functional nutrition matrix XXXXXXXX

Name: __________________________________________ Date: ____________

Sept. 2017

antecedents sleep/relaxation

Mother - asthma, COPD, low To sleep- 11pm

thyroid, Lupus, eczema, Awake - 4 am
gives immune and environmental
inflammatory inputs Gets up at least 1x a night to
balance use the bathroom
Father - no relationship
Throat closing Mold issues
Birth - vaginal
Itchy anus Post nasal drip
Early nutrition - formula fed exercise/movement
Post nasal drip
Energy a 5 out of 10
High ferritin
Not exercising at this time due
Bladder issues to how she feels.
oxidative
gastrointestinal stress, energy
production
SIBO
triggering events Heavy metal and mold issues
Childhood - strep, antibiotics, Bloating Greenish stools
Extreme fatigue
Teens - anorexic/bulimic, nutrition/hydration
constipation, tonsillectomy,
Anxiety Very limited diet. Suspects
asthma
25yo-1st child, antibiotics. histamine and oxalate issues.
26yo - 2nd child, antibiotics Heavy metal and mold issues
Numbness and tingling in extremities Hydration good.
29yo - breast augmentation
30yo - 3rd child Itchy anus
38yo- 4th child, numbness No alcohol or caffeine
began
41yo - implants removed
structural
detoxification stress/resilience
integrity
High stress 9 out of 10
No libido
Says she is a "ball of stress"
mediators
No period for 6 years
What makes better or worse? History of depression Extreme fatigue, 8 out of 10

Diet Anxiety Hormone imbalances

Under active thyroid

relationships/networks
mind, spirit,
hormones,
emotions, Married, has 4 daughters
neurotransmitters
community

Adapted from The Institute for Functional Medicine www.functionalnutritionalliance.com