerned about.Whether you are just starting out in practice or have reached a point of fatigue and burnout, "how" as well as "how much" you are compensated for your considerable efforts helping patients is extremely important. Regardless of our motivations for entering the medical profession, all of us have some expectation for personal income we can or should attain.

Gastrointestinal Lab Markers That May Be Telling You to Use Immunoglobulins

In the world of functional medicine, testing has come a long way. Not only do we have more types of tests that can be performed, but the analysis has evolved, too.

Treat the Patient, Not the Disease: Advancing the Patient-Centered, Functional Medicine Approach to GI Dysfunction

When it comes to functional medicine, no other organ system exemplifies this patient-centered approach better than the gastrointestinal system.

New Frontiers in Cardiovascular Medicine: Vitamin K2 as MK-7, Part 3

As scientists continue to find evidence that interfering with vitamin K may have unintended effects like vascular calcification, they also hope to research how calcification can be prevented.

New Frontiers in Cardiovascular Medicine: Vitamin K2 as MK-7, Part 2

When the body uses vitamin K in blood clotting, the vitamin K is recycled through a redox reaction. Warfarin prevents clotting by blocking the recycling enzyme in this reaction. But this inhibition of vitamin K in the vasculature by warfarin may be detrimental.

New Frontiers in Cardiovascular Medicine: Vitamin K2 as MK-7, Part 1

Vitamins have captured the attention of health-conscious people ever since the term "vitamin" was coined in 1912. Named "vita" for life or life-giving and "amin" for amine compounds, scientists now know much more about these crucial dietary components, including the fact that not all vitamins contain amine groups. There is still more to learn about how vitamin intake from our diets prevents or causes disease, or how diseases may cause vitamin deficiencies. But some experts are raising a new concern: that the common drug warfarin is actually contributing to disease by interfering with vitamin K.

Nailing and Scaling the 80/20 Rule in Cardiometabolic Disease Treatment

If you talk to non-clinicians in the health care industry, you may not be surprised to find they are not overly impressed with the average clinician's understanding of business philosophy. Who would blame us clinicians? We focus on patient care, and the most important thing we may learn about the "business" of conventional medicine is how to optimize billing and coding.

Endotoxins: The Missing Piece in the Autoimmunity Puzzle

It's no secret that so many Americans suffer from chronic disease, especially autoimmunity. We have done a great job making the connection to leaky gut; however, sometimes healing leaky gut can be a conundrum, and new evidence supports the idea of endotoxins playing a role in patients that seem to stall in their treatment.

Strategies for De-Stressing Your Practice

We usually discuss stress and its effects on our patients, but today I'd like to discuss the impact of stress on the physician.Physicians, and all health care practitioners, face innumerable stressful conditions every week. In my 18 years of clinical practice, some of the "biggies" have been related to documentation and electronic medical records, technology glitches, staffing and staff-related concerns, maintaining CE requirements, malpractice costs (and ALL costs in general) among others. Over the same time period, it seems these have intensified or even multiplied, and the cumulative effects are significant.

Lifestyle Medicine's Approach to Tackling the Chronic Pain Problem

According the CDC, NIH, and Institute of Medicine, more than 30% of Americans are living with some form of chronic or severe pain. To put this in perspective, 116 million Americans live in pain, compared to the 30.3 million who suffer from diabetes, 25.4 million who suffer from cancer...

Neurotransmitters, Mood and the Perception of Stress, Part 3

The hypothalamus is directly innervated by neuronal systems that produce neurotransmitters, such as serotonin (5-HT), dopamine and norepinephrine (NE), that are involved in mood regulation and play various other roles in cognitive health. During the acute stress crisis, the mesolimbic dopaminergic reward system is stimulated to help maintain morale. However, during chronic stress or depression, the reward system is down-regulated by stress mediators, resulting in anhedonia.

Neurotransmitters, Mood and the Perception of Stress, Part 2

When we talk about "stress," or allostatic load, in terms of the perception of an event, we must realize that these "events" must first be translated into neurochemical signals before they trigger the HPA axis. Therefore, the sensitivity and outcome of translating these events (whether they are ongoing events, memories of past events, or stressful anticipation of unrealized events), is highly dependent upon signaling from other neurotransmitters. In fact, the signaling neurotransmitters that manage mood and affect often overlap with measures of HPA axis activation, and cannot be easily distinguished in some subjects.

Neurotransmitters, Mood and the Perception of Stress, Part 1

When we talk about "stress," or allostatic load, in terms of the perception of an event, we must realize that these "events" must first be translated into neurochemical signals before they trigger the HPA axis. Therefore, the sensitivity and outcome of translating these events (whether they are ongoing events, memories of past events, or stressful anticipation of unrealized events), is highly dependent upon signaling from other neurotransmitters. In fact, the signaling neurotransmitters that manage mood and affect often overlap with measures of HPA axis activation, and cannot be easily distinguished in some subjects.

Setting Successful Treatment Expectations for Your Patients in the New Year

You've created an amazing A-Z plan for your patient. You're excited to apply all your functional medicine knowledge. They walk out the door with pamphlets, instructions, and a bag of supplements you're sure will alter the course of their chronic illness. The patient gets home and realizes, "Oh, oh...I can't do all this!" Two to four weeks later at follow-up, the patient tells you they only did one or two things on the list of 10 perfectly planned interventions for their condition. You feel like you failed, but really, you set your patient up for failure.

A Scientific Turn of Mind

"It's all in your head."This is the last thing a patient with stubborn symptoms wants to hear from their doctor. I recently said this to my 40-year-old female patient with chronic insomnia, fatigue, depression and pain, not because I couldn't find the root cause for her health concerns, but precisely because the brain had become the primary initiator and perpetuator of her symptoms.

The Challenges and Pitfalls of PPI Withdrawal

Proton pump inhibitors (PPIs) are among the most widely prescribed drugs worldwide, accounting for a profit in the billions for the pharmaceutical industry. They are the leading Western treatment for GERD, dyspepsia, and peptic ulcer disease. But the problem is that PPIs are not used judiciously for the short-term, such as healing a gastric ulcer; instead, patients are prescribed PPIs, then kept on them indefinitely without regard to the long-term potential harm of these medications.

Using Community to Motivate Patient Movement

Let's face it. Advising patients to exercise and engage in regular physical activity is a prescriptive no-brainer. The case for movement as medicine continues to solidify as journal after journal elucidates the anti-inflammatory powerhouse that exercise is. Whether for the reduction or reversal of obvious cardiometabolic diseases like diabetes and heart disease or of lesser-known chronic complex conditions like autoimmunity, cancer and dementia, exercise should be a foundational strategy to reduce inflammation and change epigenetic signaling for a healthier future for all patients.

Autoimmunity: Common Protocols to Consider for Every Case

Fifty million Americans suffer from at least one autoimmune condition. Comparatively, 12 million suffer from cancer and 25 million from heart disease. This statistic cannot be explained with genetics, as genes don't change or evolve that quickly.

The question in cardiometabolic disease is not what are you eating, but who are you feeding?

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.

Mapping the Cardiometabolic Patient Journey

Mapping the Cardiometabolic Patient JourneyAs 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.Read more

Cardiovascular Disease: New Clinical Options for Expanding the Therapeutic Target, Part 3

A New Pleiotropic PathFrom 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.Read more

Cardiovascular Disease: New Clinical Options for Expanding the Therapeutic Target, Part 2

Vector of Truth: Medical Research is an Arc of DiscoveryAnyone 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.Read more

Cardiovascular Disease: New Clinical Options for Expanding the Therapeutic Target, Part 1

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.Read more

The Gym Inside Your Door

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

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

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

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

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.

How to Make Your Practice Stand Out in a Crowded Field

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!

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

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

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?

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"

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

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?

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

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

The Real Solution to the Health Care Crisis

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.

Care: The Secret Sauce to a Successful Clinic

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

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

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

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

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

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

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

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

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

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.

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

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

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.