Dr Abshire on a different approach to chronic disease

I believe the United States has stellar acute care: Intensive care, Emergency Medicine and Surgery. The current disease base model works extremely well in these situations. When we implement a better approach to chronic disease, incorporating mind-body-spirit and systems biology science, we will have the best approach to healthcare on the planet. We will be able to afford the burgeoning costs of healthcare in our aging population currently threatening to break us. We will lower demands on emergency rooms, lower healthcare costs for employers and government, reduce absenteeism and increase presenteeism at both work and school, allow for greater productivity in the workforce, and free our children to reach their true potential.

The medicine of the future is available right now; it is just not being implemented fast enough. There is generally a decade or more delay between the time when new research calls for new treatment guidelines and their implementation. This is especially true regarding research in nutrition and physiology. Those of us bucking the system do not claim we have all the answers, but current and emerging scientific knowledge allows us to shift from the current disease model to a preventive model. This is the new medicine where all science, particularly nutrition and physiology, is included instead of primarily drug research. We are moving from an organ systems approach to a systems biology approach. Our health really depends on a complex web of interactions between the organ systems, the environment, and a persons unique genetic make up.

The Functional Medicine Matrix Model relies less on the currently used organ system, differential diagnosis of a condition, and more on the antecedents, triggers, and mediators of a condition or conditions.

This medicine is very patient centered. We do not use standard treatments for standard diagnoses. A very thorough patient history is obtained and all facets of the history, symptoms, known diagnoses, and previous studies are organized into categories of Fundamental Clinical Imbalances. This takes longer than the standard provider encounter.

These Fundamental Clinical Imbalancesinclude: Genetics; Hormonal-Neurotransmitter; Reduction-Oxidation-Mitochondrial; Detoxification; Biotransformation - Excretory; Immune – Inflammatory; Digestive – Absorptive – Microbiological; and Structural Integrity.

We then look for patterns in the imbalances which point to Fundamental Physiological Processes.

The processes that may be involved include communication inside and outside the cell, bio-energetics, energy transformation, replication, waste-elimination, protection-defense, transportive, and circulatory. Non-standard lab studies may be done to further elucidate what is happening in the physiology.  A few examples of non-conventional labs, going further upstream of disease in our biochemisty include: looking at intermediate metobolytes of the krebs cycle and other metabolic processes for clues to deficiencies, toxicities or specific genetic variations, checking the ratio of omega 3 to omega 6 fatty acids, testing for toxic exposures and hidden food sensitivities, and analyzing gut microflora, or simply a deeper look with standard labs, such as adding evaluations for T3 and antibodies on a thyroid panel. We look for how to best break the cycle of disease and restore normal physiology.

We organize what we belive are the antecedents - the pre-existing conditions or risk factors, the triggers - what started the disease cycle, and the mediators - what keep the dysfunctional processes going. The antecedents may include genetic predispostion, which is usually not simply a single gene; the trigger may be an environmental factor such as environmental toxins, antibiotics, other drugs, viruses, bacteria, specific food, or a high glycemic load diet; the mediators can be a pattern of abberant metabolism, which can be slow to revert back to normal even with the removal of the trigger, and/or it can be ongoing environmental factors.

The well known metabolic syndrome can be used to illustrate the matrix model. The genetics and epigenetic changes passed on to us by our parents consuming a diet high in processed food can be considered the antecedents. Eating processed foods and other environmental factors are the triggers. Other environmental factors might be pollutants suggested to be related to early insulin resistance. The mediators are: a high glycemic load diet, other lifestyle choices and the metabolic pattern of insulin resistance. The pattern of some combination of symptoms or signs of diabetes, hypertension, cardiovascular disease, hyperlipidemia, obesity, osteoporosis, cancer, and dementia, (alzheimers has been termed the type 4 diabetes), points to aberrant, runaway, endocrinally mediated abnormal fat and sugar metabolism causing insulin resistance, i.e. a fundamental hormonal imbalance and a disturbance in a fundamental physiological process.

Reversing the insulin resistance can cure many diseases and is preferred over the alternative of poly-pharmacy therapy.

The main advantage and practical utility of the matrix is in being able to uncover problems in fundamental body processes before they become disease, and to treat diseases that are very difficult to diagnose and are commonly missed. This approach can correct symptoms that are problematic for a patient which a traditional doctor must say. “I cannot find anything wrong; all the tests are normal, or your symptoms do not warrant more testing. Come back when it gets worse and we will test again to see if you have a disease I can treat.”

Other real advantages of using nutritional approaches to support of key body systems is there is relatively little danger. The treatment may correct other problems at a pre-symptom stage. Drug side effects are avoided, and less drugs end up in our water supply, because food, vitamins and botanicals break down normally. Food and low cost simple, non-patentable, over the counter supplements may be used. Eventually we can institute a public health model of education and implement some of the cornerstones of treatment in an over the counter fashion, quoting Hippocrates, ' To make food thy medicine and medicine thy food.'

When there is no clear disease, or the patient is in the pre-disease state traditional medicine often fails to act. It is best to catch abnormal physiology and correct it than to wait for an advanced stage to take action. This will save healthcare dollars in the long run and prevent needless suffering.

Fortunately, awareness is rising. Two Functional Medicine experts, Jeffrey Bland, Ph.D., and Mark Hyman, M.D. were invited to present to congress and into the White House to discuss healthcare.

For more information on Functional Medicine go to www.functionalmedicine.org

For more information on Integrative and Functional lab Tests go to www.metametrix.com

The co-founder of the Institute of Functional Medicine can be found at www.JeffreyBland.com