Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions.

Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies.

Assessment for Adverse Food Reactivity. A Clinician’s Guide.

Patients frequently note adverse food reactions and report significant food restrictions as a result. Physicians need to consider the nutritional consequences and necessity of such voluntary dietary limitations. They also should consider adverse food reactivity in their differential diagnosis for many frequently seen concerns.

Refractory Depression, Fatigue, Irritable Bowel Syndrome, and Chronic Pain: A Functional Medicine Case Report.

Introduction: Single-disorder or single-organ-system clinical practice guidelines are often of limited usefulness in guiding effective management of patients with chronic multidimensional signs and symptoms. The presence of multiple long-standing medical problems in a given patient despite intensive medical effort suggests that addressing systemic core imbalances could complement more narrowly focused approaches.

Case Presentation: A 72-year-old man experiencing longstanding depression, fatigue, irritable bowel syndrome, and chronic pain in the context of additional refractory illnesses was assessed and treated, guided by a system-oriented approach to underlying core imbalances termed functional medicine.

Vitamin D therapy in individuals with prehypertension or hypertension: the DAYLIGHT trial.

Background: A large body of epidemiological and experimental evidence suggests that vitamin D deficiency may promote hypertension. This raises the possibility that vitamin D supplementation could be a simple intervention to reduce blood pressure, but data from prospective, randomized trials are limited.

Methods And Results: A double-blind, randomized, controlled trial was conducted at 4 sites in the United States.

Elevated Deoxycholic Acid and Idiopathic Recurrent Acute Pancreatitis: A Case Report With 48 Months of Follow-up.

Recurrent pancreatitis is a potentially life-threatening condition with a well-established differential diagnosis. In a significant number of cases, no explanation exists. This case report documents one patient with a clear pattern of recurrent acute pancreatitis and no identifiable cause despite great effort.

Three measurable and modifiable enteric microbial biotransformations relevant to cancer prevention and treatment.

Interdisciplinary scientific evaluation of the human microbiota has identified three enteric microbial biotransformations of particular relevance for human health and well-being, especially cancer. Two biotransformations are counterproductive; one is productive. First, selective bacteria can reverse beneficial hepatic hydroxylation to produce toxic secondary bile acids, especially deoxycholic acid.

Vitamin d deficiency: time for inaction?

In 1998, the British Medical Journal boldly stated in an editorial headline, "Vitamin D Deficiency: Time for Action."(1) The urgency was clear: vitamin D deficiency was going undiagnosed and untreated in large numbers of people. Patients were at risk and suffering needlessly.

Introduction to traditional Asian therapeutic diets: two enduring perspectives.

In some ancient systems of medicine, health was understood as a state of balance, and diet was considered essential to achieving and maintaining that balance. Traditional Chinese medicine and Ayurveda are based on this premise. Here we present an overview of these two traditional systems' views on diet and eating.

Nutritional assessment in vegetarians and vegans: questions clinicians should ask.

Not all who adhere to vegetarian, vegan or other special diets have nutritionally sound eating habits. The clinical consequences of an insufficiently mindful vegetarian or vegan diet include many common symptoms such as anxiety, brain fog, depression, fatigue, insomnia, neuropathies and other neurologic dysfunction. Patients with such symptoms who report having a vegetarian or vegan diet, or a diet that severely restricts meat consumption, require a slightly expanded differential diagnosis.

Effect of country of origin, age, and body mass index on prevalence of vitamin D deficiency in a US immigrant and refugee population.

Objective: To determine the prevalence of vitamin D deficiency (VDD) (25-hydroxyvitamin D level <20 ng/mL) and severe VDD (25[OH]D level <10 ng/mL) in a Minnesota immigrant and refugee population.

Patients And Methods: This retrospective study evaluated a cohort of adult immigrants and refugees seen at Health Partners Center for International Health in St Paul, Minnesota. Study participants were all patients seen from August 1, 2008, through July 31, 2009, with a first vitamin D screen (N=1378).

Impact of vitamin D deficiency on the productivity of a health care workforce.

Objective: To define the relationship between vitamin D status and employee presenteeism in a large sample of health care employees.

Methods: Prospective observation study of 10,646 employees of a Midwestern-integrated health care system who completed an on-line health risk appraisal questionnaire and were measured for 25-hydroxyvitamin D.

Results: Measured differences in productivity due to presenteeism were 0.

Drug-nutrient interactions: a case and clinical guide.

Advances in pharmacokinetics and pharmacodynamics require new competencies related to pharmaceutical prescribing. First, both physicians and pharmacists need to recognize the potential negative impact of nutrients and dietary supplements on the absorption, metabolism, and utilization of prescription drugs. Second, physicians, even more than pharmacists, need to recognize the potential negative effects of pharmaceuticals on the absorption, metabolism, and utilization of nutrients.

The TU-025 keishibukuryogan clinical trial for hot flash management in postmenopausal women: results and lessons for future research.

Objective: The aim of this study was to assess the efficacy of TU-025, keishibukuryogan, a Japanese prescription herbal medicine used for hot flash management, in American women.

Methods: This randomized, double-blind, placebo-controlled, phase II trial enrolled 178 postmenopausal women aged 45 to 58 years with a Mayo hot flash score greater than 28 per week who met other inclusion criteria. After a 1-week placebo run-in period, participants were randomly assigned placebo, or 7.

Interventional nutrition in cancer survivorship. A case study.

Interventional nutrition is an emerging field in medicine that utilizes advanced laboratory technologies to identify a patient's clinically relevant biochemical uniqueness in order to treat the metabolic contributors to multifactorial symptoms such as fatigue, insomnia, and pain. This article presents a complex case in which a breast cancer patient's severe symptoms fit no clear disease pattern and prevented her from undergoing chemotherapy and radiation treatment. Specialized testing for metabolic, gastrointestinal, and immunologic function uncovered important nutritional deficiencies that could not be identified through isolated tests or addressed by supplementation with a daily multivitamin.

The impact of integrative medicine on pain management in a tertiary care hospital.

Background: Optimal inpatient pain management remains a major institutional and therapeutic challenge. Nontoxic, nonpharmacological approaches to treating pain show promise but have not been widely implemented, nor has their effectiveness been evaluated.

Aims: To evaluate the effectiveness of an inpatient integrative medicine consult service for pain management in 6 settings across an entire tertiary care hospital.