Inside Functional Medicine: What Is the Report of Findings?
by Dr. Mitchell Rasmussen, DC, CFMP + Kate Daugherty, MS, CNS
Functional Medicine can mean so many things. To us, it doesn’t mean ‘run fancy labs and sell expensive supplements’. It is a process of HEALTH CORRECTION based on effort, education, and direction. With this series, we’re giving a peek-behind-the-scenes at the dialogue that goes into OUR version of Functional Medicine.
After an Initial Functional Medicine consult, we order patient-specific labs that help to illuminate what’s going on inside to contribute to various symptoms.
The Report of Findings is when we reconvene to review the labs in detail and outline the steps in the direction of wellness. The following is a real case example to show how we interpret results in the context of symptoms, and how we approach healing.
CASE EXAMPLE: This is a 23 year old female who presented with fatigue, various musculoskeletal aches and pains (mild to moderate), headaches, persistent anxiety, and GI complaints including gas/bloating and abdominal pain after eating.
LAB TESTS ORDERED: GI Effects Stool Test, DUTCH Plus Hormone Test, Comprehensive Bioscreen
INITIAL THOUGHTS:
We see a number of immune system challenges. This includes Epstein-Barr Virus, CMV Infections, past Candida issues, past Strep Throat issues, as well as a prior Hashimoto’s Disease diagnosis. This is A LOT of stress on the system.
The gut seems to be one of the key ‘culprits’ in the health picture. This is not new, more than 2000 years ago Hippocrates stated “all disease begins in the gut”. Our GI tract is home to some 100 trillion different organisms, and houses roughly 70% of our immune system. (!!) Additionally, when see an imbalance in gut diversity plus a potential pathogen growing, it tends to deleteriously affect the ecosystem, leading to intestinal permeability (leaky gut).
Once this process occurs, your bloodstream is flooded with components that were never supposed to be there. This then causes the immune system to react to whatever component have spilled out of the gut and into the bloodstream.
We recognize the cycle: Over-worked immune system.. causing food sensitivities and other GI symptoms.. causing breakdown of the lining of the gut.. causing inflammatory immune response.. increasing stress chemistry and other barrier breakdown.. on and on.
This cycle tends to happen ad infinitum until we actually address the causes. WHY? Because the immune system is only doing its job. If the gut continually allows toxins and the like out of the gut and into the bloodstream, the proper immune response is to mount an inflammatory reaction, to “kill” said invader. BUT— if the invader is actually being propagated from within the body, it can cause this response to just continue unchecked.
Let’s take a moment to make some connections.....
With the gut, balance is KEY. We need to “knock back” some of the organisms present in elevated amounts, while simultaneously working to support the growth of the species that support health.
We know you react with gas and bloating to certain foods. This is one possible sign of Small Intestinal Bacterial Overgrowth (SIBO). Other clinical indications of SIBO include elevated Products of Protein Breakdown, elevated Fecal Fats, and detection of higher levels of Methanobrevibacter smithii via the genetic sequencing of the organisms in your gut. All of these are present on your stool test.
Further, we see an overgrowth in your GI tract of a potential pathogen. This pathogen is associated with some of the symptoms and conditions you currently suffer from.
We know that fat malabsorption is associated with fat-soluble vitamin insufficiencies (A, D, E, K). This is the case with you as seen in your bloodwork.
Your complex symptom picture likely means the process of healing is going to take some time. Our job is NOT to go back in time, but to go forth from here with a plan of healing some of your biggest contributing factors.
PLAN OF ACTION:
First, some of your nutrient deficiencies need to be addressed. The nutrients you are lacking in have so many necessary metabolic functions. We need sufficient blood levels in order for our physiology to work efficiently. In the short term, we’ll use a supplementation protocol to quickly correct the issues. ((In the longer term, nutrition will lay the groundwork.))
Second, we need to rebalance your gut. We need to help your immune system bring the ecosystem back into homeostasis, and we need to support food digestion and absorption. I want you to look at health like this: you CAN NOT be healthy without a healthy gut.
Your GI tract is what allows the right nutrients into your bloodstream and keeps out the things that aren’t supposed to be there. Without good gut integrity, AUTOIMMUNE DISEASE is incredibly common; through a process known as ‘molecular mimicry’.
Through some intense lifestyle modification, followed by specific and targeted probiotic supplementation down the line a few months, we will work to bring your gut ecosystem back into balance.
Third, and MOST IMPORTANTLY, we need to teach you and help you perfect exactly what a healthy diet looks like FOR YOU. Dietary choices are primary drivers of our health. It sounds so cliché, BUT it’s true. All of the high-end metabolic testing and supplement protocols would be for naught if we didn’t support a true lifestyle change. It comes from education about what exactly to eat.
Oftentimes, we don’t get the education or understanding or coaching necessary to eat a healthy diet. You could buy a healthy cookbook and make some recipes, but if you don’t change your understanding of nutrition and your relationship to your food, it will likely never work long-term. If we can get you to really understand which foods work for you, and which foods cause or exacerbate certain symptoms (much beyond your gut!!), you will have developed a deep understanding of how to move forward for the next decades; properly fueling your body while also being intimately aware of exactly which foods/drinks don’t “agree” with you.
You will be working one-on-one with our nutritionist. She will work with you on not just what to eat and when to eat it, but how and why to eat. She will teach you how to meal plan and prep, how to be mindful when you consume food, how to respect the direct cause/effect relationship of your diet and your health, and how to fuel your body for success.
The interesting part about this particular process is, we don’t yet know exactly which foods you should probably avoid and those you could probably eat more of. This will be a path of discovery over the first few months. We are right there with you, in real time helping you discern how best to eat for your unique biology to work as well as it could.
Fourth, we will help you with your understanding of the role of the stress response in chronic disease. Stress directly causes or exacerbates every chronic condition we suffer from. Stress hormones are another contributor to leaky gut. Stress hormones elevate levels of certain immune mediators in the blood stream. The stress response, over time, even tends to make our cognition slow and our metabolism dysfunctional. Stress response, over time, tends to wreck us.
We encourage you to work with our mental health therapist, Kristen. She will work with you on real-world strategies to become more mindful with the goal of helping you develop strategies to manage your stress response. Having a therapist on the team gives you an advantage for more complete Brain-Body healing. Particularly as it relates to the gut.
Fifth, we will be promoting health from a physical medicine perspective. “Motion is lotion” and the better we can get you to move, the better your everyday experience can be. An exercise routine, joint mobility, and corrective exercise can all be addressed with the help of Dr. Brittany.
>> This feels like a lot, but we will be with you every step of the way. <<
IN SUMMARY:
This is all about YOU. You will be given so much direction during this process. With the home movement plans, the diet, and the lifestyle and supplement changes, there is A LOT of the work being put directly on you. Luckily, we have an excellent team and are well-equipped and well-versed in working cases very similar to yours.
The support from the team, as well as our experiences having treated numerous cases similar to yours, gives us great excitement at the possibilities for your long-termhealth projection. We believe strongly that if you follow through with the guidance earned through your sessions, you will achieve a level of health that you likely assumed was never again possible for you.
With that being said, our clinical experience with cases similar to yours tells us that this isn’t going to be a walk in the park. There will likely be numerous ‘speed bumps’ along the way. I don’t want you to make any mistake and think this is going to be straightforward.
It’s ok though. You can still be healthy. If you stay diligent, accept guidance whole-heartedly, and just plain work; you can still be incredibly healthy and high-functioning as you age.
>> Health is a VERB, not a NOUN. <<
It is something we are either working toward, or away from. It’s never something we “get” when we achieve a certain level. Sure, we can ‘be healthy’. But HEALTH is a constant striving toward a direction of less chronic suffering and more chronic thriving.
The quickest summary: As we attack your underlying metabolic disturbances with targeted nutraceuticals and pharmaceutical-grade supplements, help you learn how exactly to fuel your body with your diet, and how to maintain a healthy understanding of your stress response, we will also help YOU change YOUR life. That is what this is all about.
ABOUT THE AUTHOR:
Dr. Mitchell Rasmussen, DC, CFMP serves as Director of Functional Medicine at The Facility in Denver, CO. He sees patients in-person and via Telehealth to get to the root cause of dysfunction and restore a state of well-being using nutritional intervention, supplementation, and lifestyle change.
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Want to work with a functional medicine doctor to run labs and assess nutrient status? Struggling with hormone imbalance, IBS, weight gain, mood changes? Let's look at BIOCHEMISTRY. Read more about Functional Medicine at The Facility here.
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