Dr. Abbott is a college friend and previous podcast guest. He is also a member of the Future of Functional Medicine Review clinical newsletter. He has put many of the concepts we discuss into practice and produced an excellent case study. If anyone from our audience has a case study worth sharing, please email firstname.lastname@example.org and I will happily review.
70 y/o female
Food for Thought
Visit 2 – Testing and Initial Recommendations (returned 1 week later following echocardiogram)
Financial considerations, insurance coverage, availability of testing and desires of the patient all were taken into account when determining to test. Patient desired a minimalist approach and was open to herbal treatments over drugs. Given previous testing and the patient’s complaints, I focused on nutrient status, markers of inflammation and thyroid health. I did not pursue hormone testing as I believed her symptoms would improve as part of a targeted gut approach. I also choose to not test thyroid antibodies and instead elected the initial screen with TSH and free hormone levels..
Initial treatment followed an anti-microbial pathway given suspicion for methane predominant SIBO with dysmotility. Treatment was empiric in nature without comprehensive stool testing. Prokinetics and anti-biofilm agents were added given concerns for constipation and the potential for increased efficacy with herbal antimicrobial treatment. The treatment was targeted for 6-8 weeks with reassessments over the next 2 months prior to changes in therapy. A combined dietary and herbal regimen was a good place to start and it was predicted that the patient would show significant improvement.
Visit 3 – Lab Interpretation and Treatment Evaluation (4 weeks after initial appointment)
Overall no signs of anemia on CBC, normal liver and kidney function on CMP, fasting glucose of 82, HbA1c of 5.2 and Tg/HDL-C ratio less than 2 is supportive of good cellular metabolism. Iron levels are within normal limits and patient does not appear to need any intervention for anemia or iron overload at this time. Thyroid function is suboptimal but not requiring intervention at this time. Inflammation, as measured by HS-CRP, appears low. A suboptimal homocysteine and elevated B12 may indicate some disturbances in methylation, B vitamin metabolism. Given concerns for impaired estrogen metabolism and detoxification as well as increased need/suboptimal absorption in the small intestine given concerns for SIBO, the patient likely will benefit from a period of targeted B vitamin supplementation.
Visit 4 – Follow-Up (4 weeks later, 8 weeks after initial appointment)
Visit 5 – Follow-Up (3 weeks later via email)
Take Home Points
Dr. Ruscio’s Comments:
Again, an excellent case study which illustrates a few important concepts:
Thank you, Dr. Abbott, excellent work.