A Case Study from Kara Fitzgerald, ND.
Kara will be speaking on this topic at our conference on 29th October, few seats are still available, book here.
A 62-year-old gentleman named Robert presented to my office recently with a diagnosis of hypertension and hyperlipidemia. He was about to retire from a lifetime of high-stress, demanding technical work. He was motivated to improve the quality of his health so he could maximize enjoyment of his later years with family and friends. (What a fabulous goal!) He presented to me as a relatively healthy American male, balding with mild abdominal adiposity. His blood pressure (left arm sitting) was 130/85. He had moderate hearing loss requiring hearing aids in both ears as a result of receiving ototoxic antibiotics as a small child. He had his hearing checked at regular intervals, which generally showed no change or a slight decline. He
In my practice, I a set of core clinical imbalances that are linked to the basic physiological processes. These serve to marry the mechanisms of disease with the manifestations and diagnoses of disease. Many common underlying pathways of disease are reflected in these clinical imbalances. The Matrix components include: Assimilation Imbalances, Biotransformation and Elimination Imbalances, Defense and Repair Imbalances, Energy Imbalances, Communication and Transport Imbalances, Structural Integrity Imbalances and Mind, Emotions and Spiritual Imbalances. As the greater medical community embraces individualized, systems-thinking, this model (or similar) will likely be widely adopted.
With Robert, I ordered a comprehensive battery of standard labs, including: chemistry screen, complete blood count, lipid, thyroid and iron panels; insulin, celiac serology and HLA genes, fibrinogen, homocysteine, hs-CRP, Lp(a) and testosterone. Nutrient testing included: amino acids, organic acids, lipid peroxides, essential and toxic elements, vitamin D, E, CoQ10, A, beta carotene, fatty acids, stool microbiota analysis with digestive markers; IgG4 food sensitivities. To identify key areas of imbalance and treatment direction, I placed the significant laboratory findings along with his clinical history and treatment into a table comprised of the key Matrix imbalances (Table 1).
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Table 1. Assessments, Laboratory Findings and Treatments
Organized According to the Functional Medicine Matrix
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Clinical Assessment
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Initial Laboratory Results
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Initial Recommended Treatment
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Fundamental Lifestyle Factors: Nutrient Imbalances
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| Hypertension
Maldigestion/malabsorption (MSQ: GI) |
Low B12 (elevated urinary methylmalonic acid)
Low serum COQ10
Low serum vitamin D
Low fecal elastase (poor digestion)
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Methylcobalamin 5000ug SL QD
CoQ10 300mg PO QD
D3 5000IU PO QD
HCL 500mg titrate to tolerance
Digestive enzymes: 2 with main meals |
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Defense and Repair (e.g. Immune, Inflammation, Infection/microbiota)
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| Food allergies/sensitivities Dysbiosis
History of antibiotics
Intestinal hyperpermeability
(MSQ: GI, Joint, Energy)
Environmental allergies (MSQ: Nose)
Hypovitaminosis D
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Celiac gene: HLADQ2
Low serum vitamin D
IgG4 testing” +3 to dairy, mild positives 5 additional foods
Stool testing: microbiota imbalance, low fecal elastase |
Vitamin D3, Digestive enzymes, HCL – as noted in “Nutrient Imbalances”
Glutamine-based GI repair powder
Probiotic combination:100 billion CFU per day
Dietary changes: Lower carbohydrate, gluten and dairy-free, minimal sugar, protein at all meals. Whole foods, minimally processed, organic diet. Rotate mild reactants. |
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Assimilation (e.g. Digestion, Absorption, microbiota/GI, Respiration)
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| Dysbiosis
History of antibiotics
Intestinal hyperpermeability
Maldigestion/malabsorption
(MSQ: GI )
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Celiac gene: HLADQ2
(Celiac serology negative)
IgG4 testing” +3 to dairy, mild positives 5 additional foods
Stool testing: microbiota imbalance |
As noted in “Defense and Repair” |
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Communication (e.g. Endocrine, Neurotransmitters, immune messengers)
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| Hypertension
Hyperlipidemia
Family history of heart disease and diabetes |
Low HDL
Low-normal free testosterone
High-normal fasting blood glucose
(thyroid panel, essential elements and amino acids all within normal limits)
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Dietary changes as noted in “Defense and Repair”
Cardiovascular exercise prescription
DHEA 50mg PO QD
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Energy (e.g. Energy Regulation, Mitochondrial Function)
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| MSQ: fatigue
Statin rx
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Low serum vitamin D
Low serum CoQ10
B12 deficiency
(cardiovascular, inflammatory and oxidative markers all within normal limits) |
Alpha lipoic acid 200mg: 1 tab TID
As noted in “Nutrient Imbalances” |
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Mental, Emotional, Spiritual
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| High-stress work life |
N/A |
Pending retirement
Exercise prescription |
Robert adhered to all of the treatment recommendations. His complaints largely resolved, as seen in his follow-up MSQ below. He was able to discontinue his medications. His blood pressure was on average around 110/70. He lost over 20 pounds and became an avid hiker. His success inspired those around him, including his wife and sons, who all moved towards a healthier lifestyle.
As part of the Matrix model, questions we can ask while we are sorting the data
This case is interesting in that hypertension, Robert’s chief complaint when he presented to me, really didn’t require direct intervention. Rather, an investigation of ATMs led to the identification of a possible pre-celiac malabsorptive condition that likely caused
Interestingly, it was noted that Robert had lost ½ inch in height at his annual physical exam. A bone density test (DXA scan) revealed osteopenia, also associated with celiac-induced malabsorption.
A final twist to this case is that Robert’s most recent hearing test revealed a mild, but significant improvement, a remarkable finding considering the duration and cause of the impairment. While it cannot be determined what contributed to the improvement specifically, a systems- rather than a symptom- approach to his treatment favors the occurrence of such an event.
For detailed, referenced cases using The Institute for Functional Medicine’s Matrix
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