“The human body has been designed to resist an infinite number of changes and attacks brought about by its environment. The secret of good health lies in successful adjustment to changing stresses on the body.”
(Harry J. Johnson)
The dominant culture of medicine excels at acute illness care but is, frankly, terrible at chronic illness care.
I was personally driven to practice functional medicine because I wasn’t getting the kind of results with my chronic complex patients that I thought I should be getting. I didn’t have the tools to look beyond the labs, because what I needed to know wasn’t taught in modern medical school. But once I discovered functional medicine I immediately began to see the benefit for patients with collections of chronic, sometimes vague symptoms, because functional medicine isn’t about treating symptoms, but about trying to understand what about the disease is making the person unwell. I strive to understand what is happening biochemically that is causing a state of dis-ease.
From that perspective, functional medicine is able to set aside a formal diagnosis—instead that diagnosis is simply a jumping-off point. I don’t care as much about the diagnosis as I do about why the patient has the diagnosis. In many cases of chronic illness, we’re not looking at a single physical ailment—a tangible thing—instead we’re looking at a collection of symptoms.
The dominant culture of medicine says there is really nothing we can do except prescribe drugs to suppress the symptoms that we don’t like to see. And many patients go to the doctor and respect his or her authority, so they accept that drugs are the only options. But, generally speaking, patients want to be and feel well. And the drugs don’t always address all of the cognitive and digestive issues that come along with chronic illness.
Virtually all of my patients with chronic illness have digestive issues. Some patients have chronic diarrhea, another large segment has alternating diarrhea and constipation, and then another subset has constipation alone. Given those statistics, when a new patient comes into my functional medicine practice, I start by learning about their bowel history—I’m listening for information about what kind of digestive issue they have and how often they experience these problems.
One common cause of gastrointestinal issues in patients with chronic illness is leaky gut. A high percentage of these patients had conditions like colic or recurrent ear infections early in life, and, as a result, were exposed to antibiotics. Antibiotics cause dysbiosis that can lead to leaky gut.
Gastrointestinal function starts with digestion and nutrient absorption, but it’s much bigger than that. There is a whole microbiome that lives in the gut. Dysbiosis happens when that microbiome gets disordered. The dysbiosis can lead to inflammation in the gut, which can lead to leakiness of the mucous membranes. When the mucous membranes become leaky, the microorganisms and food particles in the gut begin to have abnormal interactions with the immune system. The body begins to see partially digested food particles as invaders and the immune system tries to make antibodies against them. This leads to food sensitivities and allergies.
But leaky gut doesn’t just affect the body’s relationship with food; it can also cause antibodies to build up against the brain. Studies have shown that chronic inflammation in the brain leads to continuous activation of the microglia—the white blood cells of the brain. The microglia are actually making antibodies against certain parts of the brain. So leaky gut can also make the blood-brain barrier leaky, meaning that things that shouldn’t be getting into the brain often are.
In functional medicine, we start the process of helping patients with digestive issues by treating the gut with dietary manipulation. We ask patients to eliminate common food irritants out of the diet, usually focusing first on removing gluten and casein. Not surprisingly, for many patients with chronic illness, removing those two things from the diet makes a big impact on their gastrointestinal function.
In addition to the elimination diet, I’ll start patients off on some supplements—usually a probiotic and some kind of immune support, like a casein-free colostrum product. I’ll also encourage the patients to use a concentrated phytonutrient product, called “Dynamic Greens.” I also recommend a multivitamin with concentrated B vitamins.
What I won’t do is take the patient off his or her current prescription medications. I’m looking for improvement, so what we do is keep everything stable and start to manipulate the diet and the nutrients in order to see improvement. The progress will be incremental. When we start to see progress, we can begin to slowly wean down the medicine dosages. Many patients are surprised to hear me say that my goal is not to make them drug-free. Instead, my goal is to help you be as functional as possible—if that takes diet, supplements, drugs, surgery, or some combination, I’ll be happy to try it.
When you are making changes to nutrition, you have to have some turnover of the cell components before seeing a difference. A three-month trial is a reasonable amount of time to wait to see if the nutritional intervention is making a difference. I see almost all of my patients at three-month intervals, and every three months I ask, “Are you better, are you worse, or are you the same?” If they’re better, we stay on the same nutritional course. If they are worse, or unchanged, it tells me that something about my initial assumptions was wrong and I need to go back through the labs. I start to look at the issues from a new perspective.
Functional medicine is anything but a one-size-fits-all approach, making it a complementary way to treat patients with chronic illness. The progress is incremental, but the improvements that happen keep me doing this work.
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