New Frontiers in Functional Medicine

As you probably know, stem cell therapy outside of the research setting is the Wild West. It’s offered everywhere, here and outside of the US (there’s a whole “stem cell tourism trade”). Radical claims are made routinely without much evidence or oversight. Pricing for therapy, and protocols used, vary widely, although anyone (even those participating in research trials) can expect to spend thousands of dollars. Given that my patient has MS, I reached out to Dr. Terry Wahls and asked if she had any insight into a direction for us. She suggested I look into a massive, years-long multi-center clinical trial using stromal vascular fractions (AKA adipose-derived stem cells and growth factors) for a variety of conditions, including MS. The first publication from this study out February 2017, focusing on safety of SVF over 5 years, demonstrated a very low number of adverse events, and significant improvement in pain rating in a variety of musculoskeletal diseases. (N =1524)

In general, I am a fan of IgG food sensitivity testing. While we can in some cases manage just fine using a standard elimination and challenge protocol, IgG testing can benefit patients in a few ways, such as: providing motivating data, individualizing the foods needing to be removed and identify less-common antigenic foods. However, if you are using IgG food sensitivity testing in practice, you’ve no doubt encountered false negatives and positives. (Indeed, you may have abandoned IgG testing for these reasons!) Dr. Brent Dorval, through a rather remarkable epiphany during his post-doctorate work, formed the hypothesis that testing for IgG/food immune complexes, along with the specific complement protein (C3d) that induces the inflammatory response, would increase the reliability of the test considerably. After a number of years of bench and clinical research, Brent finalized the methodology for his assay (now called the FIT Test, offered through KBMO Diagnostics) and the rest is history. Tune into our podcast for an overview on IgG food sensitivity testing (great if you are new to using this laboratory test, or an individual interested in this testing), and specific details about the unique FIT test, including case studies. See the links below for all the info on the FIT Test, including his current publication. Stay tuned for more research in the pipeline!

Functional hypochlorhydria is a condition we see so often, yet Prilosec is a top ten medication: what’s the disconnect? Probiotics: which ones, how much, combo or single strain? What does the research really show probiotics are actually doing? Is there any truth to probiotics colonizing the GI tract? And what about soil-based probiotics, any reason to be jumping on that bandwagon? What is the correct lab test for identifying pancreatic exocrine insufficiency (PEI), and what is the optimal range? Is there any utility to testing fecal fats? What enzymes (vegetarian or animal-based), botanicals and other interventions are appropriate for addressing PEI?

Have you been wondering what you should really do with the 23andme genetic data that you’ve gathered? Wondering if you should even take the test at all? Or wondering what the future of genetic/epigenetic medicine is? This podcast is for you. I am especially excited to bring you this conversation with epigenetic legend, Dr. Moshe Szyf. The study of epigenetics is continually breaking new ground in understanding how our environment dramatically influences our gene expression. With myriad published research studies and his ongoing work, Dr. Szyf is at the forefront in shaping this evolution. The power of epigenetics to alter the course of our health is compelling, and I hope you will enjoy the discussion we had, which I hope will be one of many.

Thanks to Dr. Susan Blum, functional medicine has even more to offer for patients with rheumatoid arthritis (RA) and osteoarthritis (OA). She shares new insights about RA’s underlying causes, details what goes missed in treatment plans, and gives practical tips for mining data from stool tests, utilizing functional blood markers, and combining herbs and probiotics to reverse processes that other practitioners may think are permanent

Fibromyalgia can be a particularly difficult condition to address conventionally, but Functional Medicine really has a lot to offer here. In this podcast, we mine the wealth of information that Dr. David Brady brings to the table on this important topic, including: · The signs and symptoms of fibromyalgia and how it is diagnosed (previously-defined tender points are no longer used!) – see also Dr. Brady’s questionnaire at www.fibrofix.com · What other mimicking conditions need to be considered or ruled out · How fibromyalgia differs from chronic fatigue syndrome—vastly different disorders that are commonly confused · Why not all pain is driven by inflammation · How not to fall into the trap of only looking at mitochondrial dysfunction · Organic acids, catecholamines, food reactivity and other relevant labs for assessment and tracking · Childhood and adult stress patterns in (especially female-dominated) fibromyalgia, and how that factors into interventions · Additional intervention options such as sleep support, energy pathways, detox, exercise, diet, immune balancing to reset metabolic patterns and promote recovery

Dr. Cabeca is a wealth of information and inspiration when it comes to women’s health. I am delighted to share my conversation with her this month, in which you’ll learn about: - How Dr. Cabeca transitioned from performing multiple surgeries per week, to only needing to recommend a handful per year with a functional medicine approach - The best lab tests and specimens for hormone assessment - The importance of liquid chromatography mass spectrometry for serum free testosterone measures - Factors to be aware of that can confound hormone testing results - Estrogen metabolites and the importance of methylation assessment - The sweet spot of keto-alkaline status for sex hormone balance, cortisol management, mental clarity, insulin sensitivity and weight loss (target pH of 7, and some ketones 3+ days per week) - The benefits of vaginal testosterone and DHEA for tissue repair and incontinence - Watching out for behavior change with testosterone to ensure appropriate dosing and saving marriages! - Addressing vaginal dryness with safe oils and DHEA, diet and lifestyle

Everyone is abuzz with Functional Medicine these days- the IFM Certification process is humming along, and record numbers of clinicians are making the transition to this amazing and satisfying practice. But what about the business of FxMed? Ahhhh! Daunting! Arguably, the establishment of a financially successful FxMed practice is a top concern on many of our minds. How do we make our practices grow and thrive without blowing out our HPA axis? This month’s podcast is with Dr. Dan Kalish, CEO and founder of the Kalish Institute. Dan is a world-renown clinician and highly successful businessman who assists many doctors in the transition to a lucrative practice. A podcast full of pearls and ideas, Dan message is: Jump in, the water’s fine. You’ve got this!

Dr. Alschuler is a world-renowned expert in integrative oncology. Lise is well-versed in the current literature and has done a remarkable job in translating findings into actionable steps (listen for her approach to the five key bodily pathways in oncogenesis and how to address them). A teacher to her core, Lise a mentor to many of us, myself included. This is a jam-packed discussion on cancer prevention and management, from the soul-searching demands of a cancer diagnosis to highly practical treatment approaches.

Dr. Seyfried has dedicated his career to changing the way we think about- and therefore treat- cancer. Going back to Otto Warburg and others, couple with newer research Tom and his colleagues are actively conducting, it’s clear that the origin of cancer is in a fundamental disruption of mitochondrial oxidative phosphorylation. Cancer is not, as is commonly thought, a genetic disease. While somatic genetic mutations abound, their origin is from a proliferation of reactive oxygen species generated by damaged mitochondrial cellular respiration. The triggering agents for cancer are anything that disrupts mitochondrial energy metabolism, from chemicals and xrays, to viruses, diet (including GMOs) and lifestyle habits. Switching primary fuel sources from glucose to ketones by using the calorie-restricted ketogenic diet (RKD), we start to shut down the energy supply to cancer cells and reverse the trajectory of the disease.

The Art of Medicine: A Soul-Stirring Chat with Sidney Baker, MD

Science has demonstrated for over a century that fat simply isn’t the macronutrient villain it’s been made out to be. Join me and Dr. Mark Hyman as we spend some time discussing his new NYT best-selling book Eat Fat, Get Thin. We drill down into the research that has been published over the years demonstrating the largely beneficial aspects of most fatty acids.

The oral-systemic disease connection has long been established (recall older recommendations for prophylactic antibiotics before dental work in individuals with endocarditis or joint implants), but with the emerging data on the oral microbiome, new attention is being paid to oral health and the prevention of diseases ranging from cardiovascular to autoimmune and more. A transient bacteremia is the normal course after brushing, but when there is a breakdown in oral health and alterations to the oral microbiome, this transient bacteremia leads to chronic, systemic inflammation, contributing to the course of systemic disease. There is much we can do to support our patients in correcting this inflammation, not the least of which includes a healthy, sugar-free diet; regular cleanings and appropriate brushing techniques. Ideally, the dentist is a part of the functional medicine team. Disordered sleep breathing is a wide-spread, underappreciated problem in children and adults. Once thought to be primarily stress or trauma related, bruxism is now understood to be evidence of disordered breathing (see reference link below). Additionally, a scalloped or fissured tongue (macroglossia) also contribute to disordered sleep breathing.

David S. Ludwig, MD, PhD, is a practicing endocrinologist and researcher at Boston Children’s Hospital, Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. He is Founding Director of the Optimal Weight for Life (OWL) program at Boston Children’s Hospital, one of the oldest and largest family based weight management programs. He also directs the New Balance Foundation Obesity Prevention Center. Described as an “obesity warrior” by Time Magazine, he has been featured in the New York Times, Boston Globe and USA Today and on NPR, ABC, NBC, CBS, CNN and other networks. His new book ALWAYS HUNGRY? published on January 5 is a New York Times bestseller drdavidludwig.com/ www.facebook.com/davidludwigmd/

As a clinician measuring urine, serum and salivary hormone levels in my patients routinely, I’ve always got questions around which testing method is the best. Thus, I was excited to chat with Mark Newman and pick his brain on all things hormone testing. As he says, “I’m an inch wide and a mile deep. I’ve spent pretty much my whole career in measuring reproductive and adrenal hormones.” It’s true. As you’ll hear, Mark is a font of knowledge in this arena. In this interview, Mark covers the various specimen type and their respective utility and limitations, we then dive into a discussion around the unique characteristics of the DUTCH test….In brief, DUTCH is an easy 4 specimen urine test, collected over the course of a day, covering the bases of sex and adrenal hormones, plus metabolites (including 2-Methoxyestrone) and melatonin. It’s reflective of 24-hour output, but diurnal variation is captured as well-- thus great for cortisol.