Dr. Kara Fitzgerald | New Frontiers in Functional Medicine, Longevity, Epigenetics

Have you been wondering what you should really do with the 23andme genetic data that you’ve gathered? Wondering if you should even take the test at all? Or wondering what the future of genetic/epigenetic medicine is? This podcast is for you. I am especially excited to bring you this conversation with epigenetic legend, Dr. Moshe Szyf. The study of epigenetics is continually breaking new ground in understanding how our environment dramatically influences our gene expression. With myriad published research studies and his ongoing work, Dr. Szyf is at the forefront in shaping this evolution. The power of epigenetics to alter the course of our health is compelling, and I hope you will enjoy the discussion we had, which I hope will be one of many.

Thanks to Dr. Susan Blum, functional medicine has even more to offer for patients with rheumatoid arthritis (RA) and osteoarthritis (OA). She shares new insights about RA’s underlying causes, details what goes missed in treatment plans, and gives practical tips for mining data from stool tests, utilizing functional blood markers, and combining herbs and probiotics to reverse processes that other practitioners may think are permanent

Fibromyalgia can be a particularly difficult condition to address conventionally, but Functional Medicine really has a lot to offer here. In this podcast, we mine the wealth of information that Dr. David Brady brings to the table on this important topic, including: · The signs and symptoms of fibromyalgia and how it is diagnosed (previously-defined tender points are no longer used!) – see also Dr. Brady’s questionnaire at www.fibrofix.com · What other mimicking conditions need to be considered or ruled out · How fibromyalgia differs from chronic fatigue syndrome—vastly different disorders that are commonly confused · Why not all pain is driven by inflammation · How not to fall into the trap of only looking at mitochondrial dysfunction · Organic acids, catecholamines, food reactivity and other relevant labs for assessment and tracking · Childhood and adult stress patterns in (especially female-dominated) fibromyalgia, and how that factors into interventions · Additional intervention options such as sleep support, energy pathways, detox, exercise, diet, immune balancing to reset metabolic patterns and promote recovery

Dr. Cabeca is a wealth of information and inspiration when it comes to women’s health. I am delighted to share my conversation with her this month, in which you’ll learn about: - How Dr. Cabeca transitioned from performing multiple surgeries per week, to only needing to recommend a handful per year with a functional medicine approach - The best lab tests and specimens for hormone assessment - The importance of liquid chromatography mass spectrometry for serum free testosterone measures - Factors to be aware of that can confound hormone testing results - Estrogen metabolites and the importance of methylation assessment - The sweet spot of keto-alkaline status for sex hormone balance, cortisol management, mental clarity, insulin sensitivity and weight loss (target pH of 7, and some ketones 3+ days per week) - The benefits of vaginal testosterone and DHEA for tissue repair and incontinence - Watching out for behavior change with testosterone to ensure appropriate dosing and saving marriages! - Addressing vaginal dryness with safe oils and DHEA, diet and lifestyle

Everyone is abuzz with Functional Medicine these days- the IFM Certification process is humming along, and record numbers of clinicians are making the transition to this amazing and satisfying practice. But what about the business of FxMed? Ahhhh! Daunting! Arguably, the establishment of a financially successful FxMed practice is a top concern on many of our minds. How do we make our practices grow and thrive without blowing out our HPA axis? This month’s podcast is with Dr. Dan Kalish, CEO and founder of the Kalish Institute. Dan is a world-renown clinician and highly successful businessman who assists many doctors in the transition to a lucrative practice. A podcast full of pearls and ideas, Dan message is: Jump in, the water’s fine. You’ve got this!

Dr. Alschuler is a world-renowned expert in integrative oncology. Lise is well-versed in the current literature and has done a remarkable job in translating findings into actionable steps (listen for her approach to the five key bodily pathways in oncogenesis and how to address them). A teacher to her core, Lise a mentor to many of us, myself included. This is a jam-packed discussion on cancer prevention and management, from the soul-searching demands of a cancer diagnosis to highly practical treatment approaches.

Dr. Seyfried has dedicated his career to changing the way we think about- and therefore treat- cancer. Going back to Otto Warburg and others, couple with newer research Tom and his colleagues are actively conducting, it’s clear that the origin of cancer is in a fundamental disruption of mitochondrial oxidative phosphorylation. Cancer is not, as is commonly thought, a genetic disease. While somatic genetic mutations abound, their origin is from a proliferation of reactive oxygen species generated by damaged mitochondrial cellular respiration. The triggering agents for cancer are anything that disrupts mitochondrial energy metabolism, from chemicals and xrays, to viruses, diet (including GMOs) and lifestyle habits. Switching primary fuel sources from glucose to ketones by using the calorie-restricted ketogenic diet (RKD), we start to shut down the energy supply to cancer cells and reverse the trajectory of the disease.

The Art of Medicine: A Soul-Stirring Chat with Sidney Baker, MD

Science has demonstrated for over a century that fat simply isn’t the macronutrient villain it’s been made out to be. Join me and Dr. Mark Hyman as we spend some time discussing his new NYT best-selling book Eat Fat, Get Thin. We drill down into the research that has been published over the years demonstrating the largely beneficial aspects of most fatty acids.

The oral-systemic disease connection has long been established (recall older recommendations for prophylactic antibiotics before dental work in individuals with endocarditis or joint implants), but with the emerging data on the oral microbiome, new attention is being paid to oral health and the prevention of diseases ranging from cardiovascular to autoimmune and more. A transient bacteremia is the normal course after brushing, but when there is a breakdown in oral health and alterations to the oral microbiome, this transient bacteremia leads to chronic, systemic inflammation, contributing to the course of systemic disease. There is much we can do to support our patients in correcting this inflammation, not the least of which includes a healthy, sugar-free diet; regular cleanings and appropriate brushing techniques. Ideally, the dentist is a part of the functional medicine team. Disordered sleep breathing is a wide-spread, underappreciated problem in children and adults. Once thought to be primarily stress or trauma related, bruxism is now understood to be evidence of disordered breathing (see reference link below). Additionally, a scalloped or fissured tongue (macroglossia) also contribute to disordered sleep breathing.

David S. Ludwig, MD, PhD, is a practicing endocrinologist and researcher at Boston Children’s Hospital, Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. He is Founding Director of the Optimal Weight for Life (OWL) program at Boston Children’s Hospital, one of the oldest and largest family based weight management programs. He also directs the New Balance Foundation Obesity Prevention Center. Described as an “obesity warrior” by Time Magazine, he has been featured in the New York Times, Boston Globe and USA Today and on NPR, ABC, NBC, CBS, CNN and other networks. His new book ALWAYS HUNGRY? published on January 5 is a New York Times bestseller drdavidludwig.com/ www.facebook.com/davidludwigmd/

As a clinician measuring urine, serum and salivary hormone levels in my patients routinely, I’ve always got questions around which testing method is the best. Thus, I was excited to chat with Mark Newman and pick his brain on all things hormone testing. As he says, “I’m an inch wide and a mile deep. I’ve spent pretty much my whole career in measuring reproductive and adrenal hormones.” It’s true. As you’ll hear, Mark is a font of knowledge in this arena. In this interview, Mark covers the various specimen type and their respective utility and limitations, we then dive into a discussion around the unique characteristics of the DUTCH test….In brief, DUTCH is an easy 4 specimen urine test, collected over the course of a day, covering the bases of sex and adrenal hormones, plus metabolites (including 2-Methoxyestrone) and melatonin. It’s reflective of 24-hour output, but diurnal variation is captured as well-- thus great for cortisol.

JEFFREY S. BLAND, PhD, FACN, CNS, is an internationally recognized leader in the nutritional medicine field. He co-founded of the Institute for Functional Medicine in 1991 and is known to many as the “father of functional medicine.” Over the past 35 years, Dr. Bland has traveled more than six million miles teaching more than 100,000 health care practitioners in the USA, Canada, and 50 other countries about functional medicine.

Imagine: You’re a busy FxMed clinician, working overtime treating, educating and supporting your patients as they transition to a new state of health. It’s exciting, and you’re inspired to be practicing medicine in a way you never thought possible. But (to put it mildly) you’re struggling with time management: FxMed is a lot of work! And then into your life comes an individual just as passionate as you are about functional medicine, who happens to be a trained, certified Functional Medicine Coach! They’ve learned the “ins and outs” of Positive Psychology, so they understand the change process and can guide your patients supportively and effectively. They’re also familiar with the Functional Medicine model, having been taught by many IFM faculty, so they can assist you with educating and “translating” the FxMed processes. Would this individual be a Godsend to your practice? YES! Learn about functional medicine’s newest team member in this podcast with the Founder and CEO of the Functional Medicine Coaching Academy, Dr. Sandy Scheinbaum. This podcast is perfect for clinicians, folks interested in a FxMed Coaching career, and anyone interested in the process of FxMed.

According to Dr. Bob Hedaya, it’s malpractice NOT to use functional medicine when practicing psychiatry. ALL of the nodes on the Functional Medicine Matrix [gastrointestinal, endocrine, immune, toxicity, nutritional status and especially psychological, social and spiritual] influence mental health, mental function and brain function. The bottom line is, a good functional approach yields better health, less medicine. In this case-focused inspiring podcast, hear about Dr. Hedaya’s years of clinical experience in using functional medicine to address tough psychiatric conditions.

From Cell to Soul: A Functional Approach to Women’s Hormone Management with Sara Gottfried, MD. Dr. Sara Gottfried has elegantly distilled her years of clinical experience and thousands of patient contacts into a user-friendly body of knowledge for physician and layperson alike. She’s truly a functional/systems medicine pioneer, combining the best of scientific data with the art (and heart) of medicine. An expert in the area of women's hormones, Dr. Gottfried candidly shares her own personal experience with hormone imbalances. Sara was pivotal on my own journey toward better self-care, as you’ll hear in this podcast.

One of the cornerstone tools of functional medicine is the elimination diet, be it a straightforward gluten/dairy free plan, or an involved, customized removal of many different foods. On top of this, we want our patients to choose clean, organic sources of foods. This dietary prescription is a tall order for many of our patients. Many years ago, Jen Fugo (author of The Savvy Gluten-Free Shopper: How to Eat Healthy Without Breaking the Bank) was prescribed just such a diet. With very limited funds, she figured out how to navigate the myriad pitfalls and change her life. Today, she’s dedicated her career to assisting individuals on therapeutic diets make the transition healthfully, affordably and successfully.

As a former Olympian and current Iron Man triathlete, (he qualified for the world championship in Hawaii this year!) Dr. Keith McCormick was diagnosed with severe osteoporosis at 45 years old. His own healing journey lead him to become a world expert on treating osteoporosis from a functional and integrative perspective. His 2008 book, The Whole Body Approach to Treating Osteoporosis, is useful for patient and clinician alike. This podcast is a goldmine of pearls for clinicians treating individuals with bone loss. Topics covered include underlying pathogenic mechanisms, laboratory evaluations and treatments-pharmaceutical and natural. Health savvy patients will find Dr. McCormick’s content useful.

Just released April, 2015, Natural Cures for Dummies is a superb survey of all things Natural Medicine. In this podcast, Dr. Banks and I cover a ton of content: The book, appropriate diets, including the elimination diet and the perils of gluten, we cover his approach to detox, appropriate supplements, genomics and systems medicine, Functional Medicine and so much more.

The oral microbiome is an important part of the gut microbiome and tending to its balance should a routine part of any good “gut protocol.” Indeed, dysbiosis of the oral microbiome (and a leaky oral mucosa) might be key underlying imbalances in pathogenesis of systemic diseases, including autoimmune (IBD, rheumatoid arthritis, Sjogren) as well as cardiovascular disease. As clinicians, addressing our patient’s oral health may be the missing link in treating many systemic diseases. This podcast is great for clinicians as well as anyone interested in gut health, the oral microbiome, autoimmunity, leaky gut and cardiovascular disease.

Dr. Winston Cardwell’s podcast: best home mold testing, laboratory testing for toxin exposures, best air filtration systems, home cleaning products, “green” building materials, “green” flooring sources and much more!

Chronic pelvic pain (CPP), including interstitial cystitis, chronic UTI, myofascial pain, pelvic floor pain, dyspareunia is a common, underappreciated problem in women. Indeed, one study looking at primary care practices found pelvic pain an issue in almost 40% of all reproductive-aged women. CPP is also identified in men, most commonly caused by prostadynia or prostatitis. What can we do as functional medicine clinicians to assist this population? Turns out, quite a bit. Listen to this very interesting and inspiring conversation I had with Jessica Drummond, MPT, CCN, CHC, founder and CEO of the Integrative Pelvic Health Institute. Jessica has made it her mission to train clinicians and treat women using a functional approach to chronic pelvic pain. As a physical therapist who later trained in nutrition (and is currently working on her PhD), Jessica discusses the multifactorial influences on CPP including: gut/microbiome health, hormone imbalances, nutrient deficiencies, stealth infections, diet, mind/body and toxins and what to do about them for our patients.