Welcome to my website and my very first post. I am so excited to get this launched. My transition into Functional Medicine has been “life altering”. I have been able to transform the health of many a patient, which wasn’t always the case using only my traditional allopathic training. Yesterday, at the end of an appointment, a relatively young patient stood up and said “Thank you” as she started to cry, “You have given me my life back”. This was such a profound moment and I was humbled that I could affect this kind of change in someone’s life.
But what is Functional Medicine? By definition, according to the Institute of Functional Medicine: “Functional medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership.” By targeting root causes of diseases a cure is affected rather than merely treating symptoms.
Since my introduction to Functional Medicine, the field has grown. The Institute of Functional Medicine has certified its first groups of doctors and the world renowned Cleveland Clinic has opened a Functional Medicine Clinic.
Curious Cases of Fatigue and What Do You Mean You Don’t Know?
When I first started in private practice in 1997, a common complaint that would present is fatigue. Less than 1% of the time, my exam and evaluation would point to a diagnosis. A common response I got was that “What do you mean you don’t know what is wrong with me?”
This was troubling that I couldn’t determine a cause or that I could not do more for this subset of patients. After awhile, I used to preface my workup of fatigue with the following statement: “Most of the time I am not able to determine a cause of your fatigue.” I would introduce the possibility of depression (a common presentation of fatigue) and say that if they were in the majority, we would have to approach it from a lifestyle perspective. With a very motivated patient, I found that this approach worked to some degree. Many of these patients were eventually given a diagnosis of Chronic Fatigue Syndrome or Fibromyalgia. In my quest for a better way to treat them, I attended lectures, read articles and remained on the look out for a better way.
Long interested in Integrative Medicine.
Growing up in an Eastern European household, my siblings and I were no strangers to natural remedies. We all dreaded having crushed garlic mixed with lard applied to our feet to draw out fever as children. Despite that we dreaded it, the remedy worked.
Post residency, I took my first job in Seattle where I was further exposed to alternative treatment modalities. Seattle is home to a Bastyr, a naturopathic medical school. I mentored two naturopath students in my practice, collaborated with a lovely naturopath in the community and frequently reviewed natural treatments as an alternative to the allopathic treatment I was offering, particularly when the allopathic options carried adverse side effects. These cumulative experiences peaked my initial interest in integrative medicine, which combines mainstream medical therapies and complimentary alternative medicine therapies for which there is some high-quality scientific evidence of safety and effectiveness as defined by the NIH. So while functional medicine is slightly different than integrative medicine, they both maximize patient outcome by using any modality that will benefit the patient.
The tipping point
5 years ago, I entered into social media. It was during this time I came across this article on glutathione by Dr. Mark Hyman, a well-known Functional Medicine physician. This was the tipping point. (Read the article it is a good one.) Dr. Hyman basically summarizes that glutathione (an amino acid and potent antioxidant) when deplete will make you feel fatigued. It is deplete in all of the chronically ill patients Dr. Hyman has treated in the past 10 years. It also becomes more readily depleted in patients who have an impaired GSTM-1gene. The treatment is to boost glutathione levels, through diet and lifestyle, along with supplementation.
Since those early days, I have come to learn that it is more than just a GSTM-1 gene defect. It is about balancing all that is all that is out of balance, which leads to optimal health.
Why everyone should be interested in Functional Medicine?
I thought I would share a few cases.
Case #1: K.S., a 37-year-old hairdresser who presented with chronic fatigue of 10 years. Fortunately, she was still able to work but unfortunately had seen multiple doctors with no change in how she was feeling. I put her on an elimination diet of gluten and dairy, added 5HTP as her sleep was not restorative and recommended progesterone as her symptoms pointed to a progesterone deficiency. When she returned 4 weeks later to review labs, she was pain free. This was one of the first life altering moments I experienced in Functional Medicine. She tested positive (by elimination diet and blood testing) to be intolerant of gluten. She also had a gene mutation aka single nucleotide polymorphism (SNP) of her MTHFR gene. I think this explains why Prozac worked only briefly for her. Prozac prevents the re-uptake of serotonin. If you have a gene mutation and don’t make serotonin as readily, preventing reuptake may not help. 5HTP is a precursor to serotonin and bypasses the MTHFR gene, which explains why this worked for her.
Case #2: C.H., a 22-year-old female who presented with panic attacks occurring 10-15 times daily since the age of 15. I eliminated the foods that she was intolerant of; rebalance the flora in her gut and within a couple days of a prescription treatment for dysbiosis, her panic attacks stopped. Her response to this was “ I don’t know what to do with myself now that I am not panicking.” A word on why our GI tract is so important: it houses 60-80% of our immune system in the Gut Associated Lymphoid Tissue, GALT and produces 80% of our serotonin via the enteric nervous system. Restoring balance in this patient’s GI tract restored her levels of serotonin, which is commonly used to treat panic disorder.
Case #3 JC, a 50-year-old female presented with true muscle weakness, which was worse with exercise. She was being evaluated by neurology to exclude MS and or ALS. On evaluation, she had significant deficiencies in CoQ 10, carnitine and B12 along with a methylation defect (MTHFR defect). Replacing these nutrients as well as working on her digestion to ensure she was absorbing the nutrients she ingested rendered her symptom free in 6 months.
There is much more detail to each of these cases. But, I thought I would share the basics so I could highlight why functional medicine is so very important in optimizing health. Through this blog I hope to share tips, and clinical pearls so that anyone reading this can enjoy optimal wellness too.
Have you ever heard of functional medicine? Or have you ever had symptoms that no one could diagnosis?
Photo Credit: Matthias Ripp