How many mechanics does it take to check the oil?
The other day, I met with a new client for the first time. She warned me ahead of time that I should not be shocked by her reasons for coming to see me, so I was somewhat prepared.
What I felt as I read her intake information was anger, not shock. Here was a positive, intelligent woman in her 50s who, because of various debilitating symptoms and diagnoses, is bouncing from specialist to specialist. Currently, she has 12 different doctors, none of whom are in communication with any other.
There is something really wrong with her care. For one, can you imagine how time consuming her health care demands are? Can you imagine the expense? Both the time and expense are unsustainable, but more what's more outrageous is she is not getting better.
The human body is so much more intricately designed than an automobile, but none of us would consider having 12 different mechanics from 12 different garages working on the same car to fix different problems. It just doesn't make sense.
A seemingly unrelated but relevant true story: My (very bright) sister once wrecked her car’s engine by driving without any oil. When my dad asked her why she didn’t add oil when the oil light went on, her response was, “The oil light’s been on for a long time. I thought it was broken.”
When I think about our current medical model, I see that it is based in the same faulty thinking. Typically, when we go to the doctor’s office, we end up trying to fix the symptom (the oil light’s broken), when there is actually an underlying issue that’s causing the symptom (there’s an oil leak).
Although the symptoms we experience might be uncomfortable or painful, in reality, symptoms are our bodies' signal that there's something out of whack. If we simply address the symptom, we miss an opportunity to heal. For example, say I go to my general practitioner because I'm feeling chronically anxious. If I'm like 1 in 6 Americans, I'll end up leaving the office with a psychiatric prescription in hand.
Typically, my conventional doctor will ask the question "What symptoms do you have?" rather than the question "Why are you experiencing symptoms?" These two questions drive thinking in different directions and result in different treatment protocols.
If a doctor's focus is what the symptoms are, that information is used to determine a diagnosis, and therefore a treatment that is "standard of care." "Standard of care" means that similarly qualified practitioners would have managed the patient's care under the same or similar circumstances. "Standard of care" treatment provides legal protection for the doctor as well as helps ensure that the treatment is covered by insurance. Pretty straightforward, right?
Understandably, most of us put great stock in a doctor's diagnosis and recommended treatment.
The problem with asking WHAT
No doubt, "what?" is an excellent and necessary question. The problem is, if it's not accompanied by "why?" both the doctor and the patient are left with a superficial understanding of the patient's complaints.
When a doctor's question asks why the patient is experiencing symptoms in the first place, it drives the doctor to look for the underlying cause of the symptoms.
Why is this important? Because the root causes of symptoms and disease may radically vary from person to person.
Take anxiety for example.
One person's anxiety might stem from blood sugar imbalances. Blood sugar imbalances are common, easy to correct and can have a fundamental impact on how one feels day to day.
A possible and logical intervention: Concentrate on incorporating more fat with every meal, eat more frequently, and reduce sugar and refined grains.
Another person's anxiety might stem from inflammation. Inflammation anywhere in the body can agitate the hypothalamus-pituitary-adrenal (HPA) axis, causing agitation, lack of sleep, and mood issues.
A possible and logical intervention: Identify possible sources of inflammation, which might include an underlying infection, or a toxic burden from exposures to chemicals, food sensitivities, gut issues or sugar intake.
Another person's anxiety might be rooted in low stomach acid, which prevents that person from properly digesting protein. Protein is rich in soothing amino acids such as tryptophan. Low stomach acid means that B12 (vital for energy, mood, cognition and stress resilience) and calming calcium are also not absorbed.
A possible and logical intervention: Sit down in an unstressed environment while eating. Breathe, give thanks and CHEW. These simple steps can ease stress, allowing the parasympathetic nervous system, which governs digestion, to turn up the release of hydrochloric acid and other digestive enzymes. Yes, it's true. an act as simple and accessible as chewing food can make a world of difference to one's health outcomes.
Another person's anxiety might stem from gut bacteria imbalances. Dysbiosis, where gangs of bad bacteria crowd out the good gangs, can wreak havoc on moods. Our good bugs actually manufacture many of our B vitamins which are essential for calm, adrenal health and stress resilience. Bad bugs off-gas toxins, which inflame the gut and ultimately can inflame the brain.
Possible and logical interventions: Reduce the sugar and refined grains that feed the bad bugs. Increase fiber intake to feed the good bugs. Incorporate fermented foods.
Would medication have addressed the root cause in any of these instances? Nope.
Please sit up and take notice: if we do not ask why we are experiencing symptoms, we will be distracted by the blinking oil light and never identify the oil leak.
Things are shifting
There's a shift - really a revolution -- happening in the world of medicine and it's about time.
This fundamental shift is called functional medicine. Jeffrey Bland, considered the father of Functional Medicine, gathered a group of doctors in 1990 to brainstorm a different approach to health care. He was frustrated with what he called a "fragmented, organ-based specialty care." The group concluded that identifying the early signs of chronic disease would benefit both patients and our overburdened, expensive healthcare system.
Soon after, Bland and his wife founded the Institute of Functional Medicine to offer courses in this new approach. Today, more than 100,000 healthcare practitioners in 73 countries have studied the principles and practices of functional medicine. Medical schools are beginning to teach functional medicine, as faculties from many US med schools have enrolled in the IFMs continuing education courses. IFM does not offer a standalone degree, but postgrad certification.
So what is Functional Medicine? Functional medicine seeks to identify and address the root causes of symptoms and chronic disease. Functional medicine practitioners view the body as an integrated and finely tuned system, rather than a bunch of different organs operating independently. It's a radically different approach that is based on the fundamental tenets of functional medicine practitioners:
- We know each person is bio-individual. A treatment or diet that is right for one person may not be right for another.
- We focus on the patient in front of us. Our practices are “patient centered” rather than “disease centered."
- We believe that optimal health is a balance of internal and external factors affecting the mind, body and spirit.
- We believe that all body systems are interconnected.
- We believe that true health goes far beyond the absence of disease.
- We believe that “health span” is more important than “life span.”
Allow me to digress for a moment and ask an important question:
Why is a shift necessary? Why now?
Many of the institutions that form the foundation of the United States were revolutionary at the time they were envisioned, created and put into practice. As Sir Ken Robinson illustrated in his TEd Talk on "Changing Education Paradigms," an institution grows out of a society's current needs, challenges and understanding of the way things work. Yet when a society evolves, our institutions need to evolve too. We begin by asking good questions, then examine the research, make modifications, and streamline procedures. It takes a lot of work to change institutions because usually they're big, multifaceted, and there are a lot of stakeholders who disagree with what changes are necessary. Some resist change altogether.
But sometimes, continuing to spackle up the cracks in outdated systems no longer suffices. This is where a paradigm shift is important.
Our current Western medical system is an excellent example of an institution that reflects the needs, challenges and understanding of a different time. Illnesses like tuberculosis, smallpox, cholera and scarlet fever no longer are common. Instead we are seeing a radical surge in chronic conditions such as Type 2 Diabetes, dementia, auto-immune disorders and autism. In many instances, unfortunately, the United States is leading the pack in disease rates. I'm not sure about you, but I'm not going to sit around and wait for the "cure." Hell no.
Western medicine is brilliant in an emergency.
I know my father-in-law would not have survived his heart attack two months ago without emergency surgery. If I broke an arm or ingested something poisonous, I would rush to the hospital, knowing I'd be in excellent hands.
Yet emergencies aside, the mainstream medical model in the United States focuses mostly on treating disease as opposed to preventing it. In the face of chronic conditions, it emphasizes treatments such as prescription and over-the-counter medications.
It is also increasingly specialized. You have digestive issues? Go see a gastroenterologist. Hormonal issues? Here's a referral to an endocrinologist. Mood issues? You need a psychiatrist. It's great to have expert help, but the reality is that your endocrinologist is not talking to your psychiatrist. Neither one is comparing notes with your cardiologist. That's a problem. If each of your practitioners is prescribing medications, each of them is introducing an intervention that impacts the work of the other doctor. No matter how fine the print on the medicine's box, side effects are very real effects. Like my client (and many more like her) has experienced, this system has become prohibitively expensive and most doctors, due to their training, don't seem to be looking too far beyond medicine and surgery for interventions.
Let the 4 Ps lead the way.
So let's talk about functional medicine. A good way to do that is to discuss the 4 Ps, coined by Dr. Mark Hyman, director of the Institute of Functional Medicine, a main driver behind education and training in this paradigm shift.
- Predictive. Predictive medicine takes into consideration a patient's health history, family history, genetic screening and diagnostic tests to get a clear picture of any disease susceptibilities. Once weaknesses are identified, interventions can be put in place before the onset of disease. Why wait until someone is pre-diabetic to treat when there are many markers to watch? Predictive medicine pays attention to trends and possible weaknesses in a patient's health.
- Participatory. Functional medicine requires participation on the part of the patient. No one cares about your health as much as you do. A patient therefore must be willing to take responsibility for necessary lifestyle and dietary modifications. Patients in this paradigm do not sit back and pop pills while their health degenerates. The functional healthcare provider becomes the facilitator for the patient's health journey. The patient becomes the healer.
- Personalized. Everyone has a unique genetic makeup and biochemistry. Even with a similar diagnosis, patients are unique. Functional medicine address the whole person, not the disease.
- Preventive/Proactive. Preventing disease is a heck of a lot cheaper than treating one. Why wait? No more "It looks like you have a heart trouble. Come back and see me in 6 months." Instead, a functional practitioner is looking beneath the surface, supporting the client to restore optimal health.
Now don't get me wrong.
I am not anti conventional medicine, so I am not proposing throwing the baby out with the bath water. Conventional medicine addresses part of our health picture really well. Broken arm? In need of stitches? No need for personalized, preventative medicine there.
Functional medicine does not replace conventional medicine. We need both. I use both and will recommend both systems to my clients.
In future posts, I will talk about how to find functional practitioners, the growing pains of functional medicine and where nutritionists and health coaches play a role in this new paradigm.
So what now?
If you want to be part of this paradigm shift and take advantage of the medical model of the future, here are some easy action steps.
- Ask WHY. Do NOT assume that your symptom is the problem. Ask why it's there. I don't care if your mom and grandma had the same symptom. Shift your perspective to ask WHY that symptom is surfacing in your body right now. There's a reason, and it's not all genes.
- Move into a place of authority when it comes to your own health. Keep a file of all your diagnostic tests and panels. Look at the numbers and how they're trending, even if you don't yet know what they mean. Ask a LOT of questions of your doctor. For example, "Is there a way that I can address this through diet and lifestyle?" If your doctor says "no," keep in mind that your doctor most likely received little to no nutritional training in med school.
- If your child is considering a future in healthcare, have her or him read up on functional medicine and see make sure that the schools she/he is considering are offering classes in a functional paradigm. It's the wave of the future, considering the trends of chronic illness in this country.
- Put functional medicine on your doctor's radar. Recommend to your conventional doctor that he/she participate in the Institute of Functional Medicine's training. There are free programs, conferences and a certification program. We don't want to replace our doctors. We want them to get caught up to speed on prevention and a more systems-based approach to health.
- Be suspicious of medications, even ones that we've assumed are innocuous. If you take ANY medication continually, like Accutane, birth control pills, acid pump inhibitors, Advil, you need to ask some questions about side effects and alternatives. Start to dig deeper than simply addressing symptoms that surface. Remember: the body is designed to heal. How can you make changes to support it in doing so?
- Don't wait for a diagnosis to pay attention to your symptoms, even if your doctor chalks up your symptoms to a) aging, b) needing an anti-anxiety med; c) imagination. No one knows your body better than you do.
Like my new client, we need empowerment when it comes to our own health. Start to ask for and expect the 4 Ps: healthcare that is predictive, proactive, participatory and personalized. It's happening and I'm excited to be a part of it. I'm also excited to share more about how to participate in this shift in the coming months. Ultimately, we all want to become people who can look "under the hood." Our body is our vehicle in this lifetime and we need to better understand how to ensure a smooth ride.
As always, I appreciate your time and the privilege of space in your inbox.
Be good to yourself and others.