Why Do We Need Functional Medicine?

• Our society is experiencing a sharp increase in the number of people who suffer from complex, chronic diseases such as diabetes, heart disease, cancer, mental illness, and autoimmune disorders like rheumatoid arthritis.
• The system of medicine practiced by most physicians is oriented toward acute care, the diagnosis and treatment of short-duration trauma or illness that requires urgent care, such as appendicitis or a broken leg. Physicians apply specific, prescribed treatments, such as drugs or surgery, that aim to treat the immediate problem or symptom.
• Unfortunately, the acute-care approach to medicine lacks the proper methodology and tools for preventing and treating complex, chronic disease. In most cases, it does not consider the unique genetic makeup of each individual or factors such as environmental exposures to toxins and the aspects of today’s lifestyle that directly influence the rise in chronic disease in modern Western society.
• There’s a giant gap between research and the way doctors practice. The gap between emerging research in basic sciences and integration into medical practice is enormous, as long as 50 years, particularly in complex, chronic illness.
• Most physicians are not adequately trained to assess the underlying causes of complex, chronic disease and apply nutrition, diet, and exercise strategies to treat and prevent these illnesses in their patients.

How is functional medicine different?

Functional medicine involves understanding the origins, prevention, and treatment of complex, chronic disease. Hallmarks of a functional medicine approach include:

• Patient-centered care. Functional medicine focuses on patient-centered care, promoting health as a positive vitality beyond just the absence of disease. By listening to the patient and learning his or her story, the practitioner brings the patient into the discovery process and tailors treatments that address the individual’s unique needs.
• Functional medicine is an integrative, science-based healthcare approach. Functional medicine practitioners look upstream to consider the complex interactions in the patient’s history, physiology, and lifestyle that can lead to illness. Each patient’s unique genetic makeup is considered, along with internal (mind, body, and spirit) and external (physical and social environment) factors affecting total functioning.
• Functional medicine integrates optimal medical practices. Functional medicine integrates traditional Western medical practices with what is sometimes considered alternative or integrative medicine, creating a focus on prevention through nutrition, diet, and exercise; use of the latest laboratory testing and other diagnostic techniques; and prescribed combinations of drugs and botanical medicines, supplements, therapeutic diets, detoxification programs, or stress-management techniques.

Functional medicine is more than just a different approach to healthcare; it is an entirely different philosophy about how we provide and consume healthcare. I can honestly say that in my practice, I don’t treat diseases but rather patients, some of whom have diseases whereas some do not. I focus on normalizing the underlying physiology and restoring healthy function through nutrition and lifestyle changes.

People often have significant symptoms, and they feel sick, but they don’t meet the technical requirements for a particular diagnosis. This means they don’t get any treatment in many offices, but this is just the beginning for my patients. I work with my patients to discover the dysfunctional patterns that lead to their symptoms and then develop strategies to correct them and restore optimal health. 

The functional medicine approach to treating chronic disease is based not on one agent or modality as a curative or palliative solution. It focuses on the idea that improving how our cells work by lowering harmful toxins and stress in the body will help our cells produce energy better, which can lessen the signs and symptoms of chronic disease. While many nutritionally oriented doctors realize that standard nutritional support protocols alone benefit mild to moderate chronic disease cases, more severe cases often require a more comprehensive functional approach.

This functional medicine philosophy and approach were initially developed for clinical use in chronic fatigue patients with excellent results. Because of the commonality observed in many chronic conditions, it has been used over the years with great success in other disorders, including fibromyalgia, rheumatoid arthritis, and autoimmune disorders. ^1-8 The seminal work of Bland, Rigden, Cheney, and others in treating chronic fatigue syndrome has served as a successful template, and this approach is now used in treating a broad range of chronic diseases^1-7.

The functional medicine philosophy is centered on the premise that a breakdown of the intestinal mucosa by the chronic ingestion of food- and water-based toxins and the use of common prescription and over-the-counter drugs (such as antibiotics and NSAIDs) can lead to dysbiosis and a hyperpermeable intestinal mucosa, or leaky gut syndrome. This intestinal hyperpermeability can result in the intestinal mucosa failing to act as a selective barrier. This process leads to crossing food-based toxins and partially digested food proteins through the intestinal mucosa and into the systemic blood supply. The eventual result is increased food allergies and a toxic load. (see Figure 1).

This increased toxic load can, over time, lead to increased stress on the liver and its ability to detoxify these substances through phase I and II pathways adequately. This process will ultimately result in increased systemic tissue toxicity.

Higher tissue toxicity is believed to be a key cause of mitochondrial dysfunction, leading to the body’s cells, like muscle cells, struggling to use oxygen for energy production effectively. This pathway accounts for the majority of ATP production. Decreased cellular ATP production can account for many (if not all) of the symptoms and signs associated with many chronic disease states, such as chronic fatigue syndrome (CFS) and fibromyalgia (FMS).

Increased intestinal permeability can also result in partially digested medium- to large food proteins entering the blood supply and acting as antigens. The resulting antigen-antibody complexes seem to have an affinity for the synovium of articulations. This results in an inflammatory response in the joint linings commonly seen in arthritides, such as rheumatoid arthritis (RA). The main therapeutic agents used initially by standard medical physicians in the treatment of RA are (ironically) NSAIDs. NSAIDs, according to the PDR, result in increased intestinal permeability. Is it possible that the traditional allopathic therapy for arthritis has only resulted in palliating the patient’s symptoms while exacerbating the disease?

The functional medicine approach focuses on healing the gut lining, fixing any imbalances in gut bacteria, supplying the body with things that help detoxify tissues, lowering oxidative stress, and helping cells return to normal function. Assessment begins by determining intestinal health, the liver’s functional reserve, and its detoxification abilities. Such an assessment is commonly done with the help of patient symptom questionnaires, such as the metabolic screening questionnaire, and functional laboratory studies, such as the lactulose/mannitol challenge for evaluating intestinal permeability and the complete digestive stool analysis (CDSA) for detecting markers of digestion, absorption, and colonic flora. The liver’s ability to detoxify can be checked using caffeine clearance and conjugation metabolite challenge tests, which look at the two main liver detoxification processes (phase I and phase II). Standard clinical laboratories do not perform these tests but are available through specialized laboratories that offer functional testing.⁹

After gathering the data, a treatment program (see Figure 3) is chosen, which might involve certain nutrients to fix any intestinal hyperpermeability (leaky gut syndrome). You can use individual nutrients like L-glutamine, purified hypoallergenic rice proteins, inulin, pantothenic acid, and antioxidants. However, formulary medicinal food 11 is usually much easier and more clinically practical. Digestion and absorption problems shown on the CDSA can be managed by temporarily using pancreatic enzymes and HCL (if needed) for patients who do not have gastritis or ulcers. Dysbiosis, a term used to describe an imbalance of colonic flora, can be addressed by administering Lactobacillus acidophilus and probiotics such as fructooligosaccharides (FOS)>

Any pathogenic bacteria, yeast, or parasites detected on the CDSA should be treated with the prescription (or natural) agents suggested by the sensitivity tests on the CDSA. These may include nonprescription substances such as berberine, garlic, citrus seed extract, artemisia, uva ursi, etc. Bland, Rigden, Cheney, and others describe this program of gut restoration as the “Four R’s’ approach^3-4.

“Four R” Approach to Gastrointestinal Restoration

Remove: Eradicate any pathogenic microflora, yeast, and parasites with natural or prescription agents suggested on the CDSA (i.e., berberine/goldenseal, garlic, artemesia, citrus seed extract, uva ursi, etc.).

Eliminate known allergenic foods and follow a modified elimination diet. Avoid dairy and gluten-containing foods and emphasize fresh, non-processed foods.

Replace: Provide pancreatic multidigestive enzymes and HCL if appropriate, particularly if the CDSA shows markers of malabsorption.

Reinoculate: Administer Lactobacillus acidophilus, bifidobacteria, probiotics such as fructooligosaccharides (FOS) and inulin.

Repair: Provide nutrients to support gastrointestinal mucosal integrity, such as L-glutamine, antioxidants, glutathione, Acetylcysteine (NAC), zinc, pantothenic acid, medium-chain triglycerides (MCTs), fiber, etc.

Once intestinal problems are fixed, you can boost liver detoxification by supplying nutrients needed for phase I and phase II detox processes. These may include individual nutrients such as N-acetyl cysteine, methionine, cysteine, glycine, glutamic acid, glutathione, and antioxidant nutrients (see Figure 3). However, using a specifically designed formulary, medicinal food products are much more practical and efficient to use clinically.

Patients with high phase I cytochrome P450 enzyme activity and slow phase II conjugation activity should receive antioxidant therapy before starting detoxification. The treatment slows the production of highly toxic biotransformed intermediate molecules, which increase oxidative stress in the body.

Combine this with a diet prioritizing fresh foods and eliminating processed and allergenic foods. This regimen will reduce the patient’s dietary toxic load (exotoxins), while the intestinal program will reduce gastrointestinal-derived toxins (endotoxins). Following a modified elimination diet, which eliminates the ingestion of gluten- and dairy-containing foods, and discontinuing as many drugs as possible will also help during the detoxification process.

References

1. Bland J, Bralley A: Nutritional upregulation of hepatic detoxification enzymes, J Appl Nutr 44, 1992.
2. Rigden S.: Research study-CFIDS study preliminary report: Advances in diagnosing and treating the chronically ill, 1991, Seattle.
3. Rigden S: Enterohepatic resuscitation program for CFIDS, CFIDS Chron Spring, 1995.
4. Cheney PR, Lapp CW: Entero-hepatic resuscitation in patients with chronic fatigue syndrome: A pyramid of nutritional therapy, CFIDS Chron Fall, 1993.
5. Lanfranchi RG, et al.: Fibromyalgia, chronic pain, and the leaky gut syndrome. Today’s Chiropr, March/April:32-9, 1994.
6. Rowe AH: Allergic fatigue and toxemia, Ann Allergy 17:9-18, 1959.
7. Pressman AH: Metabolic toxicity and neuromuscular pain, joint disorders, and fibromyalgia, J Am Chiropr Assoc Sept:77-78, 1993.
8. Gantz NM, Holmes GP: Treatment of patients with chronic fatigue syndrome, Drugs 36(6):855-862, 1989.
9. Great Smokies Diagnostic Laboratory: 63 Zillicoa St., Asheville, NC 28801, 1-704-253-0621, www.gsdl.com.
10. HealthComm International, Inc., Functional Medicine Research Center, P.O. Box 1729, Gig Harbor, WA 98335, 1-800-843-9660, www.healthcomm.com.
11. Metagenics, Inc., 971 Calle Negocio, San Clemente, CA 92673, 1-800-692-9400.

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