Understanding Functional Medicine

A couple of weeks ago, I touched briefly on the new field of Functional Medicine and remarked that while it’s far from accepted by the vast majority of conventional physicians, the prestigious Cleveland Clinic had opened their own Institute of Functional Medicine, headed by the popular physician-author Mark Hyman, MD.

I added that we at WholeHealth Chicago have been ordering Functional Medicine diagnostic tests and treatment programs for years, so unless you’re also travelling to Cleveland to visit the Rock and Roll Hall of Fame, a trip there for functional medicine is really not necessary.

Here’s a quick case history
Let’s use it to set the stage for simplifying the whole idea of Functional Medicine:

Barbara is a middle-aged woman about to start Humira for her rheumatoid arthritis. Although her insurance will pick up Humira’s $5,000 per month cost, she’s rightfully nervous about its side effects. Nevertheless, her rheumatologist doesn’t want her to develop joint deformities and thus is encouraging her to proceed.

The only problem is that all her test results specifically for rheumatoid arthritis have been negative. Her doctor called it seronegative (for serologically negative) rheumatoid arthritis, meaning she didn’t have the antibodies in her blood that cause an attack on joints and lead to inflammation. Nonetheless, he encouraged Barbara to proceed with treatment.

To which Barbara sensibly asks “Well, do I have it or not?”

Barbara decided to get a second opinion at WholeHealth Chicago, and at her first appointment we ordered two tests commonly used in Functional Medicine: a test for intestinal permeability (also called leaky gut) and a food sensitivity profile (which checks to see if her immune system is regarding any of 96 commonly eaten foods as the enemy).

The food sensitivity profile, by the way, is not the same as the skin test used by allergists. That test is looking for foods causing allergy symptoms, including rashes and lip swelling.  A food sensitivity profile looks for sensitivity symptoms such as joint pain, indigestion, sinus congestion, and fatigue.

During her visit, Barbara also learned about the food sensitivity elimination diet, in which you eliminate and then reintroduce the so-called Big Six food sensitivities: dairy, egg, corn, gluten, citrus, and soy. She would try it and return in three weeks.

On her second visit, Barbara smiled and told us that she was virtually symptom-free. She reported that when she started reintroducing each of the Big Six, one every two days, she discovered that her joint pain was triggered by gluten and dairy. This was confirmed by her lab test, which showed her immune system was creating antibodies against gluten and dairy. In addition, her small intestine was indeed leaky, with gluten and dairy molecules passing into her bloodstream, carried to her joints, and triggering areas of painful inflammation.

Over the long haul, Barbara would avoid these foods (though usually 100% elimination isn’t necessary) in order to not only relieve her painful joints, but also to allow the lining of her intestine to heal itself. A few nutritional supplements, mainly glutamine and probiotics, would help speed the healing process.

What about Barbara’s rheumatoid arthritis?
Rheumatoid arthritis is in fact a real medical condition in which the immune system starts creating antibodies against the lining of joints, which triggers inflammation. It’s called an autoimmune disease because the immune system is attacking the body of its owner as if it’s a foreign invader.

A diagnosis of rheumatoid arthritis (as well as other autoimmune disease) is fairly easy to make today with the availability of sophisticated blood tests. It’s true that drug treatment is effective, but it’s fraught with risks from meds like NSAIDs, steroids, immune suppressants, and the like.

What Barbara has is specifically not disease (remember, she didn’t have the telltale antibodies in her blood). Rather, her joint pain is a function of some of the things she’d been eating–pizza, milk, and cookies.

This is the big takeaway
When you’re trying to unravel perplexing chronic symptoms…

Step one  Have your doctor order appropriate tests to either diagnose or rule out actual disease.

Step two  If your tests are negative and symptoms persist, seek out a Functional Medicine practitioner to unearth how inadvertent lifestyle choices might be the underlying basis of your problems.

Were Barbara to ask her rheumatologist to test her for leaky gut, she’d likely experience his total ignorance, hearing a dismissive “there’s no such thing” or a “I’m a rheumatologist, not a gastroenterologist.” This is a pitfall we hear again and again from people who have made their way to WholeHealth Chicago.

In fact Barbara’s seronegative rheumatoid arthritis is, in reality, a condition in which her joints are inflamed by gluten molecules leaking through her intestinal wall. For Barbara, gluten is such an inflammatory grain that it’s probably responsible for her leaky gut in the first place.

Applying Functional Medicine’s principles
Next week we’ll discuss adrenal fatigue, one of the most commonly seen, but often overlooked, functional causes of the afternoon energy crash. The diagnostic test for it, in which you collect four samples of saliva, is simplicity itself.

But let me leave you with my single favorite functional medicine test. By now, everyone knows the symptoms of hypothyroidism (underactive thyroid) include cold hands/feet, dry skin/hair, weight gain, and a sense of sluggishness. You tell your doctor this, she orders a TSH (thyroid-stimulating hormone) test, says the results are normal, and recommends you eat less and exercise more.

We know the TSH test misses a lot of hypothyroidism, so a normal test result doesn’t tell you much of anything. But remember, your thyroid controls your body temperature so go to any drugstore and buy an ovulation thermometer, a highly sensitive instrument that predicts ovulation. Take your temperature just as you’re waking up, before you get out of bed. If, after five days, you average 97.6 or lower then you probably have low thyroid.

You likely also have low thyroid if in bed with your partner you hear, “Honey, are you dead? Your feet feel like blocks of ice.” Or if on this Christmas morning one of your presents is a pair of nice thick wooly socks to wear to bed every night.

Are the principles of Functional Medicine becoming clearer?

Can you now say with confidence: “Hey, maybe that heartburn I get after a late-night lasagna and Chianti isn’t cancer of the esophagus after all. I’m going to stop eating at 6 pm, see how I feel, and cancel that gastroscopy my gastroenterologist has scheduled.”

Be well,
David Edelberg, MD