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Food, Medicine, and Function
The food we eat becomes the basic building blocks of our biology. A poor diet creates poor-functioning cells, tissues, organs, and biological systems and leads to disease. A nutrient-rich whole foods diet does the opposite. Inflammation is a common denominator in most chronic diseases, and our modern-day lifestyle is primarily to blame. An overload of processed foods, sugar, starch, and exposure to toxic chemicals damages our mitochondria, overwhelms our detox organs, creates oxidative stress, hormonal and mood imbalances, cognitive decline, and so much more. Functional Medicine treats disease by removing what is causing d...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 24, 2022 Category: Rehabilitation Authors: Mark Hyman, Elizabeth Bradley Source Type: research

Dietary Approaches to Treating Multiple Sclerosis-Related Symptoms
Although there is no dietary pattern than has been proven to be effective for reducing the number of relapses or enhancing lesions in patients with multiple sclerosis (MS), several pilot studies have demonstrated the efficacy of dietary plans to reduce MS-related symptoms. Low saturated fat (Sw.), low fat vegan (McDougall), modified Paleolithic (Wahls), gluten free, Mediterranean, intermittent fasting, calorie restriction, and intermittent calorie restriction (fasting mimicking diet) all have been associated with reduction of MS-related symptoms such as reduced fatigue, improved mood, and improved quality of life. Mediterr...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 24, 2022 Category: Rehabilitation Authors: Terry L. Wahls Source Type: research

Mycotoxin Illness: Recognition and Management from Functional Medicine Perspective
Mold toxin exposure by inhalation and ingestion has significant health consequences for humans. In this article, we discuss the sources of these everyday toxins and their relevance to patient health. The effects of mycotoxins can present across all body systems, and the resulting symptoms can be acute, cumulative, and chronic. These effects can occur discretely, but they can also present alongside other clinical entities. It is important for the clinician to recognize the phenomenon of mycotoxin illness, because as a primary cause, it does not resolve with current standards of care for conditions secondary to it. (Source: ...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 23, 2022 Category: Rehabilitation Authors: Alice Prescott Sullivan Source Type: research

Social Determinants and Health Equity in Functional Medicine
The functional medicine matrix provides us with an opportunity to understand how social determinants of health (SDOH) and health related social needs may be root causes and contributors to current health and illness among patients. The matrix also allows us to map and recognize the intersectionality of SDOH on exposures and behaviors that influence antecedents, triggers, mediators, lifestyle factors, and clinical imbalances. Incorporating SDOH into clinical evaluations helps uncover and address the complex factors that lead to health disparities in order to provide more optimal patient-centered care. (Source: Physical Medi...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 23, 2022 Category: Rehabilitation Authors: Nazleen Bharmal Source Type: research

Patient-Reported Outcomes and the Patient-Reported Outcome Measurement Information System of Functional Medicine Care and Research
The functional medicine model of care is focused on patient-centered rather than disease-centered care. Patient-centered care incorporates the patient ’s voice or experience of their condition alongside conventional biological factors to provide a “more complete” account of health. PROMIS Global, an NIH-validated patient-reported outcome (PRO) measure that evaluates the health-related quality of life, can be incorporated within the functiona l medicine model of care to evaluate self-reported physical, mental and social well-being across various conditions and guide personalized management strategies. Proper incorpora...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 23, 2022 Category: Rehabilitation Authors: Michelle Beidelschies, David Cella, Irene Katzan, Christopher R. D ’Adamo Source Type: research

Fasting and Fasting Mimicking Diets in Obesity and Cardiometabolic Disease Prevention and Treatment
Worldwide obesity has risen to record levels generating a major risk factor for metabolic syndrome, diabetes, hypertension, and cardiovascular disease as well as cancer and neurodegenerative diseases. Herein, the authors discuss the impact of obesity on life span and cardiometabolic disease in mice and humans and how different types of fasting can help prevent and treat them. The authors argue that specific types of fasting regimens, which are associated with low burden, high long-term compliance, and safety, can reduce obesity and other disease risk factors, lower morbidity, and extend health span. (Source: Physical Medic...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 23, 2022 Category: Rehabilitation Authors: Amrendra Mishra, Valter D. Longo Source Type: research

Environmental Medicine
Environmental toxicant exposure, according to many researchers in the field, is the leading cause of chronic disease and premature death globally. For the purposes of this review, we will use obesity and type 2 diabetes as examples of toxicant-induced chronic diseases. Endocrine Disrupting chemicals (EDCs) such as phthalates and bisphenols, per- and polyfluoroalkyl substances (PFAS), and persistent organic pollutants (POPs) have been linked to increased risk for obesity and type 2 diabetes in both animal and large epidemiologic studies. These two conditions are well-documented examples of evidence for mechanisms of both ad...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 23, 2022 Category: Rehabilitation Authors: Anne Marie Fine, Lyn Patrick Source Type: research

Preface
I am honored to dedicate this issue of Physical Medicine and Rehabilitation Clinics of North America to Functional Medicine. Nutrition and medicine have been my passion for the past 30 years, and using food as medicine to address chronic disease and individually treat patients is part of the foundational approach of functional medicine. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - June 23, 2022 Category: Rehabilitation Authors: Elizabeth Bradley Source Type: research

The Identification and Management of Small Intestinal Bacterial Overgrowth
Small intestinal bacterial overgrowth (SIBO) can exist in common conditions such as irritable bowel syndrome, obesity, cirrhosis, and Parkinson. Using the functional medicine matrix broadens the lens of how to evaluate SIBO. Assessing the predisposing factors, triggers, and contributors of SIBO enables the provider to better understand possible management strategies. Applying the functional medicine 5R program, remove, replenish, repair, reinoculate, and rebalance includes conventional treatment of SIBO and expands the provider ’s toolbox on different modalities to restore gut function (Source: Physical Medicine and Reha...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 16, 2022 Category: Rehabilitation Authors: Seema M. Patel, Melissa C. Young Source Type: research

Contrarian or Mainstream
Incorporating Functional Medicine into our Physical Medicine and Rehabilitation Clinics of North America series was not a difficult decision. Functional Medicine probably has a different connotation to the Physical Medicine and Rehabilitation (PMR) specialist, as we pride ourselves as experts providing strategies for a wide range of functionally limiting disorders. I would ask the PMR specialist to keep an open mind and allow our fine guests to present useful information that reveals itself as they peel back some of the layers in patient care that we may have lost along the way. (Source: Physical Medicine and Rehabilitatio...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 26, 2022 Category: Rehabilitation Authors: S.F. Martinez Tags: Foreword Source Type: research

Women: Diet, Cardiometabolic Health, and Functional Medicine
Cardiovascular disease was previously considered a problem for men, despite more women dying annually from cardiovascular causes. As a result of flawed assumptions, clinical research relied on men, leading to biased guidelines and treatment protocols. Emerging evidence demonstrates that women have unique sex and gender differences that must be considered, particularly their cardiometabolic health, in a systems biology framework that can be organized into a functional medicine model of care. Our aim is to help clinicians recognize the value added by functional medicine in the assessment of women vis- à-vis cardiometabolic ...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 11, 2022 Category: Rehabilitation Authors: Sara Gottfried Source Type: research

Radiofrequency Ablation for Zygapophyseal Joint Pain
This article provides an overview of the epidemiology of zygapophyseal joint pain, patient selection and outcomes data associated with RFA, and risks and contraindications of the procedure. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Benjamin Gill, Cole Cheney, Nate Clements, Allison Glinka Przybsyz, Zachary L. McCormick, Aaron Conger Source Type: research

Sacroiliac Joint Interventions
The sacroiliac joint complex (SIJC) is composed of complex anatomy of numerous potential pain generators that demonstrate varying pathophysiology and differing innervations. This heterogeneity has been a challenge to advancing research and clinical care. Moving forward, individualized approaches taking these factors into account may be a path forward to improved outcomes. Thus, as we move toward precision medicine in interventional spine care, it is imperative to investigate more targeted diagnostic and therapeutic approaches to the SIJC. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Aaron J. Yang, Byron J. Schneider, Scott Miller Source Type: research

Spinal Cord Stimulation
The rapid development of neuromodulation specifically as it pertains to spinal cord stimulation (SCS) has ushered in an era of new and novel waveforms and programming methodologies. Accompanying this evolution has been a significant investment in clinical trials and outcomes-based research solidifying the foundation of SCS while investing in future indications and therapy expansion. Critically evaluating the existing literature to apply these therapies diligently remains vital to the future of neuromodulation. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Mehul J. Desai, Ryan Aschenbrener, Eduardo J. Carrera, Nirguna Thalla Source Type: research

Intrathecal Pumps
This article discusses patient selection criteria, medication selection, risks, complications, supporting data, and future directions of intrathecal drug delivery systems. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Tyler Ericson, Priyanka Singla, Lynn Kohan Source Type: research