1

We’re going to go over every aspect of the Functional Medicine Matrix,

and its web-like connections, which helps us to determine the triggers

leading up to chronic health conditions, Then were going to break apart

key assessment questionnaires that help you pinpoint what areas in the

body are being affected by the triggering events, and finally, steps that

need to be taken in a specific order, to reversing chronic health

conditions. But first, I want to talk about the importance of proper

detoxification. Because sometimes we need to detoxify in order to re-

gain our health and resolve chronic health conditions.

Detoxification Key Points: the body has a number of functions and

organs involved in detoxification: skin, lungs, intestine, liver, kidneys

and lymphatic system. External applications can be useful to facilitate

the detox process, saunas, foot detox pads, Epsom salt baths. Internal

processes like juice fasts, and detox supplements designed to clear and

drain all channels and organs of elimination.

Here are the primary organs of Elimination for detoxification: colon,

lungs, kidneys, skin, liver, lymphatics.

Here is the process of Detoxification and Elimination: on the left side

the toxins enter in through our lungs, skin and intestines. From there

they all have to be filtered through the liver. Toxins then exit the body

through the skin, kidneys, colon, and lung. Excess toxins get stored in

our fat cells, bone marrow, liver, central nervous system and brain,

joints, blood, tissues, and muscles. And of course these stored toxins

2

produce the symptoms like acne, skin rashes, allergies, arthritis, joint

pain, autoimmune disorders, cardiovascular disease, chronic fatigue,

constipation, diarrhea, diabetes, fibromyalgia, headaches, hormone

imbalances, inflammatory disorders, IBS, neurological/brain disorders,

obesity and overweight issues.

Of course this requires time and planning. First, understand you need

to stop the incoming garbage: junk food, sugar, packaged foods that

have chemicals, additives and food coloring. Get tested so you know

what the possible triggers are. And trust the laboratory results to

identify sensitivities and triggers to your complaints. Remember food

sensitivities do not necessarily cause an immediate reaction, so don’t

think just because you don’t have an immediate reaction after eating

the identified food antigen, your body is not reacting, because it is, at

the gut level of the small intestine barrier, and it is causing

inflammation, and putting a demand on your immune system. Then,

you need to support your body by removing the identified food

sensitivities and the toxins they have created, not to mention all the

garbage and built-up toxins your body has been exposed to throughout

your lifetime.

So you might ask how can I increase the out- going garbage?

The answer is through elimination and detoxification to increase the

garbage out:

What do you want to eliminate? Allergens, toxins, harmful organisms.

How? Through the colon, skin, kidney, liver, and lymphatics.

3

Before we talk about elimination, I want to talk further on healthy

digestion. Proper digestion, absorption of nutrients, and elimination of

wastes are essential for optimal health. The gastrointestinal tract,

which regulates all of these functions, is considered to be the “seat of

health.” The goal of many nutritional approaches is to maximize the

health of this important system.

The gastrointestinal tract begins at the mouth and ends at the rectum.

It includes the mouth, esophagus, stomach, small intestine, and large

intestine. However, the liver, pancreas, and gallbladder also play

important roles in digestion.

What goes in must come out – We all know what goes in at the top

comes out in a different form at the bottom. However, what happens in

between? And why is it important that all the different components of

the digestive system work properly?

Where does it start? The process starts in the brain when you begin to

think of food, and then becomes more potent when that first delicious

aroma of your favorite food hits your nostrils. Powerful chemical

messages are set in motion to get you ready to digest and assimilate

food. Now, as soon as the food hits your mouth, when you actually

begin to taste and eat the food, enzyme, amylase, is produced to help

you begin the process of digestion.

Chew your food well. This is particularly important, as chewing

activates the enzymes and prepares your stomach for producing gastric

juices, such as pepsin and hydrochloric acid, to break down proteins.

4

As food passes into the stomach, it is mixed with hydrochloric acid

and pepsin. Stomach acid is crucial for proper digestion. This is why

using antacids for prolonged periods, which inhibit hydrochloric acid

production, can be detrimental to our health.

Hydrochloric acid not only assists in protein digestion, but also helps to

prevent small intestine bacterial overgrowth (coined SIBO). In addition

it stimulates the production of digestive enzymes, stimulates peristalsis

(bowel movements), and facilitates the absorption of minerals. As we

age, we produce less and less hydrochloric acid and pepsin.

Many times when you suffer from acid indigestion, it’s not because you

have too much acid. It’s more likely you are low on stomach acid. This

causes undigested food in the stomach to ferment and bacteria to grow

on it, causing burping, gas and indigestion. Without proper digestion

and absorption of nutrients you become malnourished.

Symptoms of Low hCL:

Acid indigestion

• Asthma

• Belching

• Gas and bloating

• Fullness hours later

• Foul breath

• Fullness with meals

5

• No taste for meat

• Mouth sores

• Stomach aches

Ways to increase hCl –

• Apple cider vinegar (1/2 tsp in water before meals) • Betaine hCL tablets before protein containing meals

• Herbal Bitters (1 tsp before meals)

• don’t drink liquids at meals or just small sips of water

• Relax at meal times (stress shuts down digestion).

It Takes Guts To Be Healthy

Once your stomach has churned all that food into a liquid soup

called chyme, it is passed to the next phase of the processing

machine, your small intestine – which is anything but small. The

surface area, if unfolded covers the size of a football stadium. Your

food should be fully digested and absorbed here.

Once your food enters the small intestines, the pancreas is activated

to send in the digestive enzymes to break down carbohydrates,

proteins, and fats and to neutralize stomach acid. If you are low on

enzymes or your pancreas does not have enough available minerals,

then you may have symptoms such as gas, bloating, and/or pain in

the middle part of the abdomen.

6

Ways to increase digestive enzymes Eat whole, fresh organic foods and take digestive enzymes: protease,

amylase, lipase, cellulase

• Protease for protein

• Amylase for starch

• Lipase for fats

• Cellulase for vegetables

• Eat fermented foods: yogurt, kimchee, sauerkraut, kefir

• Eat only one type of protein at a meal

Your liver has the hardest job of all is a key organ in digestion and

elimination. It helps to emulsify fats and breaks down hormones,

including cholesterol. It also helps breakdown synthetic chemicals, such

as food additive and pesticides. The liver makes cholesterol and

distributes fat-soluble vitamins such as A, D, E, and K to the tissues.

The Liver produces bile, which is stored in the gallbladder. Bile contains

bile salts to emulsify and breakdown fats, making them easier to digest.

As we eat especially fats), the gallbladder and liver release bile into the

duct that connects the liver, gallbladder, and pancreas to the small

intestine.

If you had your gallbladder removed, the bile and bile salts have to be

secreted into the small intestine where there is no repository for

storing bile. Thus, digestion may be problematic. Taking some OX bile

or other liver nutrients may be needed to support digestion of fat, so as

7

not to develop a fatty liver.

You should keep your liver in tip-top shape, or you will overproduce

cholesterol, have problems digesting fat, be unable to breakdown

excess hormones, leading to cancer, and hormone imbalances, and be

inefficient at breaking down chemicals. If these substances are not

broken down and excreted, they will recirculate and begin to poison

your cells. If you have experienced brain fog, then you know what it is

like to have toxins recirculating in your body.

Symptoms of Liver Toxicity:

• Fatigue

• Aching all over

• Allergies

• Dizziness

• Feeling Sleepy throughout the day

• Lack of concentration

• Poor Memory

The Liver is also a blood filter and a garbage removal system. It

actually acts as a security guard protecting access to the blood and

cells. When your food goes through the small intestines and

enterocytes, the next destination is to your liver. That is because the

liver is a security guard and determines if something is harmful or good

for us. It can stop harmful toxins from making it any further into our

8

system. It is the home of phase 1 and phase 2 of liver conjugation for

toxin elimination.

Be good to your liver. Take care of your disposal system. We can

support liver detoxification by helping Phase 1 & 2 conjugation

pathways clear out the toxins. This is done through homeopathic liver,

kidney, and lymph drainage remedies, and medical grade protein drinks

designed for hepatic detoxification (refer to the Done-for–You-

Protocols on liver detoxification.

Phase I: Biotransformation

Enzymes change the biochemical structure of toxins, drugs, etc to many

reactive intermediate metabolites. This part is governed by at least 50

different enzymes. The primary enzyme system is known as the

cytochrome P450 (CP450) monooxygenase system.

These metabolites are usually less active, but they can be even more

toxic than the original toxin. It is important that these metabolites are

processed and excreted. If not, they will accumulate in fatty tissues of

the body rather than in the bloodstream.

Phase II: Conjugation pathways

Through different metabolic pathways, amino acids (glycine,

glutathione, taurine, methionine, cysteine, and glutamine), sulfur,

vitamins, minerals, and other natural substances bind or conjugate to

the metabolites from the phase I enzyme process so that they can be

eliminated. If the nutrients needed to conjugate the toxins are in low

supply, the toxins recirculate as new toxins that are sometimes more

9

toxic than the original substance.

Phase II of the detoxification process involves conjugating or binding

amino acids, sulfur, vitamins, minerals, and other natural substances to

the metabolites or toxins from the phase I enzyme process. It is

through this phase II process that the toxins are then eliminated

through urine and feces.

Phase II conjugation is sluggish if perfumes or scents start to cause

symptoms.

Hormones, natural waste products, medications, and fat-soluble

vitamins are also broken down through the liver detoxification process.

Here are the Phase 1 & 2 Liver detoxification pathways. This is what

happens during conjugation. In phase 1 the liver takes fat-soluble toxins

like metabolic end products, micro-organisms, contaminants, pollution,

insecticides, pesticides, food additives, drugs and alcohol and turns

them into a water soluble form to be eliminated from the body via the

gallbladder, bile and stool or kidneys and urine.

In this slide Phase 1 uses the Cytochrome P450 Enzymes to perform

several pathways of detoxification like: oxidation, reduction, hydrolysis,

hydration, dehalogenation. But it needs specific nutrients to perform

these functions like: Vitamins B2, B3, B6, B12, folic acid, glutathione,

flavonoids. In Phase 2 uses conjugation pathways, sulfation,

glucoronidation, acetylation, amino acid conjugation, and methylation

to turn fat soluble waste into water soluble so it can be eliminated. But

phase 2 needs other specific nutrients to complete this process:

10

methionine, cysteine, magnesium, glutathione, vitamin B5 & B12,

vitamin c, glycine, taurine, glutamine, folic acid and choline. These

nutrients work synergistically, so are best if combined in a

detoxification formula. Refer to your member’s resource section, I give

you several choices.

A Healthy Large Intestine is Key in the elimination phase. The last bit

of digestion happens when whatever is left of your food – mainly

water, bacteria and fiber – enters the large intestine. About 2.5 gallons

of water pass through the large intestine daily. The large intestine or

colon is where your friendly bacteria live. These bacteria help to

produce enzymes, manufacture B vitamins, and protect us from food

poisoning, keeping bad bugs from taking up residence in our

gastrointestinal tract. It is really important to have a healthy amount of

good bacteria populating the colon.

You can keep the good bacteria happy and proliferating by consuming

fermented foods such as yogurt, cottage cheese, sauerkraut, miso,

natto, and fiber. The yogurt should be sugar free and have live

organisms. However, taking probiotic supplements (lactobacillus,

Bifidus, etc.) is a good way to increase these friendly bacteria in your

gut. Each probiotic capsule may contain the equivalent of 15 tubs of

yogurt. So eating yogurt is not sufficient.

Constipation and Diarrhea are two health issues you may experience if

the colon is not working efficiently. Constipation may occur if there isn’t

enough water in the bowel. This may happen when digestion is slowed

down, when you do not consume enough fiber, or if peristalsis is

11

sluggish. Diarrhea can occur if there is too much water in the bowel.

This may happen when food is not digested well. It will move through

the digestive system too quickly without using up enough water during

the digestive process. A low-fiber diet can create either bowel issue.

Refer to the PDF on the Bristol Stool chart, so you understand what a

normal bowel movement should look like. Urinate properly with good

hydration, good water, sweating through exercise or saunas to help the

lymphatics, lungs and skin remove toxins. This is the way the body

takes out the trash. We need good functioning systems to take the

garbage out.

Ways to Improve Bowel Health

• Increase fiber – eat more vegetables & fruit.

• Take fiber supplements or powders (Not psyllium to harsh long

term)

• If constipated take Magnesium Citrate (it rehydrated the bowel) –

too much cause loose stool.

• Don’t strain when going to the bathroom (hemorrhoids may

develop)

• Control stress- stress shuts down digestion.

The kidneys receive 20% of the blood pumped by the heart. Blood

flows to the kidneys. They remove waste and then return the

12

processed, purified blood back to the body. Waste material and water

leave the blood and enter the urinary system. Toxins end up in the

urine.

The Lymph System is a system of vessels. The lymph fluid circulates

throughout the body. It is found in every organ and tissue of the body.

It flows right alongside the blood vessels.

The lymph fluid picks up nutrients, hormones, waste products,

bacteria, and cellular debris. Lymph nodes act as a toxin filter. The

lymph fluid is circulated by physical activity.

Methods of Detoxification:

Respiration: breathing (gas exchange), coughing, sneezing, clearing

mucus

Skin: sweating, sebaceous gland secretion, tears

GI system: liver function, gallbladder, bowel, and intestinal tract

function

Kidneys: acid/alkaline balancing, urination

Circulation and lymph systems: blood flow, lymph circulation, and

immune function

Consider eating like a bird. Many times we can over burden our GI

system by just eating too much. So just eat small, eat often, and maybe

make a general rule of thumb to decrease your calories to around 20%.

Eat with mindfulness, slow down, set your fork down between bites,

savor the flavor, avoid multi-tasking, TV, newspaper, reading emails and

13

just enjoy the food. This way you are less likely to overeat. We

recognize that it’s important to eat when you are hungry, but not when

you are bored, tired, frustrated, sad, mad, or if you see a billboard with

a delicious burger. You want to eat when your body says it’s hungry

because this way it will regulate how many calories to eat.

You want to be sure to eat clean foods, whole foods. We talked about

eating clean foods which come from the earth and not foods

manipulated by man, because those are processed foods, and have

chemicals, artificial flavoring & coloring, or sugar added. So the plant

foods are a wonderful choice. We want them to be minimally

processed whenever possible so you obtain true natural benefits out of

them, ones intended for your body. So think about using veggies,

beans, fruit, and oats, which are better choices. You also want to avoid

those foods that might be triggers for you. Like wheat, gluten, dairy,

soy or known triggers, that you were tested for.

Eat a Mediterranean Diet which is anti-inflammatory. You might have

heard about this. One of the ways you can help yourself is by eating

good fats. Fats are not all bad. Your body needs a certain amount of

good fats to make hormones. You want to prioritize the good fats.

Choose healthy fats found in fish like salmon, flax seeds, chia seeds,

unprocessed olive oil, butter, ghee, and coconut oil. You want to avoid

the bad fats found in most vegetable oils. Avoid trans fats these are the

hydrogenated oils we talked about earlier, avoid margarine. Avoid fried

foods because these are oxidized, highly heated fats. And avoid baked

goods that you know have unnecessary bad fats. Remember the

Mediterranean diet has been proven to have wonderful fats that your

body needs. It also has many plant foods high in minerals or

electrolytes necessary to run your body. Remember humans are

14

electrical beings they need electrolytes like a car needs spark plugs, for

energy.

Manage your meals. Eat a big breakfast…eat breakfast like a king, then

eat lunch like a queen and dinner like a pauper because if you do, you

will notice you will be leaner in your mid-section, you will be trimmer

all around.

You will have more muscle, less fat and more energy if you flip

Breakfast, Lunch and Dinner around. So just think of this picture. The

inverted BLD. You will feel better and your body will thank you if you

eat breakfast like a king, lunch like a queen and dinner like a pauper.

You don’t want to eat a large meal just before bed because the body

detoxifies in the evening. If it’s too busy digesting it will skip

detoxification, and your body will build and store toxins. Remember

Quality, Quantity & Timing are important in order to have true health.

It’s all about eating the right quality and the right quantity of food and

time it appropriately. One of the things many of my patients think

about is that they find it inconvenient to eat breakfast or it’s difficult if

they find out they are allergic to dairy or wheat. Then they’re not sure

what to eat for breakfast. Consider using a protein shake that is picked

personally for you. This way you can have that one meal taken care of.

Breakfast is an important meal of the day and should never be skipped

because it’s important for maintaining body composition which helps

you stay healthy, and necessary for that get up and go and to maintain

healthy blood sugar for the day.

By understanding the web-like connections that affect all body

systems you will be able to accurately:

15

• Assess

• Diagnose

• Prevent

• Reverse many chronic conditions

Reasons why patients go to the doctor in the first place.

By understanding the web-like connections ROOTED IN OUR GUT that

affect our body systems, we begin to understand a new concept.

Which I coined the 4 W’s: WHAT, WHERE, WHEN & WHY.

WHAT: is being affected? WHERE is it coming from? WHEN did it start?

WHY is happening now, what triggered it?

We need to be like forensic detectives putting all the pieces of the

patient’s puzzle together.

As a functional nutritionist I will teach you to look at the whole body.

Why is it necessary to do this, because there are many factors that can

be disrupting your patient’s health? It will be up to you to delve into

your patient’s signs, symptoms, history, genetic background, stress

level, sleep patterns, environmental influences, diet, lifestyle, and

exercise routine, because these all can affect the health of your patient.

But the good news is these can all be adjusted or balanced to help bring

your patient back to the optimal health that they deserve.

Let’s start with “WHAT” is being affected? We need to find out what

the patient’s signs and symptoms are, and what area of the body they

16

perceive is being affected. To get a good understanding of their unique

health status we want to start by utilizing basic assessment and history

intake questionnaires. It is through this process that we can determine

what systems of the body need to be looked at by evaluating our

patient’s key signs and symptoms.

So have ready the “Metabolic Assessment Form” you can download it

from your Members Resource area, as we will go over this in detail.

Then, after having reviewed assessments and history the next step

would be to ask specific questions like “WHERE” is the problem coming

from? “WHEN” did the problems start? “WHY NOW” – so what event

triggered it?”

Here is where we use the “Functional Patient Assessment Chart”

modified from the Functional Medicine Matrix, to determine “WHERE

“WHEN”? “WHY”

So we have to look at external and internal influences. For instance, if

you’ll look at the Functional Patient Assessment Chart, you can

download it from your Members Resource area Lesson 2, and look at

the top left side, we have predisposing factors, pre-existing family

history or genetic or environmental exposures. If we know the clients

family history, that diabetes runs in the family, for instance. This will

give us a clue as to the possibility of them having it. However, just

because they have a family history of diabetes does not mean they will

develop it, not if they eat healthy and exercise. Then we need to know

how stress impacts them. If they are under chronic stress, this can

impact their adrenals and their sleep patterns, causing fatigue or

insomnia. If their cortisol level is too low in the morning they will have

17

fatigue upon arising, if their cortisol is elevated in the evening they

could have insomnia issues. Stress can cause elevated cortisol which is

a fat storage hormone, and can lead to the development of fat around

the mid-section. Then we want to look for triggering events. These are

events that may have triggered their illness. For example a person’s

mother dies and the stress from that event can have a huge impact on

their body, that can trigger the onset an illness. For instance stress like

this can trigger autoimmune diseases like Hashimoto’s. The gene

remains dormant until activated by a stressful event. We also need to

know if they are in any toxic relationships that may be causing any

untold stress, which may lead to the breakdown of any systems in their

body. We need to look at Relaxation/sleep patterns. If they have

fatigue issues, we need to know if they are getting enough sleep. Do

they turn off all devices before bed: phones, tablets, computers, and

the TV? All the white light disrupts sleep patterns, and interferes with

deep REM sleep. Are they able to relax so they can get to sleep? Are

they having difficulty getting to sleep or staying asleep? Are they doing

anything to reduce their stress like exercise, yoga, Tai Chi, meditation,

or prayer? Are they well hydrated, lack of hydration causes

constipation? If they are de-hydrated the body will rob water from the

colon to hydrate the body and unfortunately in doing so, surrounds the

cells with toxic water from the bowel! Ask what kind of supplements or

vitamins are they taking? Are they deficient in anything? This could

contribute to their illness. Do they have any support networks, people

whom they can turn to help them cope or heal? All that I just

mentioned are outside influences that can affect the health of the

body.

18

Now in the middle of the Functional Patient Assessment Chart we have

all internal web-like connections that affect our state of health. This is

where we look at the web-like influences each body system can have

on another. You can see how the gut can impact every system of the

body and why a health gut can reverse or prevent illness.

At the top center will start with environmental inputs, diet, nutrition,

exercise, and trauma and how these can affect the immune system

and affect inflammatory balance which can then affect the

gastrointestinal status. Then the Immune and inflammatory balance

can affect the structural balance of the body. We want to look at

oxidative stress (free radicals), and energy production, how is their

energy level. Do they feel rested upon rising or exhausted? Are they

having difficulty falling asleep? We want to look at detoxification, are

they able to detoxify properly or is their system overloaded with

toxins? Have they been environmentally exposed to any toxic

substance or heavy metals? Adrenal fatigue can impair our ability to

detoxify, so one system affecting the other. Then we need to look at

hormones and neurotransmitters. If they have been exposed to

plastics (endocrine disruptors), these affect the hormones. A build-up

of the bad estrogens can lead to cancer. Are their hormones balanced:

Adrenal, Thyroid, Endocrine hormones and the neurotransmitters for

the brain? Is the brain balanced? Are they having problems focusing,

are they anxious or having anxiety attacks, depression or are they ADD

or ADHD? These are all neurotransmitters affecting the brain. Then we

also want to look at neuro-inflammation of the brain. If the brain is

involved as well as the gut, there is a gut/brain connection which can

affect both brain and gut barriers. If both barrier junctions are open

19

they lead to inflammatory diseases. And inflammation causes many of

the chronic diseases that many people have. So whatever affects the

gut can affect the brain as well. We see this in Autism Spectrum

Disorders (ASD). Then we want to look at the mind, spirit, emotions

and community. Whatever is going on in the mind, their belief

systems, can affect their health. The spirit and emotions can also have a

huge impact on their state of health, and whether or not, they are

connected in their community. Having connections is very powerful,

and provides a sense of well-being and value. I hope by now you can

see how this inter connecting web of internal and external influences

can affect the body on many levels. Each person is unique and thus

should be evaluated individually. This is what is known as personalized

medicine. This is what makes the difference in resolving chronic health

conditions, by getting to the root of the problem.

So let’s start with the Metabolic Assessment Form. This is a down

loadable form that you can provide to your patients. You can utilize the

4 W’s here too. WHAT system or multiple systems of the body are

being affected? Where is it coming from? Is there leaky gut, dysbiosis,

allergies? When did it start, can help you determine what it is. For

instance they took antibiotic, became constipated; now have gas and

bloating. Asking Why it reared its head now can help you pinpoint

exactly what it is and where its coming from. Why now? What event

triggered this condition? For instance why has this 30 year old female

developed a thyroid condition when she never had issues with her

thyroid before, or why does this 50 year old male all of a sudden

develop Type 2 Diabetes? Something triggered it! So we need to know

WHAT we are looking at, WHERE it is affecting the body, When it

20

started and WHY it’s there. Gathering all this information will help us

determine what course of action is required to establish optimal health

such as detoxification, modified dietary changes or lifestyle changes.

Now this course is about the GUT being at the root or bottom of ill-

health, no pun intended. But there are many things that can affect the

gut. So how do we determine if in-fact, it is a gut issue? Well most of

the common health complaints usually involve the gut, so they will be

colon/ large intestine issues or small intestine related.

Now let’s take a look at the Metabolic Assessment Form Category 1

Write next to it “Colon”. These questions are directed at the colon. If

they circle 2’s and 3’s and have more than three circled, there is a good

chance that they have colon issues.

Circle 0, 1, 2 or 3 an so on down the line. 3 being severe

1. So do they have feelings that the bowels do not empty completely?

2. Do they have lower abdominal pain relieved by passing stool or gas?

3. Do they have alternating constipation or diarrhea?

4. Do they have diarrhea?

5. Do they have constipation?

6. Do they have hard dry or small stool?

7. Do they have a coated tongue or “fuzzy” debris on the tongue?

8. Do they pass large amounts of foul smelling gas?

9. Do they have more than 3 bowel movements daily?

10. Do they use laxatives frequently?

If they are circling 2’s and 3’ threes being more severe, and choose 3 or

more of the questions, then the colon most certainly is involved.

21

Now I’ll have you look over on the right of the Metabolic Assessment

Form. Category VII or 7 write “Small Intestine” next to it. These

questions are directed at the small intestine and usually involve SIBO

(small intestinal bacterial overgrowth), digestive issues or motility

issues.

So the first question there is:

1. Abdominal distension after consumption of fiber, starches, and

sugar. Unfortunately if someone has SIBO these foods feed the

bacterial overgrowth and compound the problem.

2. Abdominal distention after consumption of certain probiotic or

natural supplements. Again possibility of SIBO, Certain probiotics can

feed the bad bacteria making them have a bloated abdomen.

3. Lowered gastrointestinal motility, constipation. This is usually

caused from inflammation or lack of enzymes to break down their

food so it sits there causing gas and bloating, or there could be a

hiatal hernia that’s preventing food from passing from the stomach

to the bowel.

4. Raised gastrointestinal motility, diarrhea. Food sensitivity usually

causes this.

5. Alternating diarrhea and constipation. Something is irritating

them. Stress can cause this, or food allergies.

6. Suspicion of nutritional malabsorption. Causes can be from

inflammation, leaky gut, or low digestive enzymes.

22

7. Frequent use of antacids. Acid stomach most frequently is caused

from low digestive enzymes or low stomach acid, not too much

stomach acid.

8. Have you ever been diagnosed with Celiac Disease, Gluten

sensitivity, Irritable Bowel Syndrome, Diverticulosis or Diverticulitis,

or Leaky Gut Syndrome? Yes or no.

So in Category VII or 7 If they are circling 2’s and 3’ and choose 3 or

more then the small intestine is most certainly involved which means

either low digestive enzymes, SIBO, Leaky Gut, or food sensitivities.

If they chose 2’s or 3’s for the first choice or second choice, with

abdominal distension, think SIBO-

Genova Diagnostic laboratory offers a Small Intestines Bacterial

Overgrowth Breath Test (for hydrogen/methane* H>20, M>3

Combo>15). There should NOT be Bacteria in the small intestines. SIBO

is an overgrowth of bacteria in the lower part of the small intestine,

which should be almost sterile. It is where we do our digestion and

absorption. When doing the bacterial breath test a lactulose challenge

drink is swallowed. If not digested by bacteria, it continues to the G.I.

tract. Then, undigested molecules are fermented by bacterial. Bacterial

metabolism produces hydrogen and methane gases. Hydrogen and

methane are absorbed into the bloodstream and carried to the lungs.

Expired air contains elevated levels of hydrogen and methane gasses.

In this Breath Test Report - we’re looking at hydrogen and methane

gases collected over a period of two hours. The timeframe is related to

23

where in the gut the gas is produced. We look for changes in the

baseline from the graph above and you could see the legend on the

right bottom that shows a mild bacterial overgrowth in the small

intestine.

In this second report we see this person has a severe overgrowth

problem.

There are two types of SIBO. People with SIBO Hydrogen tend to have a

fast transit time and loose stools. SIBO Methane hasa slow transit time

and infrequent bowel movements with hard compacted small stools.

Each has its own treatment. I will discuss treatment and diet in Lesson

Three.

SIBO Methane- Slow intestinal motility – have infrequent bowel

movements which tells you they are not breaking down their food and

may need digestive enzymes as well as, Betain hCl with pepsin for

protein digestion. Inflammation can cause swelling of the small

intestine, not allowing food to pass- think gluten or food sensitivity

here.

SIBO Hydrogen - raised motility that means their system is aggravated

by something their eating, this can cause diarrhea - think food

sensitivities or allergies. You might want to do a food sensitivity test in

either case as well as the breath test.

Cyrex Array 10 10/90. They test for:

DAIRY and EGGS Modified

GRAINS Raw and Modified

24

BEANS Modified

NUTS and SEEDS Raw and Modified

VEGETABLES Raw and Modified

FRUIT Raw and Modified

FISH and SEAFOOD Raw and Modified

MEATS Modified

HERBS Raw

SPICES Raw

GUMS

BREWED BEVERAGES and ADDITIVES

There could also be a parasite if there is unrelenting bloating with

diarrhea. I recommend Doctor’s data’s CSAP3 which tests yeast,

bacteria, parasites and digestion as well as for inflammation of the

intestine lining. What sets Doctor’s DataCSA3P apart from Genova’s

CDSAP3 is Doctor’s Data will culture what they find in the way of yeast

and bacteria, against natural substances or medications that will kill the

bacteria or yeast that they find. So for those of you just starting out,

this test is very informative. Let’s look at the top of this page titled

Bacteriology Culture. Notice the commentary listed as Bacteria

Information: this explains the report of findings. Expected /Beneficial

Bacteria. These are the good/friendly bacteria. When you see NG – this

means there is “No Growth”. You then know to give these beneficial

bacteria and that the lack of these friendly bacteria could be causing

some of their problems. These beneficial bacteria have many health

producing effects in the GI tract including: manufacturing vitamins,

fermenting fibers, digesting proteins and carbohydrates, and

propagating anti-tumor and anti-inflammatory factors.

25

Commensal (imbalanced) Flora is the middle column. These bacteria

are neither beneficial nor pathogenic. However, imbalances can occur

when there are insufficient beneficial bacteria and raised levels of

commensal bacteria. Dysbiosis is the far right column and represents

the problematic bacteria when listed. If they found dysbiotic bacteria

they would culture them against prescriptive agents and natural

compounds to determine which is the most effective at combating the

bad bacteria or yeast. Now look in the middle of the report the heading

Yeast Culture. Here is where they culture to see if there is yeast

present. There are none in this area of the report. You will notice there

are normal yeast and dysbiotic yeast columns. There is also a little box

to the left titled Microscopic Yeast –If you see many here this could be

indicative of a yeast overgrowth of the microscopic kind. They will need

to do the Candida diet and supplementation protocol if present.

Parasitology Page – Here you will find out if they have parasites either

worms – macroscopic parasites or microscopic ones. They will provide

pictures of them too.

Digestion/Absorption – Inflammation – Immunology page.

Under Digestion/Absorption you will learn if they are having problems

breaking down specific foods.

Elastase represents pancreatic insufficiency. Low levels have been

indicated in chronic pancreatitis and or cancer. Muscle fibers are an

indicator of incomplete digestion leading to bloating, gas, and feelings if

fullness. Cellulase is enzyme that aids vegetable digestion, having too

many vegetable fibers may indicate not chewing enough, eating on the

run or rapid transit time. High levels of carbohydrates may indicate

carbohydrate malabsorption or sensitivity. Now let’s look at the middle

26

titled Inflammation. These are all inflammatory markers. If any are out

of range you will want to read the commentary to the right. Here

Calprotectin is outside the reference range. Now look at the bottom

blue bar titled Immunology Secretory IGA is secreted by mucosal tissue

and represents the first line of defense of the GI mucosa and is

essential as an immune barrier.

Elevated levels outside the reference range have been associated with

an unregulated immune response. Think food sensitivities or leaky gut.

Now back to the Metabolic Assessment Form look at Category II write

down Intestinal Permeability next to it on the Metabolic Assessment

form. These questions are directed at finding out if they have intestinal

permeability also called leaky gut.

1 increased frequency of food reactions. This tells you there's

something going on with intestinal permeability.

2 unpredictable food reactions. This tells us the tight junctions are

open in the small intestines, allowing undigested food particles to

enter the blood stream, these circulating immune complexes can

now trigger an unpredictable immune response.

3 aches, pains and swelling throughout the body. This is a pretty

good indicator of systemic inflammation, telling us something's

going on with the immune system, think food sensitivities.

4 unpredictable abdominal swelling. This tell us somethings going

on in the small intestines.

5 Frequent bloating and distension after eating. Since it is right after

eating the small intestines is involved and the tight junctions must be

27

open for an immediate reaction to food ingested.

6. Abdominal intolerance to sugar & starches. If there is a reaction

to sugar & starch, think food sensitivities, candida or dysbiosis.

These three categories are the main categories that tell us about the

gut. However, many of the body systems are affected by the gut. You

will understand this after we go through this upcoming case study.

So when someone comes to you with multiple symptoms, how do you

determine where the problem is coming from, if the symptoms cross

over multiple categories in the Metabolic Assessment Form, and

therefore systems of the body?

Let’s review this case study. Cherry a 56 year old female complains of

having abdominal bloating, gas, headaches, constipation, fatigue,

weight gain, foggy headed, poor memory, insomnia, and has aches and

pains throughout her body.

Based on that information alone what systems come to mind:

Colon – constipation, gas, bloat

Intestinal Permeability – aches & pains, abdominal distension

Small intestines- abdominal distention, constipation

Stomach – abdominal distension, constipation

Pancreas – abdominal bloating

Biliary insufficiency – difficulty losing weight

Hepatic detoxification – weight gain, bloating, poor bowel function

Sugar metabolism – fatigue

Adrenal Hypo Function – can’t stay asleep, insomnia, fatigue,

28

headaches

Thyroid Hypo – fatigue, weight gain, constipation, headaches, mental

sluggishness

The symptoms she gave us are too vague to make a diagnosis at this

point. So this is where you as a Functional Nutritionist rise to the

occasion and can make a difference. Because when you start asking

specific questions they help pinpoint the root of the problem. By asking

specific questions you will begin to understand where to start, if they

need further testing, what specialty laboratory test to use to verify your

suspicions, and what nutritional support or Dietary and Lifestyle

modifications might help the situation at hand.

Now look at the top of the Metabolic Assessment Form

Part 1 where it says: Please list your 5 major health concerns in order

of importance.

You want to make sure they have filled this out. If they haven’t you

need to ask them what are their 5 major health concerns.

So she tells us her 5 major health concerns are:

1. Abdominal bloating, gas

2. Constipation

3. Fatigue

4. Insomnia

5. Weight gain

29

Here is where you focus on her first major complaint. If you do not

address her 5 major complaints and help her resolve them, she will

never come back to you, number 1, and number 2, if you do not

address her major complaints straight away, you are doing her a dis-

service, because she has put her trust in you to help her with these

major complaints.

So her first major complaint is abdominal bloating. Only a few things

cause this:

- Lack of digestive enzymes

- Low stomach acid

- Candida , dysbiosis,

- Parasites

- SIBO

- Food sensitivities/allergies

- Biofilms

You need to ask her these questions to determine which one causing

her complaint:

When did it start? How long have you had this? She may answer in

any number of ways but her answer should direct you to the next

question, or to take the next step.

If she doesn’t know, you might ask her these questions:

Do you feel like your food just sits there hours after eating it? If

Yes, think low digestive enzymes. This is an easy fix, recommend a

good digestive enzyme mix that includes enzymes for all food

30

groups:

Amylase – for starch, lipase- for fats, cellulase – for vegetables,

sucrase – for sugars, protease – for protein as well as betain hCl

with pepsin - for protein. And follow the Diet For A Healthy Gut ,

provided for you in the Members Resource section.

There are a lot of digestive enzyme products on the market I like

Digestin by Progressive Laboratories. It is a 2 phase enzyme formula

that has pancreatic enzymes and stomach enzymes. So it helps the

small intestine and the stomach breakdown food for improved

absorption. It’s important to give digestive enzymes if a food allergy

or sensitivity is presenting. By breaking down food into smaller

molecules, the immune system is less likely to react to it.

Do certain foods cause the bloating? If yes think food

allergies/sensitivities, recommend the Cyrex Array 10 Food Sensitivity

Test. If No ask

Do you feel worse after eating sweets or carbs? If yes ask Did you

take antibiotics about the time it started? Then ask her if she craves

sweets or carbs. If yes, she might have a Candida yeast overgrowth –

have her take the Candida Questionnaire, provided for you in the

Members Resource section. If she rates high direct her to take the

stool test Doctor’s data’s CSA because it checks for Candida and other

yeast overgrowths as well as bacterial overgrowths and cultures the

yeast against natural anti-fungal’s and prescriptive anti-fungal’s so you

know what to give her that will be the most effective. It also checks for

good bacteria or lack thereof and checks for deficiencies of digestive

31

enzymes and inflammation of the intestinal lining. If yeast are present,

follow the Candida Protocol provided for you in the Members

Resource section, will be discussing this later in Lesson Now a serious

4+ candida infection can take 6 month to get under control and

requires a Candida diet along with supplements to knock it back and

heal the gut wall.

If a person has Candida or yeast overgrowth they will have Leaky Gut.

Before going on a Candida elimination Program you have to clear the

liver first, because the die off can cause herximer reactions, because a

clogged liver can’t handle the die off, so the toxins spill over into the

blood stream causing toxic side effects like: headaches, fatigue, joint

pain or rashes. Trust me you want to clear the liver first so they don’t

suffer. Then attack the candida, replace the good bacteria and heal the

gut wall.

Follow the 5 R Gut Restoration Program provided for you in the

Members Resource section.

Ask Do you have unrelenting gas & bloating no matter what? Have

you been out of the country, or did you go swimming in a lake, pond

or river around the time it started? If yes, she may have a microscopic

parasite. Direct her to take Doctor’s data’s CSAP3 test. It checks

everything the CSA test does, with the addition of three additional

parasite tests for micro and macro parasites. The results will reveal

everything about the large intestines. But there are three more

categories’ that fit abdominal bloating.

Category II - Intestinal Barrier – check for Leaky Gut. Cyrex labs offers

32

Array 2 Intestinal Permeability Profile. It’s the most accurate of all labs

out there. If positive follow the Apex Repair & Clear Program provided

for you in the Members Resource section.

Think SIBO (Small Intestines Bacterial Overgrowth) – go back and look

at Category VII or 7 Small Intestines. If a person does not tolerate

probiotics, prebiotics, galactans, sugars, or fiber, they may have SIBO.

This is serious upper abdominal distension no matter what they eat. If

left unchecked, the altered environment of the small intestines can

affect the absorption of essential nutrients, such as fats and proteins.

Recommend the Small Intestines Bacterial Overgrowth Breath Test by

Genova Diagnostics. If positive they MUST follow the SIBO diet. I like

the Small Intestinal Microbial Environment Dietary and Nutritional

Guide by Apex Energetics. It is a cut and dry guide of foods to avoid,

recommended foods, supplements to avoid and recommended

supplements that are supportive. It also recommends exercises to

increase digestive motility. Exercises like gargling with several glasses of

water throughout the day to activate the vagal motor nuclei by utilizing

the palate muscles, gargling aggressively to induce tearing, or induce

repeated gag reflexes by gently pressing down on the tongue with a

tongue depressor. They also recommend performing coffee enemas

(with organic enema coffee- see Members Resources for where to get

this), to induce activation of enteric motility and to hold the enema

contents for as long as possible to activate the brain-gut axis. Will go

over diets more in Lesson Three –Food as Medicine Course, which is

the next part of your program.

One of those 7 areas should uncover the cause of her abdominal

33

discomfort. Start with the easy stuff like digestive enzymes and

probiotics and rule out as you progress down the list.

Constipation can also cause abdominal distension and gas. We need to

find out why she is constipated. What is her diet like? Does she eat

bread, hard cheese, nuts or nut butters or protein bars? These foods

can cause constipation. Is she drinking enough water? Has she tried

fiber and probiotics? Is this problem chronic or acute? If acute, has she

recently had antibiotics? Antibiotics destroy good and bad bacteria

alike. The good bacteria create a mucilaginous slippery substance that

helps the stool slide along. Without this, the stool becomes very sticky

and can’t move through the bowel like it should. Recommend a colonic

with a probiotic infusion at the end and a round of probiotics along

with a fiber supplement that combines soluble and insoluble fiber. I

like Orthomolecular’s Fiber Plus and Ortho Biotic. Also recommend the

Diet For A Healthy Colon, provided for you in the Members Resource

section. They should have a healthy bowel movement within 3 days.

These are gentle yet very effective protocols without having to use

harsh laxatives.

If this does not solve the problem there could be something more

serious going on. Ask if there is any pain or tenderness in the bowel

area or the low back. If low back pain they might be experiencing a

diverticulitis attack. The kidneys are in the low back. When there is a

bacterial infection in the pockets if the diverticula this can cause severe

inflammation of the large bowel and pain in the back because the

kidneys become overwhelmed with toxins. If there is pain and

tenderness in the area of the large intestine even after a successful

34

colonic, (meaning they emptied their colon) there could be a mass or

scar tissue choking off the colon. You need to ask how long it has been

since they had a bowel movement. Have they seen blood in their

stool? If yes refer them to a Gastroenterologist, to be on the safe side!

When there is chronic constipation, a diet with poor food choices, and

lack of water, all contribute to this problem. Recommend a series of 6

colonics done once a week for 6 weeks and be sure during this time

they are taking fiber and probiotics, drinking 2 quarts of water daily and

eliminating constipating foods such as, bread, pastas, gluten, dairy,

nuts, nut butters, or foods that cause gas like: dairy, broccoli, cabbage,

cauliflower, garlic, and onions.

More likely there is inflammation due to wheat/gluten sensitivity.

Gluten inflames both the small and large intestine making it difficult to

have a bowel movement.

You might after all this recommend the Cyrex Array 3 Gluten

Autoimmunity test, to see if gluten is the culprit.

If left unchecked gluten can trigger autoimmune diseases like

Hashimoto’s Autoimmune Thyroiditis. Through molecular mimicry,

gluten has strands of protein peptides that resemble the thyroid.

So the immune system mistakenly attacks the thyroid causing an

autoimmune condition!

35

Once an autoimmune condition is triggered you can never reverse it.

You can only manage it by keeping down the inflammation. Also, once

you have one autoimmune condition, you can have multiple ones

because the circulating immune complexes in your blood stream are

carried to various parts of the body. They not only breach the gut

barrier, but can breach the blood brain barrier, causing

neuroautoimmunity. I spoke about this in great detail in lesson one.

Lastly, if a person has severe unrelenting abdominal distension with

hard dry pebble-like stools and gas – think SIBO Methane. Here they

have a slow transit time and infrequent bowel movements with hard

compacted small stools. So again Genova’s breath test – “Bacterial

Overgrowth of The Small Intestine.”

Gosh that only covers abdominal distension, gas and constipation.

What about the other Major complaints like fatigue, weight gain and

insomnia? Those will be covered in the Mastering Functional Nutrition

Lessons.

For a comprehensive and personalized treatment program, each person

must be individually evaluated to determine the cause of their health

issue. Like a forensic detective you will begin to gather all this

information and use it to pinpoint the key categories of the body that

indicate specifically those areas that need to be addressed.

Remember to test don’t guess

Getting back to the 5 key symptoms of the Metabolic Assessment Form

36

- Her last one was weight gain. In Lesson 4 we will cover this – You will

be given a Bonus “The Six Hidden Weight Gain Factors.

Now in the next lesson, Lesson 3 you’ll be given several bonuses:

Bonus 1 - The 4-Step Plan to Heal Leaky Gut Syndrome, with 6 Healing

Foods & Supplements

Bonus 2 – The Autoimmune Paleo Diet – for reducing inflammation

Bonus 3 – The Mind Diet – Reversing Alzheimer’s and Neuro-

inflammation that contributes to ADD, ADHD, Autism Spectrum

Disorders, anxiety and depression.

Bonus 4 – How to make fermented vegetables.

Bonus 5 – How to make healing bone broth

We’ll see you there.