Practitioner Question of the Month – November 2018

Dr. Michael Ruscio’s Monthly – Future of Functional Medicine Review Clinical Newsletter Practical Solutions for Practitioners In Today’s

Dr. Michael Ruscio’s Monthly – Future of Functional Medicine Review Clinical Newsletter

Practical Solutions for Practitioners

In Today’s Issue

Practitioner Question of the Month

Joe Mather says

Given your openness to changing your mind with new information and effort to give evidence-based recommendations to patients – I think it would be valuable to hear your thoughts on what you’ve changed your mind on in your clinical practice. You’ve alluded to not commonly using adrenal or food sensitivity testing. What other parts of your practice have evolved? Is there anything you’ve done a 180 on with the benefit of experience and study?

For me – I’m skeptical of MTHFR in most patients, I think the benefits of fish oil have been largely oversold, and am much more conservative regarding vitamin D supplementation. I also prescribe a lot more statins / Zetia than in years past.

Great question Joe.  I try to work my evolution constantly into the dialogue of the case studies and podcasts.  A few highlights, a bit curtly stated:

  • Adrenal testing, near useless
  • MTHFR testing, not helpful
  • Most gene testing, not helpful
  • SIBO and GI infection/dysbiosis testing, mildly helpful but often overused
  • Food allergy testing, not helpful
  • Expanded thyroid, not needed initially – focus on larger picture first
  • Agreed on vitamin D, although I entertain a higher dose in minimally responsive autoimmune cases
  • Fish oil – Agreed, however looking at 3/6 ratio might have utility for CVD prevention – as discussed here https://drruscio.com/practitioner-2018-feb-research/#r2

Underlying philosophy: To the degree which testing distracts one from effectively listening to the patient, their response to therapies and in applying the established treatments, it will detract from clinical outcomes.

Practice Tip

Make sure you have a talented tech consultant on your team.  We recently determined in a staff meeting that our new patient intake process was easily one of the more difficult tasks our staff was confronted with.  Upon digging into the details of the process we determined there were 2 points of automation would greatly reduce the amount of staff time needed to process new patients thus allowing us to facilitate the process while freeing staff members for more important functions elsewhere. It was only after meeting with our staff and IT person and discussing the automation of these pain points that we were able to identify a workable solution.  Take the time to establish technological solutions to bottlenecks in your office, it is well worth it.

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I’d like to hear your thoughts or questions regarding any of the above information. Please leave comments or questions below – it might become our next practitioner question of the month.

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Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

4 thoughts on “Practitioner Question of the Month – November 2018

  1. Thanks for addressing the question and pointing me back to your review on the Omega 3 Index. I agree with your comments there.

    Ran across this yesterday for those interested: The REDUCE IT trial (Vascepa which is 4g EPA daily + a statin) looks positive in lowering CV events in primary and secondary prevention. I’m not sure that the weight of the previous evidence on fish oil for CV prevention is as positive as this review suggests, however this recent trial will likely change things. The full study will be published soon and detailed results at the upcoming AHA Conference in November.

  2. Thanks for addressing the question and pointing me back to your review on the Omega 3 Index. I agree with your comments there.

    Ran across this yesterday for those interested: The REDUCE IT trial (Vascepa which is 4g EPA daily + a statin) looks positive in lowering CV events in primary and secondary prevention. I’m not sure that the weight of the previous evidence on fish oil for CV prevention is as positive as this review suggests, however this recent trial will likely change things. The full study will be published soon and detailed results at the upcoming AHA Conference in November.

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