About Dr. Kara Fitzgerald
Dr. Fitzgerald received her doctorate of naturopathic medicine from National College of Natural Medicine in Portland, Oregon. She completed the first CNME-accredited post-doctorate position in nutritional biochemistry and laboratory science at Metametrix (now Genova) Clinical Laboratory under the direction of Richard Lord, Ph.D. Her residency was completed at Progressive Medical Center, a large, integrative medical practice in Atlanta, Georgia under the direction of Cheryl Burdette, ND and Susan Tanner, MD. Dr. Fitzgerald is lead author and editor (with J. Alexander Bralley, Ph.D.) of The Metametrix Institute’s Case Studies in Integrative and Functional Medicine, a contributing author to Laboratory Evaluations for Integrative and Functional Medicine and the Institute for Functional Medicine’s updated Textbook for Functional Medicine. Dr. Fitzgerald is on faculty and a Curriculum Advisory Committee member at Institute for Functional Medicine, and is an Institute for Functional Medicine certified practitioner. She is an adjunct faculty member at University of Bridgeport in the school of Human Nutrition and a member of The Institute for Therapeutic Discovery.
04:50 A Case Study Involving SIBO and Dysbiosis of the Lips: Dr. Fitzgerald very recently had a young patient with SIBO and exfoliative cheilitis, a deep chronic peeling and cracking of the lips. She was able to heal the SIBO, but the lip condition continued. Dr. Fitzgerald noticed a correlation with the onset of the SIBO and occasional thrush-like tongue coating. Nutrient supplementation did not help. Could it be a bacterial dysbiosis of the lips? She tried a safe antimicrobial oil based treatment by opening berberine capsules and mixing the contents with coconut oil and applying it liberally and regularly to affected lips. Her patient added probiotics to the mix. It worked, but still needs to be applied multiple times daily.
13:05 Inflammatory Continuum: Most of us have some allergic bias or immune system dominance. It is not an on or off switch. Immune imbalances can exist without symptoms or disease, making you vulnerable to clinical disease or some other problem. They are functional imbalances that allow you to later develop allergic disease or autoimmune disease. Both are immune system dominance, meaning that it is imbalanced and overactive. Both allergic and autoimmune diseases are epidemic in the west.
15:41 Early Signs of Immune Dysfunction: If you have seasonal allergies, you have allergic disease. It is your body over-reacting to pollen. It shouldn’t. Hay fever did not exist in the early 1800s, but it was epidemic by the end of the 1800s. At the time it was attributed to the pollution of industrialization.
18:23 What Does Pollution Do to Our Immune System? The allergic response is the first line of defense to getting toxins out of our bodies.
21:11 Reducing Toxin Exposure: Clean living guidelines are the best way to eliminate or reduce exposure. We can reduce the problems associated with toxins by making sure that we are nutritionally replete. One way to inhibit absorption of metallotoxins in the gut and the brain is by making sure we have adequate intake of our essential minerals. The transport proteins that are present in the gut and at the blood brain barrier, allow us to absorb minerals. If you are deficient in these, which most of us are on a standard American diet, more of these proteins will be expressed to absorb any mineral present, causing toxins to hitch a ride into the gut and through the blood brain barrier.
23:53 We all have a toxic burden: Clinicians should ask how relevant a patient’s toxic burden is to the pathogenesis of this patient. It determines how aggressive to be with detox. Look for current environmental exposures and get rid of them. Do all foundational functional interventions. Make sure they are minerally replete and have adequate vitamins, amino acids, ensure methylation and glutathione conjugation, and all of our phase 2 detox pathways are up and running. When you do foundational nutrient interventions and dial in the diet, you are preparing the body to remove the compounds itself because the liver is now functioning and detox systems are now functioning. For a subset of individuals, they are ready to go into more aggressive detox. The more aggressive detox is done on those who require this only after functional interventions are done. Individuals who are depleted in minerals will absorb more toxins and have a more difficult time detoxing.
26:50 Iron Deficiency: This is huge in our pre and peri menopausal female population, allowing for the rapid absorption of cadmium and lead into circulation and into the central nervous system. It is an easy fix.
27:22 How to Be Replete with Minerals: Dr. Fitzgerald is in favor of real food. Pinpointed micronutrient prescriptions are appropriate after lab testing to look under the hood for micronutrient insufficiencies and biochemical ramifications. We can map out what is happening and determine if dietary correction is adequate or are micronutrients needed for a period of time. It shouldn’t be a lifetime need. We should probably all be taking probiotics (unless you have SIBO), and essential fatty acids. Nutrient deficiencies are always found in allergy and autoimmunity.
30:10 Micronutrient Testing: Organic acid testing is a standard investigation and a useful tool. There is some variability, but a good sized nutrition deficiency should always show up as increased presence of certain organic acids. A classic example is a B12 deficiency. It is an accumulation of methylmalonic acid. It is a precursor to a few things and feeds the CREB cycle. If there isn’t adequate B12, methylmalonic acid will accumulate in the body. You can infer from this elevation that B12 is needed. Even a genetic mutation causing this would require B12 support. An organic acids test is a nice annual investigation for those of us working on wellness.
33:43 Optimizing Performance: Micronutrient testing is useful for athletes. Athletes can have these same imbalances. They can be corrected to improve performance and wellness.
34:58 Hidden Food Additives: We want to go as close to the original food as possible. It depends upon the individual. Some of us may have to make our food at home until some resilience is developed. MSG is a common issue and should be avoided. Understand what you are eating and recognize the terms. MSG is more of an intolerance than an allergy, setting off a different cascade of mechanisms. It is still inflammatory. Histamines, found naturally in foods are a potential issue as histamine intolerance. An intolerance can present similar to an allergy.
37:22 Nickel and Allergies: People with contact dermatitis that cannot wear cheap jewelry, probably have a nickel sensitivity. Many foods have nickel in them, like chocolate.
37:50 The Challenge of Figuring It Out: It is challenging for the clinician to figure out whether it is allergic disease or allergic disease with the possibility of intolerances. If you are struggling with what you think are allergies, but you’ve done the traditional investigations, you may need to work with a good clinician who is aware of intolerances.
39:27 Diet Limitations as Treatment: If you limit your diet in an attempt to treat yourself, you could become nutrient depleted and have a more difficult time recovering from the illness. Eat whole foods. You should eliminate the top problem foods: gluten, diary, soy, citrus, fish, and/or nuts. You could go full-on Paleo and maintain an adequate nutritious diet.
41:08 The Role of Digestion: Toxins and disturbances in our microbiome predispose us to allergic disease. We have an increased incidence of classic allergic response when we have low stomach acid. Proton pump inhibitors, which inhibit stomach acid, are one of the top 10, and maybe the top 5 prescribed drugs. By lowering stomach acid, you inhibit your body’s ability to break down proteins. The protein fragment is larger than it should be and to the immune system, it will look like a problem.
44:25 The Problem with Low Stomach Acid: Using an HCL titration works to upregulate stomach acid. If you have been taking a proton pump inhibitor or acid blocker for a while, you cannot jump right into HCL. You need professional guidance. SIBO is associated with low stomach acid. The classic presentation of low stomach acid is bloating, abdominal pain, and lots of gas after eating. Our stomach acid is our first line of defense in our immune system. It blasts the bad bugs and the loss of this can be problematic in the stomach, small intestine and large intestine, disturbing the microbiome and lending itself to the underlying pathogeneses of allergic disease and autoimmune disease.
47:10 The Fundamental Process of Digestion: Digestion begins with thinking about what you are going to eat. You start salivating, bringing enzymes forth. It creates a cascade. The stomach starts sequestering hydrogens to drop the pH. Pancreas and gallbladder prepare to receive food. We evolved to do this in a parasympathetic state, a relative calm. That is when we can digest optimally.
49:58 Dr. Fitzgerald’s Favorite Nutrient: Essential acids, primarily EPA and DHA (as well as alpha lipoic and gamma linolenic acid) are so important in having our membranes adequately stocked.
50:47 EPA/DHA and Reducing Inflammation: We need supplemental EPA/DHA. We have too many omega 6s relative to omega 3s. It is very important when treating allergic disease and autoimmunity. The field of lipid biochemistry is just exploding. Lipid mediators, like pro-inflammatory eicosanoids which produce arachidonic acid, are fundamental to all things inflammation, no matter the arm of the immune system that is triggering the inflammation. We consider how to reduce the effect of these. Current thinking is that chronic inflammation is a failure of the resolvants, which come in after the acute phase of the inflammatory response and do clean up. The resolution of inflammation isn’t just that things wind down and go away. It is an active process and has as many compounds involved as inflammation. EPA and DHA have the major resolvants. From EPA are the pro-resolving mediators themselves and from DHA are the neuroprotectins and many other compounds. Many are biologically active and present in immune cells.
55:30 EPA/DHA and Traumatic Brain Injury: The lasting damage associated with TBI is from the ensuing inflammation. In studies, patients unconscious in the hospital with TBI were given very high dose EPA/DHA and at least in one, they were not expected to survive. It is suspected that the pro-resolving lipid meditators were are large part of what turned around the conditions of the patients. Baby aspirin promotes production of the lipid mediators. That may be one of the reasons why it is anti-inflammatory.
1:00:12 One Health Policy Tip for Americans: Functional medicine generalists should be the first line of care. We have all have deficiencies. If we could do one thing, we should get more potassium in our diets. We need about 4 to 5 grams of potassium in our diets each day. Dr. Fitzgerald likes avocado and coconut water as sources of potassium, but sweet potato, green vegetables and colorful vegetables, melons and fruits all have potassium. It will help turn down the volume of chronic disease.