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Functional Medicine

Cross-Discipline, Evidence-Based
Healthcare for Chronic Disease

Dr. Ralph Ofcarcik, Ph.D.
Red Mountain Spa Director of Nutrition Services

Trust me. There are a growing number of intelligent, patient-centered clinicians (MD’s, DO’s, DC’s, ND’s, PhD’s, RD’s, RPh’s, etc.) who look beyond pharmaceutical intervention as the proprietary therapy for control of chronic disease. Last month, I was honored to be among 67 of them – functional medicine aspirants – who, along with yours truly, were participants in a 5 ½ day intensive course entitled Applying Functional Medicine in Clinical Practice (AFMCP). All of us were there with high expectations because we believed, conceptually, in functional medicine’s multi-discipline integrative protocol as a viable modality for health restoration. Everyone was ravenous for information . . . no one left hungry.

AFMCP, and other courses, were developed and orchestrated by the Institute for Functional Medicine (IFM), a medical training organization located in Gig Harbor, Washington. Having evolved over decades, two individuals are given credit for both the development of functional medicine (as a science and practice) and the founding of IFM: David Jones, MD (current IFM president and patriarch of functional medicine practice) and Jeffrey Bland, PhD, long considered the high-guru of functional medicine science – a title well-deserved. During the past 4 years, IFM has conducted 15 live continuing medical education programs (ACCME certified) attended by 1014 MD’s and DO’s, and 1332 from other healthcare disciplines – a testimony to the increasing interest in functional medicine. The Institute also publishes landmark textbooks in functional medicine, clinical nutrition, and nutrigenomics – spearheaded by Bland and Jones, but also involving dozens of other field-leading clinicians.

In addition, IFM and Bland publish monthly Functional Medicine Updates; audio CD’s featuring historical research perspectives and current investigations on timely topics (autism, stress, detoxification, etc.). Also included are thought-provoking interviews with leading published scientists. This is not easy listening but the information is priceless. To have someone methodically reviewing thousands of applicable journal articles each year and condense pertinent information into a dozen 60-minute commentaries is invaluable. (Note: It was pointed out at the AFMCP training that if healthcare professionals reviewed 2 journal articles each day, they would be decades behind at the end of the year).

A fundamental tenet of functional medicine, i.e. a condition or imbalance in one system of the body may impact the condition of all others, intuitively usurps the use of compartmentalized therapies for chronic conditions. Per Dr. Bland, functional medicine’s potential in restoring balance is the result of deploying interventions compatible with the interconnected “web” – no “silos” of medicine, no gastroenterology, no urology, etc. Knowing this, some FM practitioners have found it necessary to change their titles. Tom Sult (MD, Board Certified in Family Practice, and one of our AFMCP instructors), for instance, jokingly introduced himself as a

PsychoNeuroSpiritoMusculoGastroEntegumentoLymphoCardioInflammoMembrano-
UrinoRespiroEndocrinoSkeletoReproductoEnergetoSocioImmunoEcteroOlogist

. . . Well, you get the idea. Functional medicine a multi-system intervention balancing act, unique to every individual, and integrated with the best scientific information supportive of optimal long-term outcome.

Functional medicine, however, is more than therapy based upon integrated physiologies. There are actually 6 principles which, viewed as both a healthcare practitioner and consumer, makes perfect sense and . . . music to the ears.

• Biochemical individuality One size (or dosage) fits all is unheard of in FM shops. Recognizing the uniqueness of each individual (genes, genetic expression to environment) is imperative for the development of custom therapies supportive of health restoration. What’s one genome’s COX-2 inhibitor is another genome’s poison.
  
• Patient centered (as opposed to disease centered) For FM practitioners, this means going beyond treating a symptom or marker. FMers want to know why. Why is our blood pressure elevated? Rather than (or in addition to) simply treating the marker (example: catopril/HCTZ - conventional medicine or bonito peptides/celery seed extract – natural medicine), FM therapists look far upstream to determine what event (or series of events, i.e. antecedents) in our immediate and distant past could have triggered (or impacted) imbalance resulting in hypertension. Could it be insomnia, stress, or a new medication? Possibly an injury, recurring intestinal disturbance, migraines? Digging deeper nearly always offers additional opportunities for intervention supportive of genuine wellness.
  
• Dynamic balance of internal and external factors What we eat, drink, and breath (external factors) can impact (positively or negatively) our risk of disease. According to Walter Willett (MD and Nutrition Dept. Chair, Harvard School of Public Health), “Genetic and environmental factors, including diet and life-style, both contribute to cardiovascular disease, cancers, and other major causes of mortality, but previous lines of evidence indicate that environmental factors are most important.”
  
• Web-like interconnections of physiological factors The impact of some systems interrelationships is now well-documented. Included in the tool chests of many FM practitioners is a functional knowledge of intervention possibilities for organ connection imbalances involving the gut-liver, gut-liver-brain, brain-endocrine system, immune system-cardiovascular system, psychosomatic influences-immune system, etc.
  
• Health as a positive vitality (not merely the absence of disease) The interaction of the mind and body has been said to be symbiotic in pursuit of optimum health. Nurturing the human spirit in support of robust, healthful living is an important issue recognized in FM.
  
• Promotion of organ reserve It’s no secret that many of us acquire disabilities at the end of life requiring assistive living and/or machines for survival. Plotted on a chart, this period is known as the “morbidity curve”. An ongoing pursuit of functional medicine is to postpone disability (thereby gaining a few more “quality” years) and compress morbidity (shortening the time we are dependent on others before we die).

If you have chronic disease, step up to improved healthcare by seeking out a functional medicine clinician. I would almost be willing to guarantee that your first appointment will create a favorable first impression; it will certainly be a change from doctor’s office visits in the past. FMers ask lots of questions in an attempt to determine the underlying cause(s) (again, looking for antecedents and opportunities to intervene upstream) of your symptomology. It is likely that the physician will be taking notes on a form known as the Functional Medicine Matrix which has lines (for notes) under the 8 major inter-dependent biologic areas, the pillars of functional medicine: immune & inflammatory imbalance, GI imbalance, structural imbalance, energy production/oxidative stress, detoxification/biotransformation, hormonal/neurotransmitter imbalance, diet/nutrition/exercise, and mind/spirit. Although physicians trained in FM are not adverse to prescribing medicines, they are more likely to borrow from evidenced-based natural medicine, detoxification protocols, gut health restoration principles, stress modulation, nutrition, and other lifestyle precepts as the long-term strategy for restoring health. And although they will not have time to lead you in a meditation, they may prescribe it. (Per one AFMCP physician instructor: Some individuals have been able to lower their C-reactive protein – a blood marker of inflammation – by as much as 90% by meditation alone). And don’t be too surprised if you find out that your depression and gastro-intestinal disturbance is a result of low stomach acidity. Family history of MS? – your physician may prescribe gluten-sensitivity testing.

At Red Mountain Spa, both Brad Crump, DC (our Health Services Mgr.) and I can now count ourselves among the AFMCP alumni. And although not a strict medical setting, Red Mountain excels, intervention-wise, in 3 of the 8 FM Matrix pillars – environment (diet, nutrition, exercise), mind and spirit (yoga, tai chi, meditation, pleasurable spa treatments, etc.), and detoxification (15 successful programs and counting). (Note: A physician instructor at AFMCP taught us the components of an effective clinical detoxification program. I am delighted to report that Red Mountain’s detox program was 100% compliant with all of the recommendations).

Personally, the IFM training has forced me to think differently, now - in terms of a time frame of antecedents, when attempting solve each client’s personal health puzzle. This dig-deeper mindset has been surprisingly helpful to the client, as well, as we work together to unravel the heath-affecting chain of events that culminated in the current condition. For example, one 48-year-old guest with arthritis in her hands was taking a prescription NSAID for pain relief. Upon probing into her health history, I discovered:

1. She had a 10+ year history of recurring constipation, starting about the time she started a new job (highly stressful but it paid well).
2. (Via a software analysis) She ate little soluble fiber.
3. She began experiencing arthritic pain for the past 3 years.
4. For the past year, she has had trouble concentrating at work. She called it “cloudy thinking”.

In putting together the pieces to the puzzle, it appears that the stress of the new job (10 years ago) may have contributed to the chronic constipation. The ensuing auto-toxicity likely caused “leaky gut” allowing pro-inflammatants to be absorbed systemically resulting in joint inflammation. Since we now know that inflammatory molecules can pass through the blood-brain barrier, it is conceivable that the “cloudy thinking” may be another manifestation of elevated inflammation. Looking at this as an unfolding sequence of events:

Stress

Chronic Donstipation

Auto-Toxicity

Leaky Gut

Arthritis and Cloudy Thinking

Using this model, allows for plenty of intervention possibilities. For example, I recommended:

• Yoga or tai chi (for exercise and development of stress tolerance) as opposed her
  current exercycle workouts.
  
• A higher fiber diet (more fruits, vegetable, whole grains, legumes) to “get things moving” and provide optimum nourishment for intestinal wall cells. I also recommended drinking more water.
  
• A fish oil supplement to reduce inflammation. (She consumed fish 1-2X/month and did not consume flaxseeds or flaxseed oil)
  
• Had she not been participating in a clinical detox program (ours), I would have recommended
  that she do so.
  
• I further suggested that she contact an FM practitioner in her area for stool sample testing to develop of an individualized 4-R gut health restoration program which, in addition to the use of digestive enzymes, pro- and pre-biotics, may require medical intervention.

To find a functional medicine practitioners in your area, visit the IFM website, http://www.functionalmedicine.org.