Functional Nutrition Head to Toe

  • Master the Functional Nutrition Head to Toe through the Functional Medicine Lens; Advanced Physical Exam Workshop and Functional Nutrition Interpretation

    Drs. Michael Stone, Elizabeth Boham, Kristi Hughes, and Yael Joffe will be offering a workshop in functional nutrition assessment February 2014 in both Johannesburg and Cape Town. The workshop will review components to be integrated into a functional medicine assessment, provide sessions dedicated to improving hands-on testing abilities and techniques, and expand the use of nutrition physical exam elements through skills building.

    The Landscape
    Decline in Physical Exam Skills
    “Although certain diagnostic skills have been under fire since a paper presented to the American Medical Association in the 1950s discussed the inability of doctors to recognize some clinically relevant heart sounds, during the last two decades or so physical exam skills have fallen by the wayside.... Although new technologies allow doctors to explore parts of the body that they can’t examine any other way, they don’t give the whole picture. They can’t feel where an abdomen is tender, discern clues from the look on a patient’s face or focus on a particular area because of how it feels or what the patient says.”1
     “Deficiencies in physical examination skills among medical students, housestaff, and even faculty have been reported for decades.2 Such studies have examined skills deficits in areas as diverse as pediatric cardiac auscultation3 and musculoskeletal exams,4 and have noted the gradual demise of physical examination teaching in rounds, where only 14.6% of the time is devoted to such teaching.5 Frequent studies recommending against annual physical exams may indicate that practicing clinicians today spend much less time actually performing such examinations,6 leading to further loss of skills.

    Deficits in Nutrition Education

    The evidence is compelling that the root cause of most chronic disorders lies within our lifestyle choices, particularly our daily food choices7 Nutrition education, however, is rarely part of a primary care physician’s training. In fact, the number of US medical schools requiring nutrition education and the average hours spent on nutrition education have both declined in the last 10 years.8 IFM is meeting this challenge by developing a systems-oriented functional nutrition program that provides powerful clinical tools, knowledge, and skills. Functional nutrition is the advanced practice of personalized nutrition assessment, diagnosis, intervention, and monitoring with the goal of promoting optimal health and preventing diet-and-lifestyle-related disease.


    The Workshop
    Functional Nutrition Head to Toe: Comprehensive and Innovative Approaches to Nutritional Assessment responds to the need to re-establish the fading art of physical examination and to strengthen physician nutrition knowledge. Veteran physicians can benefit from this learning journey as they begin to discover previously unrecognized nutrition-related findings through the nutrition-oriented physical exam and laboratory assessments. New healthcare providers can increase their exam skills, create a nutrition physical exam kit, and begin to interpret nutrition-related laboratory results from conventional tests and functional assessments. Nutrition professionals can expand the scope of their physical exam skills and clinical interpretation to include observations from their very first meetings with clients.
    Functional Nutrition Head to Toe: Comprehensive and Innovative Approaches to Nutritional Assessment is a unique interactive workshop in which all elements will be taught through the functional medicine lens, focusing on the ABCDs of nutrition assessment:
    • A = anthropometrics and body composition
    • B = biomarkers, laboratory and functional tests
    • C = clinical indicators uncovered during physical exam
    • D = the Dietary, Nutrition, and Lifestyle Journal

    The PFC-MVP model is also used to create a bridge between assessment and intervention, helping clinicians to keep a close watch on the building blocks of nutrition:

    • P = protein
    • F = fats
    • C = carbohydrates
    • M = minerals
    • V = vitamins
    • P = phytonutrients

    The functional medicine operating system for practicing advanced health care includes an emphasis on how to gather and organize medical and life information in a systems biology model. The functional medicine timeline will be used to anchor the nutrition assessment and to further expand knowledge of nutrition-related concerns from various stages of life, including metabolic imprinting that happens in the womb. Nutritional biomarkers and functional laboratory tests will be explored to glean insight concerning health-related issues that could respond to personalized nutrition and dietary modification. The advanced nutrition assessment and physical exam will provide deeper clinical insight; when considered through the functional medicine systems biology model, key underlying causes of disease can emerge, guiding further treatment and patient management. Video clips of leading clinical experts performing the nutrition physical exam will be viewed, followed by hands-on workshops that enable attendees to observe, perform, and then explain physical exam findings. The PFC-MVP methodology will be used to organize all the laboratory and physical exam findings and to advance skills in personalized nutrition and therapeutic interventions.

    The Functional Nutrition Screening Room will be available by appointment to all participants on Friday and Saturday mornings, offering the experience of gathering and organizing key clinical data. Dr. Michael Stone will review the findings from these unique exams on Saturday, so each attendee will leave with more clinical insight in how to identify risks, modify or improve health, and further ensure wellness through personalized nutrition. During the program, Elizabeth Boham will work with attendees to assess personal information gathered from their own ABCDs of nutrition assessment and their Dietary, Nutrition, and Lifestyle Journals, with laboratory results, to identify areas to improve their health.

    Key Takeaways

    This workshop will strengthen exam skills and techniques, enable attendees to start using the ABCDs of nutrition assessment methodology in patient management, leverage the PFC-MVP organization system for macro and micronutrients in all aspects of assessment, and facilitate the adoption of practical clinical applications to strengthen wellness plans for patients and clinicians alike.
    Workshop Details

    • Four pre-course webinars
      • Kristi Hughes, ND
      • Michael Stone, MS, MD
      • Elizabeth Boham, MD, MS, RD
      • Deanna Minich, PhD
    • Onsite course and workshops
    • Onsite Screening Room experience (30 minutes in exam room stations)
    • Two post-course webinars
      • Yael Joffe, PhD
      • Michael Stone, MD, MS and Elizabeth Boham, MD, MS, RD

    Workshop Prerequisites

    • Participation or completion required in one or more of the following:
    • Functional Medicine Introductory eCourse through The Institute for Functional Medicine - click here
    • Functional Medicine Study Group participation in 2010-11 or 2012-13 cohorts (FMSA)
    • Applying Functional Medicine in Clinical Practice attendance (FMSA or IFM)
    • Highly recommended—personal assessment and healthcare details gathered before attendance:
    • Your own Functional Medicine Timeline filled in to date identifying key healthcare events and diagnoses, along with uncovering antecedents, triggers, triggering events, and mediators
    • Your own Functional Medicine Matrix organizing clinically relevant content, exploring pathophysiology, and seeking for patterns to emerge
    • Your current biomarkers and functional laboratory markers from blood as follows:
      • Complete blood count with differential (WBC, RBC, Plt, hemoglobin, hematocrit, MCV, MCH, MCHC, neutrophils, lymphocytes, monocytes, eosinophils, basophils, MPV)
      • Fasting Complete Metabolic Panel with GGT, phosphorus  (glucose, sodium, potassium, chloride, calcium, albumin, globulin, albumin/globulin ratio, AST, ALT, GGT, phosphorus)
      • Lipid panel (total cholesterol, HDL, LDL, TG, VLDL) with apolipoprotein A1 and B
      • hsCRP
      • Fasting insulin
      • HgbA1C
      • Homocysteine
      • Methylmalonic acid
      • 25 hydroxy vitamin D
      • Iron panel with ferritin (serum iron, total iron binding capacity, transferrin, and saturation)
      • TSH, free T4, free T3
      • Optional: The Nutra-Eval test from Genova, a blood and urine test, is recommended for those seeking a very comprehensive and complete assessment of their personal nutrition status.

     

    References


    1. Max J. The lost art of the physical exam. Yale Medicine. 2009;43(2). http://yalemedicine.yale.edu/winter2009/features/feature/51079

    2. Janjigian MP, Charap M. Kalet A. Development of a hospitalist-led-and-directed physical examination curriculum. J Hosp Med. 2012;7(8):640-43.

    3. Germanakis I, Petridou ET, Varlamis G, et al. Skills of primary healthcare physicians in paediatric cardiac auscultation. Acta Paediatr. 2013;102(2):e74-8.

    4. Beran MC, Awan H, Rowley D, et al. Assessment of musculoskeletal physical examination skills and attitudes of orthopaedic residents. J Bone Joint Surg Am. 2012;94(6):e36.

    5. Stickrather C, Noble M, Prochaska A, et al. Attending rounds in the current era. JAMA Intern Med. 2013;173(12):1084-89.

    6. Gordon PR, Senf J. Is the annual physical examination necessary? Arch intern Med. 1999;159:909-910.

    7. Diet, Nutrition, and the Prevention of Chronic Disease. Report of a Joint WHO/FAO Expert Consultation. World Health Organization: Geneva, Switzerland, 2003.

    8. Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Academic Medicine. 2010;85:1537-1542.

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