Posted 08\/12\/2012<\/p>\n\n\n\n
Several previous health tips have mentioned the phrase \u201cfunctional medicine\u201d and I have a sneaking suspicion that many readers aren\u2019t quite sure what it is, how it works, or how it differs from the conventional treatment you\u2019ve likely been receiving all your life. Today, walk alongside me and try your hand at diagnosing digestive problems using a functional medicine<\/a> approach.<\/p>\n\n\n\n As a quick review, there are two basic types of symptoms:<\/p>\n\n\n\n Out of 100 random patients who come to us with symptoms, just 5 to 10% are experiencing disease-based symptoms. The other 90 to 95% are having functional symptoms.<\/p>\n\n\n\n Importantly, functional symptoms, though often dismissed as harmless by conventional physicians, can be debilitating. Digestive symptoms alone from a functional disorder–severe heartburn, chronic bloating, stomach pain, unpredictable diarrhea and constipation–can make life miserable. The situation isn\u2019t helped when your doctor says \u201cNothing to worry about. You\u2019re fine,\u201d or \u201cYou\u2019ll just have to learn to live with it.\u201d Or \u201cTake this pill and you should feel better.\u201d<\/p>\n\n\n\n Here\u2019s an easy way to identify disease-based symptoms: they start at a certain point and get steadily worse + test results shift from negative to positive. This makes disease-based symptoms easier to diagnose with the passage of time. If you have a new symptom that\u2019s getting worse and you\u2019ve not been to a doctor, schedule an appointment with your health care practitioner muy pronto<\/em>.<\/p>\n\n\n\n Conversely, functional symptoms come and go, often for years. They\u2019re not dangerous but can be singularly annoying or even control the way you live your life. When confronted with patients who have symptoms that are clearly functional, conventional doctors prescribe medicine to relieve the symptoms, but rarely suggest significant lifestyle changes and virtually never recommend nutritional supplements as therapy.<\/p>\n\n\n\n Functional medicine physicians, on the other hand, work to get your physiology back in order, usually recommending a combination of lifestyle changes, supplements, and occasionally hands-on therapy such as massage, chiropractic, or acupuncture. If you follow through with the suggestions, most of the time your body starts functioning smoothly again and your symptoms disappear.<\/p>\n\n\n\n With that background, let\u2019s walk through a fairly typical functional medicine approach to a common group of symptoms. At the end of this health tip, you may feel qualified to say, \u201cYou know Dr. E, I could really do a lot of this myself.\u201d And that\u2019s why we\u2019re here.<\/p>\n\n\n\n By the way, even if you\u2019re symptom-free, digestion-wise, you might work through this, just to see how functional medicine is applied.<\/p>\n\n\n\n Background<\/span> Let\u2019s assume your symptoms have been around for quite a while and your doctor shrugs when you mention your bloating, diarrhea, or heartburn, saying something like \u201cWell, your gastroscopy was fine and so was your colonoscopy. Your gallbladder looked fine on ultrasound. Nothing\u2019s wrong, so just keep taking your\u2026\u201d<\/p>\n\n\n\n The most common symptoms of digestive dysfunction<\/span> are heartburn, burning or pain in the upper abdomen (usually before eating), indigestion within an hour of eating, bloating, and change in bowel movements (constipation, gas, diarrhea). There are also other symptoms, apparently unrelated to digestion, that often improve when digestive issues clear up, including fatigue, skin rashes, muscle aches, joint pain, and chronic sinus congestion. However, bloating seems to be symptom #1. If I established a national chain of medical offices called \u201cBloating Centers of America\u201d I\u2019d do very well indeed.<\/p>\n\n\n\n Functional medicine approach to symptoms<\/span> Now be your own doctor and sort out your digestive symptoms or those of a friend by applying a typical functional medicine framework.<\/p>\n\n\n\n Step 1: Find out if symptoms are caused by a food sensitivity <\/strong>\u00a0Generally called provocative testing because we\u2019re trying to provoke your body into giving us an answer, this is easy–no blood tests, no probing any of your precious orifices. Also known more specifically as gastrointestinal detoxification or a food sensitivity elimination diet, for about three weeks you eliminate dairy, egg, corn, gluten, citrus, and soy, along with a few other commonly irritating foods (and foods containing chemicals, additives, and preservatives). Click here for instructions. You can speed the detoxifying process by using a product called UltraClear Sustain<\/a>, which contains nutritional supplements that enhance liver and intestine detoxifying systems.<\/p>\n\n\n\n If you feel better (you see improvement in your digestive symptoms and any others), you\u2019ll start reintroducing one food group every three days, in a clear attempt to \u201cprovoke\u201d your symptoms, until you recognize the food culprit by the return of symptoms. Then, just avoid that food. Nothing terrible will happen if you give into a craving. Just don\u2019t be surprised the next day when your digestion feels off.<\/p>\n\n\n\n In other words, your symptoms were not a disease, but rather a function of your dietary habits<\/em>. Functional medicine–viola!<\/p>\n\n\n\n Step 2: Print out and complete this useful Functional Medicine Digestive Symptoms Questionnaire courtesy of Integrative Therapeutics<\/strong>, a supplement manufacturer specializing in products related to digestion. Now place it next to your computer so I can walk you through your results.<\/p>\n\n\n\n Finished? Okay, here we go:<\/p>\n\n\n\n Section A Symptoms related to the initial phase of digestion<\/span> (chewing, swallowing, food churning in your stomach and mixing with acid and enzymes). If most of your symptoms are in the A group, you could begin by eating more slowly and chewing your food more thoroughly. You\u2019d be surprised by the number of people whose chronic indigestion occurs because they wolf down their meals. If this doesn\u2019t help, consider a month-long trial of digestive enzymes and betaine hydrochloride–try one first, then the other–taken at the onset of each meal. These enhance the digestion that occurs in your stomach. (For more on these products, see the links in Treatment, below.)<\/p>\n\n\n\n Section B Symptoms of gastric irritation or even a stomach ulcer<\/span>. For these, you\u2019d definitely not want to use betaine, which increases acid. For this group of symptoms, virtually anything that reduces acid should give you relief (from Maalox to Tagamet to Prevacid), but with symptoms like these you should see your doctor, likely undergo a gastroscopy, and get tested for the presence of the ulcer-causing bacterium Helicobacter pylori<\/em> (H. Pylori<\/em>).<\/p>\n\n\n\n Section C Symptoms of inadequate digestive enzymes<\/span>, especially those produced by the pancreas. As we age, we produce smaller amounts of enzymes and the symptoms listed here can result. If your symptoms are clustered in this section, try a month of pancreatic enzymes with each meal and see if you improve. To confirm this diagnosis, I\u2019d suggested one of the most commonly used tests in functional medicine, the Comprehensive Stool Digestive Analysis (aka the CDSA or \u201cthat poop test\u201d). You collect a small amount of your waste from three separate bowel movements and send it directly to a lab. The results yield a vast amount of information about all your digestive processes and generally can show the region of your intestine that\u2019s functioning poorly. This test also checks for imbalances of intestinal bacteria and the presence of parasites and candida (yeast).<\/p>\n\n\n\n Section D Other symptoms occasionally associated with poor digestive function<\/span>. Significant positive results in this group (such as blood in stool) may require that you have a colonoscopy, lab testing for food sensitivities, and\/or undergo a trial period of strict changes in your eating habits.<\/p>\n\n\n\n Section E Symptoms of the liver and gallbladder<\/span>. Again, lots of positive answers may indicate a need for further testing, such as the capacity of your liver to clear toxins (another functional test) and an ultrasound of your gallbladder (looking for gallstones).<\/p>\n\n\n\n Step 3: Six functional medicine principles for restoring digestive health <\/strong>If you have no luck identifying a food culprit after completing the Step 1 self-test for hidden food sensitivities, here\u2019s a plan to treat your digestive symptoms:<\/p>\n\n\n\n 1. Optimize digestion by taking a high-potency digestive enzyme (such as Similase<\/a>) with meals. If no improvement, enhance your stomach acid with Betaine<\/a>.<\/p>\n\n\n\n 2. However, if you have symptoms of heartburn, stomach burning, or irritation, avoid the Betaine and instead work to heal your stomach lining with\u00a0Rhizinate<\/a>\u00a0(deglycyrrhizinated licorice) or\u00a0aloe vera juice<\/a>.<\/p>\n\n\n\n 3. The lining of your small intestine is where you absorb food. Restore healthy intestinal mucosa using specific nutrients containing glutamine (an amino acid) and antioxidants (Permeability Factors<\/a>, OxyPerm).<\/p>\n\n\n\n 4. If your stool samples show parasites or candida, boost intestinal defense with parasite-killing herbs (Para-Gard<\/a>), though you may also need an anti-candida or anti-parasite prescription drug.<\/p>\n\n\n\n 5. Enhance your liver\u2019s detoxification (Blue Heron<\/a>, a fiber combination to absorb and eliminate toxins, plus\u00a0Detoxication Factors<\/a>).<\/p>\n\n\n\n 6. Re-establish healthy bacteria (TheraBiotic<\/a>,\u00a0ProBiotic Pearls<\/a>).<\/p>\n\n\n\n Here\u2019s a brochure that expands on everything above.<\/p>\n\n\n\n I hope by now you can see the clear difference between conventional medicine\u2019s approach to symptoms (symptom leads to diagnostic tests that, if negative, lead to prescription drug to suppress symptom) and functional medicine\u2019s more complex exploration of your symptoms followed by tests of function, dietary changes, and supplements to improve function rather than suppress symptoms.<\/p>\n\n\n\n If you need a skilled hand with any actual digestive problems, call and schedule with me or my associate Casey Kelley, MD. Our nutritionists, Marla Feingold and Seanna Tully, are well-versed in functional therapies as well. If you live too far away for an office visit, Marla and Seanna can arrange phone consultations, but (sorry) we can\u2019t bill insurance for phone services.<\/p>\n\n\n\n Be well,<\/p>\n\n\n\n David Edelberg, MD <\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Posted 08\/12\/2012 Several previous health tips have mentioned the phrase \u201cfunctional medicine\u201d and I have a sneaking suspicion that many readers aren\u2019t quite sure what it is, how it works, or how it differs from the conventional treatment you\u2019ve likely been receiving all your life. Today, walk alongside me and try your hand at diagnosing […]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,45,2333,50,3],"tags":[1404,1059,1419],"class_list":["post-5074","post","type-post","status-publish","format-standard","hentry","category-blog","category-f","category-functional-medicine","category-healthy-lifestyle","category-knowledge-base","tag-disease-based-symptoms","tag-functional-medicine","tag-gi-complaints"],"yoast_head":"\r\nDigestive problems: a functional work-up<\/strong><\/h2>\n\n\n\n