A Functional Medicine Case Study Let’s look at an example through the lense of Functional Medi- cine. Sally is a 46 year-old woman who came to me describing years of fatigue. Chronic Fatigue Syndrome is one of the most com- mon issues I see in my practice. These patients often get bounced from doctor to doctor seeking answers for why they feel so drained all the time. Unfortunately many of them get labeled as simply depressed or anxious, or worse yet, as malingering to get some kind of secondary gain. Chronic Fatigue Syndrome wasn’t even a recog- nized diagnosis in standard medical textbooks until recently. Now we call it Systemic Exertion Intolerance Disease (SEID).


Actually, as a diagnosis I don’t like it. It’s more of a descrip-


tion. It means one is really tired, most of the time, for more than 6 months and there are no other identifiable causes for the fatigue. As a Functional Medicine practitioner, I want to figure out why this patient is tired. We are discovering that there are probably many different contributing factors to SEID, ranging from infectious to hormonal to genetic.


In Sally’s case, like with all of my patients, I started by listening


to her story. We talked about childhood issues (she was 6 weeks premature, breast-fed, remembered having lots of ear infections with rounds of antibiotics, and had bad acne as a teenager), had a couple of major stressful events in her twenties (bad breakup, several moves around the country, career changes), hormonal shifts (gained 25 pounds after her first pregnancy and never lost it), possible toxin exposure (well water tested positive for arsenic), possible lingering infections (had Mono when she was a teenager, likes to garden and recalls many tick bites), and what her life is like now (too busy to care for herself, no time for exercise, feels like she has lost her purpose in life). I also did a thorough physical exami- nation, looking for subtle clues of nutritional deficiencies and other diseases.


This takes time. My typical first patient intake visit is 90 to 120 minutes. One can easily understand that the 7 to 12 minutes average physicians are “allowed” to spend with their patients in their typical schedule isn’t sufficient to address the roots of chronic illness.


I used the Functional Medicine Matrix tool to identify Sally’s


‘Antecedents’ (the set up for illness, see page 19). Her mother had a lot of food allergies; breast milk may carry antibodies against these foods which would have “primed” Sally’s immature gut to be in- flamed and reactive. There was a possible imbalance in beneficial gut bacteria from the childhood antibiotics, leading to “Leaky Gut Syndrome” or Intestinal Hyperpermeability. This often results in food sensitivities as the inflamed gastrointestinal system can’t digest food properly. This inflammation can show up as teenage acne, irritable bowel syndrome, or even cause more systemic problems like thyroid issues or depression...or chronic fatigue.


Sally had several ‘Triggering Events’ in her twenties, any of


which could have caused significant internal stress and set her up for illness. Major life events like divorce, moving, job loss are further drains, and Sally had a string of these. She also had a happy Triggering Event -- the birth of her child. But this was yet another strain on her system. The 25 pound weight gain could have par- tially been due to high levels of cortisol in her system. Cortisol is a stress hormone that affects insulin, blood sugar, and weight gain.


20 Essential Living Maine ~ July/August 2015


Looking again at the Functional Medicine Matrix, there were


several possible Mediators/Perpetuators that kept Sally sick. I ran some tests that showed persistent arsenic as well as mercury and lead in her body. She had fluctuating antibody levels against Epstein-Barr Virus, the bug that causes Mononucleosis. Most people fight off Mono and never get it again, but some patients have immune system dysfunction that makes them vulnerable to chronic infections. Her lifestyle habits weren’t optimal: she lacked regular physical activity and a healthy diet as well as stress manage- ment exercises.


When I lay out Sally’s case like this it seems obvious why she felt tired all the time. But remember, she had seen numerous smart physicians who didn’t have the tools they needed to put it all together. She had a very competent Primary Care Physician who performed an appropriate evaluation. Her regular blood testing (thyroid, anemia panel, chemistries, celiac disease) were all normal. She didn’t “look sick”. Her PCP had tried some antidepressants and sleep medicines without success, then basically told her he didn’t know what was wrong with her. Fortunately there is a happy end- ing.


One of the cardinal rules of Functional Medicine is “heal the


gut first”. If Sally’s gastrointestinal system wasn’t working properly, she wouldn’t absorb the healthy foods I recommended for her, and she wouldn’t eliminate the toxins that needed to come out of her body. I ordered a functional stool panel which confirmed the pres- ence of unhealthy bacteria, a mild yeast overgrowth, and immune dysfunction from likely food sensitivities. A combination of natu- ral antimicrobials, essential fatty acids, and a medical food shake helped to heal her gut. I started her on an anti-inflammatory diet. For the first time in 20 years, she wasn’t constipated and her belly pains and gas began to improve.


Over the next several months we made progress with her


exercise and stress reduction techniques. She started practicing some relaxation breathing, at first just for 1 minute a day then longer as she began to see how good it made her feel. But her energy still flagged.


I ran some more functional nutritional testing that showed a


blockage in her mitochondrial metabolic pathway, or Kreb’s cycle. (The mitochondria are the power plants of our cells, turning our food into energy.) Guessing this was from a combination of vitamin depletion and heavy metal toxicity, I started a nutraceutical regi- men to support her detoxification enzyme function. As her body cleaned itself up, she felt better. She had more energy to exercise, which helped her feel even better. Without going on a diet, she lost 15 pounds in the next 5 months. She got stronger, happier, and healthier.


There was no miracle cure here. Sally still had her ups and


downs and fell off the health wagon a few times. But because she was a member of her own healthcare team and because she under- stood the factors that made her feel ill, she was able to keep picking herself up. There was light ahead. She’s still working on herself, as we all are. Will she be able to tow 70 rowboats when she’s 70 years old? I don’t know. But I’m eager to see how Functional Medicine will help Sally achieve her genetic potential.


One can apply this paradigm to Diabetes, Cardiovascular Dis- ease, and the other chronic maladies that so many of us suffer from.


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