Microsoft word - module objectives

University of South Florida
Metabolic and Nutritional Medicine Module I: A Metabolic, Anti-Aging and Functional
Approach to Endocrinology
Upon completion of this module, the doctor will:
Recognize the hormonal changes that women and men manifest with aging Discuss the functions of estrogen, progesterone, testosterone, and DHEA in the body Know the structure of the sex hormones and their metabolism Understand the intricate web that the hormones are in the body Discuss the risks and benefits of estrogen, progesterone, testosterone, DHEA,pregnenolone and melatonin Know the symptoms of estrogen, progesterone, testosterone, and DHEA loss Learn the symptoms of estrogen, progesterone, testosterone, and DHEA excess Understand the differences between synthetic and bio-identical hormones Review the literature on synthetic, bio-identical hormone replacement Understand the adrenal system and its affects on other sex hormones and hormonereplacement Initiate or suggest hormone replacement treatment Understand reasons bio-identical hormone replacement should be considered Monitor treatment, adjust dosages, alleviate side effects of BHRT Recognize the clinical manifestations of hypothyroidism Know the factors that cause decreased production of T4, affect 5’diodinaseproduction, cause an inability to convert T4 to T3, and causes associated withdecreased T3 or increased reverse T3 Learn factors that increase the conversion of T4 to T3 Understand the crucial role that iodine has in the function of the thyroid gland Prescribe or suggest treatment for hormone replacement including compoundedthyroid medications Review of the key signs and symptoms of adrenal fatigue Know the physical examination findings present in adrenal fatigue Learn the laboratory test that aid in the diagnosis of adrenal fatigue Discuss the Women’s Health Initiative findings and its clinical implications Understand the limitations of serum testing for steroid hormone levels and FSH Understand the importance of measuring tissue level of hormones, in diagnosinghormonal imbalances and in monitoring bio-identical hormone replacement Understand the impact of stress on the body Understand the physiology of the stress response Learn what tests best measures the physiologic response to stress Understand how to identify and treat adrenal dysfunction Understand how stress effects the cardiovascular system, insulin resistance, immunedysfunction, neurotransmitter balance, hormone balance, and thyroid function Review information on safe and effective therapies to correct adrenal dysfunction Discuss innovative testing that identifies thyroid dysfunction when TSH is normal Differentiate between progesterone and synthetic progestins relating to structure,pharmacologic actions and risks Explain the literature concerning the risk of breast cancer as it relates to differencesin progesterone and synthetic progestins Explain research and clinical studies suggesting that progesterone therapy protectsagainst breast cancer Discuss the advantages and disadvantages of testing hormone levels in differentbody fluids Discuss the methodology of scientific support for, and the differences in saliva, urineand blood testing of hormones Present scientific and clinical studies that suggest conventional venipuncture serumtesting underestimates tissue uptake of sex-steroids delivered topically Be familiar with the basis of steroid synthesis Understand the urine monitoring of hormone levels and metabolites. Specificalgorithms will be shared to facilitate ease of use in clinical practice Know the hormonal changes that occur with aging in males Know the cardiovascular, cognitive, bone, sexual, and emotional effects of hormonedepletion and hormone restoration in males Learn to monitor and restore optimal hormone levels in males Discuss the differences between compounding and manufacturing medications Review the various licensure needs to compound medications Discuss the various patient care areas that involve specialized compounding Review various medication dosage forms that can be compounded Discuss the various types of equipment needed in compounding Learn how to evaluate a patient for iodine deficiency Review the roles iodine plays in the body Learn the criterion required to make the diagnosis of PCOS Learn conventional and metabolic treatments for PCOS Learn the different bases that hormones can be placed in along with theiradvantages and disadvantages Module II: A Metabolic, Anti-Aging and Functional
Approach to the Treatment of Hypertension, Diabetes,
Coronary Artery Disease and Metabolic Syndrome
Upon completion of this module, the doctor will:
Understand the glycemic index and its use in determining the glycemic index andglycemic load of foods Identify patients with Syndrome X/Metabolic Syndrome Learn nutritional supplements and lifestyle recommendations for treatment of thecomponents of metabolic syndrome Establish a treatment course and treat patients with insulin resistance, diabetes, andneuropathy Discuss risk factors for heart disease including elevated cholesterol, triglycerides,lipid fractionation, homocysteine, lipoprotein (a), ferritin, fibrinogen and c-reactiveprotein Look at interventions for chronic endothelial inflammation Understand the role of inflammation in cardiovascular inflammatory disease Discuss free radical production, glycation, oxidation and apply to patient treatment Understand the causes of endothelial dysfunction Know botanical treatments to augment the care of insulin resistant patients Evaluate the link between oxidative stress and glycemic control Know which laboratory tests to order and to properly evaluate insulin resistance,diabetes mellitus, and risk factors for heart disease Discuss the role insulin has in the development of hypertension Learn nutritional treatments for hypertension Learn laboratory evaluations to aid in the diagnosis and treatment of heart diseaserisk factors Describe several interactive mechanisms that tie various components of theMetabolic Syndrome and Cardiovascular disease Review diet, lifestyle and nutraceutical options for clinically managing dyslipidemia,cardiovascular inflammation, homocysteine, insulin resistence and related conditions Understand how various nutrient deficiencies lead/support metabolic syndrome Learn what lifestyle factors to modify in order to treat/prevent metabolic syndrome Review the complete physiology of hypertension Examine metabolic and anti-aging approaches to hypertension through nutrition andsupplementation Review cholesterol physiology and its contribution to atherosclerosis Assess the current literature on dyslipidemia Examine effective nutrition and nutritional supplementation strategies for dyslipidemia Review a model of cardio metabolic disease Access the current literature on the complex physiologic relationships underlyingcardio metabolic disease Examine effective nutritional strategies and nutritional supplementation on cardiometabolic disease Learn the difference between insulin sensitivity, insulin resistance, and Type IIdiabetes Understand the counter-regulatory hormones and how their normal functionscontribute/cause insulin resistance Understand why only some patients with insulin resistance develop Type II diabetes Redirect the focus of the treatment of Type II diabetes from the insulin perspective tothe point of view of the counter-regulatory hormones Understand the consequences of increased sugar intake to the body Learn the numerous diseases that are linked to a high sugar diet Study sugar substitutes, their use, and possible side effects Learn the symptoms of reactive hypoglycemia Know the diseases associated with insulin resistance Learn the interplay between metabolic syndrome and psychiatric illnesses Understand that medications that are commonly used to treat depression and othermental health diseases may increase the patient’s risk of metabolic syndrome Investigate how targeted nutraceuticals can support cardiovascular function Define toxic blood syndrome and discuss interventions to improve Identify the inflammatory index and how to investigate silent inflammation Discuss the role of energy medicine in optimum health List five nutraceuticals that promote favorable vibrational frequencies in the body Discuss how electrical medicine assists in optimizing cellular function Define the complex role of energy and the heart Learn how the new triad of bioenergetic energy in cardiac health, i.e., coenzymeQ10, L-carnitine and D-ribose can help prevent and overcome heart disease Discover why ATP is so essential in optimizing diastolic function of the heart Learn about the most 20 common toxins that are found in our everyday life Explore the relationship between chemical toxins, inflammation, and disease Discover the role that heavy metals play in heart disease Module III: A Metabolic, Anti-Aging and Functional
Approach to Gastroenterology, Neurotransmitters, and
Upon completion of this module, the doctor will:
Learn new treatment modalities for multiple sclerosis, stroke recovery, Parkinson’sdisease, ALS, and Alzheimer’s disease Evaluate the energy producing ability of the mitochondria and their role in revitalizingneurological tissue Learn factors associated with intestinal permeability Discuss the consequences of inflammation on the neurological system Look at the role endocytic receptors, scavenger receptors, and RAGEs has on theinflammatory response Understand the importance of the gastrointestinal tract’s role in the immune system Understand the crucial role that neurotransmitters have in the body and how theyimpact various organ systems Learn the many reasons why patients have a difficult time losing weight and keepingit off Have a comprehensive understanding of the relationship between the GI tract andneurotransmitter function Evaluate the role of diet and antibiotics in the management of gastrointestinaldysfunction Demonstrate the unique biochemistry of individual patients and examine theramifications of nutrition, medications, and stress on the immune system during thefirst years of life Explain the gastro-intestinal system’s interface with the environment Discuss the role of nutrition and digestion in the balancing the gut flora, as well asthe role of nutrition in gastrointestinal disease Identify the symptoms and diseases associated with yeast overgrowth Be knowledgeable about the treatments of yeast overgrowth Know the symptoms associated with dysbiosis Learn the common conditions associated with leaky gut syndrome Determine the common signs and symptoms of low gastric acidity Know the diseases associated with low gastric acidity Learn the protocol for HCL acid supplementation Realize the symptoms and diseases associated with food allergy Ascertain the symptoms of pancreatic insufficiency Determine the symptoms of bile salts deficiency Find out new treatments for hiatal hernia Learn the causes and treatment of hemorrhoids Learn the treatment for inflammatory bowel disorders Realize the symptoms of acute and chronic gallbladder problems Find out how to treat gallbladder disease Understand the increased mortality associated with celiac disease Understand the changes that occur in the bowel with celiac disease Learn testing methods to evaluate if a patient has celiac disease Discover the false positives and false negatives that can occur with antibody testingfor celiac disease Recognize the reasons for false positive results that can occur with biopsy whenevaluating a patient for celiac disease Know the extraintestinal manifestations that can occur with celiac disease besidesdermatitis herpetiformis Learn treatment methods for all forms of celiac disease Recognize other autoimmune diseases that are associated with celiac disease Know the differential diagnosis for celiac disease Recognize that gastrointestinal and vaginal flora change with age Learn the mechanism of action of probiotics Know which bacteria that occur in the gastrointestinal tract that are friendly andwhich are pathogens Learn the desirable characteristics of an effective probiotic Recognize what foods can be used as probiotics Understand the beneficial effects of normal gut flora Learn which disease processes can be treated with probiotics Learn the differential diagnosis of irritable bowel disease Learn treatment modalities for irritable bowel disease Understand what an allergy elimination diet is and be able use this treatmentmodality with a patient Learn the role of probiotics in the treatment of antibiotic-associated diarrhea Understand the criteria to be a prebiotic Review the medical literature on the use of prebiotics Recognize prebiotic substances and the organisms they work on Understand that protozoan infections of the gastrointestinal tract may be the cause ofunrecognized systemic illnesses Learn conventional and natural therapies for parasitic infections Know the role that neurotransmitters play in weight loss Recognize the importance of hormonal balance in weight loss Understand that the ingestion of foods that the patient is allergic to can cause weightgain Recognize the role that sleep deprivation plays in weight issues Understand that the body’s ability to effectively detoxify also plays a role in weightgain Learn that weight gain creates an inflammatory response in the body Know the chemistry behind why some foods are addicting Review the scientific literature on nutrients that can aid in weight loss Know the role that yeast overgrowth plays in weight gain Have an understanding of basic neurochemistry as it relates to mood and cognition Recognize common neurotransmitter balances and how to diagnose them Discuss the major neurotransmitters in brain function and their understood roles inbehavior and in neurological disorders Understand the function of receptors for these substances and factors which impacttheir regulation Discuss the metabolism of these substances within the body, including theprecursors and substrates necessary for function in the nervous system as well ashow they are metabolized in the body Understand the limitations of measurement of the neurotransmitters and the role thatthe blood brain barrier plays in controlling access of substrates and cofactors to thebrain Recognize circumstances where functional imaging techniques may aid in diagnosisand therapy of conditions related to neurotransmitter dysfunction Recognize some of the many interactions of neurotransmitters with hormonalfunction and dysfunction Recognize the parameters within the Functional Medicine Matrix that would indicatethe need for attention to neurotransmitter function and identify common antecedents,triggers and mediators when an imbalance or dysfunction is suspected Learn metabolic and anti-aging treatment options to improve mood and cognition Module IV: A Metabolic and Anti-Aging Approach to
Amino Acid and Fatty Acid Metabolism, Drug Induced
Nutrient Depletion, Stem Cells and Regenerative
Medicine, Spirituality and Osteoporosis
Upon completion of this module, the doctor will:
Know the role of nutrition in maintaining optimal health as the patient ages Learn phase I and phase II detoxification and the consequences of the body’sinability to detoxify Learn nutritional depletions caused by medications Understand the relationships among the biotransformation enzyme systems Know the common warning signs indicating that toxicity may be a factor for thepatient Understand the roles of physical, psychological, and spiritual health in Metabolic andAnti-Aging Medicine Know essential, conditionally essential, and non-essential amino acids andsymptoms of amino acid deficiencies Learn new treatment plans for osteoporosis Look at pharmaceutical inhibitors of Phase 1 cytochrome P450 enzymes Learn treatment modalities for the dietary and nutritional support of detoxification Look at metallothioneins and genetic polymorphisms Know the function of fatty acids in the body Know treatments for amino acid deficiencies Learn disease process that have amino acid deficiencies as an antecedent Be aware of the diseases that can be treated with fatty acid replacement Understand that fatty acid intake can change the amount of medication that a patientmay need Teach new pain control options used in Metabolic and Anti-Aging Medicine Understand fatty acids may have profound effects on the network of inflammatorymediators altering prostanoid synthesis, PPAR activity, and the response to cytokines Review the basic concepts behind the disciplines of metabolomics and nutrigenomics Define the critical steps involved in signal transduction and intracellular signaling,with emphasis on transmembrane receptors, intracellular kinases, transcriptionfactors and DNA response elements Learn how DNA expression can be modified by specific dietary and lifestyle factors Identify the differences between types of stem cells Learn how stem cells are harvested for autologous use Learn about the current applications of stem cells from literature review Identify future applications for autologous stem cells Understanding of basic pathophysiology of thyroid metabolism as it relates to cardiacfunction Evaluate the current myths regarding thyroid replacement therapy Understanding of how thyroid deficiency can directly relate to cardiac disease,hypertension, hyperlipidemia, arrhythmia and heart failure Look at the role that genomics, pharmacogenomics, proteomics, and nutrigenomicshas in Metabolic and Anti-Aging Medicine Look at a patient-centric system of health care that addressed biochemicalindividuality and genetic uniqueness to improve health and function of the patient Understand the relationships among the biotransformation enzyme systems Teach the participant the value of a preconception medical evaluation Learn what tests to order on a patient for a preconception medicine evaluation Aid the participant in the interpretation of labs results in a preconception medicineconsult Learn the importance of EPA/DHA supplementation use in the mother and how itlater affects the health of her child Study implementation modalities for patients with fatty acid deficiencies Discover how patients are exposed to toxins Realize what nutrients aid in phase I detoxification of the liver Understand that a toxic metabolite can build up between Phase I and Phase IIdetoxification that may be more toxic than the original metabolite Learn the six phases of Phase II detoxification Ascertain how to treat a patient with abnormal phase I or phase II detoxification Explain how amino acid insufficiencies can manifest among a population that over-consumers dietary protein Demonstrate expertise in strategies for planning corrective interventions with aminoacids Explain how fatty acid insufficiencies can manifest among a population that over-consumers dietary fat Explain the types of toxicants and their respective levels of health threats Describe methods of assessment for xenotoxin exposures and endotoxin burdens Demonstrate expertise in strategies for planning corrective interventions to reducetoxin loads and improve detoxification function Doctor will achieve an expanded awareness of the common environmental toxinsand their impact on the body; this awareness can then be used to help patients makeinformed decisions about healthy lifestyle choices Doctor will gain a working knowledge of the scientific evidence supporting the role ofenvironmental and endogenous toxins in initiating and perpetuating chronic diseaseand accelerated aging; this information can then be used to enhance thepractitioner’s diagnostic skills in the recognition of toxin-related disease Doctor will gain an understanding of current knowledge regarding thebiotransformation and elimination of environmental toxins and the scientific basissupporting the use of nutrients and plant-derived factors for enhancing theseprocesses as a strategy for treating toxin-related disease and improving overallhealth; practitioners will be able to use this information to expand their therapeuticrepertoire Review the basic concepts behind the disciplines of metabolomics and nutrigenomics Define the critical steps involved in signal transduction and intracellular signaling,with emphasis on transmembrane receptors, intracellular kinases, transcriptionfactors and DNA response elements Learn how DNA expression can be modified by specific dietary and lifestyle factors Identify risks associated with non pharmaceutical grade fish oils Identify future applications for autologous stem cells Basic understanding of the pathophysiology of Vitamin D Knowledge of the implications of vitamin D deficiency Explain the symptoms of the various headache types Identify non-pharmacological treatments for head pain Describe the mechanism of action of Butterburr in reducing the frequency of migraine Outline a treatment plan utilizing various treatment options for the migraine patient Review the pathophysiology of peripheral pain transmission and the variousreceptors involved Review the use of topical pain medications and the rationale for use Review various herbs and supplements that can help in the management of thechronic pain patient Know the mechanisms of how Vitamin K works in the body Review the importance of Vitamin K in vascular health Understand the use of Vitamin K supplementation in patients taking Warfarin Module V: Clinical Intensives
Upon completion of this module, the doctor will:
Review hundreds of case histories so the practitioner leaves the Module with acomprehensive approach on how to treat the patient the next day from a Metabolicand Anti-Aging Medicine approach Learn new nutritional treatment modalities for osteoporosis, ADD/ADHD, allergies,asthma, anorexia, anxiety, arthritis, cancer, candidiasis, dysbiosis, Alzheimer’sdisease, heart health, closed head injury, URI, congestive heart failure, diabetesmellitus, neuropathy, depression, eye health, chronic fatigue syndrome/fibromyalgia,energy enhancing, prevention of migraine headaches, lipid management, hepatitis C,hypertension, IBS, Crohn’s disease, ulcerative colitis, immune building, insomnia,restless leg syndrome, liver health, periodontal disease, BPH, skin disorders, strokerecovery, sports nutrition, stress reduction, hypothyroidism, hyperthyroidism, varicoseveins, weight loss, PMS, polycystic ovarian syndrome, dysmenorrhea, cervicaldysplasia, wound healing, and nutritional needs for vegetarians, and much more Module VI: Herbology and the Functional Regener-
ative Matrix
Upon completion of this module, the doctor will:
Learn the botanical treatments of many major disease processes Know the side effects of botanical medicines Understand antecedents, triggers, and mediators of illness Learn the interaction that herbs may have with medications Understand and be able to treat infectious diseases such as hepatitis from ametabolic approach Learn functional clinical imbalances that can occur in the body Learn how nutrition affects gene expression Review history and traditional uses of common herbs Review the medical literature on herbal therapies Define the frontiers of research for botanical medicines: identify key ongoingquestions regarding evidence-based effectiveness, consistency of preparations andconcerns regarding safety Learn to utilize readily available databases to make informed evidence-baseddecisions regarding botanical medicines Gain an understanding of the rationale and proposed mechanisms behind thepotential therapeutic use of selective herbal supplements for specific health disordersincluding chronic inflammation, immune dysfunction and minor infections Familiarize doctor with extraction and dosage forms of herbal therapies Familiarize doctor with the DSHEA act and labeling Have the doctor understand and explain standardization of herbal extractions Educate the doctor on what are the necessary requirements for a quality herbalextraction Have doctor learn clinical synergistic effects of drug therapy and herbal therapieswhere applicable Have doctor become aware of potential adverse interactions with drug-herbprescribing Have particpants gain a working knowledge of the dosing required to gain atherapeutic endpoint with herbal remedies Gain basic understanding of the functional medicine principles including thefunctional medicine tree and matrix Identify the core clinical, functional medicine imbalances with examples Apply the functional medicine matrix in a clinical setting when addressing complexpatients Understand the importance that B vitamins play in the prevention of disease Learn in case history format the symptoms of all of the B Vitamin deficiencies Know the diseases and disorders that can be treated with different B Vitamins Know the signs and symptoms of Lyme disease Understand that Lyme disease may be a contributing factor for other diseases Discover the testing methods to diagnose Lyme disease Realize the commonly used antibiotics to treat Lyme disease Learn metabolic therapies for the treatment of Lyme disease Find out co-infections that may occur with Lyme disease Learn the history of restless leg syndrome Know the definition of restless leg syndrome versus the definition of periodic limbmovement disorder Realize the risk factors for the development of restless leg syndrome Discover the difference between the primary and secondary causes of restless legsyndrome Know the coexisting diseases that may occur with restless leg syndrome Study the symptoms of restless leg syndrome Know the symptoms of periodic limb movement disorder Know the four essential diagnostic criteria for restless leg syndrome Find out the lab studies that need to be ordered to diagnose restless leg syndrome Learn the differential diagnosis of restless leg syndrome Gain knowledge of the drug therapies that are available to treat restless legsyndrome Know the difference between tolerance and augmentation in the treatment of restlessleg syndrome Ascertain the different treatments for intermittent restless leg syndrome, daily restlessleg syndrome, and refractory restless leg syndrome Learn non-drug therapies for restless leg syndrome Recognize that arthritis is one of the most common diseases Know the radiologic findings seen on x-ray to diagnosis osteoarthritis Find out about the two forms of osteoarthritis Understand conventional therapies for osteoarthritis Learn metabolic therapies for osteoarthritis Know common foods that are linked to allergies and arthritis Recognize the side effects of different treatment options Learn treatment options for ankylosing spondylitis Know the symptoms of ankylosing spondylitis Identify specific plant and plant compound as effective antivirals Understand the mechanism of action of specific plant and plant compounds asantivirals Become proficient in recommending plant and plant compounds for specific humanviruses Identify botanicals that are effective for infectious disease Understand the mechanism of action of specific botanicals in their ability to modulateinfectious disease Become proficient in recommending botanicals for specific infectious diseases Module VII: Mitochondropathy, Heavy Metal
Toxicities, a Metabolic, Anti-Aging and Functional
Approach to Auto-immune Diseases, Cognition
Enhancement, and Fatigue
Upon completion of this module, the doctor will:
Understand the molecular triggers of the immune response and their receptors Look at intracellular signaling pathways and their gene products Look at the cellular and molecular biology of immunity and inflammation Learn clinical approaches to immune imbalance and inflammation Understand that micronutrient insufficiency leads to DNA and mitochondrial damage Look at disorders of mitochondrial function Understand the nutritional and environmental regulation of toxic metals Know the role that heavy metal toxicity places in disease Recognize the role that excitotoxins play on the developing brain Learn treatment plans on help a patient maintain their memory Learn new treatment modalities for patients with memory loss Learn the role that excitotoxins play in disease Understand the role of antioxidants in cellular redox control Recognize the clinical manifestations of chronic fatigue and fibromyalgia Review the role of cytokines as organizers of the inflammatory response Learn the cellular and molecular biology of immunity and inflammation Look at the molecular triggers of the immune response and their receptors Understand the loss of tolerance, Th1/th2/Th3/Th4 imbalance and the role of normalgut flora Explore the role of altered bioenergetics in the diathesis of chronic disease Learn the counter-regulatory control points of immune imbalances Approach to autoimmune diseases and cognition enhancement Define and differentiate the various clinical profiles associated with fatigue Understand key biochemical features that underlie energy deficits in patients Understand fundamental tools of laboratory assessment in patients with fatigue Create and understanding of the physiology of the glutamate receptors system Demonstrate how the immune system interacts with glutamate receptors to inducehuman disease Discuss specific CNS diseases and the role played by glutamate receptordysfunction in these diseases Discuss the glutamate receptor system in peripheral disorders Discuss way to protect the brain and systemic system from glutamate receptor overactivity Understand how to measure all components of memory, including P300, WMS,CNSVS and other related factors Know the connection between the brain’s testing results and the appropriatediagnosis Learn how to approach treatment for memory loss and how to prevent it Understand toxic metal exposure from the environment Recognize the symptoms and conditions related to toxic metals exposure Design a protocol with appropriate chelation agents for heavy metal toxicities Learn the risk factors for Alzheimer’s disease Know the role of heavy metals in memory loss Recognize the effects of fluoride on the brain Understand the role stress plays on cognition Know the role hormonal balance plays in memory maintenance Recognize the affects of sugar on cognitive decline Learn nutrients that may help maintain cognition Recognize medications that may affect memory Learn symptoms of chronic mercury poisoning Examine the research on the safety of mercury amalgams Look at the diseases related to mercury poisoning Examine the diseases aggravated by allergies to metals Learn nutritional detoxification methods for mercury toxicity Examine symptom improvement after amalgam removal Look at the role that environmental toxins may play in autoimmune diseases Know metabolic/anti-aging treatments for lupus Learn metabolic/anti-aging treatments for Raynaud’s phenomenon Lean how new diagnostic tests for rheumatoid arthritis Know the differential diagnosis for high anti-CCP Know metabolic/anti-aging treatments for rheumatoid arthritis Exposed to nutrients that affect NF-Kappa Beta Learn how to evaluate and work-up a patient with chronic fatigue syndrome (CFS)and fibromyalgia (FM) Recognize the brain imaging changes that occur with CFS and FM Recognize the autonomic and cardiac manifestations in CFS and FM Understand the impaired mitochondrial function that occurs in CFS and FM Learn the immune dysfunction that is present in CFS and FM Look at conventional treatments of fibromyalgia Learn the numerous metabolic/anti-aging treatment modalities for fibromyalgia Find out the how to treat mitochondrial dysfunction Understand the role Guaifenesin plays in the treatment of fibromyalgia Understand that salicylates affect the efficacy of Guaifenesin Learn common medications and natural products that contain salicylates Discover what physical modalities can be used in the treatment of fibromyalgia Learn the factors suspected of promoting CFS Discover immune abnormalities that can be present in CFS Realize the nutritional treatments for CFS Understand the role that hypothyroidism and adrenal fatigue play in CFS and FM Review the evolution in thought regarding the pathophysiology of autoimmunediseases from genetically determined, static disorders of adaptive immunity (T and Blymphocytes) to a dynamic process involving defective programming of regulatoryand Th17 lymphocytes by cells of the innate immune system (dendritic cells andmacrophages) Review the mechanisms by which infections, imbalances in gut flora, food antigens,toxins, and other environmental factors can trigger the breakdown in immunetolerance that leads to autoimmune disease in susceptible individuals Explore the practical applications of this model for detecting autoimmune disease atan earlier stage, recognizing potential environmental triggers, and makingappropriate recommendations for lifestyle changes and non-pharmaceuticalinterventions Understand some of the important interactions of the endocrine system with immunity Learn how the endocrine system can affect autoimmunity Know several laboratory test that can be used in addition to the standard tests forautoimmunity Know the treatment options to augment usual and customary treatment ofautoimmunity Module VIII: A Metabolic, Anti-Aging and Functional
Approach to Psychiatry and Cancer Therapies,
Nutrition and the Athlete, a Metabolic and Functional
Approach to Laboratory Evaluations
Upon completion of this module, the doctor will:
Learn advanced integrative approaches to cancer therapies Explore clinical approaches to structural imbalances Learn what determines test result accuracy, sources of error and what is involved inthe management of quality assurance systems in a clinical laboratory Understand how reference ranges are established and displayed Understand organic acid metabolism and how this relates to evaluating nutrientinsufficiency and toxic imbalances Learn how to evaluate a patient’s level of oxidative stress Understand how urinary porphyrin analysis can evaluate functional effects ofenvironmental toxins Learn how to evaluate a patient’s level of vitamins, minerals, and toxic metals Understand the use and advantages of DNA identification of stool microbes Learn the use of genomic analysis in the management of patient health risks Learn how to evaluate patient levels of phthalates and other bioactive plasticizersand how this can affect steroid hormone interactions and potential health risks Learn how analysis of stool microbes, chemistry, immunology and enzymology canbe used to evaluate and treat intestinal disorders Know treatments for psychiatric illnesses from an Anti-Aging and Metabolic approach Learn nutritional support programs for the competitive athlete Learn the role that nutrients play in the treatment of psychiatric illness Write prescriptions for exercise plans for healthy patients and those with specialneeds Learn new treatment modalities in the area of sports medicine from a an Anti-Agingand Metabolic approach Learn how to wean a patient successfully off of prescription medications such ashypnotics and antidepressants Review the biochemical basis of psychiatric diseases Discuss the neurobiology and chemistry of the sleep wake cycle in the context ofcircadian rhythms and identify treatable disorders that can interrupt restorative sleep Explain the role of the orexin secreting neurons in sleep disorders, includingnarcolepsy/cataplexy Map a treatment or interventional plan to optimize restorative sleep Introduce the principles of functional medicine, focusing on biochemical individuality Explore the relationship between genes and environment as risk factors for disease,as well as opportunities to optimize health and well-being Discuss the importance of laboratory testing that emphasizes optimal wellness andlooks at factors that change before the outward manifestation of disease. Casehistories will be discussed Emphasize the fundamental functional imbalances that every clinician shouldconsider when seeing a patient: environmental inputs, immune and inflammatoryimbalance, energy production/oxidative stress, gastro-intestinal imbalance,detoxification and biotransformation, hormonal and neurotransmitter imbalance,structural imbalance, and emotional imbalance Apply the new-found understanding the gene-environment interaction in clinicalpractice Understand the reasons for the failure of traditional chemotherapy Learn new protocols for advanced stage cancers Have a basic understanding of how clinical lab tests are run Learn what determines result accuracy, sources of error and what’s involved inmanagement of quality assurance systems in a clinical laboratory Understand how reference ranges are established and displayed Learn how to detect and treat food allergies and how this can affect health Understand how to evaluate a patient’s level of vitamins, minerals and toxic metals Understand organic acid metabolism and how this relates to evaluating nutrientinsufficiency and toxic imbalances Learn how analysis of stool microbes, chemistry, immunology and enzymology canbe used to evaluate and treat intestinal disorders Understand the use and advantages of DNA identification of stool microbes Learn how anaerobic bacterial imbalances in the gut can affect health and treatments Learn the use of genomic analysis in the management of patient health risks Learn how to evaluate patient levels of phthalates and other bioactive plasticizers,how this can affect steroid hormone interactions and potential health risks Recommend appropriate mineral and vitamin repletion based on exercise needs Recommend the correct protein to carbohydrate ratios and specific sources tooptimize nutrient timing depending on age Recommend amino acids that are evidenced based to improve recovery from astrenuous exercise program Recommend nutraceuticals and herbal compounds that will reduce lactate loadingand reperfusion injury Recommend the appropriate nutrients to support inflammation and post surgeryrecovery Investigate the role that diet has in cancer prevention Provide the existing and new research on metabolic therapies for the treatment ofcancer Identify scientific rationale for using antioxidant/micronutrient/ phytochemicalcombinations with standard conventional cancer therapies Provide supporting literature concerning nutriceuticals and if they can be used ascomplementing cancer therapies Address alternative treatment of specific cancer types Learn therapies that may prevent or treat the side effects of radiation orchemotherapy Provide step-by-step guide to the safe and gradual withdrawal from tranquilizers,antidepressants, and sleeping aids Identify the symptoms of anti-depressant and hypnotic medication withdrawal Learn nutritional support for benzodiazepine withdrawal Learn the effects that anti-depressants have on the brain Learn nutritional support for discontinuation of SSRIs, tricyclic and MAO inhibitoranti-depressants Learn nutritional support for hypnotic withdrawal Know the antidepressant-induced mental, behavioral, and cerebral abnormalities thatcan occur with their use Learn metabolic treatments for depression, anxiety, OCD, schizophrenia, and manicdepression Recognize the biochemical imbalances that result in a mental illness Understand the decline in endocrine function that occurs in all organs with age Know the behavioral effects of endocrine disorders and their application to geriatricpsychiatry Lean laboratory abnormalities that occur with hyperparathyroidism Recognize the drug effects that occur on bone strength Understand how the mode of delivery of PTH determines the skeletal response toPTH Review the literature on the effect PTH treatment has on the risk of vertebralfractures in postmenopausal women with osteoporosis Module IX: A Metabolic and Functional Approach to
Children’s Health
Upon completion of this module, the doctor will:
Understand that the health of the mother when she is pregnant greatly impacts thehealth of the child Review the literature on metabolic approaches to prenatal health Learn antecedents and mediators that affect the development of ADD/ADHD Learn nutrients that have been shown in medical trials to aid in the treatment ofADD/ADHD Understand the importance that gastrointestinal health plays in ADD/ADHD Learn the side effects of conventional treatments for ADD/ADHD Recognize the behaviors and symptoms of a child with Autism Spectrum Disorder(ASD) Learn the common factors present in ASD children Discover laboratory profiles to identify unique treatment options available for ASD Review the literature on the history of vaccinations Understand the role that detoxification plays in ASD Recognize the role oxidative stress plays in ASD Ascertain the possible role allergies may play in ASD Look at nutritional supplementation that has been found successful in the literature inthe treatment of ASD Review a new study on hyperbaric treatment for children with autism Look at the role of antibiotic use in children Learn herbal therapies that may function as antibiotics Review the current statistics on childhood obesity Gather new information on metabolic modalities to treat and prevent childhoodobesity Review a metabolic approach to the treatment of childhood allergies Realize that insulin resistance may begin in childhood Understand the role that exercise plays in overall health in childhood Learn metabolic approaches for the treatment of infections Know detoxification therapies for children Learn treatment modalities for teens with aggressive behaviors Recognize the role diet plays in the psychological health of a child Learn metabolic treatments for childhood depression Understand the importance of bowel health in a child Learn metabolic and functional treatments for asthma Know metabolic therapies for learning disabilities Module X: Homeopathic Applications to Metabolic
Upon completion of this module, the doctor will:
Gain an understanding of historical development of homeopathy Understand the concept of homeopathic pharmacology Define the legal status and prescribing rights of homeopathic medicines in regards toOTC and RX status Describe the nomenclature for homeopathic medicine doses Review homeopathic medicine manufacturing and the process of succession Describe the differences between a Materia Medica and Repertory Familiarize the students with the thought process and rationale for selection ofhomeopathic medicines Provide a foundation for understanding Constitutional, Complex and Clinicalhomeopathic prescribing Provide a framework for students to select homeopathic medicines as a part of theintegrative model for health care Educate the student on homeopathic medicine dosing for common complaints suchas arthritis, headaches, migraines, sinusitis, allergies and other common chroniccomplaints Educate the student on homeopathic medicines for more acute conditions such assore throat, colds, flu and adjunctive support for traditional medicines Educate the student on homeopathic medicine dosing and application of topical andoral and Injectable forms of homeopathic for the management of soft tissue injury,reactivation of metabolism and enhancement of detoxification pathways Familiarize the student with homeopathic medicine dosing and selection for commoncold and flu and allergy complaints Familiarize the student with homeopathic medicine dosing and selection for commonGI complaints such as diarrhea and constipation Familiarize the student with homeopathic medicine dosing and selection for upperrespiratory conditions such as cough, sinusitis, and mucolytic support Familiarize the student with homeopathic medicine and selection for behavior issues,night terrors and bedwetting Familiarize the student with homeopathic medicine dosing and selection for commonbumps, bruises and scrapes Familiarize the student with the theory and research related to homotoxicolgy Familiarize and gain a working knowledge of the six phase process of chronic illnessand the definition of each of the phases Familiarize the student on the immunity model for homeopathic medicine Teach the student to apply homotoxicologic preparations for recoupling of oxidativephosphorylation and retarding the chronic inflammatory cascade Teach the student application of homotoxicology in the geriatric population Introduce the concept of gemmotherapy to the student Provide a working knowledge of dosage and application of gemmotherapy medicinesso that the student can apply this information clinically Introduce the concept of diathesis and the theory behind oligo therapy Provide a working knowledge of dosage, protocol and application of oligo therapy sothat the student can apply this information clinically Module XI: IV Therapies
Upon completion of this module, the doctor will:
Learn pre work-up evaluations of IV therapy patients Learn how to set up an office to do IV therapies Learn how to follow a patient during IV therapy treatment Learn IV protocols for medical conditions Learn IV chelation therapies for heavy metal toxicities Learn oral and rectal chelation therapies Learn IV protocols for nutritional therapies Know IV therapies for infectious diseases Module XII: Toxic Metals and Functional Toxicology
Upon completion of this module, the doctor will:
Learn how to assess a patient for toxic metal exposure Look at the incidence of exposure to toxic metals Discover treatment modalities for retention of toxic metals including EDTA, DMPS,DMSA Learn nonpharmaceutical agents that chelate out heavy metals Understand the importance of adequate mineral status before testing a patient forheavy metal toxicity Learn the symptoms of heavy metal exposure Study the common toxins that affect health including organohalogens,organophosphates, organic solvents, and heavy metals Know the mechanisms of toxic injury including disturbances in cell signaling,alterations in structural entities such as the mitochondria, and impaired synthesis ofspecific molecules such as fatty acids, proteins, nucleotides, glutathione, andphospholipids Discover hormonal disruption that can occur with toxin exposure Understand the biotransformation that can occur with drugs, metals, and xenobioticsbefore they are excreted from the body Find out how biotransformation by cytochrome P-450 enzymes affects the toxicnature of compounds Study the mechanism of oxidative stress caused by toxins Learn about detoxifying enzymes and genetic polymorphism Know about metallothioneins and genetic polymorphism Discover nutritional and environmental factors that modify susceptibility toenvironmental toxins Learn how to assess the toxicologically affected patient Gather information on how to teach a patient how to have a detoxified lifestyle Discover the five organs of detoxification in the body and how to aid a patient indetoxifying these organs Module XIII: A Metabolic Approach to Pain
Upon completion of this module, the doctor will:
To review the literature on integrative treatments in Pain Management.
To examine cases in depth and link the presentation to underlying physiologicprocesses framed with the Anti-Aging context.
To provide clear therapeutic substitutions to the cases Review the pathophysiology of peripheral pain transmission and the variousreceptors involved Review the use of topical pain medications and the rationale for use Review the various herbs and supplements that can help in the management of thechronic pain patient Discuss the new medical treatments for migraine headaches Review CAM treatments for migraine headaches Discuss the various opiate medications available and rationale for use Discuss the pathophysiology and treatment for fibromyalgia.
Discuss the role of addiction and various treatment approaches as it relates toopiates and smoke cessation.
Discuss the interplay of psychiatric disorders in the chronic pain patient Review chronic back pain and various treatment approaches Review the use of OMT/acupuncture for chronic pain syndromes and varioustreatment approaches.
Module XIV: Individualized Weight Management for
the Patient
Upon completion of this module, the doctor will:
Understand the multi-factorial causes of weight gain Evaluate genetic markers for particular foods that show benefits in weight loss Evaluate genetic markers for exercise recommendations bases on genetics Know nutritional depletions that are caused by bariatric surgery Learn how to replace nutrients in patients that have had bariatric surgery Learn individualized therapies for weight management Understand the role of inflammation in weight gain Understand the importance that allergies play in gaining weight Recognized that hormonal imbalances can cause weight gain including: sexhormones, thyroid, insulin, and cortisol Understand the value of sleep deprivation and weight management Appreciate the value that detoxification plays in weight management Comprehend the role yeast infections may play in weight gain Evaluate the role of neurotransmitter function in weight gain Appreciate the importance psychological dysfunction has on weight gain and weightloss Understand the science behind why some foods are addicting Know the role that stress plays in weight gain and whether a patient can successfullylose weight Review healthy eating programs for weight management that are individualized tothe patient’s needs Understand the importance of energy metabolism and production in weightmanagement Module XV: A Metabolic Approach to Brain Fitness:
How To Enhance and Keep Memory and Focus at Any
Upon completion of this module, the doctor will:
Understand the role that toxins have in memory loss Appreciate how exercise helps maintain cognition Learn commonly used medications that may cause memory loss Identify nutrients that help maintain memory and focus Comprehend exercises that help maintain memory Understand the affect that psychotropic and pain medications have on memory Understand the role recreational drugs have on memory loss Value the role sex hormones have in maintaining memory and focus includingpregnenolone, estrogens, progesterone, testosterone and DHEA Learn how optimal thyroid function helps maintain memory and focus Comprehend the role that insulin dysfunction plays in memory loss Learn the risk factors for Alzheimer’s disease Recognize the effects of fluoride on the brain Know elevated plasma homocysteine levels are a risk factor for dementia Understand the value of sleep hygiene and its affect on memory Realize the key role stress has on cognition Understand the relationship between health status and cognitive functioning Identify the fatty acids that aid in memory maintenance Understand the role that inflammation plays in memory loss Learn that level of education affects memory Understand that intake of foods that the patient is allergic to can affect cognition Identify toxic metals that can affect cognition Understand the role neurotransmitters have on memory Learn the parts of the brain that affect memory Module XVI: Advanced Integrative and Metabolic
Cardiovascular Medicine
Upon completion of this module, the doctor will:
Understand, review and apply in clinical practice the pathophysiology of vascularbiology, vascular aging, hypertension, dyslipidemia and cardiovascular risk factorsand testing.
Understand, review and apply to patient care nutrition, nutritional supplements,exercise and weight management in the treatment of hypertension, dyslipidemia andvascular disease.
Understand, review and discuss the clinical presentation and cardiovascularrelationships of hypertension, dyslipidemia, coronary heart disease and CVD.
Understand, review, discuss, select and apply new noninvasive diagnosticcardiovascular tests to identify CV disease early and select appropriate treatment.
Understand, review and discuss traditional, new and emerging CHD risk factors toprevent and treat CHD and CVD in clinical practice.



forum Vogelgrippe : Vorbereitung der Schweiz und Unterstützung des Kampfes in Asien von Jean Louis Zurcher und Marcel Falk Der Bundesrat hat sich am Freitag mit derjetzigen Zeitpunkt klein. Zwei Einschleppungs-Vogelgrippe beschäftigt. Er hat entschieden,routen müssen dabei bedacht werden: übergesamte Bevölkerung abgegeben wird. DieserSchmuggel aus den Ländern und über Zugvö

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HEALTHCARE INSPECTORATE WALES Care Standards Act 2000 INSPECTION REPORT Private and Voluntary Healthcare Plas Coch Rhyl Road St. Asaph LL17 0HU Date of Inspection 15th January 2008 You may reproduce this Report in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of the Healthcare Inspecto

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