In my previous post I listed a number of mistakes doctors often make. In this post I’ll address other ways medical practice and research is inadequate and what functional medicine is.
About the genetic origin of diseases
Both research and standard medical practice put far too much emphasis on genetic causes of modern diseases. Delving into the literature reveals that the genetic contribution to inflammatory disease tends to be very small and highly indirect. Most studies show that there is a genetic component of susceptibility to chronic illnesses, but there is always an environmental trigger (with the exception of truly genetic diseases). To quote Rioux & Abbas: ”Some people inherit an unfortunate combination of genetic sequences, such that exposure to an external trigger causes their immune response to turn on their own tissues”
I think the emphasis on genetics is an unfortunate case of fashion being more important than substance. When it became possible a while back to perform genome sequencing on large populations it was all the rage. People were thrilled that we would finally be able to find the cause of every disease, right there in our genes. Many must have been hugely disappointed when it turned out that a certain gene variant often increased the risk of developing a certain disease with just a few percent, or only in the combination with other gene variants, and even then only rarely. That many people carrying those gene variant(s) still don’t develop the associated disease must’ve been a troubling insight. Conversely, studies show that even when people are lacking those variants they can still develop the condition. To be noted is also that the genetic contribution varies between diseases. For instance are type 1 diabetes and Hashimoto’s examples of conditions with a high level of familial clustering, whereas rheumatoid arthritis and multiple sclerosis are considered to have a low level of inheritance.
Focusing too much on genetic causes is a mistake, because it’s clearly not the whole picture. What has been essentially forgotten is that…
… the incidence of inflammatory and metabolic disease has changed in modern times, while our genes have not.
… people who get these conditions are often well for many decades before disease strikes, while they’ve definitely had the same genes their entire life (although it should be noted there are a few true genetic disorders that for different reasons don’t apparent until a certain age).
… many with autoimmune disease go in and out of flares. How would a constant genetic sequence alone be able to cause that?
… while some of these diseases occasionally run in families, very many cases are sporadic with no known heritability. Note that even if a particular disease does run in a family, it could be due to common environmental triggers in combination with gene variants that increase risk.
Let’s look at the example of type 1 diabetes. This is one of the autoimmune diseases considered to have a high rate of inherited genetic susceptibility. Nevertheless, the average of seven studies reveal that if one monozygotic twin develops type 1 diabetes, only in 35% of cases will the other twin do so. Monozygotic twins carry the same gene sequences so why do a staggering 65% of the other twins never develop the same disease? The answer is that contact with an environmental influence (trigger) is required to spark self-destruction of tissue. Speculatively, quite a few of these 35% could also have been exposed to the same trigger as their sibling.
Still, the idea of genetic significance in inflammatory disease persists. The emphasis on genetics is convenient for doctors since if they can rely on it as an explanation they don’t have to spend huge amounts of time (which they don’t have anyway) digging into possible root causes. Interestingly, I’ve also realised that some patients tend to prefer genetic explanations as well, possibly because…
… it seems like the most likely explanation since other members of their family have the same disease.
… it was the explanation they heard first (and the first explanation that human beings hear tends to stick unproportionally well).
… it takes away any possible self-blame.
… it removes any pressure to change lifestyle or go through the arduous and possibly expensive process of seeking alternative treatment.
… it allows you to keep your trust in the medical system, that your doctor knows everything there is to know and the responsibility for getting better is not all on your shoulders.
That said, information about one’s genetics is sometimes a valuable clue to what cellular processes might be working inefficiently and what pathways could possibly be aided to help restore health.
About pharmaceutical drugs
There is absolutely nothing wrong with pharmaceutical drugs per se. I don’t care much for fundamentalism concerning natural vs unnatural. Some drugs are great and some are absolute necessities. All means are allowed when trying to get a person back to health. The problem is that most drugs used for inflammatory or metabolic conditions don’t work very well. Or they do a bunch of things they were not intended to do.
But my largest concern with many drugs is that they don’t attack the underlying cause of disease (with a few exceptions such as anti-microbial substances), but instead treat symptoms and let the underlying pathogenic process go on. This means no true improvement. The real problem is left alone, smoldering, causing other symptoms, wearing the organism (person) down, prematurely aging them and possibly causing a toxic and expensive drug dependence.
About waiting for research to find a cure
Having done research myself I’ve come to understand that progress is slow. It has to be. A well-planned study often takes many years to conduct, and before any promising new results can be put to clinical use several other studies must find the same thing. Often media will report on a new potential drug target or the discovery of some new disease mechanism. That’s great. However, you may falsely get the impression that a cure is just around the corner.
When people suffering from such diseases read about exciting new developments, I’m not sure they realize how far away the benefits from those research projects often are. They may not be put into clinical practice for decades, if at all – many promising leads don’t pan out. The use of some drugs is restricted to certain countries. Also, some of the most powerful methods of restoring your health might never be studied at all in our life time.
In short, the chronically ill often don’t have the time to wait and those who wishes to reverse their condition need to take matter into their own hands.
About functional and personalised medicine
As I’ve mentioned in my previous posts, it isn’t standard medical practice today to look for underlying causes. It is too difficult and time-consuming, and most practitioners haven’t gained the necessary knowledge. Functional medicine, on the other hand, looks at your body as a whole, takes all symptoms and medical history into consideration and aims to treat the real causes of disease. I’ve realised that many complementary health care practitioners like nutritional coaches, naturopaths, chiropractic doctors etc. are not only able to connect the dots better than ordinary doctors, but they are, despite what one might assume, also more scientifically oriented. They’re the ones who are up to date with science, know their cell biology and genetics, make use of it, and have a higher success rate.
However, complementary practitioners also make mistakes. They may focus on one or a few phenomena and believe everything to be caused by those. Some may believe that almost everything is caused by stress (although this is actually more often a mistake of standard medicine), or gluten, while some believe it’s always mold, or lyme disease, or vitamin D deficiency or mercury etc. Or that acupuncture is the solution to everything. Sometimes, researchers studying those things make the same mistakes because they are able to see correlations between a certain phenomenon and a whole range of diseases.
Accordingly, these practitioners will use only a few treatment approaches, perhaps the ones who fixed themselves once. The same goes for online forums and Facebook groups where some members (with the best of intentions) are dogmatic about how a particular method will save us all, and if you’re not seeing results you simply aren’t doing it right. This is understandable but unfortunate. I personally aspire to apply a wide range of methods when looking for disease-causing agents, every time, with each client and their unique mix of genetic and environmental factors. I wish to advise on and inform them about a powerful arsenal of nutritional, microbe-killing, stress-reducing, homeostasis-promoting means of reversing chronic illness that suit their specific needs. I also intend to devise an improvement plan designed to match the individual’s abilities, drive and ambition, severity of symptoms, social situation and financial circumstances. I don’t believe that one size fits all.