The articles on this page explore topics related to the Energy Advanced Practice Module:
The Role of Mitochondria in Chronic Pain
IFM educator Kristi Hughes, ND, explains how the Energy Advanced Practice Module
(APM) provides the framework and tools to work with patients with chronic pain. Learn more about important mediators and interventions for these patients at the Energy APM.
Neurodegeneration and Microbial Balance
Many promising studies have found that specific diets high in vegetables and beneficial fats have protective effects on patients at risk of or suffering from neurodegeneration. IFM's Energy Advanced Practice Module
(APM) includes a food plan for working with patients with energy dysfunction like neurodegeneration. Recent research suggests that one of the ways diet impacts neurodegenerative disease is through changes in the microbiome.
In a study of 31 stool samples from patients with multiple sclerosis (MS), distinct, unusual microbiota were identified compared to controls. The fecal microbiome differed from healthy controls, particularly the dominant populations of bacteria, although the overall diversity was the same in MS and healthy samples. Strikingly, patients with active disease (not in remission) showed decreased species richness. In particular, Bacteroidetes
was reduced in patients experiencing symptoms. Several other species showed decreases, including:
- Parabacteroides (known to be involved in bile metabolism) and Prevotella (Bacteroidetes),
- Adlercreutzia and Collinsella (Actinobacteria),
- and Erysipelotrichaceae (Firmicutes, known to be involved in bile metabolism).1
The authors suggest that this decrease in the abundance of microbes known to be involved in fatty acid metabolism (via bile), combined with the induction of anti-inflammatory pathways by phytoestrogen and bile acids metabolites, may be key to remission in MS.1
Preventing and treating neurodegeneration is just one of the many topics covered in the Energy APM
. Learn the latest clinical information about the effects of diet, exercise, stress, and other factors on energy-related conditions including fatigue, headaches, depression, chronic pain, neurodegeneration, and more. Join us this July 16-18 in Chicago, IL and you’ll walk out the door with a suite of clinical tools to help you assess, diagnose, and design personalized treatments for these patients.
- Chen J, Chia N, Kalari KR, et al. Multiple sclerosis patients have a distinct gut microbiota compared to healthy controls. Sci Rep. 2016;6:28484. doi: 10.1038/srep28484.
Root-Cause Treatment for Depression
Marta is on her third antidepressant, with no relief. She asks you what else she can try. How do you work with patients like Marta?
The low efficacy of antidepressants combined with the high prevalence of depression has left many clinicians challenged about how to help patients with depression. When several prescriptions fail, the clinical encounter can seem as hopeless as the patient feels.
Depression is a multi-factorial condition with a large number of potential antecedents and triggers, many of which will be discussed at the Energy Advanced Practice Module
(APM) this July 16-18. Given the wide range of potential causes and factors that influence depression, how can you get to the bottom of what’s causing your patient’s depression and provide the right treatment? Dr. Richard Panico
, IFM educator and board-certified psychiatrist, will delve into the considerations and labs you can use to pinpoint the causes of depression for each individual and treat it at its roots.
For patients like Marta, who have tried several antidepressants to no avail, other methods may yield better results. Testing her fatty acids may indicate that she is deficient and would respond well to EPA treatment (like many others1,2,3). If she experienced depression after giving birth, zinc may be playing a role—decreased serum zinc (along with a host of other factors) may increase the likelihood of postnatal depression.4
Learn more about the many points of leverage for treating depressed patients at IFM’s Energy APM
. In addition to learning about the causes of and treatments for depression, expert educators will present assessment and treatment strategies for fatigue, headaches, migraines, chronic pain, and neurodegenerative disorders. Get the tools you need to help patients with these complex, chronic issues.
- Sublette ME, Ellis SP, Geant AL, Mann JJ. Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry. 2011;72(12):1577-84. doi: 10.4088/JCP.10m06634.
- Mozaffari-Khosravi H, Yassini-Ardakani M, Karamati M, Shariati-Bafghi SE. Eicosapentaenoic acid versus docosahexaenoic acid in mild-to-moderate depression: a randomized, double-blind, placebo-controlled trial. Eur Neuropsychopharmacol. 2013;23(7):636-44. doi: 10.1016/j.euroneuro.2012.08.003.
- Carney RM, Steinmeyer BC, Freedland KE, Rubin EH, Rich MW, Harris WS. Baseline blood levels of omega-3 and depression remission: a secondary analysis of data from a placebo-controlled trial of omega-3 supplements. J Clin Psychiatry. 2016;77(2):e138–43. doi: 10.4088/JCP.14m09660.
- Roomruangwong C, Kanchanatawan B, Sirivichayakul S, Mahieu B, Nowak G, Maes M. Lower serum zinc and higher CRP strongly predict prenatal depression and physio-somatic symptoms, which all together predict postnatal depressive symptoms. Mol Neurobiol. 2016 Feb 5. doi: 10.1007/s12035-016-9741-5.
Modifiable Lifestyle Factors and Neurodegeneration
Nutrition is a key modulator of cognitive health. This is especially true for patients with a family history or increased genetic risk for neurodegenerative disease.
For instance, research suggests that dietary interventions that are high in phytochemicals and antioxidants may be neuroprotective and slow neurodegeneration.1-7 Furthermore, nutrition may play a key neuroprotective role in patients at risk of stroke,8 as well as slowing the progression of Parkinson’s disease.2,7,9 In patients with multiple sclerosis, an anti-inflammatory diet with supplementation specific to the disease etiology has been well-tolerated and significantly reduced symptoms.3,4
What specific nutrients and vitamins support cognitive health and reduce neurodegeneration? Several possibilities exist. In animal studies, a variety of vitamins and nutrients have protective effects on mitochondria, including CoQ10,10 acetylcarnitine,11 and resveratrol.11 In this video, IFM educator Robert Rountree, MD, explores the latest research on the coenzyme nicotinamide adenine dinucleotide (NAD):
At IFM’s Energy Advanced Practice Module (APM), educators will present cutting-edge science around nutrition interventions. In particular, educators will focus on how to support the mitochondria, reduce fatigue, and protect neurons. Terry Wahls, MD, will present nutrition and lifestyle interventions to prevent and even reverse neurodegeneration, and you will walk out the door with tools and techniques to personalize nutrition treatment for neurodegeneration, fatigue, chronic pain, and much more.
- Gómez-Pinilla F. Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci. 2008;9(7):568-78. doi: 10.1038/nrn2421.
- Seidl SE, Santiago JA, Bilyk H, Potashkin JA. The emerging role of nutrition in Parkinson’s disease. Front Aging Neurosci. 2014;6:36. doi: 10.3389/fnagi.2014.00036.
- Bisht B, Darling WG, Grossmann RE, et al. A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue. J Altern Complement Med. 2014;20(5):347-55. doi: 10.1089/acm.2013.0188.
- Riccio P, Rossano R, Larocca M, et al. Anti-inflammatory nutritional intervention in patients with relapsing-remitting and primary-progressive multiple sclerosis: a pilot study. Exp Biol Med. 2016;241(6):620-35. doi: 10.1177/1535370215618462.
- Kita T, Asanuma M, Miyazaki I, Takeshima M. Protective effects of phytochemical antioxidants against neurotoxin-induced degeneration of dopaminergic neurons. J Pharmacol Sci. 2014;124(3):313-19. doi: 10.1254/jphs.13R19CP.
- Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis. Nutr Neurosci. 2015;18(3):125-36. doi: 10.1179/1476830514Y.0000000117.
- Agim ZS, Cannon JR. Dietary factors in the etiology of Parkinson's disease. Biomed Res Int. 2015;2015:672838. doi: 10.1155/2015/672838.
- Ayuso MI, Gonzalo-Gobernado R, Montaner J. Neuroprotective diets for stroke. Neurochem Int. 2017 Feb;pii:S0197-0186(16)30408-9. doi: 10.1016/j.neuint.2017.01.013.
- Nataraj J, Manivasagam T, Thenmozhi AJ, Essa MM. Lutein protects dopaminergic neurons against MPTP-induced apoptotic death and motor dysfunction by ameliorating mitochondrial disruption and oxidative stress. Nutr Neurosci. 2015;19(6):237-46. doi: 10.1179/1476830515Y.0000000010.
- Sandhir R, Sethi N, Aggarwal A, Khera A. Coenzyme Q10 treatment ameliorates cognitive deficits by modulating mitochondrial functions in surgically induced menopause. Neurochem Int. 2014 Jul;74:16-23. doi: 10.1016/j.neuint.2014.04.011.
- Fišar Z, Hroudová J, Singh N, Kopřivová A, Macečková D. Effect of simvastatin, coenzyme Q10, resveratrol, acetylcysteine and acetylcarnitine on mitochondrial respiration. Folia Biol (Praha). 2016;62(2):53-66.
Treating Patients with Pain
With over 55% of Americans reporting that they have had pain in the past three months, and 11% experiencing daily chronic pain, your clinical practice likely sees patients with pain on a daily basis.1 Pain has a deep, lasting impact on patients, both physically and emotionally. Yet other than prescribing symptom-suppressing anti-inflammatories and opioids, the options for treating pain seem limited. In surveys, many primary care providers report that their medical education did not adequately prepare them for treating patients with pain.2,3 Advanced training makes a difference, increasing treatment of chronic pain in the clinical setting as well as clinician confidence in offering those treatments.3 References
Evaluating and personalizing treatments for pain, particularly chronic pain, is critical to helping these patients get out of the cycle of pain and reduce potentially debilitating medications. IFM’s Energy Advanced Practice Module (APM) provides advanced training in how to design, implement, and personalize treatment plans for patients with chronic pain, as well as other disorders related to energy dysfunction including headaches, fatigue, and neurodegeneration.
Join us this July 16-18 in Chicago, IL, to gain new skills in treating patients with chronic pain, neurodegenerative disorders, and fatigue. The next time you see a patient with one of these disorders, you’ll be equipped with the tools to assess and design personalized treatment strategies that don’t just rely on drugs to manage symptoms.
- Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 2015;16(8):769–80. doi: 10.1016/j.jpain.2015.05.002.
- Upshur CC, Luckmann RS, Savageau JA. Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006;21(6):652-55. doi: 10.1111/j.1525-1497.2006.00412.x.
- O'Rorke JE, Chen I, Genao I, Panda M, Cykert S. Physicians' comfort in caring for patients with chronic nonmalignant pain. Am J Med Sci. 2007;333(2):93-100. doi: 10.1097/00000441-200702000-00005.
Assess Energy Dysfunction With These Tools
Fatigue and low energy are common patient complaints in the primary care setting. Finding the right treatment for each patient with fatigue requires accurately assessing the underlying causes of the problem. This is not always easy. Where do you start? How do you proceed when a patient is no longer able to accurately report their level of dysfunction, as they may not remember what “normal” feels like?
Good assessment tools are particularly critical for cases of fatigue. In the video clip below, Deanna Minich, PhD, FACN, CNS, a functional nutritionist and IFM educator, discusses how she assesses patients with fatigue and energy dysfunction. She discusses the specific assessment tools she uses, as well as how she interprets the information that patients provide (and sometimes don’t provide) on these assessments.
Learn more about assessing and treating fatigue and other types energy dysfunction at IFM's Energy Advanced Practice Module
. You’ll come away with tools that help you identify the underlying causes of energy issues and provide a framework for effective personalized interventions.
Address the Cause of Energy Disorders
Fatigue is a common presentation in primary care offices. It can be particularly challenging to address because of the numerous potential underlying causes. This also makes it especially well suited to the Functional Medicine approach. While there are many forms of fatigue, one that seems to be on the rise is Chronic Fatigue Syndrome, recently renamed Systemic Exertion Intolerance Disease (SEID).
Recent estimates are that between 836,000 and 2.5 million Americans have CFS/SEID1
and an estimated 84-91% may be undiagnosed. These figures suggest that chronic, debilitating fatigue and difficulty with exertion are poised to become even more common presenting complaints in clinicians' offices.1
Standard treatment for CFS/SEID mostly focuses on symptom management. However, recent research has provided evidence that supporting mitochondrial function could help many patients with CFS/SEID. A recent 8-week randomized controlled trial of patients with CFS/SEID tested the efficacy of supplementation with CoQ10 (200 mg/day) and NADH (20 mg/day) versus a placebo.2
In the patients who received supplementation (n=39), a significant improvement in general fatigue level score was found, while no such improvement was seen in the placebo group (n=34). Lipoperoxide levels were also significantly different pre- and post-treatment in the supplemented group.2
This suggests that mitochondrial support may be an effective tool for healing these patients over time.
Treating all types of fatigue, including CFS/SEID, requires supporting the underlying energetic needs of cells. Learn more about energy production, transport, and dysfunction from our expert clinicians and researchers at IFM's Energy Advanced Practice Module
You'll come away with diagnostic tools and clinical treatments to achieve better outcomes with your patients suffering from fatigue and other types of energy dysfunction.
- Institute of Medicine. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. 2015; Feb 10. Full report available at http://www.iom.edu/Reports/2015/ME-CFS.aspx.
- Castro-Marrero J, Cordero MD, Segundo MJ, et al. Does oral coenzyme Q10 plus NADH supplementation improve fatigue and biochemical parameters in chronic fatigue syndrome? Antiox Redox Signal. 2015; 22(8):679-685. doi:10.1089/ars.2014.6181. Full text available at http://online.liebertpub.com/doi/full/10.1089/ars.2014.6181
Fighting Dementia and Cognitive Decline
Dementia diagnoses continue to rise and are largely driven by an increase in the incidence of Alzheimer disease (AD). This increase is predicted to steepen as those from the Boomer generation move into their golden years. As a result, patients seeking to prevent or forestall the onset of dementia are likely to make up an increasing proportion of office visits for clinicians who see geriatric patients. Fortunately, in the rapidly evolving field of dementia research, new information about prevention is being published every day.
Two recent studies point to potential causes of dementia and AD and suggest relatively simple interventions to reduce risk. In an article published in BMJ this month, researchers showed that benzodiazepine ever-users had more than a 50% increased risk of AD (odds ratio = 1.51), even when benzodiazepines were taken many years prior to diagnosis.1
A dose-response relationship was also seen, with those taking higher doses for longer periods having the greatest increase in risk. Although the mechanism underlying this risk is unknown, the findings suggest that other interventions should be considered when treating anxiety and sleep issues in older adults.
A study published in August in Neurology2
found that adults who were vitamin D deficient had a 51% increased risk for all-cause dementia (hazard ratio HR] = 1.51) and those who were severely deficient had a 122% increased risk (HR = 2.22) compared with those with sufficient in vitamin D, even after adjusting for several other risk factors. Although the results of the study did not prove causation, they suggest that a relatively simple intervention for helping older adults prevent the onset of this disease: Get more vitamin D (via diet, supplements, and/or sun exposure)! A related commentary also suggests that disturbed sleep may be an intervening factor,3
implying yet another lifestyle factor that may be a point of leverage for clinicians.
At IFM's Energy Advanced Practice Module
, one of the main focuses will be presenting ways that you can help prevent cognitive decline, including AD and other types of dementia, in your patients. We will present results from cutting-edge research on energy dysfunction and cognitive decline as well as provide you with the tools to help put that research into practice.
Treating Migraines Doesn't Have to be a Headache
Chronic migraine headaches can be incapacitating for patients, but treating and preventing them doesn't have to be. In Functional Medicine, we recognize that there are many triggers for this disorder, but an energy imbalance is often at the heart of the problem. Treating -- and particularly the prevention of -- migraines requires that the triggers as well as the underlying causes of the imbalance are all addressed.
In the videos below, IFM educators Monique Class, MS, APRN, and Robert Rountree, MD, discuss their approaches to this multifaceted condition.
Monique Class, MS, APRN, discusses the nutritional supplements that can treat migraines
Robert Rountree, MD, introduces a number of ways he has successfully prevented migraines in his patients
Although they both discuss their recommendations for supplement regimens, each also speaks to the importance of seeking out and eliminating triggers in order to prevent migraines. This is the hallmark of the Functional Medicine approach: Uncover the factors-whether they be behavioral, physiologic, or spiritual--leading to the imbalance and address them. Even with difficult-to-treat issues like migraines, this approach can have astonishing results.
At IFM's Energy Advanced Practice Module
, our experienced faculty team will discuss how to successfully use the Functional Medicine approach to address all types of energy dysfunction, from degenerative brain disorders and chronic pain to fatigue and depression--and, of course, migraines. You'll come away with new tools and clinical considerations to more effectively evaluate energy dysfunction and the support needed to develop personalized treatment strategies for these issues.
Using APOE Genetic Testing to Guide Treatment Plans
Lisa Portera-Perry, DC, discusses how she uses APOE testing in her practice
|Energy dysregulation is a component of many chronic diseases. Health care professionals may not generally think of mitochondrial dysfunction when their patients present with headache, fibromyalgia, metabolic syndrome, infertility, fatigue, pain, cognitive dysfunction, or neurodegenerative conditions; however, declines in optimal mitochondrial function and cellular vitality are part of the clinical picture.|
Understanding how energy dysregulation contributes to chronic diseases opens the door to powerful treatments to improve symptoms and disease progression. In the accompanying video, IFM Energy Advanced Practice Module educator Lisa Portera-Perry, DC, discusses how she uses APOE genetic testing to help guide treatment decisions in patients with disorders of energy regulation.
At IFM's Energy Advanced Practice Module
, you'll learn how to develop individualized protocols using nutrition, nutraceuticals, pharmaceuticals, and biophysical/energetic therapies to treat energy-related conditions, including migraine, seizure, neuropathy, chronic pain syndromes, fatigue, cognitive impairment, and chronic neurodegenerative disorders.