Functional Medicine: Thinking Differently About Health and Illness
I was seeing a patient the other day in my office who had come in to review her lab results. Her concerns include fatigue, poor energy, weight gain, and diffuse muscle soreness. She owns a private consulting business. She enjoys her work, but recognizes it has been a stress on her. In the late 1990’s she started to experience symptoms of a racing heart. She saw a doctor and was told she had an “adrenal issue.” She underwent ultrasound of her heart, urine cortisol (the “stress hormone”) testing, wore a heart rate monitor, and was ultimately placed on a drug to control her heart rate. She was advised by her doctor to slow down. To add to her stress, in 2002, her parents moved into her home because her mother had developed a progressive form of dementia. The mother lived another 7 years before dying of her illness. A year later a close friend, who had been diagnosed with Parkinson’s disease, also died. In the meantime, her father died of cancer. In 2006 she was diagnosed with fibromyalgia and metabolic syndrome. Her consulting business became increasingly stressful because she was not contracting work. The stress of her life was not limited to her adulthood. When I had taken her functional medicine timeline she described to me repeated physical and mental abuse as a child. As an example of her torment she said her father would beat her with a razor strap for minor issues or if she had a C on her school report card.
Stress and Diabetes Are Linked
By body mass index she was obese. At the time of her office visit her blood pressure was extremely elevated. She had never been told she was diabetic, but her results suggested to the contrary. Her hemoglobin A1c, a blood marker that reflects a person’s average sugar over time, was elevated to 6.6 (normal is 5.8 or less), and her fasting insulin level was also elevated further confirming the diagnosis. Her High Sensitivity C-Reactive Protein (HS-CRP), a marker of chronic inflammation, was significantly elevated at 6.8 (normal is less than 1.0). I had asked her to complete a cortisol test that measures levels of the hormone in her saliva at different times of the day (morning, noon, afternoon, and night). Normally, there is a rise in this hormone in the morning corresponding with awakening from sleep. However, the patient’s morning cortisol was abnormally low. Then, it did something entirely different. It rose quickly and for the remainder of the day it was quite high. It was as if her stress response was turned on high almost all the time.
When I explained the results of the tests to the patient and she found out she was diabetic she was surprised. She was extremely careful about her diet—gluten free, low carbohydrate, lots of vegetables—and could not understand how this happened to her.
Treating Stress with Functional Medicine
As a functional medicine doctor one of the more challenging parts of my job is teaching my patients to think differently about their health and illness. The current system has taught us for every consequence, disease, there is a cause that is either known or unknown. It is a system that asks us to be satisfied with simplistic, linear cause-and-effect answers. We rarely dive deep and bathe ourselves in the complexity that is the reality of our lives and how we got to wherever we are. Cynically, I might add that the system likes the “unknown” answer which in medical speak is identified by the term “idiopathic,” because the consequence of idiopathic illness is usually to take a drug indefinitely. The reality is that our lives and our biologies are complex, and while disease is expressed along a final common pathway (much like chest pain might actually be the way in which several types of disease of the heart ultimately express as a symptom) there are several paths to get there. Drivers of inflammation: sugar, gluten, soy, dairy, chemicals, heavy metals, infections, nutrient deficiencies, fatty acid imbalances, sleep deprivation, sedentary lifestyle, social isolation, and stress. Research relating stress to health is substantial, and yet rarely discussed in the traditional doctor’s office setting. The effects of stress on the biological systems that make up the functional medicine matrix is profound. We can talk about the effect of stress on the microbiome, the immune system, the mitochondria, neurogenesis and plasticity of neural networks, and even neuronal apoptosis (programmed cell death) in regions of the brain serving memory, among other area. Because stress is directly linked to the immune system it is linked to inflammatory messengers that play a role in damaging blood vessels leading to coronary artery disease and stroke. The response to chronic stress in the body, a persistently elevated level of cortisol (our fight-or-flight hormone), is to down-regulate the production of sex hormones. After all, who would stop to reproduce while being chased by a saber toothed tiger? Eventually, thyroid function is affected in an attempt to protect the organism from running in the redline for too long. While cortisol drives up the blood sugar and insulin, in turn, eventually the cellular response is insulin resistance and diabetes ensues.
Stress, a Learned Behavior
For my patient it is going to be a process, as it is with all of us, to arrive at the “ah ha” moment when it all comes together and she understands what she must do for herself to help herself overcome what has developed over a lifetime. The evidence is there that early exposure to stress flips epigenetic switches that hardwire our future stress response over a lifetime; it becomes a positive feedback loop. Stress begets stress, in effect a learned behavior. But we must embrace the fact that behaviors are hard-wired neural networks. This is epigenetics, and the remedy will not be simple. What we do know is that no drug is going to re-wire the networks; a drug may only dampen its signal (i.e., an antidepressant). Instead, a desire to change DNA expression can only come through the powerful combination of intentional thoughts and emotions supported by sleep, exercise, food, and connection. This takes regular practice, much like learning a musical instrument. Even once the skill level is attained, ongoing practice maintains the ability and absence of practice reverts the system back to something much closer to the state from which it started.
At Sharlin Health and Neurology we have a HeartMath Laboratory for patients to familiarize themselves with the science of heart coherence in order to build the heart-brain connection. Patients can then rent or purchase their own EmWave device, and under the guidance of a trained practitioner flip the switched of their DNA in ways them may never have thought possible, and reverse the effects of the journey that started lifetime ago, but has kept them on a path that has lead them right here, right now.