WSHC Diamond Coaching Retreat

Fall 2015

Clinical Case X

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Optimal Health is Not Complicated

Maximize Put in what’s needed for this unique person Raw materials your body needs to function and heal Oxygen, Water, Vitamins, Minerals, Antioxidants, Protein, Healthy Fats

Minimize Take out what’s harmful for this unique person Toxins, Infections, Allergens, and Stress/Trauma

Prioritize Create an environment for healing for this unique person Sleep, Rest, Laughter, Stress Reduction Exercise, Stretching, BreathingMeaningful Relationships

And then the body will heal itself – will naturally seek wellness.

Simplifying the face of

health can be calming and inspiring to your clients.

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Meet Julie

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Case Study: Julie

Age 54, Happily Married, 5'10”, 175 lbs. Massage therapist. Devoted athlete. Primary Concerns:

“Want to maximize fitness for my soccer passion.”“I want to get rid of this gut!” Want to be under 160 lbs...just can't seem to do it.

Health history HighlightsJust recently hit menopause. Hot flashes. Sleeps well. Only few minor symptoms: throat irritation, congestion, belchingTwo childrenTwo silver fillingsLived/traveled in several places internationally; two years in Africa. Near-fatal head injury (17 y/o) Appendectomy (19 y/o)Chx home around many coal power stations and surrounded by conventional orchardsFHx of cancer (mother died of pancreatic cancer)

Meds/Suplmts: None.

What are you thinking? What interconnectedness do you see?

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Delicious Data

Fasting glucose 96 mg/dl Alkaline Phosphatase 39 U/L Albumin 4.2 g/dl Globulin 3.2 g/dl (TRR: 1.9 – 3.7) TSH 3.6 mIU/L Bilirubin 1.5 mg/dl WBC 3.8 K/ul Neutrophils 25.6% Lymphocytes 59.8% Vitamin D 33 ng/ml

Rev. 1 of Julie's map is prior to her initial consultation.What are you thinking now?

What interconnectedness do you see?

Why You Ask for Labwork Before the Initial Consultation!

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Client Follow-Up: Spelling it Out!

Your fasting glucose (being >90 mg/dl) is likely indicative of some level of insulin resistance. Even small elevations in this can promote body fat gain, especially in the belly area. 

Your TSH is also well above the threshold likely indicative of some hypothyroid function, of which increased body fat and reduced metabolism are common, coincident symptoms.  A comprehensive thyroid panel will assess this function. 

You need to ensure adequate Vitamin D levels year-long to balance your immune system and reduce the risk of autoimmune activation.   

The adrenal's primary stress hormone, cortisol, has a mediating effect on how thyroid hormone is utilized by cells. Specifically high or low cortisol secretions can be an inhibitor.  

It is common in our modern society for peri- and menopausal women to suffer from "estrogen dominance" which will promote weight gain.  Estrogen-mimicking chemicals are likely involved.  

Estrogen dominance may involve suboptimal progesterone rather than excessive estrogen, though both may be involved as adipose tissue ("fat cells") continues to produce estrogen after menopause.  

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Labwork I Recommended

RBC Magnesium (not serum) 

RBC Zinc (if available, serum is useful as a 2nd choice)

Full thyroid panel - to include specifically both Free T4, both Total and Free T3, and both common thyroid autoantibodies Tg and TPO (given your family history of autoimmune disease)

HbA1c 

Fasting insulin

Combined salivary adrenal/sex hormone panel (four-sample) 

My notes: Possible future Stool and/or Food sensitivity testing

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Pulling the Possibilities All Together

● Estrogen dominance; Low progesterone from cortisol steal ● Insulin resistance (high fasting glucose, belly fat)● Poor thyroid function due to low cortisol (mid-range TSH, weight● Poor T4 to T3 thyroid hormone conversion (low zinc)● Low stomach acid (low albumin, belching)● Low zinc (low alk phos)● Low magnesium (insulin resistance)● Toxicity from mercury fillings (low WBC, broken tooth)● Toxicity from childhood (brother's AI disease, mother's early death)

Now add the influence of her initial data (Rev. 2 includes labwork from MD visit 3 mos prior to our HH).

What interconnectedness do you see?

Recommended low-glycemic breakfast Eliminating wheat No skipped meals. Apple cider vinegar to boost stomach acid during meals. Move larger meal to lunch. Don't eat large dinner late at night post-workout.

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Chronic Adrenal Cortisol Over-Secretion

● Emotional stress (e.g. job performance or pressure, family dynamics, finance issues, peer approval, Grudges, resentment, living in the past, Preoccupation with what is missing, need to acquire more, never having “enough” of something/anything)

● But also Physical Stress in the form of chronic...Infections, Toxins (including overuse of medications), Poor detoxification ability (toxin tissue storage e.g. mercury, lead), Allergen exposure (also includes food sensitivities), Insufficient sleep, Overuse of stimulants (e.g. caffeine, sugar,...), Too much exercise (or ongoing physical trauma)

● Intended for short-term crisis support, not longer team “lifestyle” maintenance.

Elevated Cortisol (Hyperadrenal Activity)

Depressed Cortisol (Hypoadrenal Activity)

Hypervigilant Overly alert, perhaps paranoid,

doom'n'gloom preoccupation Insomnia (racing mind) Hypertension Racing heart Poor digestion Diarrhea/Constipation Depressed immune system (may get sick

easily) Anxiety (often along with Depression) “Wired and Tired”

Exhaustion Eventually: Debilitating fatigue (not

recoverable with short-term increase in sleep)

Lethargy, Malaise Depression Orthostatic Hypotension Low motivation

WS Tip: Thyroid medication will make ther person have hyperthyroid-like

symptoms (e.g. racing heart, anxiety). The adrenal gland is not strong enough to

regulate the thyroid, resulting in greater secretion of adrenaline and unbalanced

conversion of T4 to T3.

Symptoms of Adrenal Extremes

Unabated Stress

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Case X

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Pulling the Possibilities All Together

● Estrogen dominance; Low progesterone from cortisol steal. Yes!● Insulin resistance (high fasting glucose, belly fat) . Yes!● Poor thyroid function due to low cortisol (mid-range TSH, weight).

Autoimmune, Hashimoto's Yes!● Poor T4 to T3 thyroid hormone conversion (low zinc). ● Low stomach acid (low albumin, belching). ● Low zinc (low alk phos). Yes!● Low magnesium (insulin resistance). Yes!● Toxicity from mercury fillings (low WBC, broken tooth)● Toxicity from childhood (brother's AI disease, mother's early death)

Now add the influence of her initial data (Rev. 2 includes labwork from MD visit 3 mos prior to our HH).

What interconnectedness do you see?

Added Gaia Energy Vitality to boost cortisol function. Eventually upped to Pure Encapsulations Adrenal (adrenal cortex). And then Pure Encapsulations ADR.

Vitamin D, Zinc, Magnesium, Slippery Elm Probiotic with S. Boulardi Progesterone Cream Talk with physician about natural thyroid extract

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Common AI Triggers Often Begin in the Gut

Pathogenic microbes (e.g. parasite, bacteria, yeast)– Perhaps compounded by toxins secreted by the microbes

Dysbiosis (an imbalance in indigenous, human gut bacteria OR species of bacteria in the wrong place in the gut)

Food Sensitivities (that looks a little too much like a toxin, allergen, or foreign invader, especially if digestion is poor e.g. GMO foods including 90+% of non-organic soy and corn grow in the US)

Toxins (e.g. pesticides, Red #40, birth control pills, artificial sweeteners, toothpaste, mercury, alcohol)

Intestinal Permeability (e.g. Gluten, low Vitamin D, or any of the above) Poor Nutrient absorption (e.g. zinc, copper, B12, Folate, Vitamin D3) Imbalanced Immune system (e.g. low cortisol, low predominant bacteria,

history of repeated or long-term antibiotic use)

Stress and mental-emotional dis-ease are also critical. Self-rejection in the body can be a mirror of self-rejection in the mind or heart.

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Sometimes you are surprised! Eliminated dairy- and gluten-containing

foods 100% due to autoimmune activation

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* http://www.nature.com/nrendo/journal/v11/n10/abs/nrendo.2015.128.html ** http://diabetes.diabetesjournals.org/content/58/7/1509.full

● “ Furthermore, we also summarize the increasing evidence for a potential role of SCFA as metabolic targets to prevent and counteract obesity and its associated disorders in glucose metabolism and insulin resistance.” *

● “Butyrate Improves Insulin Sensitivity and Increases Energy Expenditure” **

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Dysbiosis and overall low endemic bacteria

“No pathogenic bacteria”???

Supported fab digestion with Enzymedica LypoGold digestive enzymes

Two months of GI Revive (glutamine, mucilaginous herbs)

Two probiotics: Metagenics Acute Care (S. Boulardi) and Ultimate Flora Critical Colon (high-bifido)

No antimicrobials.

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We started Metagenics Advaclear at the very beginning – given weight loss goals! Xymogen MedCaps DPO to boost methylation (B6, B9, B12, TMG) – Homocysteine was 15 umol/L Two months of background detoxification with Advaclear and UltraClear Renew. Then a cleanse.

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Liver detoxification pathways and supportive nutrients

Urine, Stool, Sweat,

Exhalation

Folate (Vit B9)

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Initial 3 months: less inflamed, fewer aches'n'pains, smaller in size, but “the scale just isn't budging”

No progress getting support with medication. Added additional thyroid support. Iodine for use on days when swimming in community pool.

After 6 mos, local functional medicine MD prescribed Armour thyroid (Yay!) Weight only (slowly!) started to come off after starting detoxification focus Much “primary food” processing in regard to empty nest from children leaving

home (and changing their roles), rediscovering connection with husband. HbA1c from 5.6% to 5.2% Autoimmune activation – TPO autoantibodies

– 124 (Aug. 2014)

– 97 (Feb. 2015)

– 68 (July 2015)

– On her way to being “un” autoimmune!?!?

Wildly Satisfied Julie

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All Things are Interconnected

Oxygen Intake and Spiritual Mindset

Stress and Stress Management

Toxins and Detoxification Ability

Sensitivities and Allergies and Immune Health

Energy Generation and Circulation

Nourishment and Absorption Ability

Genetic Predispositions and Infections

28HC Practice Pearls

Never agree to an HH without receiving the form ahead of time and, ideally, labwork also (I ask for the past two years).

Figure out the puzzle pieces. Keep revising it as you learn. Get the “big picture” organized and keep it in front of you every time you prepare to meet with a client.

Set client expectations emphatically, right from the beginning, especially about weight loss (which is usually one of the very last symptoms of inflammation or imbalance to resolve dramatically). Often inches will be lost with or without significant (but often before) weight.

Prioritize getting your client some relief as soon as possible. My top 3 choices are usually constipation, sleep, or headache. Then get to work as upstream as possible, supporting short-term needs and symptom relief as necessary.

Toxicity can often be the true root cause of an incredible array of dysfunction, imbalance, and inflammation.

Disease does usually begin in the gut.

Internal stress and resistance can also be the #1 trigger for a tremendous cascade of downstream illness. Focus on it early in your work with your clients – just not the first session.

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Helping the Whole Person

The patient is one, whole, single, unique person!

Body, Mind, Spirit

Everything is interconnected. Everything.

Think creatively about what you cannot see. What isn't obvious? What might be hidden? Ask and Listen Carefully.

Take care of yourself. You are likely the only person in ther client's healthcare world who can and will give them ther level of attention and inquiry. Your wellness in many ways will help to determine theirs.

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Thank you!