OVERVIEW: A FUNCTIONAL MEDICINE APPROACH
Functional medicine practitioners view the body as composed of many systems – all of which interact. Therefore the body has to be looked at as a whole, rather than a composite of separate parts relegated to specialists. Gut, hormones, and adrenals all interact as if they are in a large symphony. Below are some of the issues should you go to a functional medicine practitioner.
Definition: Functional medicine addresses the underlying causes of disease (not symptoms), using a systems-oriented approach, engaging patient and practitioner in partnership. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms. Functional medicine practitioners spend time with their patients, listen to their histories, look at interactions among genetic, environmental, and lifestyle factors that influence long-term health and complex, chronic disease. In this way, functional medicine supports the unique expression of health and vitality for each individual.
Health starts with the gut. There are more nerves in the gut than in the spinal cord. Ninety- nine percent of vagal nerve fibers travel from the gut to the brain. The gut makes about 95% of total serotonin. An unhealthy gut initiates inflammatory cytokines, which can lead directly to oxidative stress and dysfunctional mitochondria.
Good gut health is essential for health and decreasing autoimmune responses. The integrity of the gut parallels the integrity of the blood brain barrier (the barrier which keeps unwanted substances out of the brain). When the gut is leaky (permeable), the blood brain barrier is leaky as well. In the case of a leaky gut, undigested food leaks into the system and generates autoimmune responses leading to autoimmune diseases.
In the case of the brain, a leaky blood brain barrier will lead to neuro-inflammation and neuro-degeneration. A clinician can perform tests to assess the integrity of the gut and to measure to biome of bacteria to see if it is balanced.
Things that leads to a leaky gut are poorly digested foods, antibiotics, stress, poor sleep. In order to help the gut, one should avoid foods which generate an allergic response (food allergy tests can be done), eat a healthy, non-processed, natural diet, avoid stressors, minimize antibiotics, take probiotics and consider an elimination diet where all potentially allergenic foods are eliminated and then later re entered into the diet gradually. About 30% of people have a sensitivity to gluten; many have allergies to dairy products). Typically, a person can develop a food sensitivity to any food eaten often. If a person wants to avoid the expense of testing, he/she can take precautions as if there is a leaky gut. Dr. Levy suggests regular vitamin C-flushes can flush out anaerobic gut toxins.
Side note – curcumin (from the yellow Indian spice, turmeric) is typically not absorbed well for gut inflammation. Some formulations add phosphatidylcholine to ease absorption.
Hormone systems are a symphony. They all talk to each other. Adrenal functioning is crucial. Thyroid cannot be regulated until the adrenals glands are stabilized. Adrenal gland health can be assessed with a saliva cortisol test sampling four times in a day. With the cortisol measurements, hormones and DHEA status can be measured at the same time.
Thyroid modulates energy homeostasis, regulates calcium homeostasis, and affects carbohydrate metabolism via interactions with leptin, adiponectin and ghrelin.
Low thyroid can
- Increase susceptibility to hypoglycemia (low blood sugar)
- Increase risk for metabolic syndrome
- Increase blood pressure and cardiac disease risk
- Increase cholesterol by decreasing the LDL receptors and slowing the degradation of cholesterol.
High thyroid can
Increase insulin by increasing its half life, and impair glycemic control. Treatment should start low and slow. TSH should be less that 2 or 3 at the highest. Some believe TSH should be less than 2. It is important to measure thyroid antibodies, binding globulins (which tie up available thyroid), free T3, free T 4 and reverse T 3.
Corrections can also be made on body temperature and symptom profile.
It is important to keep blood sugar levels within a reasonable range. Poor glycemic control increases risk of cardiac disease, dementia, cognitive decline and other diseases.
Hormones are important as they affect cardiac function, cognitive function and metabolic function. Hormone replacement should start low and slow. Low testosterone in men (estrogen in women) is related to metabolic syndrome which strongly predicts the development of coronary artery disease. An excess of estrogen metabolized on the wrong pathway leads to increased risk for (breast or prostate) cancer. Supplements such as inositol, DIM or the sulphoraphanes (e.g. Cruciferous vegetables) can divert the estrogen to healthy pathways, which do not have these adverse effects. Testosterone in men may be converted to estrogen via the aromatase pathway. “Pot bellies” and male breasts are consistent with an excess of estrogen, which has adverse effects in men. Estrogen should be balanced with progesterone.
All infections and all toxins can cause cell/tissue damage and produce symptoms by increasing oxidative stress. Oxidative stress occurs when production of free radicals (highly reactive pro oxidants – that take electrons from other substances) exceeds the body’s ability to neutralize them, or to prevent the free radical production in the first place. This sets off chain reactions leading to inflammation, gut and blood brain permeability, cerebral neurodegeneration, mitochondrial dysfunction, and diseases according to a person’s susceptibilities. Excess calcium or excess iron is typically associated with oxidative stress. Vitamin C is an antioxidant that can help quell this path toward illness.SVHI Newsletter Thursday, May 23, 2013
Increasing rates of insulin resistance, diabetes, cancer, hormonal problems and obesity in the US is in part due to toxins. Toxins can affect the CYP 450 enzyme family, change DNA methylation (epigenetic modification), they can adversely affect metabolic pathways diverting them to less healthy pathways. They also increase oxidative stress. Tom Levy, MD defines a toxin as a pro oxidant – a substance that can take electrons from other molecules. Dr. Levy summarizes that if a substance does not take electrons, then it is not a toxin.
Dr. Levy states that the factors determining the expression of the toxins are: 1. Solubility characteristics of toxin 2. Molecular size 3. Physical mass of accumulation
4. Access of intrinsic chelators to sites of toxin accumulation. 5. Location where molecules of detoxification are oxidized 6. Whether chemical nature of toxins initiates oxidative chain reactions, upregulating
Of interest, is that dental procedures such as root canals have been associated with an increased incidence of cancer. Periodontal disease, implants, root canals, amalgams affect the body by increasing toxin stress through direct toxins and inflammation. Stressors to the teeth affect the acupuncture meridians and can adversely affect health.
STEPS FOR HEALING
Dr. Tom Levy recommends four basic steps in healing a. Reduce or minimize new toxin exposure b. Eliminate stored toxins c. Restore hormonal balance (sex and thyroid) d. Optimize antioxidant levels
Minimizing toxins include toxins in our food; environment, hair and face care products. It also includes infectious processes, poorly digested foods, and toxic iron status. Even most people who measure normal can be toxic. Steps to start to eliminate toxins include saunas and body scrubbing, best before a sauna or hot shower. Working up a sweat provides a natural exit/ drainage path for accumulated toxins. Dr. Levy reports that vitamin C can help with toxicity from heavy metals, and venoms, insecticides and radiation. Restoring hormone levels is discussed above. Optimizing antioxidant levels includes
intake of antioxidants such as vitamin C, E and glutathione.
In addition to being an antioxidant to quell oxidative stress, Vitamin C has had positive effects in just about any disorder. In vitro studies showed vitamin C inactivated the poliovirus, herpes virus, enteroviruses, influenza, rabies and other viruses. Some researchers propose that vitamin C can reliably ameliorate many different acute infectious diseases and neutralize any toxin treated if given the proper dose.
In vivo studies showed that vitamin C accelerated the resolution of polio, hepatitis C, viral encephalitis, measles, Lyme disease, tuberculosis, mumps, acute Herpes infections and flu. In addition to killing viruses, studies showed that Vitamin C can kill bacteria and support an optimally functioning immune system. It also helps with Lyme disease, AIDS, chronic hepatitis, the common cold, Tuberculosis, Pertussis, malaria, rabies, and dysentery.