The Basics Flashcards
What are the seven Core clinical and balances
Assimilation Defense and Repair Energy Biotransformation and elimination Transport Communication Structural integrity
What are the six principles of functional medicine
Biochemical individuality
Patient centered
Mind body Spirit
Weblike interconnections of internal physiological factors
Health is a positive vitality
Promotion of Organ reserve to enhance the health span not just the lifespan
Dynamic balance of internal and extra no factors
Key differences between conventional and functional medicine
Assessment and treatment first address the patients core clinical imbalances, fundamentals physiological processes, environmental inputs, and genetic predisposition’s, rather than heading straight for the diagnosis
Biochemical individuality is based on
Genomics and proteomics internal uniqueness
Environmental uniqueness external uniqueness
Name the web like interconnections of physiological factors
Gut liver connection Gut liver neuro connection Neuro endocrine Immuno cardiology Psycho somatic
Conventional versus functional
Differential dx vs etiology +causative patterns and connections
Eliminating confounding variable vs include all variable
Naming blaming vs new lens cognitive organization
Confirmation lab + imaging vs testing cause and mechanisms
Sym suppression vs removing causes and restoring normal function
Key differences between conventional and functional
Mapping system for patients story
CC HPI antecedents triggers mediators PMH ROS FH Diet Med + supplements Social, lifestyle, exercise Physical exam findings Lab Diagnosis by organ system disease Diagnosis and exploration of fundamental clinical imbalances
What is evidence-based clinical practice
And approach to decision-making in which the clinician uses the best evidence available in consultation with the patient to decide upon the option which suits the patient best
Antecedents
Genetic or acquired factors that predispose the individual to an illness or pattern
Triggers
Factors that provoke the symptoms and signs of illness
Mediators
Factors biochemical or psychological that contribute to pathological changes and dysfunctional responses
Three legs of the stool
Retelling the patient story with ATMs
Organizing the clinical imbalances
Personalizing lifestyle factors
What is go to it
I FM operating system
Go to it what is G
Gather yourself to create an environment of insight
How do you create an environment of insight
Intentionality a desire for healing without a specific outcome
Centering a ritual of uniqueness or preparation to separate one patient from another
Pre-sensing the art of being and creating presence through body language, voice tone, attitudes, beliefs, emotional state
What is the o in go to it
The subjective and objective details from the patients story within the functional medicine paradigm. Positioning the patient is presenting symptoms and signs, along with the details of the case history on the timeline and the functional medicine matrix
Nutrition and hydration issues of assimilation
Low hydrochloric acid Insufficient pancreatic enzymes Vitamin and mineral deficiencies Reduced probiotics In adequate fiber
Nutrition and hydration issues of defense and repair
Inflammatory diet Increased saturated fat Excessive animal products Phytochemicals bioflavonoids Vitamin D status
Nutrition and hydration factors in biochemical and illumination
Detox phytochemicals Anti-oxidants Uncontaminated food Adequate hydration Appropriate protein
Nutrition and hydration in energy
Vitamin B status
Antioxidant levels
Lipoic acid
EFA balance
Attrition and hydration in transport
Adequate hydration
Mineral balance
Nutrition and hydration in communication
Blood sugar balance Meal Timing and stress Curciferous vegetables EFA balance Phyto estrogen
Nutrition and hydration in structural integrity
Essential fatty acids deficiency
Increased transfatty acids
Electrolyte imbalance
List the steps in order
Acknowledge the patients goals
Address modifiable lifestyle factors
Sydney bakers too much not enough model what are the insufficiencies excesses
Identify clinical and balances or disruptions in the organizing systems of the matrix
Steps of initiate
Perform further assessment
Referral to adjunct care: nutritional professional, lifestyle educator, healthcare provider, specialist
Initiate therapy
Steps effective behavioral coaching
Tweak the environment
Build habits
Community support
Describe track in the go to it
Note the effectiveness of therapeutic approach and identify clinical outcomes at each visit in a partnership with the patient
List the spiral of change
Precontemplation Contemplation Preparation Action Maintenance Termination
Four steps of assessing a patient’s stage of self change
I have taken action on my problem within the last six months- 1 action Maintence
I solve my problem more than six months ago 2 Maintence
I am intending to take action in the next month 3 preparation
I am intending to take action in the next six months 4 contemplative
Aspects of the pre-contemplative stage
Lack of intention to change behavior
denial of problem
Aspects of the contemplation stage
Searching for absolute certainty Waiting for magic moment Wishful thinking Premature action Chronic contemplators substitute thinking for action I feel so stuck
Aspects of preparation stage
Commitment to action Setting a date of action Publicly announcing the intended change A plan of action with strategies and dates I am ready
Aspects of the action phase
Most of overtly modify their behavior and their surroundings they stop the behavior and they confront their fears. In short they make the move which they have been preparing
Aspects of the maintenance phase
Change never ends with the action stage
Developing an active and intelligent maintenance program is critical
This stage can last from six months to a lifetime
Aspects of termination stage
When the addiction or temptation longer exists people exit the cycle of change
Some problems require a lifetime of maintenance and never terminate
Mindfulness
Greater sensitivity to one’s environment
Openness to new information
New categories for structuring perception
Multiple perspectives toward problem-solving
Aspects of meditation
Increased BDNF
Stimulates the pre-frontal cortex
Facilitates neurogenesis
Effects of meditation
Changes the brainwave activity in the frontal cortex limbic system and hypothalamus among other areas
Increased parasympathetic activity and increase in heart rate variability
Changes in neurotransmitter levels including increase serotonin beta-endorphin melatonin acetylcholine and decreased norepinephrine and cortisol
Increase in gamma waves synchrony long-term meditators during meditation
Increases and cortical thickness and gray matter volume and right hippocampal volume and long-term meditators
Shallow versus deep breathing
Sympathetic stress response includes rapid shallow breathing to increase oxygen supply to the heart brain and large muscles
This can cause a decrease in CO2 and induce anxiety and panic
Deep belly diaphragmatic breathing slow and has a calming effect through stimulation of the Vegas nerve which runs through the diaphragm
As blood flow is greatest at lung bases deep breathing increases oxygenation without decreasing CO2 And cannot cause panic
How do you create
Express empathy
Develop discrepancy
Roll with resistance
Support self efficacy
Principles of motivational interviewing
Express empathy experience the world from the clients perspective without judgment or criticism
Develop discrepancy dissonance
motivation is a function of the discrepancy between the patients present behavior and central values
no discrepancy no motivation for change
Roll with the resistance diffuses resistance rather than amplify it as does direct or confrontational interventions
Support self efficacy develop belief in success patient as expert in his or her change
What is emergence
How genes are translated into our health and disease patterns
What is exposome
How internal metabolic factors and environmental influences on our gene expression
What is epi-genetics
How are environment shapes our structure and function
What is Nutrigenomics
How nutrients and phytochemicals speak to our genes
What is sociogenomics
How social networks influence health and disease
G O T O I T
Gather one's self and information Organize on timeline and matrix Tell the patients story Order of your priorities Initiate assessment and care Track progress
A
B
C
D
Anthropometrics
Biomarkers and functional labs POMFAB
Clinical indicators from nutrition and physical exam
Diet and lifestyle assessment
Examples of antecedents
Family history genetic predisposition, trauma, toxicity, intrauterine history, sexual abuse, intestinal permeability, infection, dietary insufficiencies, drug use
Example of triggers
Physical or psychic trauma, microbes, toxins, memories, stressful events, surgery, infection,
What are the therapeutic interventions
Consider chronicity and severity
Reduce triggers or Triggering events
Food first approach elimitation diet or low glycemic load food plan
Assess an address optimal function of organs of elimination
Apply specific medical functional foods vitamins antioxidants veterans to support nutritional balance reduce inflammation and increased vitality
Consider personalized maintenance plan
Asking a patient a question like how can I help you today or what impact have your symptoms personally had on your life and what aspect of the patient interview
A determining the triggers or precipitating events in the patient’s history
B properly placing the patient’s symptoms in the functional medicine matrix
C establishing a collaborative relationship with the patient
D organizing and analyzing the patients story on the timeline
C but check
In functional medicine the three legs of the stool the first to
A diet lifestyle and exercise
B timeline matrix go to it
C mental emotional spiritual
D aTMs lifestyle factors clinical imbalances
D ATMs lifestyle factors clinical and balances
In functional medicine
A The cause of every medical condition can be narrowed down to a single dysfunction information
B no medical condition can be narrowed down to a single dysfunction
C multiple factors can underlie a single condition and multiple conditions can be caused by a single dysfunctional process
D it is not possible to determine the cause of most medical condition
C multiple factors underlying a single condition and multiple conditions can cause a single dysfunctional process
Go to it refers to
A gather organize tell order initiate track
B gather order talk organize intervene track
C gather order tell organize interview track
D gather organize track order initiate tell
A gather organize tell order initiate track
A 36-year-old female at 23 weeks just station to your office or the new onset of anxiety. She shared with you that she cannot stop replaying her last birthing experience in her mind. One of your recommendations is that she start working imagery because it
A is a useful psychological diversion which can decrease anxiety
B is the language of the right brain and can facilitate insight into her anxiety
C activates brain function ways that are different from actual experience and will therefore help protect her from negative impacts of her previous birthing experience
D activates the optic nerve and this will help her to see the emotional root cause of her anxiety
B The language of the right brain can facilitate insight into her anxiety
The seven nodes or clinical and balances are
A digestion, defense and repair, musculoskeletal, energy, communication, transport, bio transformation and elimination
B ingestion, skin, musculoskeletal, energy, transmitters, transport, biotransformation and elimination
C A FMCP, hormone, G.I., energy, immunity, cardiovascular, detox
D assimilation, defense and repair, structural integrity, energy, communication, transport, biotransformation and elimination
D assimilation defense and repair structural integrity energy communication transport biotransformation and elimination
In which of the functional medicine go to it clinical flow process does the patient understand that they are in a partnership and their health story is heard and understood A tell B gather C organize D initiate
A tell
The readiness to change model includes the steps
A pre-contemplative, preparation, action, maintenance
B searching awareness decision and commitment
C denial anger bargaining acceptance
D suffering decision commitment relapse
A pre-contemplative preparation action maintenance
What are the first step dietary interventions
A elimination and cardio metric food plans
B detox and mito food plans
C cardio metric and detox food plans
D fodmap and elimination food plans
C cardio metric and detox
Newer research has shown an illumination diet to be effective in what condition A eosinophilic esophagitis B premenstrual dysphoric disorder C irritable bowel D tension headache
A
List the causes of digested insufficiencies
Inactivation of pepsin by hypo or achlorydria PPIs or h. Pylori autoimmune disease etc
Improper mixing (gastric surgery, gastroparesis , neuro endocrine imbalance
Pancreatic insufficiency (output issue)
Inactivation of lipase by low pH ( zollinger - Ellison syn)
Gall bladder dysfunction
Rapid transit causing malabsorption ( hyperthyroidism )
List the root cause c of digestive insufficiency
Hypochlorhydria Pancreatic insufficiency Bile acid dysfunction Dysmotility Mucosal disease
Went to suspect digestive dysfunction
Bloating belching following a meal Flatulence after eating A sense of fullness after eating Chronic intestinal infections Undigested food in the stool Iron deficiency Unintentional weight loss Chronic diarrhea or steatorrhea Distention Decreased absorption of nutrients Edema Bleeding tendency vitamin K deficiency Growth failure and children
List the causes of digestive insufficiency
Malabsorption loss of a healthy small intestine surface area
Mal digestion
Causes of digestive insufficiencies- malabsorption
Loss of help the small intestine surface area which can occur in
Small bowel disease celiac sprue Crohn’s disease
Short bowel syndrome surgical or functional
Lack of brush border enzymes disaccharidase deficiency
Bacterial overgrowth causes injury to villi
General biochemical indicators of malabsorption
Low or low normal blood glucose Low serum calcium Low serum phosphate High serum alkaline phosphatase Low serum albumin Low or slightly low total serum protein Low serum potassium Low hemoglobin
Maldigestion equals incomplete processing the food what are the five causes of
Insufficient hydrochloric acid
Insufficient intestinal brush border enzymes
Decreased CCK stimulation of the pancreas
Insufficient pancreatic enzyme
Insufficient bile acids
List the mechanisms of maldigestion - four
Conjugated bile acid deficiency
Pancreatic insufficiency
Reduced mucosal digestion
Intraluminal consumption of nutrients
Common consequences of hypochlorhydria
Small intestinal bacterial overgrowth causing carbohydrate intolerance and immediate bloating Dysbiosis Chronic candida infection Mineral deficiencies B12 deficiency
List the functions of protease enzyme
Digestion of protein to usable amino acids Prevention of food poisoning Increased blood circulation Support immune Reduce inflammation May help to alleviate food allergy reactions Reduce Side effects of cancer treatment Breakdown immune complex
What causes enzyme deficiency
Toxicity Stress Nutritional insufficiency Imbalanced pH Inhibitors in food Free radical oxidation
List the three IFM food reaction definitions
Food allergy IgE mediated type one hypersensitivity
Food sensitivities IgG mediated type 3delayed hypersitivity
Food intolerance non-immunological reaction to food like lactose intolerance
List the gut conditions associated with depressed secretory IgA
Dysbiosis SIBO Chronic stress Crohn's disease Celiac disease Autoimmune disease
How to increase secret S IgA levels in the gut
Breast-feeding Purified whey protein S bouardii Vitamin a Glutamine Medium chain triglycerides Arabinogalactans
List some of the factors involved in a clinical approach to healing the gut
Nutrients important for G.I. repair: glutamine, arginine, vitamin a, D, C, zinc
Mucosal lining support eg phosphatidylcholi
Mucosal secretion protectants such as phosphatidylcholine , whey immunoglobulin
Support for GALT function eg lactoferrin, lactoperoxidase, whey immunoglobulin
Antioxidants know to function in the GI eg catechins
Micronutrients shown to support healing eg pantothenic acid, vitamin e, carotenoids
Nutritional antiinflammatory eg curcumin, EPA, DHA
Healing the gut Essentials
Adequate essential fats (2-10 g/ day)
Adequate glutamine 10-30 g day
Adequate magnesium (250-500 mg mag amino acid chelate ) as needed
Adequate zinc (10-25 mg) as needed
Adequate probiotics 25+ billion bacteria a day to help regulate intestinal biofilm
Polyphenols what is their specific antioxidant affect
Nuclear factor kappa B
Inducible nitric oxide syntheses expression
Cox inhibition
Select the correct statement about calprotectin and lactoferrin
A they are both fecal markers used to determine damage to the intestinal mucosa caused by foods
B they are both vitamin metabolites measured in the serum
C they are both bacterial metabolites measuring immune surveillance
D both used to differentiate inflammatory disease from functional bowel disorder-correct answer
Key nutrients phytonutrients known for improving intestinal permeability include
A glycine vitamin E grapefruit seed extract
B vitamin C garlic n acetylcysteine
C glutamine n acetyl glucosamine zinc
D glutathione iodine berberine
C glutamine n acetyl glucosamine zinc
Which of the following would support the production of short chain fatty acids
A beta glucuronidase
B UPD glucuronosyltransferase
C soluble fiber correct answer
D Sulfotransferase
It is likely that three factors are required for autoimmune disease to manifest those factors are
A A trigger, a mediator like gluten, and gastrointestinal this dysbiosis
B and antecedent zonulin dysfunction and increased intestinal permeability
C The trigger, genetic predisposition, and increased intestinal permeability
D an event and mediator and genetic propensity
C
The IFM mnemonic for DIGIN stands for
Digestion Intestinal permeability Gut microbiota Inflammation Nervous system
A 21-year-old male college student with celiac complains of arthritis, depression, and malaise. He has been compliant with diet for two years, but is suspicious that he may have been eating food is contaminated with gluten nonetheless. The following lab test would confirm your suspicions
A immunoglobulin G (IgG) to gliadin
Elemental diet have been particularly useful in A asthma eczema B inflammatory bowel disease C ms and diabetes D lupus and scleroderma
A asthma and eczema ( what I choose)
What are two primary mechanisms that relate diet to systemic inflammation
A free radical production and nutritional insufficiences
B oxidative stress and glycemic load
C balance of fatty acids and carbs derived from grains
D amount of trans and medium chain fatty acids
B oxidative stress and glycemic load is what I put
List the six ways various nutrients and phytonutrients found in foods can help to mediate the complex process of inflammation
Oxidative stress
Eicosanoids ie prostaglandins thromboxanes, leukotrienes etc
Tumor necrosis factor alpha (TNF alpha ) and other cytokines
Inducible nitric oxide synthase (iNOS)
Peroxisome proliferator activated receptors (PPARS)
Nuclear factor kappa B (NF-kB)
What are the three dietary mechanisms of inflammation
Glycemic load
Oxidative stress
Types and balance of fatty acids
An advantage certain phytonutrients have over pharmaceuticals is that they can
A weakly inhibit NFkB
B inhibit cyclooxygenase prostaglandin PG -E2
C strongly inhibit lipoxygenase leukotrienes LTB4
D activate PPAR
D
PPAR is a response modulator focus on r for modulating the response
NFkB bad
46 year old female with fmh colon cancer and asthma brings in 2-OH :16 a -OH estrone test . The ratio is depressed . You counsel her that she has an increased risk for A osteoporosis B uterine fibroids C autoimmune disease D breast cancer
D breast cancer
Select the correct statement regarding transdermal estrogen therapy
A estradiol is not recommended as a transdermal agent because it’s levels are difficult to test for in serum
B testing estradiol levels prior to starting transdermal therapy is not recommended because the levels are always fluctuating
C transdermal preparations of estradiol are safer than oral
D estrone should be given transdermally in the smallest dose to achieve the best clinical effect
C transdermal estrogens bypass the hepatic first pass metabolism effect which can convert estrogens into more harmful metabolites
Inhibition of the enzyme 17/20 lyase results in A increased estradiol B decreased testosterone production C decreased progesterone production D increased DHEA
B decreased testosterone
17/20 lyase converts 17-OH progesterone and 17 OH pregnenolone into the androgen DHEA and androstenedione
Adminstration of conjugated equine estrogen has been shown to
A decrease inflammation only when given without synthetic progestin
B increase inflammatory markers regardless if given with or with out a synthetic progestin
C have no effect on inflammation
D have a protective effect on mental function but not cardiovascular function
B
CEE generally increases plasma CRP and interleukin IL 6 levels
Which of the following would you expect to be related to a finding of decreased levels of sex hormone binding globulin in the case of a woman with symptoms of estrogen dominance A lower levels of dopamine B lower levels of IGF -1 C higher levels of insulin D high levels of ferritin
C
There is a significant inverse association between levels of SHBG and fasting serum insulin in both genders
Progesterone A increases the effect of DHEA B increases the effect of estrogen C decreases the effect of estrogen D decreases the effect of testosterone
C decreased effect of estrogen
How do you tell overweight from obese
Scale and BMI
How do you tell over FAT
BIA
How do you tell over VAT
Waist circumference and waist / hip ratio
Decreased levels of adiponectin are an indication of A decreased risk of met syn B increased risk of met syn C improving insulin sensitivity D dysfunctional HDL
Adiponectin is antiinflammatory and insulin sensitizing low levels increase risk of met syn
Which of the follow correlate with a high prevalence of CHD in elderly men A low SHBG B low free T C low total T D low DHEA
Free T correlated with DHEA free is bioavailability plays a role in inflammation and insulin resistance low shbg means higher T low DHEA is means could have low t ??
Which of the following is indicative of insulin resistance A xanthomas B carotid bruit C acanthosis nigricans D diagonal ear lobe crease
C
Xanthomas are lipids
Bruits atherosclerosis
Diagonal ear lobe sudden cardiac death
