PTO Form 1553 (Rev 9/2005)
`OMB No. 0651-0054 (Exp. 09/30/2011)
`
`Trademark/Service Mark Amendment to Allege Use
`(15 U.S.C. Section 1051(c))
`
`The table below presents the data as entered.
`
`Entered
`
`Input Field
`
`SERIAL
`NUMBER
`
`LAW OFFICE
`ASSIGNED
`
`85167223
`
`LAW OFFICE 101
`
`EXTENSION
`OF USE
`
`NO
`
`MARK SECTION
`
`MARK
`
`ENTRY LEVEL CLINICAL NUTRITION
`
`OWNER SECTION
`
`NAME
`
`STREET
`
`CITY
`
`STATE
`
`ZIP/POSTAL
`CODE
`
`Moss Nutrition Products, Inc.
`
`2 Bay Road, Suite 102
`
`Hadley
`
`Massachusetts
`
`01035-9511
`
`COUNTRY
`
`United States
`
`GOODS AND/OR SERVICES SECTION
`
`INTERNATIONAL
`CLASS
`
`041
`
`CURRENT
`IDENTIFICATION
`
`Arranging and conducting educational services, namely, conducting seminars,
`educational programs, and conferences, in the field of clinical nutrition; online
`information services, namely, providing online educational newsletters in the
`field of clinical nutrition
`
`GOODS OR
`SERVICES
`
`FIRST USE
`ANYWHERE
`DATE
`
`KEEP ALL LISTED
`
`10/20/2011
`
`

`
`FIRST USE IN
`COMMERCE
`DATE
`
`10/20/2011
`
`SPECIMEN FILE NAME(S)
`
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)ORIGINAL
`PDF FILE
`
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)CONVERTED
`PDF FILE(S)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(2 pages)
`
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)ORIGINAL
`PDF FILE
`
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)CONVERTED
`PDF FILE(S)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(9 pages)
`
`SPN0-6919322242-110056606_._ENTRY_LEVEL_Class_41__Specimen_1_-
`_educational_svcs_.pdf
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0002.JPG
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0003.JPG
`
`SPN0-6919322242-110056606_._ENTRY_LEVEL_Class_41__Specimen_2_-
`_online_newsletter_.pdf
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0004.JPG
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0005.JPG
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0006.JPG
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0007.JPG
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0008.JPG
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0009.JPG
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0010.JPG
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0011.JPG
`
`\\TICRS\EXPORT11\IMAGEOUT11\851\672\85167223\xml8\AAU0012.JPG
`
`SPECIMEN
`DESCRIPTION
`
`PDF copy of webpage discussing and promoting Applicant's educational
`services, namely seminars, educational programs, and conferences in the field
`of clinical nutrition; and a PDF copy of Applicant's online educatinoal
`newsletter in the field of clinical nutrition
`
`REQUEST TO
`DIVIDE
`
`NO
`
`PAYMENT SECTION
`
`NUMBER OF
`CLASSES IN USE
`
`1
`
`SUBTOTAL
`AMOUNT
`[ALLEGATION
`OF USE FEE]
`
`100
`
`TOTAL AMOUNT 100
`
`SIGNATURE SECTION
`
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)
`

`
`DECLARATION
`SIGNATURE
`
`SIGNATORY'S
`NAME
`
`SIGNATORY'S
`POSITION
`
`/lmdougherty/
`
`Linda M. Dougherty
`
`Attorney of record, NY bar member
`
`DATE SIGNED
`
`10/26/2011
`
`FILING INFORMATION
`
`SUBMIT DATE
`
`Wed Oct 26 11:17:54 EDT 2011
`
`TEAS STAMP
`
`USPTO/AAU-69.193.222.42-2
`0111026111754385621-85167
`223-4803d5786c2ec5ff66e1f
`1b27ca276797c7-CC-8363-20
`111026110056606207
`
`

`
`PTO Form 1553 (Rev 9/2005)
`OMB No. 0651-0054 (Exp. 09/30/2011)
`
`Trademark/Service Mark Amendment to Allege Use
`(15 U.S.C. Section 1051(c))
`To the Commissioner for Trademarks:
`
`MARK:(cid:160)ENTRY LEVEL CLINICAL NUTRITION
`SERIAL NUMBER:(cid:160)85167223
`
`The applicant, Moss Nutrition Products, Inc., having an address of
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)2 Bay Road, Suite 102
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Hadley, Massachusetts 01035-9511
`(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)United States
`is submitting the following allegation of use information:
`
`For International Class 041:
`Current identification: Arranging and conducting educational services, namely, conducting seminars,
`educational programs, and conferences, in the field of clinical nutrition; online information services,
`namely, providing online educational newsletters in the field of clinical nutrition
`
`The mark is in use in commerce on or in connection with all goods or services listed in the application or
`Notice of Allowance or as subsequently modified for this specific class
`
`The mark was first used by the applicant, or the applicant's related company, licensee, or predecessor in
`interest at least as early as 10/20/2011, and first used in commerce at least as early as 10/20/2011, and is
`now in use in such commerce. The applicant is submitting one specimen for the class showing the mark as
`used in commerce on or in connection with any item in the class, consisting of a(n) PDF copy of webpage
`discussing and promoting Applicant's educational services, namely seminars, educational programs, and
`conferences in the field of clinical nutrition; and a PDF copy of Applicant's online educatinoal newsletter
`in the field of clinical nutrition.
`
`Original PDF file:
`SPN0-6919322242-110056606_._ENTRY_LEVEL_Class_41__Specimen_1_-_educational_svcs_.pdf
`Converted PDF file(s) (2 pages)
`Specimen File1
`Specimen File2
`Original PDF file:
`SPN0-6919322242-110056606_._ENTRY_LEVEL_Class_41__Specimen_2_-_online_newsletter_.pdf
`Converted PDF file(s) (9 pages)
`Specimen File1
`Specimen File2
`Specimen File3
`Specimen File4
`Specimen File5
`
`

`
`Specimen File6
`Specimen File7
`Specimen File8
`Specimen File9
`
`The applicant is not filing a Request to Divide with this Allegation of Use form.
`
`A fee payment in the amount of $100 will be submitted with the form, representing payment for the
`allegation of use for 1 class.
`
`Declaration
`
`Applicant requests registration of the above-identified trademark/service mark in the United States Patent
`and Trademark Office on the Principal Register established by the Act of July 5, 1946 (15 U.S.C. Section
`1051 et seq., as amended). Applicant is the owner of the mark sought to be registered, and is using the
`mark in commerce on or in connection with the goods/services identified above, as evidenced by the
`attached specimen(s) showing the mark as used in commerce.
`
`The undersigned, being hereby warned that willful false statements and the like so made are punishable by
`fine or imprisonment, or both, under 18 U.S.C. Section 1001, and that such willful false statements may
`jeopardize the validity of the form or any resulting registration, declares that he/she is properly authorized
`to execute this form on behalf of the applicant; he/she believes the applicant to be the owner of the
`trademark/service mark sought to be registered; and that all statements made of his/her own knowledge
`are true; and that all statements made on information and belief are believed to be true.
`
`Signature: /lmdougherty/(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)(cid:160)Date Signed: 10/26/2011
`Signatory's Name: Linda M. Dougherty
`Signatory's Position: Attorney of record, NY bar member
`
`RAM Sale Number: 8363
`RAM Accounting Date: 10/26/2011
`
`Serial Number: 85167223
`Internet Transmission Date: Wed Oct 26 11:17:54 EDT 2011
`TEAS Stamp: USPTO/AAU-69.193.222.42-2011102611175438
`5621-85167223-4803d5786c2ec5ff66e1f1b27c
`a276797c7-CC-8363-20111026110056606207
`
`

`
`FREE - Entry Level Clinical Nutrition Training
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`FREE - Entry Level Clinical Nutrition Training
`Jeff Moss, DDS, CCN, DACBN
`
`Chronic illness is to a large degree a problem of coping with an excessive 'a||ostatic load.‘ It is the patients‘ ability
`to adapt (and their efficiency in adapting) to the stress of ever-changing psychosocial challenges and adverse
`environments that will determine the degree and severity in which the stresses of life (and of illness itself) will
`affect them. Improving the physical capability of patients to adapt, will directly benefit their overall well-being.
`Dr. Moss's Entry Level Clinical Nutrition'" program will reduce your patients 'allostatic load‘ and provide a means for you to offer most
`patients, a relatively quick, inexpensive and noticeable improvement in their quality of life. Helping your patients to feel better fast is
`the best route to improved overall treatment compliance and satisfaction.
`Please click on the links below to register for upcoming webinars in the ELCN series and to watch the recorded archives of past webinars.
`
`Jeff Moss, DDS, CON, DAOBN
`Em“
`Upcoming FM Town Lecture —- June 8th. Dr. Jeff Moss from Moss Nutrition will be teaching the 8th webinar in a series
`Lay-EL
`of webinars from his "Entry Level Clinical Nutrition"“"' program. The title of this webinar is "Micronutrients and Chronic
`Cl-lN|CAL
`Illness: Vitamin D." .
`.
`. keep reading
`NUTRITION‘
`
`M0550
`..
`I"
`I Hr.
`E
`Jeff Moss, DDS, CCN, DACBN
`EN,“ WEBINAR ARCHIVE:.-- Click below to get access to part 7 of Dr. Jeff Moss's 12 part webinar series entitled "Entry Level
`LEVEL
`Clinical Nutrition. The title of this webinar is "Protein/Amino Acid Imbalance/Sarcopenia." .
`.
`. keep reading
`cLiNIcnL
`NUTBTION‘
`
`IMI.
`
`_E
`
`M0550
`
`EntI_'y Level clinical Nutrition - Part B Webinar
`Jeff Moss, DDS, CON, DAOBN
`WEBINAR ARCHIVE:.-- Click below to get access to part 6 of Dr. Jeff Moss's 12 part webinar series entitled "Entry
`ENTRY LEVEL Level Clinical Nutrition. The title of this webinar is "Loss of Muscle Mass: Sarcopenia and Cachexia &their impact on
`'
`CL|NlCAL
`Chronic Illness." .
`.
`. fl
`NUTRITION”
`Part 6
`MOSS.
`
`|El..l"l.l. _El5”l.
`Ell
`Jeff Moss, DDS, CON, DAOBN
`WEBINAR ARCHIVE -- Click below to get access to part 5 of Dr. Jeff Moss‘s 12 part webinar series entitled "Entry
`ENTRY LEVEL Level Clinical Nutrition. The title of this webinar is "Fluid & Electrolyte imbalances: Diagnostic and Treatment
`CL|NlCAL
`Considerations." .
`.
`. keep reading
`NUTRITIONT“
`Part 5
`
`Considerations for the Cataholic Patient
`Moss Nutrition
`- DOWNLOAD: Dr. Moss's chart "Considerations for the Catabolic Patient". This chart outlines the various diagnostic and
`treatment parameters for dealing with catabolic patients from the Entry Level Clinical Nutrition Perspective.
`.
`.
`. keep
`
`Jeff Moss, DDS, CCN, DACBN
`WEBINAR ARCHIVE" Click below to get access to part 4 of Dr. Jeff Moss's 12 part webinar series entitled "Entry
`ENTRY LEVEL Level Clinical Nutrition. The title of this webinar is "Acid/Alkaline Imbalance & Electrolyte Imba|ance." .
`.
`. keep
`reading
`CLINICAL
`NUTRITION”
`Part 4
`MOSSO
`
`Entry Level clinical Nutrition - Part 3 - webinar
`Jeff Moss, DDS, CON, DAOBN
`WEBINAR ARCHIVE-- Click below to get access to part 3 of Dr. Jeff Moss's 12 part webinar series entitled "Entry
`Level Clinical Nutrition. The title of this webinar is "Detailed Discussion of Blood Chemistry Ana|ytes." .
`.
`. keep
`reading
`
`http://www.fml:own.oom/public/department1D5.cfm[6/3/2011 4:32: 18 PM]
`
`

`
`FREE - Entry Level Clinical Nutrition Training
`
`ENTRY LEVEL
`CL|NlCAL
`NUTRITION”
`Part 3
`MOSSQ
`
`Entg Level Clinical Nutrition - Part 2 - Wehinar
`Jeff Moss, DDS, CON, DACBN
`WEBINAR ARCHIVE" Click below to get access to part 2 of Dr. Jeff Moss's 12 part webinar series entitled "Entry
`ENTRY LEVEL Level Clinical Nutrition. The title of this webinar is "The First Appointment Diagnostic/Motivational Regimen." .
`.
`CLINICAL k
`NUTRlT|ON""
`Part 2
`MOSS’
`
`.
`
`Entm Level clinical Nutrition - Part 1 - Webinar
`Jeff Moss, DDS, CON, DACBN
`In this introductory webinar Dr. Jeff Moss from Moss Nutrition outlines his "Entry Level Clinical Nutrition" program.
`E|'::1l'.|m’|éEA\|f.EL This is the first in a series of webinars from his "Entry Level Clinical Nutrition’”" program.
`.
`.
`. kr_eu_I‘_ea.d.LlJ.i:l
`NUTRITION”
`Part 1
`MOSS‘
`
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`

`
`Entry Level Clinical Nutrition“
`:1 supplement. of:
`The MOSS NUTRITION REPORT
`
`Jeffrey Moss, DDS, CNS, DACBN —:
`
`cPEmoss(g,;mossnutridomcom 7
`
`800-851-5444 —>-'3 www.M0ssNutrition.com
`
`#1 OCTOBER 2011
`
`A NEWADDITION— THE ENTRY
`LEVEL CLINICAL NUTRITION REPORT
`
`“Call it "Peace" 01' call it "Treason,"
`Call it "Love" area]! it "Reason "J
`V
`r’
`'
`(
`r
`But I ain't marrhiif an I H1 HG,
`No I ain't mar'chiri' any more”
`
`“I ain’t marchin anymore” — Phil Ochs
`
`“I/Vheii researchers are climbirig theflrst hillside qfaiiy
`problem, they thirile they can see the top. Bat mite they
`get there, they realize things are more complicated than
`they thought. They have to retimi tofmidameiitals aria‘
`climb an even steeper hill ahead.”
`
`“Where are the jobs?” — David Brooks,
`
`The New York Times, October 7, 2011
`
`INTRODUCTION
`
`As I am writing this newsletter during the first week
`of October, 2011, like many others I have been
`struck by two very significant events that have
`occurred at this time. The first is the Occupy Wzill
`Street protests that started in Manhattan and are i1ow
`spreading throughout the country.
`In coiinnenting
`011 these protests, Paul Kruginan, in his coluinn
`entitled "Confronting the l\/lalefactors” froin the
`October 7, 2011 edition of The New York Times,
`stated the following, wl1icl1 i11ay ring fainiliar to my
`fellow, aging baby boomers who are reading this
`monograph;
`
`“There’s something happening here. What
`it is ain’t exactly clear...”
`
`I realize tl1at so111e of you may a11d some of you 111ay
`not find favor with the protests of the ‘(vOs or the
`protests that are occurring right 110w. Nevertheless,
`for 111e, as soineone who lived in A1111 Arbor,
`Michigan in the early 705, there can be great value
`wl1e11, as stated by Phil Ochs, wl1o, for those of you
`who are not familiar with his work, is sonieoiie who
`many consider to be a better writer of‘(sOs protest
`songs than Bob Dylan, we i11ake it clear that we are
`not going to march in step anymore just because
`that is what we are supposed to do. Ofcourse,
`when we stop inarching, various responses are often
`encountered, ranging from those, as suggested in the
`
`above quote, who consider our act to be peaceful and
`reasonable to those who consider our act to be
`
`nothing more than blind passion a11d ultiinately
`treasonous. Wlietlier you consider deviating fro111
`i11arcl1ii1gi11 step to be peaceful and reasonable or pure
`passion and a11 act of treason, the fact remains that
`Moss Nutrition, a company that always considers your
`needs first over the needs others, including our
`suppliers, is what it is largely because of that time
`when a very iinpressionable young dental student was
`exposed to the idea that i11arcl1i11g to a beat that is
`dictated by those who want everyone to do what has
`always been done may not be best.
`
`Ofcourse, ifI a111 11ot inarching to the step of
`tradition and “establishinent” thinking, what do I
`march to? To answer this question, I would like to
`consider the other niajor event of this first week of
`October, 2011, the death ofSteve Jobs, co—foui1der of
`Apple Computers ai1d soineone 111ai1y are now
`comparing to Thomas Edison i11 terins ofi1111ovatio11
`and improving the lives ofniany throughout the
`world. David Brooks, in the article to which I refer at
`the beginning of this monograph, interestingly, is
`using a play on words in the title. For it is i1ot about
`“jobs,” in terins ofworking for a living, but “Jobs,” in
`terms of the great innovator. Brooks lainents that we
`may now be in a period of“innovation stagnation,”
`where replaceinents for people like Steven Jobs i11ay
`be quite rare for the foreseeable future.
`\Xfhat is the
`reason for this innovation stagnation? One possible
`reason is contained in the above quote from Brooks’
`article. True, lasting innovation is more difficult to
`accomplish than it appears it should be because,just
`when we think we have reached the “top” of the
`problem, we are forced to confront the reality that
`another, even more challenging hill to scale lies ahead.
`Wliat is the solution when we are experiencing the
`disappointinent and frustration ofsolving the first
`problem, thinking it is the only one, only to find that
`a more difficult problem lies ahead? According to
`Brooks, “return to fundamentals.”
`
`It is my opinion that functional 111edici11e, as we have
`traditionally learned a11d practiced it over the last 10-
`15 years, has brought us a long way clinically
`fro111 the “seat ofthe pants” days in ter111s of
`
`

`
`addressing the needs of sometimes complicated
`chronically ill patients. However, based on
`feedback from you, and more and more research I
`have been reading and reporting to you in The M055
`Nutrition Report and product newsletters, traditional
`functional medicine is, with increasing frequency,
`not facilitating our efforts to climb the second hill.
`What’s the solution? In my opinion, we need to
`march in a difierent direction, one that is not
`dictated by the currently fashionable approach of
`complexity for the sake of complexity that will be
`described later in this monograph. One that does
`not involve putting all of our eggs in the latest
`wonder herbal/nutrient detox/cleansing/stress
`reducing/neurotransmitter optimizing/ cures
`everything product. One that does not involve
`ordering several hundred dollars worth of laboratory
`tests or prescribing several hundred dollars worth of
`supplements for every patient at the first
`appointment.
`
`Rather, we need to march down a road that, in
`these days of complexity for the sake of complexity,
`is rarely taken; the road that takes us back to
`fundamentals. Of course, some may think that in
`today’s world of functional medicine and clinical
`nutrition, there is “innovation stagnation” in terms
`of going back to fundamentals.
`I do not believe this
`is true. Why? There are some truly great
`innovators in functional medicine and clinical
`nutrition, the critical care nutritionists, who have
`written hundreds, ifnot thousands ofpapers on
`those fundamental nutritional and functional
`
`medicine concepts and truths that will enable us to
`scale that second, more complex hill that we are
`encountering more and more with today’s
`chronically ill patients. Unfortunately, as suggested
`by the Phil Ochs quote above, there are still way
`too few who are willing to stop mindlessly marching
`and march mindfully down the road less traveled to
`the libraries and websites that feature the papers by
`these great innovators who suggest that the answers
`to the complexity ofthe second hill lie with a return
`to fundamentals. Entry Level Clinical
`Nutrition“! is dedicated to the mission of
`
`encouraging more practitioners and patients to “take
`that road less traveled.”
`
`MY PLAN TO FURTHER PUBLICIZE
`THE WORK OF CRITICAL CARE
`NUTRITIONISTS AND THEIR
`CONTRIBUTION TO FUNCTIONAL
`MEDICINE
`
`Of all the educational material I have written for
`
`Moss Nutrition, the series that continued the longest
`has been the Moss Nutrition Report.
`In fact, I have
`been writing for so long that it began during my
`very early years in the nutritional supplement
`
`industry several years before the creation of Moss
`Nutrition Products. Concerning format, review and
`commentary on important and controversial issues
`of the day as they relate to the practice of clinical
`nutrition with no references to products sold by
`Moss Nutrition, I have steadfastly persisted in the
`face of sometimes strongly worded suggestions by
`various manufacturers that I change. The frequency
`ofpublication ofthe Moss Nutrition Report has
`changed only once when the amount of issues was
`reduced from twelve per year to six per year
`approximately 9 years ago.
`
`Now, though, as Moss Nutrition enters a new
`incarnation of its existence with the manufacture of
`
`products with the Moss Nutrition name and the
`creation of Entry Level Clinical NutritionTM,
`which, as suggested above, we regard as a whole
`new way of viewing chronically ill patients and
`using nutritional supplements to address their needs,
`I feel that it is time to make another significant
`change. Why? As I mentioned, Entry Level
`Clinical Nutrition” was designed to be in
`aignment with the work of researchers and
`cinicians who I feel are among the best clinical
`nutritionists in the world, critical care nutritionists.
`However, the amount ofoutstanding publications
`these brilliant people are creating now is so
`voluminous that I can no longer begin to review
`even a small sampling using my current writing
`format. Therefore, starting with this issue, October,
`2011 I will start writing the Entry Level Clinical
`Nutrition” Newsletter — a supplement to the
`Moss Nutrition Report. This new newsletter
`series will be devoted to review and commentary on
`research and issues relating to the metabolic
`imbalances that form the basis of Entry Level
`Clinical NutritionTM. This series will be published
`three times per year. The Moss Nutrition
`Report, which will continue to cover other key
`issues relating to the practice of clinical nutrition
`(such as the current series on ionizing and non-
`ionizing radiation) will be published three times per
`year, alternating with the Entry Level Clinical
`Nutrition“ Newsletter.
`
`Specifically, what will you see in upcoming issues of
`the Entry Level Clinical NutritionTM Newsletter?
`What follows isjust a few ofthe subjects that will be
`addressed that are being found to play a key role in
`creating the signs and symptoms we see in
`chronically ill patients:
`
`I Alterations in tryptophan metabolism towards
`the kynurenine pathway.
`Metaflammation — the chronic inflammation
`
`that is virtually ubiquitous in chronically ill
`patients.
`
`

`
`Refeeding syndrome — what is really occurring
`with what we commonly call “reactive
`hypoglycemia”.
`
`Sarcopenia and the role of muscle as a major
`metabolic determinant of metabolic balance.
`
`New research on the acute phase response and
`how it explains the metabolic imbalances seen in
`chronically ill patients.
`
`This is just a sampling of the key metabolic/ clinical
`issues that will be addressed in great depth and
`detail, of course with complete referencing, in
`upcoming issues of the Entry Level Clinical
`Nutrition“! Newsletter series.
`
`ENTRY LEVEL CLINICAL NUTRITIONFM
`- A CURRENT METABOLIC AND
`CLINICAL OVER VIE W
`
`Back in the October 2009 Moss Nutrition Report I
`began to write about Entry Level Clinical
`NutritionTM, starting with my thoughts on why it is
`necessary to have such an approach for addressing
`the needs of chronically ill patients, and then
`moving on to defining exactly what it is from a
`metabolic and clinical standpoint.
`
`Why is Entry Level Clinical Nutrition“!
`needed?
`
`As I am sure you recall, back when I started writing
`about Entry Level Clinical NutritionTM in
`October of 2009, we were just beginning to realize
`the magnitude of the economic downturn that, two
`years later, shows few, if any, signs of substantially
`and permanently reversing anytime soon.
`Interestingly, even back then, I was receiving more
`and more reports from you that, while we could all
`agree that a metabolic, functional medicine—based
`approach to diagnosing and treating chronically ill
`patients was optimal, in this new economy of
`scarcity and uncertainty, this type ofapproach was
`becoming impractical from time, cost, and
`compliance standpoint for all but those few who
`could afford it and could travel to major population
`centers where most functional medicine
`
`practitioners tend to practice. More specifically, you
`made it very clear that many of the functional
`medicine lab tests were too costly and complicated
`to be used routinely and the dietary and
`supplemental programs that tended to be
`recommended with these tests were not only very
`cumbersome for the average patient but, again, too
`costly to be recommended routinely. In addition,
`the success rate for those who did the tests and took
`
`all the supplements recommended was
`disappointing.
`
`Like you, I became very frustrated by the fact that
`the use offunctional medicine, a way ofaddressing
`
`the needs of chronically ill patients that has so much
`potential, was happening on such a limited basis
`because ofsome very basic and practical concerns.
`In fact, I was so frustrated that I could not address
`the needs ofyou and your patients with functional
`medicine as often as I would like, I decided that,
`rather than just take the existing model of functional
`medicine from both a diagnostic and treatment
`perspective and try to remold it into something that
`was more time and cost efficient, I decided that a
`whole new model of functional medicine was
`
`needed, which would include the underlying
`metabolic foundation, diagnostic tools, and
`nutritional supplements. However, it was not my
`goal to discard the existing model of functional
`medicine completely. For, cost and practicality
`issues aside, it is truly, in my opinion, one of the
`best ways addressing the needs of chronically ill
`patients. Therefore, it was my intention to take all
`that is outstanding about functional medicine,
`eliminate the few limitations that include the
`
`practical issues mentioned as well as some
`methodologic concerns, and expand upon it so as to
`create a patient—centered approach that is not only
`practical, cost—effective, but metabolically superior.
`Very specifically, I wanted to accomplish the
`following:
`
`I
`
`I wanted to retain the use offunctional medicine
`tests such as organic acids and stool analysis, but
`add some simpler, cost effective diagnostic options
`that could provide similar information with lower
`cost andfewer concerns about patient compliance.
`
`I wanted to create products that were specifically
`tailored to this new model offunctional medicine
`and designed to work in complementaryfashion
`so that it would be possible to attain high levels
`of e icacy withfewer bottles of supplements.
`
`Of course, I am sure we would all agree that this is a
`fairly lofty goal that is beyond the abilities of most us
`alone to accomplish, including me. Therefore, I
`knew I would need some help. Fortunately, I soon
`realized, as I mentioned above, that there existed
`publications created by a large pool of researchers
`and clinicians that were being almost completely
`ignored by all of the alternative medicine
`community, including the vast majority of
`functional medicine practitioners. Why were they
`being ignored? Most likely it was because they
`were written by critical care nutritionists for use in
`hospital settings with very sick individuals, i.e., burn
`and trauma patients. Because of this, conventional
`thinking in both the allopathic and alternative
`outpatient communities was that the metabolic and
`nutritional needs of patients suffering from ailments
`such as chronic fatigue syndrome, fibromyalgia, or
`rheumatoid arthritis, etc. had little in common with
`
`3
`
`

`
`the needs ofacute care patients. Nevertheless, I had
`been reading these publications for several years
`previously with great enthusiasm because they
`discussed issues that we regularly regard as very
`important such as leaky gut, insulin resistance,
`inflammation, and deficiencies of key micronutrients
`such as magnesium, just to name a few.
`Unfortunately, I previously had few practical ideas
`concerning ways to take the excellent information
`from these publications and transform them into an
`effective and practical clinical tool that could be
`used on an outpatient basis in a way that is cost and
`time efficient. However, back in October of 2009
`it soon began to occur to me that, by using some
`fairly well documented extrapolations, this immense
`body ofoutstanding research from the critical care
`nutritionists could be added to our existing
`functional medicine knowledge base to create a
`different model of functional medicine that is well
`
`documented, highly efficacious, and even more
`importantly, less “high tech” and complicated in
`application, thus enabling more practitioners and
`patients in both economically affluent and modest
`locales to “get involved.”
`
`Some personal thoughts on the strengths and
`limitations of the current approach to
`functional medicine
`
`In figure 1 on the insert (page 9, in color), you will
`see a chart that outlines my interpretation of the
`current model of functional medicine from both
`
`metabolic and practical standpoints.
`
`What follows is a discussion of each aspect of the
`above chart, starting with the top box.
`
`Box 1 — Typical areas offocus in functional
`
`
`As most of you know who have attended various
`seminars and symposia on functional medicine,
`lectures and publications tend to be broadly divided
`into five primary categories:
`
`I Gastroenterology (Gut)
`
`Toxicology and Detoxification
`
`Nutrient imbalance (Primarily deficiency)
`
`Neurologic and behavioral issues
`
`I
`
`Endocrinology (Adrenal, thyroid, insulin, etc.)
`
`Box 2 — Systemic inflammation plus genetic
`propensity
`
`Based on a large body ofresearch, virtually all
`functional medicine practitioners now accept the
`idea that chronic imbalances in the five primary
`areas listed above will lead to the development of
`persistent, often low grade chronic systemic
`inflammation.
`In addition, many papers now
`
`suggest that chronic systemic inflammation
`combined with genetic propensity can have a
`powerful impact on clinical presentation
`
`Box 3 — Common diagnoses, signs, and
`symptoms
`
`It is now well recognized among functional
`medicine practitioners that chronic systemic
`inflammation and genetic propensity, when
`combined with dysfunction involving the five broad
`categories mentioned in box 1 can powerfully
`contribute to the diagnoses, signs, and symptoms
`that tend to be related to each of these categories.
`
`Box 4 — Foundational treatment guidelines
`
`It is now well recognized among functional
`medicine practitioners that, no matter what the
`clinical presentation or the functional medicine
`category that is primarily involved, treatment must
`be based on a foundation of removal ofkey
`environmental stressors such as dysbiotic organisms,
`pro—inflammatory, poor quality, nutrient—depleted
`foods, negative thought patterns, etc. In addition,
`when these foundational corrections are insufficient,
`it is often wise to introduce anti-inflammatory
`compounds such as omega—3 fatty acids, herbs such
`as curcumin, and enzymes.
`
`Box 5 — Treatment modalities specific to the
`chief complaint/area of dysfunction
`
`Of course, the disease—specific, symptom—specific
`protocols that have traditionally been used for years
`in clinical nutrition on an isolated basis still have a
`
`(These might involve
`place in functional medicine.
`the use of micronutrient supplementation,
`neurotransmitter modulators, or herbs that enhance
`gut function, insulin/glu cose metabolism, etc.)
`However, a large body ofresearch and anecdotal
`data has supported the contention made by many if
`not most functional medicine practitioners that these
`protocols will be most efiective when used in
`concert with foundational therapies that involve the
`lifestyle modifications and anti-inflammatory
`modalities mentioned in Box 4.
`
`Drawbacks of the traditional approach to functional
`medicine described above
`
`The fundamental basis of the clinical and practical
`drawbacks I am about to discuss can also be seen in
`
`figure 1. Concerning the five major fiinctional
`medicine categories mentioned (Gastroenterology,
`toxicology, nutrient imbalance, neurology, and
`endocrinology), beyond the generally recognized
`universal involvement of inflammation and genetic
`propensity and the generally recognized universal
`need therapeutically for environmental optimization
`and anti-inflammatory compounds, they tend to be
`