clinical implementation of functional nutrition and ... · clinical implementation of functional...
TRANSCRIPT
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
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
Collaborative Care TeamDelivering Impactful Lifestyle and
Nutrition Coaching
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
7 Clinical
Systems
Timeline ATMs
Individual
Predispositions
Lifestyle
Factors
©2017 The Institute for Functional Medicine
“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
©2017 The Institute for Functional Medicine
✓ 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!
The Functional Medicine
Timeline and Matrix;A Tool Designed to Support the Medical History Intake
Process and Facilitate a Coaching Conversation
Information Connection
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
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 Relationships & Networks
Transport(e.g., Cardiovascular, Lymphatic System)
Retelling the Patient’s Story
What is the Role of
the Nutrition
Professional and the
FM Matrix ?
• Educate
• Inspire
• Motivate
• Coach to Success
©2017 The Institute for Functional Medicine
Biotransformation & Elimination
Energy
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
Personalizing Lifestyle Factors
Nutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________© Copyright 2011 Institute for Functional Medicine
Transport
Stress & Resilience
Retelling the Patient’s Story
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
Professional and the
FM Matrix ?
• Educate
• Inspire
• Motivate
• Coach to Success
©2017 The Institute for Functional Medicine
Biotransformation & Elimination
Energy
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
Personalizing Lifestyle Factors
Nutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________© Copyright 2011 Institute for Functional Medicine
Transport
Stress & Resilience
Retelling the Patient’s Story
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
©2017 The Institute for Functional Medicine
Your Functional Medicine Prescription
Nutrition Professional and
Health Coaches MUST
Integrate the Physician’s FM
and Lifestyle Prescription with
Patient’s Goals
©2017 The Institute for Functional Medicine
Your Functional Medicine
Lifestyle Prescription (Sleep, Exercise, Movement, and Restoration)
©2017 The Institute for Functional Medicine
Biotransformation & Elimination
Energy
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Personalized Lifestyle Factors
Nutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________© Copyright 2011 Institute for Functional Medicine
Transport
Stress & Resilience
©2017 The Institute for Functional Medicine
Your Functional Medicine
Supplements/Medications
Prescription
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional 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
©2017 The Institute for Functional Medicine
Biotransformation & Elimination
Energy
Communication
Defense & Repair
Structural Integrity
AssimilationAntecedents
Triggering Events
The Patient’s Story Retold
Personalized Lifestyle Factors
Nutrition & Hydration
Physiology and Function: Organizing the Patient’s Clinical Imbalances
Mediators/Perpetuators Spiritual
Sleep & Relaxation
Name:____________________________ Date:___________ CC:_____________________________________© Copyright 2011 Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
IFM Toolkit Items and Activity Resources
• Daily Activity Questionnaire
• Patient Handouts
– The Power of Movement:
Living an Active Lifestyle
– Tips to Incorporate Mindful
Movement Every Day
• Resources and Referrals –
Active Living
©2017 The Institute for Functional Medicine
• Restoration Prescription
• Practicing Gratitude with the IFM
Gratitude Journal
• Patient Handouts
– 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
©2017 The Institute for Functional Medicine
The Patient Needs to be Self-
aware and Self-driven to Make
Lasting Change
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
Focus on
Implementing
Functional Nutrition in
Clinical Practice
©2017 The Institute for Functional Medicine
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
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
REVIEW the Diet, Nutrition, &
Lifestyle Journal to observe current dietary
patterns, food choices and
influential lifestyle factors
Nutrition Assessments
PFC-MVP
Biomarkers
Gather
Organise
Re-Tell
Order/Prioritise
The ABCDs of Nutrition
Evaluation
Nutrition Assessments
PFC-MVP
Biomarkers
Gather
Organise
Re-Tell
Order/Prioritise
Initiate
Functional
Nutrition
Therapeutic
Interventions
The ABCDs of Nutrition
Evaluation
“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 Assessments
PFC-MVP
Biomarkers
Gather
Organise
Re-Tell
Order/Prioritise
Initiate
Functional
Nutrition
Therapeutic
Interventions
The ABCDs of Nutrition
Evaluation
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
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
Functional Nutrition Food Plans
Medical HistoryABCDs of Nutrition
Evaluation
Anthropometrics
Biomarkers and Labs
Clinical Indications from NPE
Diet and Lifestyle Review
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
Core Food Plan Cardiometabolic Elimination Diet
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
Core Food Plan Cardiometabolic Elimination Diet
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
The IFM Food
Plan Suites
• Ideal Patient Population
• Food Plan Features
• Food Plan List
• Comprehensive Guide
• Menu and Recipes
• Suite Resources
Functional Nutrition Food Plans
Medical HistoryABCDs of Nutrition
Evaluation
Anthropometrics
Biomarkers and Labs
Clinical Indications from NPE
Diet and Lifestyle Review
Matrix Review
Chief Complaints
Conditions
Timeline and ATMs
Medication Review
Choosing a
Food Plan
©2017 The Institute for Functional Medicine
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
Clinical Indicators from
Nutrition Physical Exam
Non-specific
Diet and Lifestyle Inadequate nutrients
Prepared food
Matrix Patterns Non-specific
Your Functional Medicine Prescription
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.)
Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
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)
Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
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
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 Modifications
Lacto-Ovo Vegetarian (25P/30F/45C)
Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
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
Core Food Plan Modifications
Vegan with Soy (25P/30F/45C)
Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
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
Vegetables, starchy 1 1 1 1-2 2-3
Fruit 1-2 2 2 2-3 3
Grains 1 1 1-2 2 2-3
Core Food Plan Modifications
Vegan without Soy (20P/30F/50C)
You Are in This Together:
Patient-Practitioner RelationshipLLNESS ELLNESS
Dean Ornish, MD 2010
Standard
American / UK
Diet
Transition to the
Core Food PlanTherapeutic
Interventions
Maintain Health with
the Core Food Plan
Credit Dean Ornish-2010
©2017 The Institute for Functional Medicine
Common Obstacles: Understanding
FatNot all fats are created equal.
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
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).
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
Clinical Indicators from
Nutrition Physical Exam
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
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
Your Functional Medicine Prescription
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
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
Males
Reduced Mildly
Reduced
Standard Active
Proteins 7 7-9 9-10 10-12 12-13
Legumes 1 1 1-2 2-3 3
Dairy/Alternatives 0-1 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)
Your Functional Medicine Prescription
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
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
Males
Reduced Mildly
Reduced
Standard Active
Proteins 7 7-9 9-10 10-12 12-13
Legumes 1 1 1-2 2-3 3
Dairy/Alternatives 0-1 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
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.
Clinical Indicators from
Nutrition Physical Exam
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
Your Functional Medicine Prescription
x
Usually Rx without Caloric Guidance
Be mindful using with patients with blood sugar
concerns
©2017 The Institute for Functional Medicine
Functional Nutrition Food Plans
Medical HistoryABCDs of Nutrition
Evaluation
Anthropometrics
Biomarkers and Labs
Clinical Indications from NPE
Diet and Lifestyle Review
Matrix Review
Chief Complaints
Conditions
Timeline and ATMs
Medication Review
Choosing a Food
Plan:
Getting Started Vegan
Veggie
Mito
ReNew
Detox
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
Clinical Conditions:
Mitochondrial Pathologies
• Myopathy
• Fatigue
• Diabetes
• Multiple Chemical
Sensitivities
• Fibromyalgia
• Cancer
• Parkinson’s Disease
• ALS
• Epilepsy
• Migraine
• Skeletal muscle weakness
©2017 The Institute for Functional Medicine
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.
©2017 The Institute for Functional Medicine
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
©2017 The Institute for Functional Medicine
Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
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)
©2017 The Institute for Functional Medicine
Bibliography: 10 pages of
citations supporting the
ReNew approach
Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
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
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 Modifications
Lacto-Ovo Vegetarian (25P/30F/45C)
Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
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
Core Food Plan Modifications
Vegan with Soy (25P/30F/45C)
Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
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
Vegetables, starchy 1 1 1 1-2 2-3
Fruit 1-2 2 2 2-3 3
Grains 1 1 1-2 2 2-3
Core Food Plan Modifications
Vegan without Soy (20P/30F/50C)
Calories 1000-1200 1200-1400 1400-1800 1800-2200 2200-2500
Calorie Guidelines for
Females
Reduced Mildly
Reduced
Standard Active
Calorie Guidelines for
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)
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?