integrative medicineYou must have heard that “we are what we eat”, but are we really just that? Actually “we are what we eat (or drink), breathe, breakdown, digest, absorb (from our gut and skin), and cannot eliminate from our body, whether it’s through our thoughts, skin, breath, urine and stool! Even though we are designed to have built-in detoxification and elimination pathways, they can get overwhelmed with years of toxin exposures which our bodies are now having to handle more so than ever before in our evolution history.
My job as a Functional Medicine physician involves around dealing mainly with chronic ailments. I usually have to be a medical detective trying to help patients who have been through the conventional medical system of diagnosis and treatment of a “disease” and have found no relief.
Below is a quick check list that I keep in my mind of patients who might have signs of an overburdened detox system.
Those with:
1. Multiple Chemical Sensitivities (MCS):These patients react to just about everything- medications, nutritional supplements, foods, odors and chemicals in the environment!
2. Chronic neuropsychiatric conditions: Depression, Anxiety, Seasonal Affective disorders, Mood swings and refractory mood disorders, Chronic recurrent Headaches/ Migraines, ADHD, Learning Disorders, Autism Spectrum Disorders,
3. Neurodegenerative diseases: Parkinson’s disease, ALSAlzheimer’s dementia, some forms of peripheral neuropathies, Multiple
4. Mitochondrial disorders: Chronic Fatigue Syndrome, Fibromyalgia. Neurodegenerative disorders are also due to disturbances in mitochondrial energy production.
5. Immune system imbalance symptoms: frequent and chronic infections, allergies, asthma, eczema and other chronic dermatitis, autoimmune diseases (Hashimoto’s thyroiditis, Grave’s Disease, Rheumatoid Arthritis, Ulcerative Colitis to name a few), multiple food sensitivities, Dysbiosis (imbalance of gut bugs with possible Yeast Overgrowth or Small Intestinal Bacterial Overgrowth).
6. Signs of endocrine disruption: male and female infertility, precocious puberty, PCOS, PMS, fibroids, chronic pelvic pain, endometriosis, adrenal fatigue, hypothyroidism.
7.  Metabolic Conditions: overweight, obesity, hypoglycemia, hyperglycemia, Insulin Resistance, Diabetes Mellitus Type 2.
9.  Cancers
10. Chronic isolated low white cell counts (Leucopenia) or low red cell counts (Anemia) without any known associated cause.
You are probably aware that Functional Medicine practitioners usually take very detailed histories, do detailed examinations, and may do extensive specialized lab (Biomarker) testing. Not every test in the list below usually needs to be done on every patient. Based on clinical evaluation, the need for testing as well as the interventions are very individualized. For example, no two patients with type 2 diabetes or depression will have the same cause for it and thus testing and interventions will vary widely.

While the list below is by no means exhaustive, some general evaluation guidelines are:

1. Detailed history and intake with the help of Medical Symptom Questionnaires, Toxicity and Exposure questionnaires, Environmental and Occupational Exposure Questionnaires.

2.  Detailed Nutritional, Dental and Physical examination.

3.  Conventional Lab tests:  can be done from local labs like Labcorp/ Quest etc

Complete Blood Count looking for low white cell count, anemia, low patelet count.

Complete Metabolic Panel looking at liver enzymes, bilirubin levels, alkaline phosphatase, gamma glutamyl transferase levels.

Kidney Function Tests: Blood urea nitrogen, creatinine, cystatin C

Metabolic testing: Fasting and 2 hour post prandial insulin and blood sugar testing, fructosamine, hemoglobin A1C, detailed lipoprotein profile to assess for LDL and HDL particle numbers and sizes and other markers of inflammation specific to the vascular system

Indices like C-reactive protein, ferritin, fibrinogen to evaluate presence of inflammation.

Detailed thyroid function tests along with evaluation of antibodies against thyroid gland.

Iron absorption and storage assessment

4.  Functional Labs to test for Biomarkers: These can be:

Stool Assessments: to look for growth of disease causing bacteria/yeast in the gut, and also to assess the balance of good vs bad bacteria in the gut; looking for parasites; markers of inflammation of the gut; markers of deficient detoxifications ability in the gut itself (which can lead to recirculation within our body of our own estrogens, cancer promoters and hormone mimickers from the environment, instead of them being eliminated in the stool); assessment of pancreatic enzymes production; looking for markers of healthy absorption vs malabsorption.

Assessment for nutritional deficiencies (of all fat and water soluble vitamins, minerals, essential amino acids, antioxidants {including the master antioxidant, glutathione}, essential fatty acids). Nutritional support is a key factor influencing the proper functioning of the different phases of detoxification as I have mentioned in my previous blog

Serum testing for food sensitivities (IgG), and environmental and food allergies (IgE).

Specialized genetic and antibody testing for Gluten as well as cross-reactive foods antibodies.

Saliva testing for male and female hormones and adrenal health. If you are placed on Bio-identical hormones, you must periodically also get testeded to see how the hormones are metabolized in your body, which can vary widely. If not adequately metabolized and detoxified these can increase the risk of cancer (like breast, prostate and other hormonally related cancers) development.

Testing for neurotransmitter levels, as well as balance/imbalance between the excitatory and inhibitory neurotransmitters. This can be helpful in patients with anxiety, depression, attention problems or chronic sleep issues.

Looking for heavy metal toxic burden on the body, if indicated by a detailed clinical evaluation. One example of this would be if you have silver mercury amalgam(s) in your teeth especially old ones.

Assessment for signs of oxidative stress or damage (similar to rusting of iron that occurs in nature on exposure to oxygen) to the body due to toxins: these tests look for markers of DNA damage, as well as damage to circulating fats (lipids) in the blood. Damage (aka oxidation) to LDL, the bad cholesterol, may lead to coronary artery disease.

If indicated, checking for chronic stealth infections due to bacteria, parasites and viruses which may harm the immune system and other organ systems. These could present as chronic fatigue, muscle and joint pains, autoimmune diseases and many other vague nagging symptoms.

If indicated, evaluating and testing for mold exposure and mycotoxins. You may need to find a physician who has experience in diagnosing and treating mold related illnesses.

Genomics Testing: to assess for genetic variations known as SNPs (Single Nucleotide Polymorphisms) – like the commonly known MTHFR variants among so many others – which may lead to an increased genetic susceptibility towards accumulating toxins  and limit the detoxification capacity of our phase 1 and/or phase 2 liver enzymes.

Most of the above testing can be ordered by any physician, but the interpretation (which really is the key!) can probably only be done accurately by a trained Functional Medicine (FM) Practitioner. I strongly feel that someone with a chronic health issue, should start with a FM doctor as soon as possible, while fully realizing that in some parts of the country and many parts of the world this is not an option. Also, there are some FM practitioners who are not medical doctors and may not be able to order some of these tests. In those cases the tests could be ordered by your regular MD, with results being preferably interpreted by your trained FM Practitioner.

For some general guidelines on how to reduce and manage toxins in your life, you can read my blog..

If you feel that toxicity may be responsible for your chronic health problems, I encourage you to locate an Institute for Functional Medicine Certified Practitioner (IFMCP) in your area and get evaluated.

Good luck in your journey towards optimal emotional, mental and physical health!

October 20th, 2015

Posted In: Blog Post, Functional Medicine

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