Cardiometabolic Lifestyle Medicine: Real People with Real Success

By SHILPA P. SAXENA, MD, IFMCP

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!
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The HPA Axis: A System Beyond the Stress Response

By THOMAS G. GUILLIAMS, PHD

For many years, I have been researching, writing, and teaching about the HPA axis, primarily in the context of the stress response and chronic disease. Along with others, I have been emphasizing that the primary focus of clinicians should not be the adrenal glands, but upon the brain and the stress signals that trigger the hypothalamus in the first place (perceived mental and emotional stress, circadian disruptors, inflammatory signals and glycemic dysregulation).
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What's the Deal with Cortisol? Assessing Patients Using the Cortisol Awakening Response (CAR)

By Carrie Jones, ND, FABNE, MPH

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.
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Why Your Patients Need Full-Spectrum Turmeric

By MIA IYER, DC

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.
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19 Great Ideas from Simplexity Medicine 2.0: Quantifying Patient Resilience

By Olivia Morrissey

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.
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The Future of Health is Virtual—Are You Ready?

By SHILPA P. SAXENA, MD

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.
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Functional Medicine Therapies for the Burned-Out Brain

By Christopher Mote, DO, DC, IFMCP

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

By Vincent Pedre, MD

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.
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A Paradigm for Evaluating
Anxiety and Mood Disorders

By Christopher Mote, DO, DC, IFMCP

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.
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How to Build Resilience in
Your Patients and Your Practice

By Bill Hogarth, DC, MBS

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.
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Microbiome Availability & How Botanicals Interact with the Gut

BY THOMAS G. GUILLIAMS, PhD

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.
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This Will Make You Rethink How You’re Treating Chronic Stress

By Christopher Mote, DO, DC, IFMCP

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

BY SHILPA P. SAXENA, MD, IFMCP

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.
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Turmeric: The “Golden First-Line Therapy” for Joint Health

By Adrian den Boer, DC, ND

Osteoarthritis (OA) impacts over 30 million Americans, with joint pain and musculoskeletal pain in general being one of the top reason people see their physicians.¹ Accompanying signs of arthritis are altered joint alignment, lack of joint mobility, morning stiffness, joint swelling, joint line tenderness, bony enlargements and pain with exercise in some cases.^1,2 First-line therapies for OA include patient education, over the counter analgesics (acetaminophen) and anti-inflammatories (NSAIDs), a walking or light exercise program, weight management or nutrition program and many times a referral to a physical therapist or chiropractor to help with symptom management.¹
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Glutathione: The Master of All Antioxidants

BY MIA IYER, DC

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.
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8 Best Practices for Healthy Detoxification

By Vincent Pedre, MD

In my previous blog post, we talked about the importance of supporting the Phase I cytochrome P450 family of enzymes and Phase II conjugation pathways with specific foods and targeted nutrients. In this post, we’re talking about important considerations when creating a detox treatment plan for your patients.
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Detox or die: How to help your patients detoxify in a modern world

By Vincent Pedre, MD

Detoxification is a multi-step process that involves not only clean eating, but also awareness of water sources, exposure to toxins (both environmental and food-borne), and proper elimination. One way to think of it is, “We are what we eat, breathe, touch, and sense, but cannot eliminate.” We cannot completely control our exposure to toxins in food, food packaging, and the air we breathe, but we can take steps to support our ability to eliminate the toxins from our bodies and reduce exposures in the first place.
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Statins, Bergamot & Lifestyle Medicine

BY SHILPA P. SAXENA, MD

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.
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The Term “Adrenal Fatigue” Should be Abandoned

BY THOMAS G. GUILLIAMS, PHD

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.
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Case Study: Peripheral Neuropathy

By Adrian den Boer, DC, ND

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

By Christopher Mote, DO, DC, IFMCP

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:
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6 Strategies for Rebuilding Healthy Circadian Rhythms

By Christopher Mote, DO, DC, IFMCP

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?
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Rebuilding Stress Resiliency

By Christopher Mote, DO, DC, IFMCP

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.
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Getting to YES: How to Enroll More Patients Into Care

BY ULI ISERLOH, PhD

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

BY ULI ISERLOH, PhD

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

BY ULI ISERLOH, PhD

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

BY CHRISTOPHER MOTE, DO, DC, IFMCP

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.
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3 Patient Cases that Always Benefit from Nutritional Protocols

By Adrian den Boer, DC, ND

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, calls in sick. As you begin responding to patient messages and mentally prepare for the day, you see your first patient pull into the parking lot. Before you know it, the day is over, and you can’t help but wonder how you survived.
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Functional Medicine Approaches to Treating Urinary Tract Infections

BY ANGELA LUCTERHAND, DC

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?
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The Role of Stress and Nutrient Availability in Circadian Metabolism

BY THOMAS G. GUILLIAMS, PHD

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.
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The Breakfast of Functional Medicine Champions

BY SHILPA P. SAXENA, MD

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.
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Simplifying SIBO: Case Study + Treatment Plan

By Vincent Pedre, MD

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. As you prepare to see her, you feel a rivulet of sweat down your back, knowing this is going to be a tough case. What is the most effective strategy for a patient like this? In this blog post, we’ll use this sample case study to examine the challenges and pitfalls of diagnosing and successfully treating SIBO.
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Resetting Circadian Rhythms of the HPA Axis

By Christopher Mote, DO, DC

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

By Adrian den Boer, ND, DC and Shilpa P. Saxena, MD

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

By Adrian den Boer, DC, ND

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.
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4 Ways to Make Your Functional Medicine Clinic More Profitable

By Christopher Mote, DO, DC

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.
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Mitochondrial Dysfunction: Key Indicators You Might be Overlooking

By Angela Lucterhand, DC

How many patients walk through your door with a chronic disease diagnosis? If you answered, “almost all of them,” then you see mitochondrial dysfunction daily. In cell physiology, you learned that mitochondria are the powerhouses of cells; they are responsible for creating cellular energy, known as ATP. However, we often forget how mitochondria are negatively impacted by HPA axis and metabolic stressors, certain medications, and poor lifestyle habits.
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Ketogenic Diets for Cardiometabolic Outcomes: What is the Evidence?

by Thomas G. Guilliams, PhD.

While the ketogenic diet (KetoDiet) may have had its roots as a treatment modality for epilepsy as far back as the 1920s, variations of this diet are now mostly popular for their metabolic outcomes (e.g., weight loss, improved glycemic control, etc.) or for cognitive support/neurological conditions (e.g., Alzheimer’s disease, malignant glioma, migraine headache, and other neurologic disorders).
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Microtrauma: The Little Things Matter

By Adrian den Boer, DC, ND

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 limited her ability to move her neck in all directions and perform simple daily activities.
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Gastrointestinal Lab Markers That May Be Telling You to Use Immunoglobulins

By Angela Lucterhand, DC

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

Jeffrey Bland, PhD, FACN, CNS and Leon Schurgers, PhD

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

Jeffrey Bland, PhD, FACN, CNS and Leon Schurgers, PhD

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

Jeffrey Bland, PhD, FACN, CNS and Leon Schurgers, PhD

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

By Shilpa P. Saxena, MD

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.
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The Missing Piece in the Autoimmunity Puzzle

By Angela Lucterhand, DC

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.
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Strategies for De-Stressing Your Practice

By Christopher Mote, DO, DC

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.
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Lifestyle Medicine’s Approach to Tackling the Chronic Pain Problem

By Adrian den Boer, DC, ND

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, and 14.7 million who suffer from heart disease. More people have chronic pain than suffer from major chronic diseases, and the economic burden and complexity of chronic pain are of epidemic proportions—and growing. Musculoskeletal pain is the number one presenting complaint in clinicians’ offices, and most are ill-equipped to handle it.
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Neurotransmitters, Mood and the Perception of Stress, Part 3

By Thomas G. Guilliams Ph.D.

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.
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Neurotransmitters, Mood and the Perception of Stress, Part 2

By Thomas G. Guilliams Ph.D.

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.
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Neurotransmitters, Mood and the Perception of Stress, Part 1

By Thomas G. Guilliams Ph.D.

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.
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Setting Successful Treatment Expectations for Your Patients in the New Year

By Vincent Pedre, MD

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.
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A Scientific Turn of Mind

By Christopher Mote, DO, DC

“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.
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The Challenges and Pitfalls of PPI Withdrawal

By Vincent Pedre, MD

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.
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Using Community to Motivate Patient Movement

By Shilpa P. Saxena, MD

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.
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Autoimmunity: Common Protocols to Consider for Every Case

By Angela Lucterhand, DC

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.
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The Emergence of Autoinflammatory Syndromes

by Thomas G. Guilliams, PhD

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

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

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

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.

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.

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.

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

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

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

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.

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

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

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

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

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

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

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.

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.

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.
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Exercise Adherence Starts with an Exercise Prescription

by Jonathan Cannizzo, MSc

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.

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

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

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