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I do not do this kind of medicine, but I strongly suggest that my readers learn more about Functional Medicine and how it can help them.

What is presented here is a case that I hope you will find interesting.  I suggest all of you make an effort to learn more about this field and how it may help you.

Please contact Dr. Grisanti if you wish to learn more or would like to find a practitioner of Functional Medicine
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Severe Itching on Face and Neck, Osteopenia and GERD

A 67 year woman named Betty was initially seen in my office in May of 2014 for the following symptoms and conditions: Itching all over face and neck for a period of over three years, osteopenia, fatigue, insomnia and GERD.

Review of medical records revealed seeing an allergist and her general family doctor. The allergist ran an IgE test which was unremarkable and recommended that she take Benadryl. Her family doctor recommended Evista and extra calcium for the osteopenia, Ambien for the insomnia and Nexium for the GERD.

The patient decided to schedule an appointment with me to see if I can figure out why she was having these health problems. She simply was not satisfied with taking a medication for every symptom. She had a strong desire to identity the root cause(s) of her health challenges.

Betty’s metabolic blood profile was essentially unremarkable with the exception of a low normal protein at 5.7 and high normal RDW (part of the CBC differential).

Comments: It is important to note that a low normal protein may be indicative of hypochlorhydria (refers to states where the production of gastric acid in the stomach is absent or low) and a high normal RDW may indicate iron deficiency anemia or B-12 deficiency.

Based on Betty’s past and present history and physical examination I recommended the following labs:

Bone Resorption Test:
Positive for increased bone loss
GI Effects:
Low Bifidobacter
Low Elastase 1- pancreatic deficiency
Low normal SigA

Comments: Pancreatic elastase 1 levels below 100 are strongly correlated with severe pancreatic insufficiency; levels of 100-200 identify moderate pancreatic insufficiency.
ION Test from Genova/Metametrix Most of the amino acid were in the first and second quintile indicating a potential malabsorption issue.

Low Normal gamma-Tocopherol
Low Magnesium
Low Normal Calcium
Elevated Arsenic, Lead, Cadmium and Mercury
Elevated 8-Hydroxy-2-deoxyguanosine
Low normal Gamma Linolenic: Primose oil rotated with Borage oil
Low Myristoleic: coconut oil
Low Lauric: coconut oil
Low Myristic: coconut oil

Elevated Methylmalonate: functional marker for vitamin B12

Elevated Glucarate:
Commentary: High urinary glucarate suggests exposure to pesticides, herbicides, fungicides, petrochemicals, alcohol, pharmaceutical compounds, or toxins produced in the gastrointestinal tract. High levels of glucarate indicate your liver is working to remove these toxins. Removing the source of exposure and supporting the liver’s detoxication with nutrients such as glycine, glutathione, N-acetylcysteine, and  liver-specific antioxidants
are helpful.

Low Sulfate:
Commentary: Low urinary sulfate is an indication that total body glutathione is low due to chronic demand and sulfur-containing amino acids are needed. The amino acid N-acetylcysteine is one effective agent for
raising your glutathione and sulfate levels.

Elevated p-Hydroxybenzoate:
Commentary: High levels of p-Hydroxybenzoate is also an indication that dysbiosis is present. An overgrowth 3 of unfavorable bacteria results in a release of toxic products such as p-Hydroxybenzoate. It is well established that beneficial intestinal bacteria produce some B vitamins and provide stimulus for proper immune function Unfortunately, if your stomach acid is not adequate, if you fail to digest protein, or if your diet does not supply sufficient fiber, the result is the increase in the unfavorable bacteria leading to release of these
toxic products.

Elevated p-Hydroxyphenylacetate:
Commentary: High levels of p-Hydroxyphenylacetate is also an indication that dysbiosis is present.

Elevated Indican:
Commentary: High levels of indican is also an indication that dysbiosis is present. An overgrowth of unfavorable bacteria results in a release of toxic products such as indican. It is well established that beneficial intestinal bacteria produce some B vitamins and provide stimulus for proper immune function. Unfortunately, if your stomach acid is not adequate, if you fail to digest protein, or if your diet does not supply sufficient fiber, the result is the increase in the unfavorable bacteria leading to release of these toxic products.

Adrenal Testing Revealed
Elevated morning cortisol
Elevated evening cortisol
Borderline Low DHEA
Low Insulin
Low SigA

Priority Issues and Functional Causes of her health problems:
1: Pancreatic Enzyme Deficiency
2: Low Essential Fatty Acid- Low normal Gamma Linolenic
3: Intestinal Dysbiosis
4: Positive Bone Resorption
5: B-12 deficiency
6: Heavy Metal Toxicity
7: Vitamin E (mixed tocopherols) deficiency
8: Low carbohydrate diet/ grain-free/dairy-free for 90 days
9: Low Bifidobacter: probiotics
10: Poor detoxification—elevated glucarate, low normal sulfate
11: Elevated cortisols– support adrenal glands
12: Low SigA- primary immune function
13: Low magnesium and calcium
14: General amino acid deficiency- supplement with amino acid blend
15: Stop consuming PUFAs (soy, corn, canola safflower, cottonseed)

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