What can functional medicine offer in addition to a traditional approach to cardiovascular disease? First, it’s important to note that the best approach is a team-based approach in disease diagnosis and treatment. Adding functional medicine or a root cause analysis to traditional medicine in disease management and treatment is synergistic. Simply stated, when functional medicine works in collaboration with traditional medicine, patients experience a greater outcome!

Patient: Glen, age 65
Provider: Mark Holthouse | MD, FMI Medical Director

“I truly believe that functional medicine saved my life. The heart labs ordered by Dr. Holthouse revealed that I was in jeopardy of having a potentially life-ending heart attack. Working with the FMI team, I learned about the importance of sleep, nutrition, diet and lifestyle choices that have helped me live a healthier life – one that will allow me to watch my grandchildren grow up!”
– Glen

Case Presentation

Glen presents a fascinating story and journey with heart disease, which in many ways mimics a roller coaster ride. There is a considerable history of heart disease in Glen’s family. He lost a brother to heart disease at age 63 and his father at age 52 after he suffered an acute myocardial infarction (AMI). He also lost two uncles to heart disease.

At age 65, Glen is a slim man who doesn’t fit the expectations of someone with heart disease. Other than labs showing high cholesterol, he has exhibited minimal heart disease symptoms. In 2012, Glen was prescribed a statin drug to manage high cholesterol and his other risk factors for heart disease, such as family history.

In 2019, Glen began seeing Dr. Holthouse at FMI. Because of his family history of heart disease, Glen met with a nutritionist to learn about healthier food choices, and a health coach to monitor his lifestyle choices that included exercise and stress reduction.

He also attended group classes, which included a renew program to determine what foods should be eliminated from his diet and replaced with healthy alternatives. He also attended a webinar on Intermittent Fasting that outlined the benefits of safe and deliberate fasting. As a result of these provider meetings, insights and classes, Glen lost 27 pounds in four months and became enlightened about good lifestyle choices, including the value of restful sleep.

In November of 2019, Glen contacted his cardiologist to report night sweats and nightly snoring that interrupted his sleep. An echocardiogram ultrasound revealed an enlarged heart muscle, which indicated sleep apnea, which can be related to heart disease.

The tests also revealed that Glen stopped breathing 30 times per hour during sleep. He was treated by a sleep specialist, who suggested a CPAP machine for nightly use, which soon reduced his breathing cessations from 30 per hour to just one per hour over the course of a few months.

In February 2020, Glen met with Dr. Holthouse to review his overall health status and labs. His labs from previous years showed that HDL and trigylcerides were within normal guidelines. But his November 2019 Cleveland Heart Lab profile revealed an inflammation marker (Myeloperoxidase) at 939, nearly double the number (540) associated with high risk of heart disease. Other inflammation markers also showed high risk of heart disease.

FMI Success Story - Cardiovascular Disease Cardiometabolic Report

Dr. Holthouse immediately followed-up with Glen’s cardiologist, who ordered an electrocardiogram (ECG) stress test. The ECG results documented an abnormal recovery time. Glen then had a heart scan, which showed blockages in one of the main coronary arteries.

He underwent a coronary angiography in early April and two stents were placed in his main artery, where blockages were 85 percent. Despite normal cholesterol (result of long-term use of statin drug), low blood pressure, and a thin and fit physique, Glen suffered a heart attack while in recovery from stent placement in April. Fortunately, he survived.

Glen met with Dr. Holthouse for a follow-up on new cardiac labs. The results were quite amazing, with inflammation markers and associated heart disease risk falling in the optimal range.

FMI Success Story - Cardiovascular Disease Cardiometabolic Report

Looking Upstream

Glen’s treatment plan in 2020 and beyond will focus on looking “upstream”, rather than studying one type of problem, which is a common approach in traditional medicine. A system that is out of balance moves downstream toward disease.

With functional medicine, efforts start with the disease, and look “upstream” to uncover the imbalance or dysfunction, find out how and why it occurred, and work together with the patient to resolve it.

Glen will participate in a comprehensive, upstream, root-cause approach that is not directly linked to the heart. For instance, Dr. Holthouse will be looking at periodontal disease, gingivitis and other sources of inflammation. “We now know that bacteria in and around gums is associated with systemic inflammation and heart attacks.”

Using the functional medicine approach, Dr. Holthouse will evaluate Glen’s gut, his symptoms and food sensitivities, as well as any stress that might be affecting the good bacteria in his gut that keep the immune system in check. Mindfulness, relationships, and spirituality will be part of the functional approach as well.

“We will talk about exercise and determine if Glen is doing the right kind of exercise as opposed to exercise that impacts oxidative stress. We will look at sleep and how it impacts stress, gut health, blood pressure, cortisol, blood sugar and weight. Glen will meet with our nutritionist to ensure he continues with a healthy and appropriate diet. And he will spend time discussing any challenges he may be experiencing with our health coach.”

“As a traditional family practitioner in the past, I wasn’t looking for sources of disease. But today, in functional medicine, we look for the sources that are driving inflammation. For instance, what caused the inflammation leading to the need for stents in Glen’s artery, when he had relatively little heart disease risk, other than a genetic predisposition for heart disease? While he’s made good choices to reduce his risk of heart disease, we plan to go beyond good lifestyle choices and determine the drivers of Glen’s inflammation as we continue his functional journey to optimal health.”

Stephanie Ritari, PA-C

Stephanie Ritari is a board-certified Physician Assistant who offers primary care for adults at the Functional Medicine of Idaho Meridian Wellness Center. She specializes in Internal Medicine and has spent the majority of her career in the field of cardiovascular disorders.

Stephanie has more than 15 years experience as a Physician Assistant in a variety of medical areas, including cardiology and electrophysiology. Holistic practices have long been a part of Stephanie’s lifestyle, with a particular focus on clean living and nutrition. She has embedded functional principles into her conventional medicine practice throughout her career. After watching family members struggle to find answers for their chronic illnesses, Stephanie became more interested in finding ways to take a root cause approach in her own practice. Wanting to provide a proactive, comprehensive, and preventative scope of care for her patients, Stephanie began studying functional medicine. In 2021, she joined Functional Medicine of Idaho, where she is able to provide evidence based, root cause medicine.

Stephanie earned her Bachelor's of Science in Exercise Physiology from the University of Montana and her masters in Physician Assistant Studies from Rocky Mountain College. She is currently working towards her certification with The Institute for Functional Medicine. 

In her spare time, Stephanie enjoys spending time with her husband, son, and dog doing outdoor activities including biking, hiking, and skiing. She also loves interior design and traveling, and is hoping to start her own garden in the near future.

Dr. David Musnick, MD, IFMCP

David Musnick is a board-certified medical doctor who offers in-person and telemedicine care from the Functional Medicine of Idaho Eagle clinic (coming soon). Dr. Musnick offers Functional Medicine, Sports Medicine, Functional Immunology, and Primary Care for adults and teenagers. He specializes in sports medicine, internal medicine, frequency specific microcurrent (FSM), scars, homeopathy, prolotherapy, and low-level laser treatments. 

Dr. Musnick is interested in getting to the root of underlying causes and factors that affect healing, including diet, sleep, exercise, stress, GI health, brain region health, toxins, hormones, infections, and electromagnetic fields (EMF). In medical school, Dr. Musnick spent a year studying nutrition. He has always been interested in the complex interrelationships of different systems of the body. Taking on challenges in the past, he created new treatment programs to heal the brain after concussion, treat chronic pain, arthritis, and tough SIBO and IBS cases. Dr. Musnick wants to help his patients achieve the highest level of health, vitality and function. 

After his internal medicine residency in Seattle, Dr. Musnick completed a fellowship in sports medicine where he became interested in helping patients get back to optimal musculoskeletal health and eventually back to their favorite activities. He quickly learned that many areas of the body were interrelated and started learning more about nutrition, supplements, and other facets of functional medicine. Dr. Musnick has more than 24 years of experience in Functional Medicine and achieved a very high level of both experience and expertise with many health conditions. He is also the author of the book, Conditioning for Outdoor Fitness, and helped in writing textbook chapters on arthritis and concussions.

Dr. Musnick received his Doctorate of Medicine from the University of California, San Francisco. He is certified through the Institute for Functional Medicine as an IFMCP. He also studied in the French school of Homeopathy. He is uniquely rare in that he teaches Frequency Specific Microcurrent (FSM) and how to integrate it with functional medicine. 

In his spare time, Dr. Musnick enjoys hiking, nature photography, cooking healthy food, mountain biking, and skiing.

IFM Certified Practitioner

Aaron Dykstra, DNP, FNP-C

Aaron Dykstra is a board certified Family Nurse Practitioner with a Doctor of Nursing Practice degree. He offers pediatric primary care, including well-child checks and acute visits, in the Pediatric Department of the Functional Medicine of Idaho Meridian Wellness Center.

Functional and alternative therapies were a part of Aaron’s life from a young age, and he has implemented these principles into his conventional medicine practice throughout his career. Aaron has more than 8 years of experience in a variety of medical disciplines, including pediatrics, obstetrics, mental health, and nutrition. He has practiced in rural health clinics in California and Oregon. For the last 5 years, Aaron has had a passion for working with children and implementing positive change through the family unit. Aaron joined the Functional Medicine of Idaho Pediatric Team in 2021. His enthusiasm for educating children and parents about living a healthy lifestyle allows him to provide preventative and acute care for infants, children, and adolescents. 

Aaron obtained his Bachelor of Science in Nursing at Brigham Young University. He earned both his Master’s of Science in Nursing and Doctor of Nursing Practice through the University of Arizona. He has obtained a Family Herbalist and Family Nutritionist certifications through The School of Natural Healing by Dr. Christopher. He is currently working towards his certification with The Institute for Functional Medicine.

Outside of work, you will find Aaron spending time with his wife and 5 kids, mountain biking, running, or camping in the backyard. Aaron is a big fan of Master Chef and enjoys cooking.

Nadia Kravchuk, DNP, FNP-C

Nadia Kravchuk is a board certified Family Nurse Practitioner with a Doctor of Nursing Practice degree. She offers functional pediatric primary care, including well-child checks and acute visits, in the Pediatric Department of the Functional Medicine of Idaho Meridian Wellness Center.

Nadia and her family immigrated to the United States in 1989 where they first settled in Oregon and then moved to Idaho in 2001. Complementary medicine practices were embedded into her lifestyle at a young age, and she has implemented these principles into her conventional medicine practice throughout her career. She has more than 15 years experience in a variety of medical environments, including emergency room, intensive care unit, pediatrics, obstetrics and gynecology, family practice, and aesthetics.

Nadia joined Functional Medicine of Idaho so that she can combine functional principles with the foundations of conventional medicine to address the underlying causes of disease and promote optimal wellness. As an avid gardener, beekeeper, and sustainable living enthusiast, she understands the importance and role of optimizing nutrition, sleep, physical, spiritual, and emotional well-being. She has a passion for pediatric functional medicine and understands that early recognition and interventions can correct imbalances, prevent chronic illness, and improve overall outcomes for children.

Nadia obtained her Bachelor of Science in Nursing at Northwest Nazarene University. She earned both her Master’s of Science in Nursing and Doctor of Nursing Practice through Frontier Nursing University. In 2017, she was the recipient of the HCA Excellence in Nursing Award. She is currently working towards her certification with The Institute for Functional Medicine.

Outside of work, you will find Nadia working on her urban homestead, hiking, foraging, camping, snowboarding, and spending time with her husband and her dog, Wolfy. She is also fluent in both English and Russian.