About Functional Medicine

Most importantly, Functional Medicine helps incorporate lifestyle changes into your life to restore health, balance, and vitality. These include dietary changes, exercise, proper sleep hygiene, meditation, and other lifestyle adjustments. Based on the patterns of data shown in lab results, nutritional supplements are also prescribed to support this change.

The goal of Functional Medicine is for you to improve your quality of life so that you can better fulfill your life’s mission and enjoy life.

While most people feel better within the first few weeks, the larger healing journey can take anywhere from 6 months to 2 years, depending on the complexity of your condition and how long you’ve had it.

Our goal is for you to feel healthy without an over-reliance on medications and supplements (some may be necessary), and instead utilize a good clean diet and lifestyle to maintain your optimum health.

After you complete your program, we suggest that you check in 1-2 times per year to help keep you on track, and do a periodic Organic Acids Test to make sure your body’s systems are functioning properly.

A program of treatment in Functional Medicine usually proceeds in the following manner: Initial Visit You’ll first fill out a detailed Intake Form that we’ll review together at the first visit, via telemedicine or telephone. We will also ask more specific questions about your health history to help connect the dots of your health puzzle. During the visit you’ll receive dietary and lifestyle recommendations, and, based on your particular situation, possibly supplements. At the end of the session we’ll order 1-3 labs that will be shipped directly to you. Functional Medicine Labs These lab tests can be performed at home and usually involve the collection of saliva, urine, or stool samples that are appropriately packaged and shipped via UPS or FEDEX. The results take 2-4 weeks to arrive, during which time you should usually be experiencing positive changes from the lifestyle adjustments you’ve already been implementing. Follow-up Visits With the arrival of lab results, we will schedule time to discuss your labs, lifestyle changes, and nutritional supplements. We’ll send you a summary of the recommendations that we discussed, a supplement protocol that outlines your course of treatment for the next 6 to 12 months, and a supplement prescription from our online dispensary. We will also schedule periodic Follow-up Visits (usually every month of two) to discuss progress on health issues, lifestyle changes, and supplements.

We usually use three types of Functional Medicine labs in our approach, depending on the complexity of the patient. These include labs that test adrenal stress hormones, GI (gastrointestinal) function, and organic acids (tests for liver detoxification pathways, brain and neurotransmitter health, inflammation, oxidative damage, methylation, and energy production).

Unlike other styles of Functional Medicine, we focus on minimizing the number of labs needed to identify health issues and establish a baseline for assessing improvement. Out of hundreds of available lab tests, patients usually end up doing 1-3 labs, depending on the complexity of their condition.

We also seek to minimize the number of supplements that need to be taken at one time. While we aggressively go after pathogens and patterns of imbalance, we use a slower gentler approach to tonify and coax our body’s systems back into gear and healthy levels of function. Generally speaking with regards to supplement intake in Functional Medicine, we try not to prescribe more than 10 capsules being taken at one time.

The time to complete a program in Functional Medicine usually takes 6-12 months, depending of course on the individual patient’s condition, and their willingness and ability to stick with the program.

Of the hundreds of Functional Medicine labs available, we keep things simple by using a few key labs really well. You will likely only need to do 1 to 3 lab tests for your treatment program. This efficiency is one of the most appealing aspects of the Kalish Method, as it reduces the time and expense that it takes for your body heal and rebalance. There are 3 basic types of labs that we use: Hormonal Stress Markers, Digestive Stool Analysis, and Organic Acid Tests.

Adrenal stress labs assess the amount of stress your body has endured over the decades by measuring your daily fluctuations in cortisol (the stress hormone) and DHEA levels to assess the overall health of your HPA Axis (hypothalamus, pituitary, and adrenals).

If your HPA Axis is not balanced, it often throws off the rest of your endocrine system, so resetting the HPA Axis is usually one of the first things that we do. When it gets reset, you should feel more energy and the rest of your hormonal system should start to fall back into place.

An imbalanced HPA Axis often results in adrenal insufficiency, in which case you could be experiencing some of the following symptoms:

• Fatigue

• Loss of endurance

• Digestive problems

• Slow metabolism

• Weight gain

• Food cravings

• Blood sugar issues

• Brain fog

• Insomnia

• Hair loss (female)

• Loss of libido

We use three labs we for assessing the HPA Axis:

Adrenocortex Stress Profile (Genova Diagnostics - $195)  is the least expensive and uses saliva collected in vials over the course of the day to measure daily fluctuations in cortisol and DHEA.

DUTCH Complete (Precision Analytics - $345) uses urine collected on filter paper over the course of a day and then air-dried. It also measures levels of progesterone, the 3 estrogens, testosterone, melatonin, and their breakdown products.

Rhythm Plus  (Genova Diagnostics - $495), a saliva test that not only captures the levels of stress hormones over the course of a day, but also captures the levels and fluctuations of estrogen, and progesterone over the course of a month which is very helpful for assessing and treating various menstrual conditions. Hormonal imbalances such as unopposed estrogen, high follicular progesterone, anovulation and luteal phase defects are easily identified. This hormone test is especially useful in treatment of patients with chronic menstrual disorders.

Click here for a patient case study that utilizes an adrenal stress test.

These tests cover a variety of factors that influence digestive and overall  gastrointestinal health. The gut lining is one of the first things to go when exposed to chronic stress, as the body cannibalizes it as an easy source of amino acids. This lowers gut immunity and leads to the buildup of pathogenic bacteria in the gut, which in turn further compromises gut integrity. Eventually the intestines become permeable, and this allows for small pieces of protein to be absorbed into the bloodstream. This raises inflammation levels throughout the body and causes a variety of autoimmune reactions and unpleasant symptoms, including headaches, fatigue, depression, muscle pains, and achy joints. GI Effects Comprehensive Stool Profile (Genova Diagnostics - $415, + H.Pylori add-on $30), This is the stool test of choice for optimizing gut health. Since 80% of our immune system lies in the gut, this test provides insights that help guide dietary and clinical interventions to optimize immune health. It measures markers related to digestion and absorption, gut immune health, inflammation, the microbiome, and identifies possible parasites and bacterial pathogens. H. pylori add-on (+$30) Helicobacter pylori is an opportunistic pathogen that often shows up in times of stress, can cause a variety of unrelated symptoms (besides ulcers), is easily treatable, and we often recommend getting checked for it.

Over the course of a night, our urine collects over 1,000 unique organic acids that result from chemical reactions happening throughout our body. When we compare levels of these organic acids to those seen in healthy populations, we can identify unhealthy patterns of data manifesting from an unbalanced biochemical physiology.

Organix Comprehensive Profile (Genova Diagnostics - $395) This test picks 46 of these organic acids from a sample of frozen urine to assess a wide range of body systems, providing us with a detailed overview of our health status. These include markers related to:

• Neurotransmitter metabolites and brain health

• Mitochondrial energy production

• Liver Phase I & Phase II detoxification capacity

• Oxidative damage and antioxidant need

• Methylation sufficiency

• Vitamin and mineral status

• Amino acid insufficiencies such as Carnitine and N-Acetyl-Cysteine

• Lipoic acid and CoQ10 status

• Bacterial and yeast overgrowth

It’s an ideal test for patients who may suffer from:

• Weight issues

• Sleep abnormalities

• Depression

• Chemical sensitivities

This is a complex test that offers lots of insight into how well your body’s systems are functioning. Researchers are still discovering new ways of interpreting the data it provides. If you were to do one test a year to track how your body’s systems are doing, this would be the one, as we can compare it to previous years to see how our physiology is trending.

Most importantly, the patterns identified in the Organix Comprehensive offer a clear roadmap of dietary, lifestyle, and supplement protocols that will lead you back to balance and health.

There is a wide range of Functional Medicine practitioners. For some it evolved from their Naturopathic Medicine training. Others, including MDs, DOs, NPs, DCs, and LAcs, have done anywhere from a weekend course to the very well known IFM (Institute Functional Medicine) certification program (six 3-day weekend classes plus written case studies). I went with the Kalish Institute of Functional Medicine because it focuses on:

* Clinical application vs medical theory,

* Patient based case study vs research study based learning,

* Specific clinically based product recommendations and treatment protocols vs. research based study and application of supplements,

* Live weekly case-based online grand rounds with a teacher vs. large conference settings for 6 extended weekends.

 

Another thing I liked about the Kalish program is that it really focuses on a few key functional medical labs out of the hundreds that are available. By learning how to use these few labs really well, it's easier to get a clearer, deeper clinical impression of the patient vs. getting overwhelmed with too much information from the wide variety of labs that are out there.

These labs include:

Hormone labs focusing on the HPA Axis, including the DUTCH Test and Genova Adrenal Stress Profile. The advantage in this area that I've learned with my training is the effective application of low-dose bio-identical hormone drops to treat adrenal stress hormone imbalances. This simulates a more normal functioning endocrine system and induces the brain and body to behave in a normal manner that continues on it’s own after the drops are discontinued at 6 months or so.

Another hormone lab that I use is the Genova Rhythm, which measures estrogen & progesterone levels at different times during the menstrual cycle. This lab is not used that frequently by other practitioners, but can be very helpful for identifying and treating various menstrual cycle related disorders, including migraines, bleeding, infertility, and digestive problems.

Digestive stool labs - these range from PCR based labs that look for pieces of DNA of various friendly, unfriendly, and parasitic entities that make up our microbiome, to direct microscopic identification of parasites and bacteria. Most functional medicine providers use these labs as part of their patient assessment.

I take it one step further in that I also work with another outfit that is not as well known within the FM community, parawellnessresearch.com, run by a Vietnam vet pathologist who has seen everything under the sun, and he often finds parasites that other labs miss.

Organic acids labs - these are highly complex labs that measure 46 key urinary organic acids. These are substrates or products related to key biochemical reactions in the body. Initially developed in the 1950s to assess amino acid processing viability in infants, they are now used on adults to assess overall biochemical functionality, genetic snips that can affect enzyme functionality, and nutritional status. They include markers for:

* Glucose processing (glycolysis),

* Fat processing (beta-oxidation),

* Kreb's cycle (the 8 intermediaries of the TCA cycle),

* Inflammation and oxidation markers,

* Neurotransmitter & brain function (including dopamine, serotonin, and catecholamine status),

* Detoxification pathways (including glutathione status), and

* Compounds of bacterial or yeast origin.

 

Organic acids are complex, and new interpretations and applications are still being developed. My teacher, Dan Kalish, DC, has 30+ years of practice experience and continues to study with Richard Lord, PhD, the original developer of the Genova Organix Profile. This places me close to the cutting edge of understanding how to interpret AND apply these labs in the clinical setting and gives me a distinct advantage over many other practitioners that don't utilize or do a less thorough analysis of an organic acids lab.

 

I’ve now finished the 1-year program of the Kalish Institute of Functional Medicine, and am now enrolled in the advanced program that features an online weekly video grand rounds session with Dr. Kalish. Over the last 30 years, Dr. Kalish has studied and practiced with many of the pioneers in the field of functional medicine, developing lab interpretation and effective dietary, lifestyle, and supplement protocols that have evolved from years of trial and error. As a result, I’ve learned a highly refined and effective system of Functional Medicine that I get to share with you!