Clinical Implementation of Functional Nutrition and ... · Clinical Implementation of Functional...

Clinical Implementation of Functional

Nutrition and Lifestyle Change

Kristi Hughes, NDApplying Functional Medicine in Clinical Practice

London

March 2017

©2017 The Institute for Functional Medicine

FUNCTIONAL MEDICINE addresses the underlying causes of disease, using a

systems-oriented approach and engaging both patient

and practitioner in a therapeutic partnership.

Nutrition Inadequacy as

“Cause”

Systems Biology & FM

Matrix

Coaching Therapeutic

Partnership


O TG

Gather Oneself & Information

Organise on Matrix

Tell the Patient’s Story

Order of your Priorities

Initiate Assessment and Care

Track Progress

O I T


Functional Nutrition Operating System


Collaborative Care TeamDelivering Impactful Lifestyle and

Nutrition Coaching


The Collaborative Care Team

Collaborative Care Team

Primary Care

Physician

Functional &

Integrative Provider

Physicians Assistants &

Nurse Practitioners

Nursing & Mental Health

Nutrition Professional

Physical Medicine

and Fitness

Health & Wellness

Coach


Biotransformation & Elimination(e.g., Toxicity, Detoxification)

Energy (e.g., Energy Regulation,

Mitochondrial Function)

Communication (e.g., Endocrine, Neurotransmitters,

Immune messengers)

Defense & Repair(e.g., Immune, Inflammation,

Infection/Microbiota)

Structural Integrity(e.g., from Subcellular Membranes

to Musculoskeletal Structure)

Assimilation(e.g., Digestion, Absorption,

Microbiota/GI, Respiration)

Antecedents(Predisposing Factors-

Genetic/Environmental)

Triggering Events(Activators)

Personalizing Lifestyle Factors

Nutrition & Hydration

Physiology and Function: Organizing the Patient’s Clinical Imbalances

Mediators/Perpetuators (Contributors)

Spiritual

e.g., meaning & purpose,

relationship with something

greater

e.g., cognitive

function,

perceptual patterns

e.g., emotional

regulation, grief,

sadness, anger,

etc.

Sleep & Relaxation

Name:____________________________ Date:___________ CC:_____________________________________© Copyright 2011 Institute for Functional Medicine

Stress & Resilience

Transport(e.g., Cardiovascular, Lymphatic System)

Retelling the Patient’s Story

Relationships & Networks

Modifiable Lifestyle Factors


7 Clinical

Systems

Timeline ATMs

Individual

Predispositions

Lifestyle

Factors


PartnerHOW DO WE


Getting Healthy is a

Team Sport


“Perhaps the most basic

skill of the physician is

the ability to have

comfort with uncertainty;

to recognise with

humility the uncertainty

inherent in all situations;

to be open to the ever-

present possibility of the

surprising, the

mysterious and even

the holy; and to meet

people there.”~Rachel Naomi Remen


Role ModelHOW DO WE


✓ Physicians who exercise are more

likely to counsel patients to exercise.

✓ Those that do aerobic training,

counsel on aerobic training, and

those that do strength training

counsel on strength training.

✓ The main barriers to counseling on

exercise were:

– inadequate time

– lack of knowledge/experience with

exercise counseling

Abramson S, Stein J, Schaufele M, Frates E, Rogan S. Personal exercise habits and counseling practices

of primary care physicians: a national survey. Clinical Journal of Sports Medicine. 2000;10(1):40-8.

Yes. Provider Behavior Matters!


Goal SettingHOW TO FACILITATE


Dean Ornish, MD 2010

Illness-Wellness Continuum


Self-Care Questionnaire



Self-care Assessment?



Setting Goals for Wellness

The Functional Medicine

Timeline and Matrix;A Tool Designed to Support the Medical History Intake

Process and Facilitate a Coaching Conversation

Information Connection


Pre

con

cep

tio

n

Current Concerns

Antecedents

Triggers or Triggering Events

Signs, Symptoms or Diseases Reported

Pre

nat

al

Birth

FUNCTIONAL

MEDICINE TIMELINE

Mediators/Perpetuators

Name: ______________________________ Date: __________________ CC: _____________ @2014 Institute for Functional Medicine

Gas & Bloating,

Frequent non-bloody

stools, “sensitive

stomach”,Feeling of incomplete

voiding, low energy,

depressed mood.

44

Fam Hx of IBS, Diverticulitis

Abdominal

Pain• Missed

school

• GI eval, no

scopes

Dx as lactose

intolerance partial

improvement.

10

Vag Birth prolongedAB

X dtmembrane

rupture

Solid foods at 6 months

Bottle fed @ 4wks

Colic @ 6

weeks

Tonsillectomy @4yo

3-5 bouts of OM treated with ABX

3 4

Vag

DeliveryVag

Delivery

Weight gain

in college

History of Depression

“Post partum

depression” after

each; no treatment

Weight has

continued to “creep

up” over the years

27 29

Parents

divorced

Mother Remarried

7 9

Married

25

What is the Role of

the Nutrition

Professional and the

FM Timeline?

• Understand and Identify

• Food History

• Challenging issues

• Relationship to

Food(s)

• Coach to Success


The Nutrition and Lifestyle Coaching

Purpose


Biotransformation & Elimination(e.g., Toxicity, Detoxification)

Energy (e.g., Energy Regulation,

Mitochondrial Function)

Communication (e.g., Endocrine, Neurotransmitters,

Immune messengers)

Defense & Repair(e.g., Immune, Inflammation,

Infection/Microbiota)

Structural Integrity(e.g., from Subcellular Membranes

to Musculoskeletal Structure)

Assimilation(e.g., Digestion, Absorption,

Microbiota/GI, Respiration)

Antecedents(Predisposing Factors-

Genetic/Environmental)

Triggering Events(Activators)




Mediators/Perpetuators (Contributors)

Spiritual

e.g., meaning & purpose,

relationship with something

greater

e.g., cognitive

function,

perceptual patterns

e.g., emotional

regulation, grief,

sadness, anger,

etc.

Sleep & Relaxation


Stress & Resilience Relationships & Networks

Transport(e.g., Cardiovascular, Lymphatic System)


What is the Role of

the Nutrition


FM Matrix ?

• Educate

• Inspire

• Motivate



Biotransformation & Elimination

Energy

Communication

Defense & Repair

Structural Integrity

AssimilationAntecedents

Triggering Events




Mediators/Perpetuators Spiritual

Sleep & Relaxation


Transport

Stress & Resilience


Mother SAD

Fm Hx IBS, Diverticulitis

Bottle @ 4 wk; Solid food @6mo

Hx OM Rx ABX

Tonsillectomy @ 4yo

Parents divorced @7

Abdominal pain @10

Lactose Intolerant

Sensitive to tomato

2 kids @27&29 wt post part dep.

Divorced at 34yo (two teen boys)

SAD

Weight gain in college

Poor quality and

quantity; has to be

up to get the kids

ready

NONE; “no time” SAD; quick meals due

to being busy

Eats out often

Kids are a “handful”

Job is stressful as bank

exec asst.

Not dating and rarely has

time to socialize

• Depression

• Stress (adrenal reserve)

• Gas and Bloating

• Freq stools• SAD (inflammatory diet)

Stressful job

Family Dynamic?• Fatigue

• History of Depression

What is the Role of

the Nutrition


FM Matrix ?

• Educate

• Inspire

• Motivate




Energy

Communication

Defense & Repair



Triggering Events





Sleep & Relaxation


Transport

Stress & Resilience


Poor quality and

quantity; has to be

up to get the kids

ready

NONE; “no time” SAD; quick meals due

to being busy

Eats out often

Kids are a “handful”

Job is stressful as bank

exec asst.

Not dating and rarely has

time to socialize

Stressful job

Family Dynamic?

Stress and Food

Choices


Your Functional Medicine Prescription

Nutrition Professional and

Health Coaches MUST

Integrate the Physician’s FM

and Lifestyle Prescription with

Patient’s Goals


Your Functional Medicine

Lifestyle Prescription (Sleep, Exercise, Movement, and Restoration)



Energy

Communication

Defense & Repair



Triggering Events

The Patient’s Story Retold

Personalized Lifestyle Factors




Sleep & Relaxation


Transport

Stress & Resilience



Supplements/Medications

Prescription


IFM Toolkit Items and Sleep Resources

• Sleep History Questionnaire

• Sleep Apnoea Questionnaire

• Suggestions for Better Sleep

• Patient Handouts

– Health Benefits of Napping

– Mindfulness for Insomnia and Sleep Disorders

– Resources for Wearable Devices and Tracking Tools

• Resources and Referrals - Sleep


IFM Toolkit Items and Fitness Resources

• Exercise Goals and Tracking

Journal

• Exercise History Questionnaire

• Exercise Prescription

• Functional Medicine

Prescription and Lifestyle Plan

• Resources and Referrals –

Exercise and Fitness


Exercise = Medicine


x

5 days a week 2 days a week after work out 2-3 days a week

Moderate low Moderate low

30 minutes 30 minutes 5-10 minutes 20-30 minutes

walking hand weights stretching exercise ball

x

7.5-8.5 hours/night, dark room, no media, with air filter as white noise source.

x



Energy

Communication

Defense & Repair



Triggering Events

The Patient’s Story Retold

Personalized Lifestyle Factors




Sleep & Relaxation


Transport

Stress & Resilience

Family History:• Depression• Hypothyroidism• Diabetes II

Mother’s pregnancy: SAD and smoker

Major life stressors:• Single mother• Divorce• Job• IsolationExtra weight

Chronic antibiotics

3 Children born between 25-29

Mother dying from BrCA.

Divorce

Major Job change

In the past but

too tired now

Poor sleep hygiene,

reads in bed, falls

asleep but then

wakes frequently,

takes naps; un-

refreshed.

Diverse diet but she

does have

significant carb

cravings (candy

etc.)

Divorce

Single mother

Job change

Lives alone

No hobbies

Uses Facebook

casually to stay in

touch with children

Carb Cravings

Hurried eating

Long Hx. of IBS

Chronic ABX use early in

life

Bottle Fed

Possible exposure to toxins as a

nurse/instructor

Sensitive to scents/perfume

Depressed Mood

NSAIDs for HA

Fluoxitine for Depression

Acne

Severe fatigue

Un-refreshing sleep

Depressed Mood

Hashimoto’s?

Adiposity=inflammatio

n

IBS symptoms

3 children in short order

NSAIDs=Increased IP

Hypertension

Visceral Adiposity

Divorce

Single mother

Job change

Hypothyroidism

Post? Menopause

Hx. of Dysmenorrhea

Acne Hyperlipidemia

Hypertriglyceridemia

Hypothyroidism

Post? Menopause

Hx. of Dysmenorrhea

Acne

Insulin Resistance

Exercise History, PARQ, Exercise Rx Webinar


IFM Toolkit Items and Activity Resources

• Daily Activity Questionnaire


– The Power of Movement:

Living an Active Lifestyle

– Tips to Incorporate Mindful

Movement Every Day

• Resources and Referrals –

Active Living


Daily Activity Questionnaire


• Restoration Prescription

• Practicing Gratitude with the IFM

Gratitude Journal


– Breathing Techniques to Soothe the Soul

– Meditation: How to Get Started

– Strategies for Tranforming Stress

– ...and more

• Resources and Referrals – Mindfulness

and Restoration

IFM Toolkit Items and Restore Resources


Initiate - Resources & Referrals


The Collaborative Care Team


The Patient Needs to be Self-

aware and Self-driven to Make

Lasting Change


The Collaborative Care Team; Who

Is on Your Team Right Now?

Collaborative Care Team

Primary Care Physician

Functional & Integrative

Provider

Physicians Assistants &

Nurse Practitioners

Nursing & Mental Health

Nutrition Professional

Physical Medicine and

Fitness

Health & Wellness

Coach


Focus on

Implementing

Functional Nutrition in

Clinical Practice


Gathering

PFC-MVP Status

ABCD Evaluation

Food Nutrition History

Anthropometrics and Vital Signs

Biomarkers and Functional Labs

Clinical Indicators from The

Nutrition Physical Exam

Diet and Lifestyle Review

Functional Nutrition

Assessment ABCD Report

JNC8 updates

pending soon-come

back to the toolkit for

updated documents

Nutrition Assessments

PFC-MVP

Biomarkers

Gather

OrganiseThe ABCDs of Nutrition

Evaluation

Organising FN Findings into PFC-MVP

Functional Nutrition Biomarkers

AFMCP Nutrition Toolkit

Penlight

Pair of Latex Free Gloves

1 PTC Bitterstrip

2 Sterile tongue Depressors

1 Monofilament

1 Smell Card (smoke)

2 Ziplock Baggies, smell card in a

Baggie, then all in a ziplock Baggie

ContextHistory-Timeline

Network Influences

Company Symptoms, Other Signs

Current Biochemical Markers

QualityDiet, Food, Nutrient

QuantityDiet, Food, Nutrient

http://nsight.functionalmedicine.org

Image Library

REVIEW the Diet, Nutrition, &

Lifestyle Journal to observe current dietary

patterns, food choices and

influential lifestyle factors


PFC-MVP

Biomarkers

Gather

Organise

Re-Tell

Order/Prioritise

The ABCDs of Nutrition

Evaluation

PFC-MVP

Biomarkers


PFC-MVP

Biomarkers

Gather

Organise

Re-Tell

Order/Prioritise

Initiate

Functional

Nutrition

Therapeutic

Interventions


Evaluation

Diet and Nutrition-oriented

Therapeutic Interventions


Prescription and Lifestyle Plan

“A therapeutic

intervention is fitting the

treatment to the

individual. In that sense

it is like tailoring …

measuring and trying it

on until you get a good

fit…. You don’t always

get it the first time.”

Sid Baker, MD

Nutrition Rx


PFC-MVP

Biomarkers

Gather

Organise

Re-Tell

Order/Prioritise

Initiate

Functional

Nutrition

Therapeutic

Interventions


Evaluation


Functional Nutrition

Fundamentals

Food Is…

Food is Energy.

Macronutrients and Micronutrients.

Assimilation and Cellular Fuel.

Macronutrients

Food Is…

Food is information.

We are not our genes.

We are the expression of our genes.

Phytonutrient Spectrum Patient Education Resources

Food Is…

Food is connection.

We are who our friends are.

We are what our friends eat.

Food Is…

Food is medicine.

“Let food be your medicine and medicine

be your food.”

- Hippocrates


EXPLORING

THE IFM FOOD PLANS

Considerations for Personalizing

the Food Plans

• Choose Food List Based on Features

• Provide Tailored Food List

– Consider Macronutrient Percentages

– Targeted Calories when Appropriate

– Provide Serving Allowances

– Remove Triggering Foods

• Discuss Therapeutic Foods

• Provide Practical Tools such as Weekly Menu

Plan, Recipes, and Shopping List

Foundational Food Plans &

First-Step Dietary Interventions

Advanced

Therapeutic

Interventions

AFMCP

APMs

IFM Certification

Programme

Functional Nutrition Food Plans

Medical HistoryABCDs of Nutrition

Evaluation

Anthropometrics

Biomarkers and Labs

Clinical Indications from NPE


Matrix Review

Chief Complaints

Conditions

Timeline and ATMs

Medication Review

Choosing a Food

Plan:

Getting Started

Core Food Plan Cardiometabolic Elimination Diet

Chief Complaint and

Medical History

Weight Gain / Weight loss

Fatigue

Elevated Blood Sugar

Increased Blood Pressure

Increased Waist Line

Fatigue

GI sxs-bloating,

indigestion

Joint pain

Muscle aches

Immune dysregulation

Fatigue

Conditions

Non-specific Obesity

Metabolic Syndrome

Type 2 Diabetes

Essential Hypertension

Dyslipidaemia

Gastrointestinal • Irritable Bowel Syndrome

• Intestinal Permeability

Immune/Inflammation• Auto-immune Diseases

• Asthma

• Atopy &Skin Inflammation

• Myalgias and Arthralgias

Mood Disorders• Depression

Foundational and First Step

Intervention Considerations

Functional Nutrition Patterns


Food Nutrition History

Seeking healthy diet, all ages,

athletic, pregnancy, overweight,

overweight, underweight.

Metabolic syndrome, Type 2

diabetes, hypertension,

dyslipidaemia, obesity

Allergies, atopy, asthma, GI distress,

pain and fatigue, AI diseases.

Timeline

Seeking healthy diet, all ages,

athletic, pregnancy, overweight,

overweight, underweight.

Metabolic syndrome, Type 2

diabetes, hypertension,

dyslipidaemia, obesity

Allergies, atopy, asthma, GI distress,

pain and fatigue, AI diseases.

Anthropometrics

Non-specific, low BMI, increased

BMI, gynoid obesity, possible

imbalances.

Incr: BMI, WC, WHR, fat, blood

pressureIncreased BMI, increased ECW/ICW

Biomarkers & Labs

Normal screening values, mild

changes – MCV, alb:glob ratio,

possible macro/micronutrient

deficiencies

Incr: HgbA1C, FBS, insulin, hs-CRP,

Trigs

Decr: HDL

Incr. IgG or IgE food reactions,

celiac, autoantibodies, dysbiosis.

Clinical Indicators from

Nutrition Physical ExamNon-specific

Incr: WC and WHR

Skin tags, acanthosis nigricans,

peripheral neuropathy.

Dry skin, thin eyebrows, fluid

retention, and skin inflammation.

Diet and Lifestyle

Inadequate nutrients, prepackaged

and processed foods, fast food, high-

sodium foods, grab-and-go (take-

out) foods, imbalanced diet,

disordered eating, poor food hygiene

Excess simple sugar

High CHO intake, GI foods, low

protein, excess alcohol, elevated

trans fats.

Food triggers, allergy exposures.

Excess reliance on one food.

Functional Nutrition StatusRisk for nutrient deficiency,

imbalanced macro/micronutrients

Functional Medicine Patterns


Medical History Seeking Healthy Diet, All Ages,

Athletic, Pregnancy, Overweight,

Overweight, Underweight.

Metabolic Syndrome, Type 2

Diabetes, Hypertension,

Dyslipidaemia, Obesity

Allergies, Atopy, Asthma, GI

Distress, Pain and Fatigue, AI

Diseases.

ATMs

(Antecedents, Triggers, and

Mediators)

Family History, T2DM, CVD, HTN,

Obesity, Sedentary Lifestyle, Sleep

Disorder (inadequate sleep and

Sleep apnoea)

Antibiotics, Multiple infections,

Trauma, Stress, Familial allergies,

Mother with Group B strep, Acid

Blocking Medication, Maternal use of

PPI during pregnancy

Matrix Patterns Non-specific Structural Integrity

Transport

Defend and Repair/Communication

Assimilation

Biotransformation

Communication / Defence and

Repair

Considerations for Personalizing

the Food Plans

• Choose Food List Based on Features

• Provide Tailored Food List

– Consider Macronutrient Percentages

– Targeted Calories when Appropriate

– Provide Serving Allowances

– Remove Triggering Foods

• Discuss Therapeutic Foods

• Provide Practical Tools such as Weekly Menu

Plan, Recipes, and Shopping List

Caloric Targets, Macronutrient

Ration, Serving Sizes, and

Personalised Food Plans

Proteins

Fats

Macronutrient Distributions

for the IFM Food Plans

Macronutrient Ratio

Vegan

Core

Cardio ReNewVegetarian Core Core Mito/Keto

The IFM Food

Plan Suites

• Ideal Patient Population

• Food Plan Features

• Food Plan List

• Comprehensive Guide

• Menu and Recipes

• Suite Resources

The Core Food Plan



Evaluation

Anthropometrics

Biomarkers and Labs



Matrix Review

Chief Complaints

Conditions

Timeline and ATMs

Medication Review

Choosing a

Food Plan


Inflammatory elementsInconsistent behavioursImbalanced fatsHigh Glycaemic Impact

Standard American Diet

• Healthy foods

• Phytonutrient dense

• Balanced dietary choices

Core Food Plan

Taking the First Steps towards

improved health of our patients!

Transition Diet

Profile for when to use the Core

Food Plan

Gather/GOTOIT Core Food Plan

Chief Complaint and

Medical History

Weight Gain / Weight loss

Fatigue

Conditions Non-specific

Medical History Seeking Healthy Diet, All

Ages, Athletic, Pregnancy,

Overweight, Underweight

ATMs

Anthropometrics Non-specific

Biomarkers & Labs Normal screening values



Non-specific

Diet and Lifestyle Inadequate nutrients

Prepared food

Matrix Patterns Non-specific


Who is the Core Food Plan suitable for?

Everyone.


Who is the Core Food Plan suitable for?

All Ages


x

x

Commonly provided with either a 25/30/45 or

30/30/40 caloric guidance based on patient’s

metabolic stability

x

Taken from The Practitioners Guide to Personalising the IFM Food Plans

Macronutrient Distribution for 25P/30F/45C

Approach

TO SAVE PRACTITIONERS TIME

IFM Created Food Plans Lists with

Serving Allowances Already Filled In

Modifications for

Dietary Preferences and NeedsCommon Dietary Preferences • Vegetarian

• Vegan• Pescatarian

Common Exclusions for Allergies or Sensitivities

• Gluten (or wheat)• Grains• Dairy products• Eggs• Nuts• Shellfish

Other Lifestyle Factors and Health Goals to Consider

• Weight loss• Weight gain• Enhanced athletic performance• Pregnancy and/or breastfeeding• Targeted health outcomes (controlling blood pressure,

blood sugars, lipids.)

The Core Food Plan:

Veggie and Vegan Options

Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500

Calorie Guidelines for

Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 5 5-6 6-7 7-8 8-9

Legumes 1 1 1-2 3 3

Dairy/Alternatives 0-2 2 2-3 2-3 3

Nuts & Seeds 2 2 2-3 3-5 5-6

Fats & Oils 2 2-3 3-4 4-5 5

Vegetables, non-

starchy

7 7-8 8-10 10 10-11

Vegetables, starchy 1 1 1 1-2 2-3

Fruit 2 2 2 2-3 3

Grains 1 1-2 2 2 2-3

Core Food Plan(25P/30F/45C)

x Vegetarian and Vegan

options with and without

soy

X


Core Food Plan Modifications

Vegetarian and Vegan

Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500


Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 4-5 5-6 6-7 7-8 8-9

Legumes 1 1 1-3 3 3

Dairy/Alternatives 1-2 2 2 2-3 3

Nuts & Seeds 2 2 2-3 3-5 5-6

Fats & Oils 2 2-3 3-4 4-5 5

Vegetables, non-

starchy

5-7 7-8 8-10 10 10-11


Fruit 2 2 2 2-3 3

Grains 1 1-2 2 2 2-3


Lacto-Ovo Vegetarian (25P/30F/45C)

Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500


Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 5 5 5-7 7-8 8-9

Legumes 1 1-2 2-3 3 3

Dairy/Alternatives 1 1 1-2 2-3 3

Nuts & Seeds 1-2 2-2.5 2,5-3 3 3-4

Fats & Oils 1-2 2 2-3 3-4 4

Vegetables, non-

starchy

7 7-8 8-9 9-11 11

Vegetables, starchy 0-1 1 1 1-2 2-3

Fruit 2 2 2 2-3 3

Grains 1 1-2 2 2 2-3


Vegan with Soy (25P/30F/45C)

Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500


Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 2-3 3-4 3-4 4 4

Legumes 2-3 3 3 5-6 6

Dairy/Alternatives 1 1-2 1-2 2-3 3-4

Nuts & Seeds 3 3 3-4 4-5 5-6

Fats & Oils 3-4 4-5 5-6 6-7 7

Vegetables, non-

starchy

5 5-7 7-9 7-9 10-11


Fruit 1-2 2 2 2-3 3

Grains 1 1 1-2 2 2-3


Vegan without Soy (20P/30F/50C)


Supporting Behaviour Change

and Overcoming Obstacles

“If you do what you’ve always done,

you’ll get what you always got.” – Mark Twain

You Are in This Together:

Patient-Practitioner RelationshipLLNESS ELLNESS


Standard

American / UK

Diet

Transition to the

Core Food PlanTherapeutic

Interventions

Maintain Health with

the Core Food Plan

Credit Dean Ornish-2010


Common Obstacles: Cost


Common Obstacles: Time

Common Obstacles:

Reading Food Labels

Common Obstacles:

Portions and Serving Sizes


Common Obstacles: Understanding

FatNot all fats are created equal.


Common Obstacles:

Cutting Out Sweetened Drinks

Why is this important?

Because sweetened beverages:

• dehydrate the body

• increase caloric intake

• increase stress hormones

• elevate blood sugar

• cause damage to cells


Alternatives to Sweetened Drinks

• Mineral water flavoured with fresh

herbs or fruit

• Water mixed with fruit slices or 1

ounce of juice

• Unsweetened herbal teas

• Kombucha*

*note: choose brands containing no added sugar


Common Obstacles:

Increasing Water Intake

Body weight (pounds) ÷ 2 = Daily

water intake (ounces)

Example: Amy weighs 128 pounds.

Amy’s recommended daily water

intake is 64 ounces (128 ÷ 2 = 64).

Plan

Preparation

Portion

Pleasure

Benefits of the Core Food Plan:

Improved Relationship with Food


Improved Relationships with Others


Investment in Health

The Cardiometabolic

Food Plan

What is the Cardio Food Plan?

The Cardio Food Plan prescribed by a Functional Medicine

practitioner is appropriate for use as a long-term lifestyle plan.

This plan is designed for individuals with:

✓ Risk factors for cardiovascular disease (CVD)

✓ Risk factors for dysfunctional metabolic conditions

such as metabolic syndrome, type 2 diabetes (T2D),

or both

✓ CVD (e.g., high blood pressure, high cholesterol,

and elevated blood fats)

✓ Metabolic syndrome (e.g., high blood sugar, increased

belly fat)

✓ T2D

Profile for

when to use

Gather/GOTOIT Cardiometabolic Food Plan

Chief Complaint and

Medical History

Elevated Blood Sugar, Increased Blood

Pressure, Increased Waist Line, Fatigue

Conditions Obesity, Metabolic Syndrome, Type 2

Diabetes, Essential Hypertension,

Dyslipidaemia

Medical History Metabolic Syndrome, Type 2 Diabetes,

Hypertension, Dyslipidaemia, Obesity

ATMs Family History, T2DM, CVD, HTN, Obesity,

Sedentary Lifestyle, Sleep Disorder (inadequate

sleep and Sleep apnoea)

Anthropometrics Inc..: BMI, WC, WHR, Fat, Blood Pressure

Biomarkers & Labs Inc..: HgbA1C, FBS, insulin, hs-CRP, Trigs

Decr.: HDL



Inc..: WC and WHR

Skin tags, acanthosis nigricans, peripheral

neuropathy.

Diet and Lifestyle Excess simple sugar, high CHO intake, GI

foods, low protein, excess alcohol, elevated

trans fats.

Matrix Patterns Structural Integrity

Transport

Defend and Repair/Communication

Arteriosclerosis Thromb Vasc Biol. 2012 September; 32(9): 2052–

2059.

Fatty

Liver

Obesity

Type 3

Diabetes

Cardiovascular

Disease

Immune

Dysfunction

Endothelial

Dysfunction

Beta-cell

Dysfunction

Lipotoxicity

Osteoporosis

Modified Mediterranean Approach

Mediterranean Diet

• The most well-studied dietary approach

• Over 3800 articles on PubMed (as of 8/17/15)

• Over 1400 articles for its connection to

cardiovascular disease (as of 8/17/15)

Low Glycaemic Impact

Targeted Calories

Balances Blood Sugar

High in Fibre

Low in Simple Sugars

Balanced Quality Fats

Condition-Specific Phytonutrients

Cardio

Proteins

Fats


x

Usually Rx with a 30/30/40 Macronutrient Distribution

Could consider a mild ketogenic distribution if

reduced grains are a desire

x

Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500


Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 7 7-9 9-10 10-12 12-13

Legumes 1 1 1-2 2-3 3


Nuts & Seeds 2 2 2-3 3-4 4

Fats & Oils 2-3 3-4 4 4 4-6

Vegetables, non-

starchy

5 5-7 7-8 8-10 10-13

Vegetables, starchy 0-1 1 1 1 1-2

Fruit 1-2 2 2 2 2

Grains 1 1 1-2 2 2

Cardiometabolic Food Plan(30P/30F/40C)


x

Usually Rx with a 30/30/40 Macronutrient Distribution

Could consider a mild ketogenic distribution if

reduced grains are a desire.

x

Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500


Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 7 7-9 9-10 10-12 12-13

Legumes 1 1 1-2 2-3 3


Nuts & Seeds 2 2 2-3 3-4 4

Fats & Oils 2-3 3-4 4 4 4-6

Vegetables, non-

starchy

5 5-7 7-8 8-10 10-13

Vegetables, starchy 0-1 1 1 1 1-2

Fruit 1-2 2 2 2 2

Grains 1 1 1-2 2 2

Cardiometabolic Food Plan(30P/30F/40C)

TO SAVE PRACTITIONERS

TIMEIFM Created Food Plans Lists with

Serving Allowances Already Filled In

THE CARDIOMETABOLIC

FOOD PLANS

with Caloric Targets

The Elimination Diet

What is the Elimination Diet?

The Elimination Diet prescribed by a Functional Medicine

practitioner is a therapeutic, short-term approach followed for a

specific amount of time, often used as a first step in:

✓ Ridding the body of the most common foods

that cause inflammation

✓ Identifying food allergies, sensitivities,

intolerances, and triggers

✓ Eliminating foods with potentially addictive

and harmful components

Identifies Food Triggers

Reduces Inflammation

Supports Healthy Microbiome

Dairy-Free, Gluten-Free

Phytonutrients to Heal the Gut

Reduces Toxic Burden

No Calorie Restriction

Promotes Body Awareness to Foods

Profile for

when to use

Gather/GOTOIT Elimination Diet

Chief Complaint and

Medical History

GI sxs-bloating, indigestion, Joint pain, Muscle aches

Immune dysregulation, Fatigue

Conditions

Gastrointestinal

• Irritable Bowel Syndrome

• Intestinal Permeability

Immune/Inflammation

• Auto-immune Diseases

• Asthma

• Atopy &Skin Inflammation

• Myalgias and Arthralgias

Mood Disorders

• Depression

Medical History Allergies, Atopy, Asthma, GI Distress, Pain and Fatigue,

AI Diseases.

ATMs Antibiotics, Multiple infections, Trauma, Stress, Familial

allergies, Mother with Group B strep, Acid Blocking

Medication, Maternal use of PPI during pregnancy

Anthropometrics Increased BMI, Increased ECW/ICW

Biomarkers & Labs Inc.. IgG or IgE food reactions, Celiac, Autoantibodies,

Dysbiosis.



Dry Skin, thin eyebrows, Fluid retention, and skin

inflammation.

Diet and Lifestyle Food Triggers, Allergy Exposures. Excess reliance on

one food.

Matrix Patterns Assimilation

Biotransformation

Communication/Defence and Repair


x

Usually Rx without Caloric Guidance

Be mindful using with patients with blood sugar

concerns


The next step…

Reintroduction of foods


Food Reintroduction


Advanced

Therapeutic Foods




Evaluation

Anthropometrics

Biomarkers and Labs



Matrix Review

Chief Complaints

Conditions

Timeline and ATMs

Medication Review

Choosing a Food

Plan:

Getting Started Vegan

Veggie

Mito

ReNew

Detox


The Detox Food Plan


What is the Detox Food Plan?

The Detox Food Plan prescribed by a Functional Medicine

practitioner is a therapeutic, clinically-directed metabolic

detoxification protocol. The goals of this approach are to:

✓ Facilitate the pathways involved in the

processing and excretion of toxins

✓ Improve symptoms of pain and fatigue

✓ Enhance cognitive function and moods

✓ Improve sleep quality

✓ Optimise the metabolic detoxification

experience and lower the toxic burden


The Mito Food Plan


What is the Mito Food Plan?The Mito Food Plan prescribed by a Functional Medicine

practitioner is a therapeutic approach to managing blood sugar

levels and reducing inflammation in order to support healthy

mitochondrial function. This plan:

✓ Provides therapeutic foods that improve energy production

✓ Protects against oxidative stress

✓ Supports the body in the production

of energy

✓ Restores a sense of vitality, and helps the body use

food to support a graceful and healthy aging

process

✓ Helps reduce fatigue, pain, and cognitive problems

while supporting muscle mass and burning excess

fat

✓ Provides a framework for preventing or slowing the

progression of neurological disease


Clinical Conditions:

Mitochondrial Pathologies

• Myopathy

• Fatigue

• Diabetes

• Multiple Chemical

Sensitivities

• Fibromyalgia

• Cancer

• Parkinson’s Disease

• ALS

• Epilepsy

• Migraine

• Skeletal muscle weakness


The ReNew Food

Plan


The ReNew Food Plan is a nutritional pathway to

health for those who have autoimmune, gastrointestinal, neurological,

and other chronic health conditions.

This plan is designed as a “whole systems reboot” to set an

individual on a renewed path to wellness.


What is the ReNew Food Plan?

The ReNew Food Plan prescribed by a Functional Medicine

practitioner is a therapeutic, short-term approach followed for a

specific amount of time, often used as a first step in:

✓ Ridding the body of the most common foods

that cause inflammation

✓ Identify food allergies, sensitivities,

intolerances, and triggers

✓ Eliminate foods with potentially addictive

and harmful components

✓ Providing nutritional support for the

body’s detoxification systems


Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500


Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 6-8 8-10 10-14 14-16 16-18

Legumes 0 0 0 0 0

Dairy/Alternatives 1 1 1 1-2 2-3

Nuts & Seeds 3-4 4 4-6 6-8 8

Fats & Oils 3-4 4-5 5-6 6-7 7-8

Vegetables, non-

starchy

10 10 10 10-12 12

Vegetables, starchy 0 0 0 0 0

Fruit 1 1-2 2-2.5 2.5-3 3-4

Grains 0 0 0 0 0

ReNew Food Plan(30P/45F/25C)


Bibliography: 10 pages of

citations supporting the

ReNew approach

Caloric Targets, Macronutrient

Ratios, Serving Sizes, and

Personalised Food Plans

25P/30F/45C Distribution (primarily associated with Core Food Plan)

Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500


Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 4-5 5-6 6-7 7-8 8-9

Legumes 1 1 1-3 3 3

Dairy/Alternatives 1-2 2 2 2-3 3

Nuts & Seeds 2 2 2-3 3-5 5-6

Fats & Oils 2 2-3 3-4 4-5 5

Vegetables, non-starchy 5-7 7-8 8-10 10 10-11


Fruit 2 2 2 2-3 3

Grains 1 1-2 2 2 2-3


Lacto-Ovo Vegetarian (25P/30F/45C)

Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500


Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 5 5 5-7 7-8 8-9

Legumes 1 1-2 2-3 3 3

Dairy/Alternatives 1 1 1-2 2-3 3

Nuts & Seeds 1-2 2-2.5 2,5-3 3 3-4

Fats & Oils 1-2 2 2-3 3-4 4

Vegetables, non-starchy 7 7-8 8-9 9-11 11

Vegetables, starchy 0-1 1 1 1-2 2-3

Fruit 2 2 2 2-3 3

Grains 1 1-2 2 2 2-3


Vegan with Soy (25P/30F/45C)

Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500


Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 2-3 3-4 3-4 4 4

Legumes 2-3 3 3 5-6 6

Dairy/Alternatives 1 1-2 1-2 2-3 3-4

Nuts & Seeds 3 3 3-4 4-5 5-6

Fats & Oils 3-4 4-5 5-6 6-7 7

Vegetables, non-starchy 5 5-7 7-9 7-9 10-11


Fruit 1-2 2 2 2-3 3

Grains 1 1 1-2 2 2-3


Vegan without Soy (20P/30F/50C)

30P/30F/40C Distribution (primarily associated with Cardiometabolic Food

Plan)

Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500


Females

Reduced Mildly

Reduced

Standard Active


Males

Reduced Mildly

Reduced

Standard Active

Proteins 6-8 8-10 10-14 14-16 16-18

Legumes 0 0 0 0 0

Dairy/Alternatives 1 1 1 1-2 2-3

Nuts & Seeds 3-4 4 4-6 6-8 8

Fats & Oils 3-4 4-5 5-6 6-7 7-8

Vegetables, non-starchy 10 10 10 10-12 12

Vegetables, starchy 0 0 0 0 0

Fruit 1 1-2 2-2.5 2.5-3 3-4

Grains 0 0 0 0 0

30P/45F/25C Distribution(primarily associated with ReNew Food Plan)

20P/60F/20C Distribution(primarily associated with Mito Food Plan)

Food Plan

Facilitation

Get together with your group:

• Which of the IFM Food Plans could you

implement within your patient base?

• What challenges or resistance could you

imagine with your patients if you

recommend these Food Plans?


O TG

Gather Oneself & Information

Organise on Matrix

Tell the Patient’s Story

Order of your Priorities

Initiate Assessment and Care

Track Progress

O I T

Clinical Implementation of Functional Nutrition and ... · Clinical Implementation of Functional...

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