Notes from my Functional Medicine visit

[cdamaden]

All,
I had my first visit with my functional medicine doctor (FMD) after receiving my lab results. We met for just over an hour . The first two issues we're going to tackle are elevated metals and h. pylori. My metals testing results from Quicksilver are posted as an attachment (I believe the percentiles are population percentiles) :

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It's not clear the source of metals but she suspects part of the problem is a reduced ability to clear them (may or may not be APOE4 related). Right now the working theory is that the arsenic is from sardines and the mercury from filling and seafood.

Focus areas are on arsenic and mercury along with other troublemakers such as lead. She wants me to have my amalgam fillings removed/replaced and will start me on a protocol that will ramp up over time to help my body clear these metals. She believes that my liver is bogged down (infected, inflamed, ??) and needs some help. Other indicators of this are (from LabCorp and Dutch Comp Hormone):
-elevated Sex Hormone Binding Globulin (SHBG) at 89.6 nmol/L (was 47.1 in March 2015), which obviously impacts my free testosterone
-aspartate aminotransferase (AST) higher than desired at 36 IU/L (was 20 in March 2015)
-alanine aminotransferase (ALT) higher than desired at 39 IU/L (was also 20 in March 2015)
-high 2-hydroxyestrone (2-OH-E1)
-possible contributor of high Uron Bind. Cap of 219 ug/dL
-perhaps others I didn't catch
She indicated that the metal reduction will take about 6 months. She is hopeful that clearing the metals will help with brain fog although warned me that the treatment will likely make it worse before it gets better.

She said that iron is a serious concern but my levels were not too elevated and directed me to donate blood 1-2 x a year.

Next is helicobacter pylori. This was detected on a BioHealth Laboratory GI test. The plan here is to start an herbal protocol for 60 days, retest, and evaluate. The h. pylori could be impacting:
-reflux
-gut lining health (food sensitivities)
-elevated fasting blood glucose levels

Other issues discussed but tabled until these two issues are resolved:
-low 5a-Androstanediol (hormone in the testosterone cycle)
-malabsorption of nutrients per the VCS test, possible CIRS connection
-low cortisol with a bump above band in the afternoon
-SIBO - testing showed a pop-up at 80 minutes, which could be normal for me
-Gut's Bacteria Culture - not very robust but no bad actors

Diet changes:
Arsenic may be due to my sardines (2-3x a week), so she suggested Vital Choice brand and lower to 1-2x per week
Fish - eat SMASH = salmon, mackerel, anchovies, sardines, and herring. 2-3x per week for reduced mercury exposure. Absolutely no tuna.
She'd like to drive down my LDL-P (~1300) so we're going to reduce my saturated fat some more. Drop the coconut oil (she said some patients add back in coconut oil and have no changes in lipids, others do), add in macadamia oil and keep using the high polyphenol olive oil and avocado oil. She was onboard with my 1 pound of liverwurst, beef head cheese, or braunschweiger per week but limit other red meats.
She said to keep my current protein level of about 120 grams per day to maintain muscle mass (I weigh 170 with 5-10% body fat), and to substitute in chicken/turkey/duck for my reduction in seafood.
Eggs are OK (although I need to retest to see if egg whites cause me mild skin rashes still)
She was onboard with my mildly ketogenic diet (20% protein, 20% carbs, 60% fat)

Supplements:
Don't have full list yet, but she said it would be long . She had me discontinue:
-Kirkland Vitamin C
-Now brand Omega-3 (will substitute with cod liver oil)
-ONE multivitamin (will substitute with a COQ10 supplement and others)
-Magnesium oxide based supplement, shift to magnesium glycinate
-My multitude of vitamin B supplements, shift to B Supreme
-Resveratrol, not convinced yet and didn't know brand
-My gut-healing supplements of glutamine, licorice, and mastic gum. She has another combined supplement.
She said I could continue with my curcumin (I'm using super bio-curcumin)
She said I could continue with 4,000 IU/day vitamin D (kirkland) and vitamin K (jarrow mk-7)

Lastly, she suggested that I join a group on the internet call APOE4.info. Anybody know anything about them?

Happy to share more - send along any questions.
Chris

[hill dweller]

Thanks, Chris. Curious -- what has this cost you so far? Of course, your health is invaluable, but we aren't made of money . . . I backed out of functional med over the price. May reconsider.

[Julie G]

What a productive visit, Chris! You're very lucky to be aware of your high levels of toxic metals so that you can begin addressing them. Did you just do the blood testing via QuickSilver or the entire TriTest? Out of curiosity, have you been advised to consider removal of your mercury amalgams?

FWIW, H.pylori was also found to be an issue for me. My mainstream internist ran a blood test at one point which was negative despite the fact that I was quite symptomatic. I was stunned to learn that definitive testing had to be done via stool. My FMP also encouraged my husband to get tested as some evidence suggests partners can transmit the virus. That may be something for you to consider. As you're probably aware, emerging research suggests H.pylori is associated with a decreased ability to clear abeta which in turn triggers neuroinflammation which is already an issue for our genotype. Catching and treating this now may be very timely. Kudos on identifying and treating possible contributors for you. By sharing your experience, you're teaching us all. Thank you.

Yesterday, I read an article describing the dismal state of affairs with regards to an Alzheimer's cure entitled: Billions spent, but Alzheimer's cure elusive Pharma currently has a 99% failure rate and many recent set-backs. The “successes,” as we all know, do nothing to treat disease progression, but rather alleviate symptoms for a brief time. I found it very telling that Laurie Ryan, chief of NIH's Dementias of Aging Branch concluded:

The answer to Alzheimer's is not going to be one “magic bullet,” but an array of solutions tailored to different patients.

...which is exactly what you've found, Chris. My wish is that level of knowledge and care was available for everyone. I'm seeing a doctor in the same practice and have made huge strides in my health optimization because my treatment is so targeted and data driven.

Dr. Bredesen's goal is to make this level of care widely available and less and less expensive as it continues to roll out. By partnering with the Institute for Functional Medicine, more and more physicians are being trained. Around 250 are signed up for the March physician training. The need is tremendous.

[cdamaden]

Hill --- I think the estimates provided at their website are about right:
Initial Consult: $245. Includes the 30-minute phone/Chiron appointment, Dietary Guidelines and Case Review preparation.
Case Review: $995. Includes the Report of Findings and a 75-minute in-person consultation.
Regular Follow-ups: $200 for 30 minutes, $300 for 45 minutes and $400 for 60 minutes.
Laboratory Tests
The fee for laboratory tests ordered during the case review process is typically $600–$1,500 depending on complexity of condition and level of diagnostics required. The cost of some testing includes an administration and interpretation fee.
Supplements
The fee for supplements that are prescribed as part of your treatment plan after the Case Review is typically $150–$300. You will have the opportunity to approve or decline the supplements suggested before you are charged for them (after the Case Review Consultation).
Grand Total of Case Review Fees
The total you should expect to pay for the entire Case Review process is roughly $1,750–$3,700.
Estimated Costs for Laboratory Tests for Ongoing Treatment
Ongoing lab fees vary considerably depending on the patient and treatment plan, but average approximately $200–400/month.
Estimated Costs for Supplements for Ongoing Treatment
Ongoing supplement fees vary considerably depending on the patient and treatment plan, but average approximately $150–$350/month.

I have really inflexible health insurance but am trying to make whatever claims I can. They are paying for some of the testing. I will also use my Flexible Spending Account too.
I would like to add that this is my second functional medicine doctor, so I've gone through these costs before. Keep in mind some FMDs see the world through their specialty. That first FMD focused on a SIBO diagnosis but the treatment never really resolved anything and it took about 9 months of treatment and testing to figure that out. Although this sound really odd, I was quite pleased that this second FMD's test found the high metals, h. pylori, and the other issues. Now let's see if the protocols 1) improve the test results and 2) make me feel better (in brief, cognition and gut).

Julie --- Yes, it was a great visit. Just quicksilver but I was told there would be further testing. Yes, I will be pursuing getting my old amalgams removed.
For h. pylori, I was previously screened negative and so asked about why these results were different. She said that they've experimented with several different lab companies before settling on this one (stool test) because it best correlated results with patient symptoms, i.e., some of the labs didn't catch the h. pylori.

Chris

[hill dweller]

Thanks, Chris

[circular]

Good job Chris. I'm guessing you are lower carb and don't eat rice? I think some rice has arsenic. This is the first I've heard of it in sardines Good to know a brand that might be trustworthy. Thanks.

I also tested high mercury last spring. I was eating 1-2 servings of either salmon, shrimp, scallops, sardines, anchovies or cod a day and it was between 7 and 8. I cut back a lot, down to seafood maybe 2-3x/wk. My mercury just tested half what it was, so I hope that's encouraging to you. My doc just told me to limit seafood to 1x/wk to further reduce the mercury I'm wondering if I add a chelator if I can stick to 2-3x/wk and still get the mercury down. I'll start with more parsley and cilantro which I haven't focused on for a while, but may need to also start taking the modified citrus pectin Dr. Gundry told me to take over a year ago. I tried it twice and had headaches but will give it the due diligence third try and rule in or out that the headaches were coincidental.

[circular]

Hmmm, this unfavorable commentary from 2008 criticizes three studies used to support modified citrus pectin for chelating heavy metals. A PubMed search is warranted as usual ...

[cdamaden]

Hi Circular - thank you for sharing your experience. My rice has been limited to 1-2x month sushi, so that's clearly not the cause. I've seen a few studies on arsenic in sardines:
https://www.ncbi.nlm.nih.gov/pubmed/20934728

To be very honest, I'm not 100% sold on the high arsenic and mercury. Yes, I can read the results but this approach is outside mainstream medicine. I suspect that the protocol will lower these measurements, but I'm not quite sure that they are directly linked to health outcomes. That said, I'm still moving forward because if nothing else resolving "high" metals will allow us to address the other issues (or perhaps resolve the other issues).

I did get a copy of my long list of supplements - will spend some time this weekend to sort it all out, so I don't have any immediate claims to knowledge on chelating agents (I do recall that the doctor hesitating to call them chelating agents, instead saying they weren't quite that harsh or immediate).

The sardines I've been eating are Wild Planet, Wild Sardines in extra virgin olive oil with lemon. The fish are caught in the Pacific Ocean and packed in Vietnam. All that I've read says this brand is good. I also eat Crown Prince Smoked Oysters in pure olive oil (S. Korea) and Smoked Baby Clams in olive oil (China). According to the Monterey Bay Aquarium Seafood Watch, these also look like good choices. According to a summary of a Dartmouth study:
"Dark-meat fish Inorganic forms of arsenic were 7.4% higher in people eating dark-meat fish (tuna, mackerel, salmon, sardines, bluefish, and swordfish) once a week, compared to people who ate them less than once a month. Organic arsenic exists naturally in seawater, and while organic arsenic is believed to be relatively safe, this research suggests it might not be as harmless as scientists think. Since all seafood tends to be high in arsenic, Dr. Cottingham says, make it an occasional meal." I need to follow up and read the original report.

[circular]

Thanks for that additional background Chris!

[philking]

Chris,
Fascinating and thanks for sharing.
I have a question which Juliegee will have to respond to and that is from the Bredesen conference, I got that the E4 gene is more protective from the metals than is 3/3. I don't believe a reason was given for this or if I got this wrong.
Thanks,
Phil