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IFM Study > AFMCP - Lec 102 Intro To Functional Medicine > Flashcards

AFMCP - Lec 102 Intro To Functional Medicine Flashcards

1
Q

What is Evidenced Based Medicine(EBM)?

A

EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systemic research.

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2
Q

Good doctors use both _____ and the best available ____ and neither alone is enough.

A

individual clinical expertise, external clinical evidence(research). [Also, patient preference]

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3
Q

What are 3 characteristics EBM uses as sufficient grounds for clinical decision making and stresses the ____?

A
  1. Deemphasizes intuition
  2. Unsystematic clinical experience
  3. Patho-physiologic rationale

Examination of evidence from clinical research

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4
Q

True or False: There is increasing concern that most current published research findings are false.

A

True. It is more likely for a research claim to be false than true.

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5
Q

Moreover, for many scientific fields, claimed research findings may often be ___________________,

A

simply accurate measures of prevailing bias.

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6
Q

In absence of bias, the probability of research finding being true is ___.

A

1.5 per 10,000

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7
Q

What are some conclusions about reversal of medical practice.

A

It is common. Occurs across all practice of medicine. 1/2 of things that doctors commonly do have insufficient evidence.

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8
Q

What is Level III evidence?

A

Expert Opinions

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9
Q

True or False. Physicians should be using current guidelines as the sole source guiding patient care decisions.

A

False. Physicians should be cautious when using guidelines as the sole source guiding patient care decisions. More than 1/2 of current recommendations of the IDSA are based on Level III evidence only.

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10
Q

What is the IDSA?

A

Infectious Disease Society of America

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11
Q

Where does Modern(Conventional) Medicine work best?

A

Acute Care

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12
Q

What are MLS?

A

Modifiable Lifestyle Factors

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13
Q

What does functional medicine start with?

A

Good Medicine.

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14
Q

Which types of care are Conventional Medicine and Functional Medicine good for and why?

A
  1. Conventional is good for acute Care. Functional is not. Conventional is a tech marvel when applied properly and every tool has its highest purpose.
  2. Functional is good for chronic complex conditions. Starts with good medicine. Uses a systems approach that focuses on complex interactions within biological systems, using a holistic approach to biological research. Conventional = big problems with big intervention and so you have to expect big side effects.
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15
Q

What are the problems of applying Conventional Medicine to Complex problems?

A

Episodic care, fragmented care, more tests, more costs.

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16
Q

When do we tend to spend most money on our health?

A

Around end of life

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17
Q

What is the Conventional Medicine answer for Chronic Care?

A
  1. Name it(What is the disease, disorder, syndrome, condition).
  2. Blame it(Is this named thing really a thing? Can it be removed?)
  3. Tame it(Drugs)
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18
Q

Do Medicines cause more harm than good?

A

It can as 4-6 leading cause of death is from APPROPRIATE use of medications.

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19
Q

What is the Functional Medicine answer for Chronic Care?

A

It is a systems biology-based approach that focuses on identifying and addressing the root cause of physiologic dysfunction that contribute to disease. We think and then we link and try to turn off the “faucet”.

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20
Q

What is systems based biology based on?

A

It is based on the understanding that the whole is greater than the sum of its parts.

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21
Q

Is Functional Med better than Conventional Med?

A

No, its just different and for a different purpose.

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22
Q

What is Reductionism?

A

Knowing more and more about less and less until you know everything about nothing.

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23
Q

What is Holism?

A

Knowing less and less about more and more until you know nothing about everything.

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24
Q

How does Functional Medicine approach cause and disease?

A

1)One disease can have many causes. For example, Depression can be from vitamin D deficiency, low omega 3, prediabetes etc. 2)One cause can cause many diseases. For example, chronic inflammation can cause IBD, arthritis, diabetes, etc.

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25
Q

What is old thought on gene expression?

A

DNA transcribes to RNA(mRNA) translates to protein and results in function.

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26
Q

What is new thought on gene expression?

A

Environment (most of the control of expression of genes - even up to 90%). DNA is under methylation control. Epigenetic effects are huge and RNA is also under methylation control. Protein also under methylation control, epigenetic effects and post translational modification. And every step is under more control, feedback and interdependent interaction than previously understood.

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27
Q

What is Biochemical Individuality?

A

Refers to the unique nutritional needs each person has based on their genetics, lifestyle and environmental exposure to various stressors.

28
Q

What percentage of patients do drugs work well for?

A

30-40% +/- 5 sd. They work increasingly less as you fall of the tails of normal distribution. This is well recognized by pharma scientists.

29
Q

What is disease?

A

Disordered function. In old times, people used to think it was actual entity or thing that somehow got into the body and was to cast out.

30
Q

Per lecture in England in 1870 who termed functional medicine, what is the highest justification for all treatment being based on?

A

Based on restoring disordered functions to order.

31
Q

What happens to organ reserve as we age?

A

It decreases.

32
Q

Give an example of inherited epigenetics effects.

A

2 genetically identical mouse mothers. Both fed BPA but fed different diets. One was given supplements to help with methylation and the other was not. The offspring of the one that was not became very obese whereas the one that was given methylation factors was not.

33
Q

What is the triad of life?

A

Genes + Environment + Phenotype = Actionable Results

34
Q

What is a phenotype?

A

The observable traits/characteristics of an individual.(Attributes, conditions, diseases). It is determined by the influence of the environment on the genotype.

35
Q

What did the effectiveness and Safety of a Novel Care Model for mgmt of Type 2 Diabetes Study find at 1 year?

A 
60% of patients reversed diabetes
94% reduced or eliminated their insulin
1.3% average reduction in A1c
30 lbs average weight loss
3+ improved metabolic conditions
36
Q

What did the Accord Study find?

A

10,000 diabetics who did intensive glucose control and they had more deaths and heart attacks then those that didn’t.

37
Q

What did the Navigator Trials find?

A

No benefit to risk factor reduction.

38
Q

Do Drugs fix Diabetes?

A

No. Not a disease but a systemic disorder. Multifactorial etiology. Treat causes or downstream symptoms?

39
Q

Women’s Health Initiative found what in regards to Statins?

A

Statins increase diabetes risk by 48%

40
Q

26,000 healthy people were given statins to prevent heart disease and what happened?

A

87% increase in Type 2 Diabetes.

41
Q

What is meant by whole systems balance in Functional Medicine?

A

Remove what causes imbalance and provide what creates balance.

42
Q

What is the exposome?

A

How internal metabolic factors and environment influences the expression of our genes.

43
Q

What causes 90% chronic disease?

A

Environment-the exposome, not the genome.

44
Q

What is emergence?

A

How genes are translated into our health and disease patterns.

45
Q

What is epigenetics?

A

How our environment shapes our structure and function.

46
Q

What is nutrigenomics?

A

How nutrients and phytochemicals speak to our genes?

47
Q

What is sociogenomics?

A

How social networks influence health and disease.

48
Q

What did Max-Planck-Gesellschaft find in 2017 in regards to Epigenetics?

A

Epigenetics between generations. We inherit more than just genes. We are more than the sum of our genes. Epigenetic mechanisms modulated by environmental cues such as diet, disease or our lifestyle take a major role in regulating the DNA by switching genes on/off. It has been long debated if epigenetic modifications accumulated thru life can cross border of generations and be inherited by children and grandchildren. Now researchers show robust evidence that not only the inherited DNA itself but also the inherited epigenetic instructions
contribute to regulating gene expression in the offspring

49
Q

Functional Medicine: A clinical application of systems biology

A

1) Networks of function and causality
2) New architecture of thinking and evaluation
3) 2 key questions to identify imbalances
4) Environment(primary cause) affects gene expression and basic physiological systems
5) Basic ingredients for optimal function
6) 10 core clinical systems in health and disease

50
Q

What are the 10 core clinical systems?

A 
Assimilation
Structural Integrity
Communication
Transport
Biotransformation and Elimination
Energy
Defense and Repair
Mental
Emotional
Spiritual
51
Q

What are some principles of Functional Medicine?

A

Biochemical individuality(unique gene expression)
Patient centered vs disease centered
Dynamic balance between external and internal factors
Web-like interconnectedness
Health as positive vitality not as absence of disease
Enhancement of organ reserve

52
Q

What are 2 simple questions in regards to causes and function?

A

1) Does this person need to be rid of something(toxic, allergic, infectious, poor diet, stress)?
2) Does this person have some unmet individual need required for optimal function(SNP, epigenetic)?

53
Q

In regards to primary causes of disease, what are some things to look at that a patient needs to get rid of?

A

1) Toxins(biologic, elemental, synthetic)
2) Allergens(food, mold, dust, animal products, pollens, chemicals)
3) Microbes(bacteria, ticks, yeast, parasites, prions)
4) Stress(physical, psychological)
5) Poor diet(SAD)

54
Q

What are some ingredients for optimal function? What do you need to get to thrive?

A

1) Foods(PFCMVP, fiber)
2) Vitamins, minerals, accessory or conditionally essential nutrients, hormones
3) Light, water, air
4) Movement
5) Sleep
6) Rhythm
7) Restoration
8) Love, community, connection
9) Meaning, purpose

55
Q

What 3 things are required to master clinical medicine?

A

Master the story, master the tools and master the therapy.

56
Q

How do you master the story?

A 
Listen to the story
Discover thru dialogue
Be inclusive vs exclusive in the history
Look for patterns that connect
Assess the readiness for change
Tell the story: Re-create meaning
Connect, educate, inspire, motivate
Activate nature - the greatest pharmacy
57
Q

What are unexpected questions to ask when discovering the patient’s story?

A

What life events occurred just before or around the onset of your illness?
When were you last well?(Explore this for clues to ATM)
If you could erase 3 problems with a magic wand, what would they be?(Create a list of problems ranked in important to the patient)
Look at the progression - Timeline
What do you think caused or might be contributing to your illness?(Employ the wisdom of your patients)

58
Q

What are some clues to follow in the story?

A

1) Childhood illnesses, frequent antibiotics, stresses
2) Chemical/environmental sensitivities and history(work, home, childhood)
3) Digestive History
4) Allergy History
5) 7 day dietary history(food additives, gum, sweeteners, fiber, carbs, patterns of eating, stress and eating, eating disorders
6) Dental history(amalgams, root canals, etc)
7) Skin/hair/nails exam and history
8) Medication use(nsaids, etc)
9) Supplement use(vitamins, etc
10) Habits, stress, exercise
11) The nutrition physical exam

59
Q

What is the problem with Diagnostic Medicine?

A

Diagnosis is end of inquiry, not a waypoint in the process of understanding disease. It should be the beginning of asking a new set of questions based on systems theory. First, we can inquire about pathology but we must explore the underlying mechanism leading to the observed pathology or dysfunction. Diagnosis should not be the end, but the beginning of practice.

60
Q

In what ways is Functional Medicine a new way of thinking?

A

Focus on the Map - Matrix
Focus on patterns and connections
Focus on finding the causes that lead to clinical imbalances
Focus on learning how to create balance

61
Q

How would you treat disease “X”?

A

Don’t treat disease, treat the person and their unique relationship to the world by:

1) Taking a comprehensive history and listen carefully to patient’s story. Create a timeline and matrix. Pull out most important ATMs. Look for areas of leverage and be the copy editor to re-author their story to help reignite hope.
2) Do comprehensive physical exam including a nutritional physical exam
3) Look at current diagnosis list and do tests/consults as need to rule in/out. Come to solid diagnosis(The beginning)
4) Use GOTOIT and unless there is a compelling reason to do otherwise, start in the Gut(DIGIN and 5R). Look at other parts of the matrix.

62
Q

What tools can you look at to determine points of leverage for a patient?

A

Timeline, Matrix and ATMs Clarify the most important ATMs. Clarify who patient is. Focus on foundational lifestyle factors for that particular patient.

63
Q

What are antecedents?

A

Family history, intrauterine history, experiences, past illness, occupational exposure, nutrition, lifestyle, congenital, demographic, diet, habitual, environmental, learned, disease induced, drug induced.

64
Q

What are triggers?

A

Microbes, allergens, antigens, radiation, social interactions, memories, diverse sensory stimuli, physical or psychic trauma, stressful event, surgery, infection, toxins, etc.

65
Q

What are mediators?

A

Cytokines, ions, metabolites, prostanoids, nitric oxide, kinins, hormones, neurotransmitters, free radicals, thoughts, beliefs, social reinforcement, classical conditioning, ongoing stress/expsoure to environmental insults, chronic sleep deprivation. These can feed forward towards triggers.

66
Q

What are some properties of food that can influence a patient’s health?

A

Energy/Calories, Macronutrients, Micronutrients, Fiber, Phytonutrients, Plant Genome, Anti-nutrients, Epigenetic Influence, Influence on the Microbiome.

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