Significant Prevalence and Rising Incidence

• Affects 10% of the population
• Women more susceptible

Economic and Quality of Life Impacto

• Management imposes a substantial economic burden
• Significantly impacts the quality of life

Conventional Approaches

• Focus on symptom reduction and control of AI response
• Often fall short; can be costly

Functional and Integrative Medicine

• Focus on personalized care; addresses root causes
• Combines conventional, complementary, and lifestyle medicine

Primary Care Integration

• Early detection; preventative services
• Strong primary and community care coordination

Foundational Health Fundamentals

• Prioritize real food, quality sleep, pure water, clean air, sunlight, movement, and social interactions

Balancing the Immune System

• Support Th1 activity; modulate Th2 responses
• Reduce inflammation

Nutritional Support

• Address common nutrient deficiencies
• Remove culprit foods

Holistic Approaches

• Incorporate mind-body practices
• Balance ANS

Future Directions

• Continue education for healthcare providers
• Address root causes
• Promote multidisciplinary team collaboration
• Focus on patient-centered care

Module 1: The Microbiome-Gut-Brain Axis

1. Overview of the Microbiome
   • Definition and composition of the gut microbiome
   • Role in health and disease
   • Bidirectional communication between the gut and brain
2. Brain-to-Gut Microbiota Communication
   • Vagus nerve and its role
   • Effects of dysbiosis on the brain and body
   • Inflammatory responses and parasympathetic activation
3. Gut-to-Brain Communication
   • Signal transmitters (SCFAs, bile acids, tryptophan metabolites)
   • Signal receivers (EECs, ECCs, immune system)
   • Impact on brain function and behavior

Introduction to Nutrition and the Microbiome

1. Diet and Microbiota Composition
   • Short-term vs. long-term dietary changes
   • Diverse diets and microbiota diversity
2. Macronutrients and Microbiota
   • Impact of fats and proteins on gut health
   • Healthy vs. unhealthy fats
3. Prebiotics and Probiotics
   • Definitions and examples
   • Benefits and mechanisms of action
   • Variable responses to supplementation

Immune System and the Gut

1. Gut-Associated Lymphoid Tissue (GALT)
   • Structure and function
   • Interaction with the microbiome
2. Immune Responses and Inflammation
   • Role of gut microbiota in immune modulation
   • Mechanisms of inflammation and immune activation
3. Impact of Dysbiosis on Immunity
   • Links to autoimmune diseases and chronic inflammation
   • Examples of specific conditions (IBD, IBS, allergies)

Integrative Approaches to Gut Health

1. Lifestyle Interventions
   • Importance of regular physical activity
   • Stress management techniques (e.g., mindfulness, meditation)
2. Dietary Strategies
   • Whole foods and plant-centric diets
   • Specific dietary patterns (e.g., Mediterranean diet)
3. Therapeutic Interventions
   • Use of prebiotics, probiotics, and synbiotics
   • The potential of fecal microbiota transplantation (FMT)
   • Emerging therapies and future research directions

Module 2: Deep Dive on Nutrition & the Gut Microbiome

Bioavailability in Nutrition

• Key Concepts
  • Digestion
  • Bioaccessibility
  • Absorption
  • Transformation and Activation

Diet and Gut Microbiota Connection

• Impact of Diet
  • Source and fuel for microbiota
  • Influence on microbiota composition
  • Short-term vs. long-term diet changes

Macronutrients and Gut Microbiota

• Carbohydrates and Fiber
  • Fiber and SCFA production
  • FODMAPs and Irritable Bowel Syndrome
• Fat and Protein
  • Impact of high-fat and high-protein diets
  • Types of fats and their effects

Micronutrients and the Microbiome

• Key Micronutrients
  • Vitamin A, B, C, D, K
  • Iron and Zinc
  • Polyphenols and their health effects

Introduction and definitions

• Integrative medicine
• Integrative health practices (IHPs)
• Safety considerations

Evidence-based research for and mechanisms of action of IHPs

• Current systematic review/meta-analysis-level research for each IHP of the common chronic conditions each can effectively manage
• Review of the research literature exploring the mechanisms of action of IHPs

Chronic conditions and IHPs that can manage each condition

• Chronic pain
• Anxiety
• Insomnia
• High blood pressure
• Obesity
• Depression
• High blood glucose
• Tobacco use

Case studies and treatment plans

• Case Study 1: patient with chronic pain and insomnia
• Case Study 2: patient with high blood pressure, anxiety, depression
• Case Study 3: patient with tobacco use and obesity

Evaluate patient progress and collaborate with interdisciplinary care teams

• Case Study 1: follow up on the patient with chronic pain and insomnia
• Case Study 2: follow up on the patient with high blood pressure, anxiety, depression
• Case Study 3: follow up on the patient with tobacco use and obesity

Risks and limitations

1. Atopic Dermatitis

• Epidemiology and comorbidities associated with infantile atopic dermatitis
• Treatment Obstacles
• Step Treatment options
  • Medications
    • Topical therapies
    • Biologics
      • Adverse events
    • JAK inhibitors
      • JAK and MACE
  • Non-pharmacological therapies
    • Phototherapy

2. Psoriasis

• Treatment options
• Phototherapy
• Treatment pathway for psoriasis
• Biologics
  • Tumor Necrosis Factor Alpha inhibitors
  • Interleukin 17 inhibitors
  • Interleukin 23 inhibitors
    • Ongoing monitor parameters
  • BIOLOGICS
    • Switching biologics

3. Hidradenitis Suppirativa

• Pathophysiology of HS
• Diagnosis of HS
• Severity and Hurley stage
  • Assessment from the patient perspective
• Treatment
  • First line therapy
  • Biologics

4. Alopecia Areata

• Risk factors and Clinical presentation
• Diagnosis of AA
• Goals of treatment AA
  • Treatment options
    • Topical therapy
    • Corticosteroids
    • Intralesional treatment options
    • JAK inhibitor

5. Vitiligo

• Epidemiology
• Diagnosis
• Treatment goals
• Treatment options

6. Summarization

1. Introduction & Importance of Women's Health
   • Adolescent health
   • Reproductive health
2. Common Gynecological Issues
   • Maternal Health
   • Menopause and Agining
3. Mental Health in Women
   • Anxiety
   • Depression
   • Postpartum Depression
4. Chronic Disease in Women
5. Access to Healthcare Globally for Women

I. Introduction

• Review of hematologic lab values
• Definition and prevalence
• Importance of addressing iron deficiency anemia in women's health

II. Diagnosis and Assessment

• Overview of diagnostic tests: CBC, iron, ferritin, TIBC, and others
• Clinical evaluation and differential diagnosis
• Importance of healthcare provider consultation

III. Causes and Risk Factors

• Factors contributing to iron deficiency
• Menstrual bleeding and its impact
• Pregnancy considerations
• Other factors: gastrointestinal disorders, chronic diseases, etc.

IV. Physiological Impact on women's and children's health

• Symptoms and signs
• Complications and long-term effects
• Impact on physical and mental well-being
• Impact on offspring, including neurologic development

V. Management and Treatment

• Tailored approaches for women of different ages and life stages
• Pharmacological interventions: iron supplementation options: oral and IV
• Recommendations for iron intake
• Supplement guidelines for at-risk groups
• Testing and screening

What are the sex hormones?

• Where are they produced?
• How do they work?
• What are their primary and secondary functions and their connections to all organ system functions?

Sex hormones as neurosteroids

• What are the specific roles of sex steroids in the brain?
• What are the specific roles of sex steroids in the autonomic nervous system?
• How does the brain get sex hormones?

How do the sex steroids affect mood?

• The role of neurotransmitters
• The role of peptides
• The role of the endocannabinoid system

The integrative approach to hormone optimization

• How can the production and balance of sex hormones be optimized?
• How can sex hormones be replaced due to reduced production with aging?
• Summary of the integrative approach to hormone optimization: including nutrition, fitness, circadian rhythm alignment, relationships, toxicant avoidance, stress management
• Acknowledge the current limitations of research in this growing field

Why Functional Medicine?

Overview of PCOS

• Statistics and Prevalence
• Symptoms
• Work Up
• Phenotypes – NIH

The Gut – Microbiome

• Dysbiosis and metabolic syndrome
• What is Akkermansia muciniphila?
• Progression of Disease
• Inflammation

Food, Nutrition and Supplements

• N-acetyl cysteine (NAC)
• Myoinositol
• Epigallocatechin gallate (EGCG)
• Food as Medicine

• Permanent cessation of menstrual periods
• Loss of ovarian follicular activity
• Androgens become the predominant hormone

• Bioidentical hormone therapy options ‘
  • Risks/benefits
  • Estrogen
  • Estrogen/Progesterone
• Nonhormonal therapies
  • SSRI
  • NK3 receptor antagonist
• Supplements
  • Black cohosh
  • DIM
  • Siberian Rhubarb
  • Vitamin E treatment

• Breast cancer
• Endometrial cancer
• Blood clot

What’s going on in autoimmune thyroid disease?

• Thyroid hormone status
• Autoimmunity
• Consequences of dysthyroidism/triggers/exacerbating factors of AITD
• Symptom Overlap
• What is a “full thyroid panel”?

Role of thyroid hormone status (hypothyroidism/hyperthyroidism) in mood disorders and anxiety

• Subtreatment as cause for residual symptoms
• How to optimize thyroid hormones
  • TSH
  • T4 to T3 conversion...pharmaceutical options, co-factors

Clinical relevance of thyroid autoimmunity in mental health disorders

• Discussion of pertinent research and proposed mechanisms
• Strategies for balancing autoimmune response... myoinositol, selenium, LLLT, and NAC

Consequences of dysthyroidism/autoimmune triggers in relation to mental health

• Stress response
  • Blood sugar
  • Trauma
• Nutrient deficiencies
  • Low ferritin
  • Low Vitamin D
  • Methylation
  • B12
• Infections, gut health, and toxins

Potential protocols to support thyroid and mental health symptoms