Health Column: Focusing on root causes of disease
September 16, 2014
“Bioidentical Hormone Replacement for WOMEN”
Monday, Sept. 15
“Chronic Fatigue and Fibromyalgia”
Monday, Sept. 29
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The health care paradigm is shifting. Many physicians are changing the way they practice, analyzing the systems that keep us "healthy" and focusing on the root cause of disease instead of just treating the symptoms. Applying a holistic lens to our patients, we are also integrating complementary and alternative therapies to help them achieve wellness. This is the essence of what is called "functional medicine."
As an example, I no longer see just a Type 2 diabetic. What I typically see is impaired hormone systems, not only insulin resistance, but high cortisol, less that optimal thyroid production, and with aging, low sex hormones. I see inflammation from obesity, poor diet, delayed food allergies or leaky gut, along with oxidative stress and damage to cellular membranes. All this changes neurotransmitters that affect brain function, and that's part of why my patient is fatigued, depressed and craves carbs.
I consider advanced glycation end products that form from sugar-protein cross-links and sludge up cellular machinery. Dysbiosis, or disruption in the normal balance of gut bacteria, leads to poor breakdown of certain foods, a build up of unhealthy fatty acids, impaired metabolism and nutrient deficiencies. Detox and cellular energy systems suffer leading to a vicious cycle of downward spiraling health.
Giving my diabetic patient medication to help control blood sugar may be appropriate by the latest guidelines, but it won't do much to change the overall course of their disease. At most, it slows the inevitable. Without addressing all these underlying issues, they will never truly be well.
FUNCTIONAL MEDICINE TO THE RESCUE
Functional medicine is structured around a matrix of areas that are considered when evaluating and treating patients. We examine hormone and neurotransmitter levels, digestive and immune function, inflammation and oxidation status, detoxification pathways, and even cellular energy production and cell membrane integrity.
Considering that the bulk of disease is driven by lifestyle choices, functional medicine incorporates a holistic approach that emphasizes the patient's role in their health. Patient behavior is more important than anything else and we can't gloss over some of what I call "keys to great health," including mental attitude, eating healthy, exercising regularly, getting plenty of restful sleep, and managing stress.
At various times I've employed a dietitian, exercise physiologist and psychologist in my office to help patients address poor health habits. In recent years, I have found success employing a certified health coach and holistic nutritionist to address diet, exercise and behavioral issues.
We also integrate our colleagues of complementary or alternative medicine, such as chiropractors, physical therapists, acupuncturists or massage therapists. We encourage activities that involve working with teachers of fitness, yoga, tai chi, or meditation. The point is, we need all the help we can get, and medical doctors can't meet all these needs.
THE TYPICAL PATIENT
Back to my Type 2 diabetic patient — where do we start? Our initial visit reveals a diet that is too high in processed foods, refined carbohydrates and inflammatory fats, while being nutrient poor. Exercise is lacking, sleep is poor for a variety of reasons, and job stress is taking a toll. She is overweight and has slightly elevated blood pressure.
Lab testing reveals delayed food allergens, along with dysbiosis and leaky gut. Because 70 percent of the immune system surrounds the gut, these gut issues activate immune pathways that cause inflammation, leading to more of the stress hormone cortisol, which is further driving high blood sugar, insulin resistance, and mucking up thyroid hormone production.
Our patient had been on a medication for acid reflux, one that blocks stomach acid, and due to this is found to be low on iron and vitamin B12. This is more of the reason for fatigue and poor metabolism. She is also post-menopause and low in her ovarian sex hormones, which is part of the poor sleep, fatigue, weight gain, diminishing muscle tone, and lack of ambition.
We start with a simple digestive cleanse and detox, an easy 30-day "reboot" of her diet that helps begin the healing of the gut and fortify the liver for detoxification. She eliminates food allergens and begins supplements that replenish the beneficial bacteria and heal leaky gut. Soon she is able to stop the medication for acid reflux.
She is referred to an acupuncture colleague, starts a yoga class and is taught awareness mediation which is proven to lower the output of the stress hormone cortisol as much as 50 percent. I ask her to start walking 30 minutes every day.
Already feeling much better after a month or so, and noting improved blood sugars, we move on to replacing ovarian hormones with bioidentical hormone replacement (which by the way, has clearly been shown to be a safe and effective alternative to the cancer promoting synthetic hormone "look-alike" drugs). These help her sleep, energy and motivation, as well as her libido.
Using natural supplements, starting with iron and vitamin B12, we also include some digestive enzymes, coenzyme Q for cellular energy, fish oil and pycnogenol to lower inflammation, and berberine from the goldenseal plant to help insulin to work better. Early on we gave her intravenous infusions of vitamins as well as the master antioxidant, glutathione, to really kick-start the healing process.
After three months our patient has lost weight, is feeling "great," is off medications, and her blood sugar is well controlled with lifestyle choices and a few supplements.
AN OPTIMISTIC FUTURE FOR MEDICINE
In this age of evidence-based medicine that relies mostly on pharmaceutical driven randomized controlled trials for guidance, it is a stretch for most physicians to embrace functional medicine. It is inevitable though, because it works. Patients are consumers, and they are wisely seeking something "outside the box" as what's in the "box" is not working out so well.
While our politicians and healthcare industry leaders ponder the economics and systems for distributing healthcare, a quiet revolution is happening outside their system, and your good health will be the most important benefit. It's a welcome change, a paradigm shifting change of seismic proportions, and one that has me more excited than ever to practice the art of medicine and healing.
GJ Free Press health columnist Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 970-245-6911 for appointments or more information.