ADAPT Level One Detailed Course Outline

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ADAPT Level OneDetailed Course OutlineI.ADAPT FOUNDATIONSA. WelcomeB. Course overview1. Course overview and learning objectivesa) Clinician handout: Learning Objectives2. Learning theory: why course is structured how it is3. How to get the most out of the coursea) Time commitmentb) Study tipsc) Getting supportC. The Future of Medicine1. The epidemic of modern disease2. A new approach to medicinea) Recognizes exposome and epigenetics as primary drivers ofdiseaseb) Embraces an evolutionary/ancestral perspectivec) Applies a functional medicine approach to care3. How functional and conventional medicine differa) Patient handout: Functional vs. Conventional Medicine4. The ADAPT functional medicine systems modelD. Patient Care1. Where do you start? Where do you go from there?a) Clinician handout: FM Systems Model and the “Order of Things”2. How do you layer and structure the treatment?a) Clinician infographic: Structuring a TreatmentII.OPTIMIZING THE EXPOSOMEA. Introduction and overviewB. Nutrition1. Introduction2. Starting clients on Paleoa) Three options:(1) 30-Day Reset(2) 14-Four with 2-week on-rampb) What if your clients won’t go Paleo?kresserinstitute.com1

(1) Common objections—and solutions(a) Patient handout: Resources for Getting Started(b) Patient handout: Healthy Living on a Budget(2) Paleo for vegetarians(a) Patient handout: Paleo for Vegetarians(3) The 3 most important changesc) The Paleo Reset diet(1) Patient handout: Paleo Reset Guidelines3. Diet/lifestyle protocols for particular needsa) The importance of personalizationb) Macronutrient ratios(1) Patient handout: Macronutrient Targets(2) Patient handout: Monitoring Ketones(3) Patient handout: Blood Sugar Tracking Formc) Meal frequency and timingd) Intermittent fastinge) Carbohydrate backloadingf) Athletes: protein, post-workout meals, carbs(1) Patient handout: Paleo for Athletesg) Women: hormones, carbs, other tips(1) Patient handout: Paleo for Womenh) Paleo pitfalls and solutionsi) Case studiesj) Homework: Case assignments4. How to customize diet/lifestyle for common health conditionsa) Introductionb) Weight loss(1) Patient handout: Six Strategies for Successful Weight Loss(2) Case studyc) High cholesterol and heart disease(1) Patient handout: High Cholesterol and Heart Disease(2) Case study(3) Homework: Case Assignmentsd) High blood pressure(1) Patient handout: 10 Tips for Lowering Your Blood PressureNaturally(2) Case studye) GERD, IBS, IBD, and other digestive problems(1) Patient handout: Digestive Problems(2) Case studyf) Anxiety, depression, and cognitive disorders(1) Patient handout: Boost Your Mood Without Medicationskresserinstitute.com2

(2) Case study(3) Homework: Case Assignmentsg) Diabetes and other blood sugar disorders(1) Patient handout: Diet and Lifestyle Recommendations forBlood Sugar Disorders(2) Case studyh) Thyroid disorders(1) Patient handout: Diet and Lifestyle Changes for GoodThyroid Health(2) Case studyi) Autoimmune disorders(1) Patient handout: Diet and Lifestyle Recommendations forAutoimmune Disorders(2) Case studyj) HPA Axis dysregulation(1) Patient handout: Diet and Lifestyle Recommendations forHPA-D(2) Case study(3) Homework: Case Assignmentsk) Acne, eczema, psoriasis, and other skin conditions(1) Patient handout: Diet and Lifestyle Changes for HealthySkin(2) Case studyl) Fertility, pregnancy, and breastfeeding(1) Patient handout: Diet and Lifestyle Changes for Fertility,Pregnancy and Breastfeeding(2) Case study(3) Homework: Case assignmentsC. Basic supplementation1. Introduction2. Maintenance supplementationa) Vitamin A(1) Food sources(2) Recommended supplementsb) Vitamin D(1) Food sources(2) UV exposure(3) Recommended supplementsc) Magnesium(1) Food sources(2) Recommended supplementsd) Vitamin K2kresserinstitute.com3

(1) Food sources(2) Recommended supplementse) Vitamin C(1) Food sources(2) Recommended supplementsf) Iodine(1) Food sources(2) Recommended supplementsg) Patient handout: Food Sources of Key Nutrients3. Nutrients to be cautious of supplementing witha) Ironb) Calciumc) Vitamin E (alpha-tocopherol)d) Beta-carotenee) Folic acid4. Summary of supplement recommendationsa) Patient handout: Maintenance SupplementationD. Lifestyle1. Introduction2. Physical activitya) Introductionb) Core concepts(1) Physical activity-disease connection(2) Move like your ancestors(3) Overtraining(a) Patient handout: Are You Overtraining?c) Recommendations(1) SWAP(2) Apps, tools and resources(3) Patient handout: SWAP Your Way to Healthd) Homework: Case assignments3. Sleepa) Introductionb) Core concepts(1) Sleep-disease connection(2) The role of artificial light(3) Determining how much sleep you need(4) Sleep quality: factors that interfere, improvingc) Basic recommendations(1) Sleep hygiene(2) Sleep nutrition(3) Light controlkresserinstitute.com4

(4) Movement(5) Apps, tools and resources(6) Patient handout: Sleep More Deeplyd) Homework: Case assignments4. Stress managementa) Introductionb) Core concepts(1) Stress-disease connection(2) Definition of stress(3) HPA axis dysregulation(4) Benefits of stress managementc) Basic recommendations(1) Reduce stress you experience(2) Manage stress you can’t avoid(3) Tips for getting started with stress management(4) Apps, tools and resources(5) Patient handout: Manage Your Stressd) Homework: Case assignments5. Environmental toxinsa) Introductionb) Core concepts(1) Toxins-disease connection(2) Most harmful toxins and where to find themc) Basic recommendations(1) Minimizing toxic exposure(2) Supporting natural detoxification systems(3) Apps, tools and resources(4) Patient handout: Living Clean and Greend) Homework: Case assignmentsE. Additional resources1. Introduction2. Hardware tools (e.g. Fitbit, iWatch, Withings scale, etc.)a) Patient handout: Tools for Getting Healthy3. Websites and appsa) Food/diet trackingb) Physical activityc) Sleepd) Stress management/meditatione) Behavior changef) Food/productsg) Patient handout: Apps for Getting Healthy4. 14Fourkresserinstitute.com5

a) 14Four overviewb) 14Four affiliate programIII. GUTA. Introduction and overviewB. Basic physiology1. Review of digestive tract anatomy and physiology2. Microbiome in health and disease3. The role of the gut barrierC. Pathology1. Risk factors2. Difference between syndrome/symptom and pathology3. Pathologiesa) Hypochlorhydria and impaired bile/enzyme productionb) SIBO(1) Patient handout: Understanding SIBO(2) Clinician handout: SIBO test optionsc) Infectionsd) Dysbiosis and fungal overgrowthe) Food intolerancesf) Intestinal permeabilityg) AutoimmunityD. Diagnosis1. Identifying and working with food intolerancesa) Introduction (part of slide presentation)b) Is food intolerance testing legitimate?c) Signs and symptomsd) Recommended labs(1) Cyrex Array 3(a) Case studies(b) Homework: Case assignments(c) Clinician handout: Array 3 Interpretation Guide(d) Clinician handout: Interpretation of AntibodiesAgainst Wheat, Gluten and Enzyme Antigens(2) Cyrex Array 4(a) Case studies(b) Homework: Case assignments(c) Clinician handout: Array 4 Interpretation Guide(d) Patient handout: Preparing for Array 4(3) Cyrex Array 10(a) Case studieskresserinstitute.com6

(b) Homework: Case assignments(c) Clinician handout: Array 10 Interpretation Guide(d) Patient handout: Preparing for Array 10e) Elimination/provocationf) Follow-up testing2. Gut pathologiesa) DD CSAP BioHealth 401H(1) Case studies(2) Homework: Case assignments(3) Clinician handout: CSAP Interpretation Guide(4) Patient handout: Preparing for the CSAPb) NCNM SIBO Breath(1) Case studies(2) Homework: Case assignments(3) Clinician handout: SIBO Breath Interpretation Guide(4) Patient handout: Preparing for SIBO Breathc) Genova Organix Dysbiosis(1) Case studies(2) Homework: Case assignments(3) Clinician handout: Organix Dysbiosis Interpretation Guide(4) Patient handout: Preparing for Organix Dysbiosisd) Cyrex Array 2(1) Case studies(2) Clinician handout: Array 2 Interpretation Guide(3) Patient handout: Preparing for Array 2e) Doctor’s Data Intestinal Permeability Assessment(1) Case studies(2) Clinician handout: IPA Interpretation Guide(3) Patient handout: Preparing for Intestinal PermeabilityAssessmentf) uBiome and American Gut(1) Pros and cons(2) Clinical relevanceE. Treatment protocols1. General considerationsa) Two stages of treating the gut(1) Remove(2) Rebuildb) General guidelines and tips for antimicrobial protocols2. SIBOa) Dietb) Antimicrobialskresserinstitute.com7

ineticsOther supplements3-stage SIBO protocolPatient handout: Anti-Microbial ProtocolsClinician handout: SIBO Treatment – DurationClinician handout: Prescription Medications for SIBO TreatmentClinician handout: Pediatric SIBO and Gut Dysbiosis TreatmentProtocolsj) Clinician handout: Elemental DietDysbiosis and fungal overgrowtha) Dietb) Antimicrobialsc) Other supplementsd) Clinician handout: Botanical Protocol for DysbiosisParasites & H. pyloria) Dietb) Antiparasiticsc) Other supplementsd) Clinician handout: H. Pylori Botanical TreatmentLow stomach acid/GERDa) Dietb) Supplementsc) Other considerationsd) Clinician Handout: GERD Treatment SummaryIBD/IBS-Da) Dietb) Supplementsc) Medicationsd) Patient handout: Paleo Low-FODMAP Diete) Patient handout: GAPS Dietf) Patient Handout: How to Manage Your Stressg) Clinician Handout: IBD Remission and Maintenance TreatmentIBS-C/constipationa) Dietb) Supplementsc) Other considerationsd) Clinician Handout: Probiotics and Gut Symptom TreatmentLeaky guta) Dietb) Supplementsc) Other considerationsd) Clinician handout: Gut Barrier Interventions8

F. Probiotics and prebiotics1. Fermented foods2. Fermentable fiber3. Commercial products4. Patient handout: Fermented Foods Guide5. Patient handout: Rebuilding a Healthy GutG. Lifestyle and behavior1. Stress management2. Mindful eating3. Meal timing and frequency4. Clinician handout: Gut Lifestyle & Behavior RecommendationsH. Advanced treatments1. Probiotic and prebiotic implants2. Fecal transplantsI. Bringing it all together1. Case studies2. Homework: Case assignmentsJ. Wrap-upIV. HPA AXIS DYSREGULATION (HPA-D)A. IntroductionB. Basic physiology1. HPA axis and Adrenomedullary Hormone System (AHS)2. Stress hormones and hormone metabolismC. Etiology1. 4 categories of HPA axis stressors2. Diet and lifestyle factors3. Caffeine, steroids, and other drugsD. HPA-D vs. “Adrenal Fatigue”1. Does Adrenal Fatigue exist?2. Problems with the 3-stage model3. How to discuss HPA-D with clients and other medical professionalsa) Patient handout: What is HPA Axis Dysregulation?E. Pathology1. Allostatic load and depletion of metabolic reserve2. Genomics, epigenetics and HPA-D3. Conditions related to HPA-DF. Diagnosis1. Categories of assessmenta) Signs, symptoms & history(1) HPA-D is clinical diagnosiskresserinstitute.com9

b) Lab tests: “allostatic load battery”: what to measure?(1) Cortisol(2) DHEA(3) Cortisol awakening response(4) Cortisol: DHEA ratio(5) Optional: aldosterone, melatonin, ACTH, inflammatorymarkersc) Assessment tools for perceived stress(1) Patient handout: Perceived Stress Scale(2) Patient handout: Holmes and Rahe Stress Scale2. Comparison of available testsa) Serum vs. saliva vs. urine vs. hairb) Saliva vs. DUTCH testc) Recommended test protocolG. DUTCH Adrenal Profile1. PH Adrenal Profile2. Case studies / specific patterns of dysfunction3. Clinician Handout: Adrenal Profile Interpretation GuideH. Treatment of HPA-D1. Dieta) Macronutrients(1) Protein (timing, total amount)(2) Carbs (timing, total amount)b) Meal frequency and timingc) Specific nutrientsd) Patient handout: Diet for HPA-D2. Behavior and lifestylea) Light exposureb) Exercisec) Stress managementd) Patient handout: HPA-D Behavior and Lifestyle Strategies3. Adjunctive therapiesa) Acupunctureb) Massagec) MBCT4. Supplemental nutrients, botanicals & hormonesa) Basic nutrientsb) Adaptogens and licoricec) Glandularsd) Hormones5. Building a protocola) High free and total cortisolkresserinstitute.com10

b) Low free and total cortisolc) Disrupted diurnal rhythm / high nighttime cortisold) High free cortisol with low totale) Low free cortisol with high totalf) Impaired cortisol metabolismg) Low/high DHEAh) Low melatonini) Clinician handout: HPA-D Protocol Matrixj) Homework: Case assignmentsI. Bringing it all together1. Case studies2. Homework: Case assignmentsJ. Wrap-upV.FUNCTIONAL BLOOD CHEMISTRYA. Introduction and overviewB. Blood chemistry basics1. Principles of functional blood chemistry2. Functional vs. conventional rangesa) Clinician handout: Functional Blood Chemistry Rangesb) Clinician handout: Functional Blood Chemistry Template3. Recommended panela) Clinician handout: Professional Co-op “Case Review Panel”4. Options for ordering the panel5. Where to find additional infoC. Blood chemistry patterns1. Blood sugar imbalancesa) Hyperglycemia / MetSyn(1) Case studies(2) Additional markers(a) Clinician handout: Post-Meal Blood Sugar Template(b) Patient handout: Post-Meal Blood Sugar TestingInstructions(3) Treatment(a) Patient handout: Intermittent Fasting(b) Patient handout: The Potato Hack Diet(c) Patient handout: Protein-Sparing Modified FastGuidelinesb) Hypoglycemia / reactive hypoglycemia(1) Case studies(2) Additional markers(3) Treatmentkresserinstitute.com11

(a) Clinician handout: Interpretation of HypoglycemiaFollow-up Tests2. Nutrient imbalancesa) Iron deficiency(1) Case studies(2) Additional markers(3) Treatment(a) Patient handout: Iron Repletion Protocol(b) Clinician handout: Functional Ranges for IronMarkersb) Iron overload(1) Case studies(2) Additional markers(3) Treatment(a) Patient handout: Iron Reduction Protocol(b) Patient handout: FeGGT Score Questionnaire(c) Clinician handout: FeGGT Score Assessment(d) Patient handout: How to Determine HFE Statusc) B12 deficiency(1) Case studies(2) Additional markers(3) Treatment(a) Patient handout: B12 Repletion Protocold) Vitamin D imbalance(1) Case studies(2) Additional markers(3) Treatment(a) Patient handout: Optimizing Vitamin D Levelse) Zinc-copper imbalance(1) Case studies(2) Additional markers(3) Treatment(a) Patient handout: Optimizing Copper and ZincLevelsf) Magnesium deficiency(1) Case studies(2) Additional markers(3) Treatment3. Thyroid imbalancesa) Thyroid hypofunction(1) Case studies(2) Additional markerskresserinstitute.com12

(3) Treatment(a) Clinician handout: THEA Score Assessment(b) Patient handout: THEA Score Questionnaire(c) Patient handout: Dietary Nutrients for ThyroidHealthb) Thyroid hyperfunction(1) Case studies(2) Additional markers(3) Treatment(a) Clinician handout: Finding Low Thyrotropin Level4. Other blood chemistry patternsa) Impaired kidney function(1) Case studies(2) Additional markers(3) Treatmentb) Other metabolic patterns (dehydration, gout, edema, changes inmuscle mass)(1) Case studies(2) Additional markers(3) Treatmentc) Impaired liver function(1) Case studies(2) Additional markers(3) Treatmentd) Impaired gallbladder function(1) Case studies(2) Additional markers(3) Treatmente) Anemia (iron deficiency)(1) Case studies(2) Additional markers(3) Treatment(4) Clinician handout: ACD and IDA Iron Marker Comparisonf) Anemia (B12/folate/B6 deficiency)(1) Case studies(2) Additional markers(3) Treatmentg) Anemia (of chronic disease)(1) Case studies(2) Additional markers(3) Treatmenth) Dyslipidemiakresserinstitute.com13

(1) Case studies(2) Additional markers(3) Treatmenti) Chronic infection & immune dysregulation(1) Case studies(2) Additional markers(3) Treatmentj) Impaired methylation(1) Case studies(2) Additional markers(3) Treatment(a) Patient handout: Methylation Nutrients and FoodsD. Bringing it all together1. Full case studies with blood panels and history2. Case assignments3. Clinician manual: Functional Blood Chemistry Interpretation GuideE. Wrap-upVI. Case ReviewsA. Introduction and overviewB. Full case studiesC. Full case assignmentsD. Final thoughtsVII. PRACTICE MANAGEMENTA. Healthcare business models1. Distributed/virtual practice2. The Case Review processa) Patient handout: What is a Case Review?3. Patient flowa) Initial Consultb) Case Review appointmentc) Follow-upsB. Operations and procedures1. Staffinga) Key staff positions and roles(1) Start-up(2) Growth(3) Clinician handout: CCFM organization chart2. Onboarding new clientsa) Introductionb) Overview of stepskresserinstitute.com14

c)d)e)Initial application & follow-upEmail autoresponderScheduling the Initial Consult(1) Clinician Handout: Authorization for Services(2) Clinician Handout: Chart Prep Case Reviews(3) Clinician Handout: Chart Prep Initial Consults(4) Clinician Handout: Create BC Reports(5) Clinician Handout: Create Superbills(6) Clinician Handout: Estimate Additions(7) Clinician Handout: Estimate Approvals(8) Clinician Handout: Estimate Modifications(9) Clinician Handout: Lab Ordering Procedures(10)Clinician Handout: Onboarding AR Outline(11)Clinician Handout: Onboarding Case Review Clinician(12)Clinician Handout: Onboarding Case Review Follow-up Call(13)Clinician Handout: Onboarding Case Review Follow-up(14)Clinician Handout: Onboarding EHR Registration(15)Clinician Handout: Onboarding from Initial Consult through CaseReview(16)Clinician Handout: Onboarding Initial Consult Follow-up Call(17)Clinician Handout: Onboarding Initial Consult Follow-up(18)Clinician Handout: Onboarding Initial Consult for Clinician(19)Clinician Handout: Onboarding Initial Inquiry Follow-Up(20)Clinician Handout: Onboarding Process Registration Form(21)Clinician Handout: Onboarding Schedule Initial Consult Follow Up(22)Clinician Handout: Onboarding Schedule Initial Consult(23)Clinician Handout: Onboarding through Booking Initial Consult(24)Clinician Handout: Outline of NP Onboarding Procedure(25)Clinician Handout: Patient Guide(26)Clinician Handout: Process Appointment Encounter CaseReviews(27)Clinician Handout: Process Appointment Encounter InitialConsults(28)Clinician Handout: Schedule CR(29)Clinician Handout: Send Messages(30)Clinician Handout: Tag Questionnaires(31)Clinician Handout: Update CC Info(32)Clinician Handout: Upload Lab Results into the EHR(33)Clinician Handout: Using Ring Central3. Utilizing allied providers to improve care and increase revenue1. Why use allied providers?kresserinstitute.com15

2. The role of various allied providers: health coaches/nutritionists, nursepractitioners/physician assistants3. Incorporating allied providers into the case review model4. Additional ways to utilize allied providers to improve patient care5. Scope of practice considerations for licensed clinicians and allied providers4. The Initial Consulta) Overviewb) Key points to cover(1) Clinician handout: Initial Consult Scriptc) Follow-up(1) Sending intake paperwork, lab requisitions, and kits(2) Scheduling the Case Reviewd) Clinician handout: Patient Guide & Informed Consente) Working procedure: Initial Consultf) Clinician handout: Initial Consult Overview and Tips5. The Case Reviewa) Overviewb) New patient intake(1) Chief complaints(2) Body systems assessment(3) Diet survey and one-day diary(4) History(5) Supplement and medication list(6) Case Review questionnaire(7) Patient handout: Case Review Questionnaire(8) Patient handout: Dietary Habits Questionnaire(9) Patient handout: Environmental Exposure Survey(10)Patient handout: Food Survey(11)Patient handout: Metabolic Assessment Formc) The Report of Findings(1) Clinician Handout: Report of Findings Templated) How to structure the appointmente) Managing expectations for treatmentf) Follow-up(1) Delivering the Report of Findings(2) Delivering patient instructionsg) Working procedure: Case Review6. Follow-up appointmentsa) Overviewb) Pre-appointment questionnaire: tracking progress over timec) How to structure the appointmentd) Follow-upkresserinstitute.com16

e) Working procedure: Follow-up Appointmentsf) Patient handout: Follow-Up Appointment Questionnaire7. Processing patient chartsa) Processing initial consult appointments(1) Overview of steps(2) Preparing invoice and getting patient approval(3) Ordering supplements(4) Ordering labs(5) Delivering clinician instructions and handouts(6) Billing(7) Working procedure: Processing Patient Chartsb) Processing case review appointmentsc) Processing existing patient appointments8. Billing, insurance and reimbursementa) Relevant issues for functional medicine practiceb) Billing policies for cash practicesc) ICD-10 diagnosis codesd) Clinician handout: Registration and Agreement Form Example9. Patient communicationa) Providing first-class service while protecting your timeb) Phone vs. electronic communicationc) Patient communication policy and procedures(1) Clinician handout: Patient Communication Policy Example(2) Clinician handout: Privacy Policy ExampleC. Back-end systems1. EHR and Accountinga) Overviewb) Accounting(1) Quickbooks introductionc) EHR(1) Using the EHR(a) Process Appt Encounters - Lab Ordering(b) Navigate the PPQ - Quest & Comm for Clinicians (2 parts)(c) Create, Manage, and Use Chart Parts(d) Send Medical Records(e) Order Supplements(f) Order Prescriptions(g) Create BC reports(h) Add CPT Options to the Database(i) Add Supplements to the Database(j) Patient handout: How to Use Your Patient Portal2. Legal / Phone/ File managementkresserinstitute.com17

3. Schedulinga) Overviewb) Case review and initial consult appointmentsc) Existing patient appointments4. Collaboration & Video conferencinga) Basecampb) Teamweekc) Perch.cod) Clinician handout: Hosting a Zoom Webinare) Clinician handout: Webinar Best Practices5. Getting help6. Documentation (Work The System)kresserinstitute.com18

a) Diet b) Supplements c) Other considerations d) Clinician Handout: GERD Treatment Summary 6. IBD/IBS-D a) Diet b) Supplements c) Medications d) Patient handout: Paleo Low-FODMAP Diet e) Patient handout: GAPS Diet f) Patient Handout: How to Manage Your Stress g) Clinician Handout: IBD Remiss

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