- Functional Medicine -

The New View of Health

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New View of Health

Once perceived as the domain of medical experts tasked with keeping our symptoms at bay, the realm of personal healthcare has expanded. It now includes broader definitions, more integrated, preventive approaches — and, perhaps most important, us.

When Tyler Cooper, MD, MPH, worked as a family physician, he often saw patients who gave little thought to their health. “They wanted to live their lives the way they wanted to live them,” he recalls. “And then, they wanted a doctor to fix them.”

Cooper now works with his father, Kenneth Cooper, MD, MPH, at the Dallas-based Cooper Clinic, a recognized leader in preventive medicine. The clinic’s founding principle is that it’s far easier to maintain good health than to regain it once it’s lost.

That’s a principle being embraced by a growing number of people and institutions these days, in large part because our high-tech pharmaceutical and surgical attempts to treat and “cure” the results of unhealthy lifestyles have proven painfully inefficient, ineffective and expensive, from both an economic and human perspective.

In recent years, we’ve dumped record amounts of money into “fix-me” healthcare strategies, only to see rising levels of chronic diseases – particularly those related to poor nutrition and sedentary, stressful lifestyles.

The result: According to a population study published in the New England Journal of Medicine in March 2005, today, for the first time in history, the current generation of children is predicted to have a shorter life expectancy than their parents.

According to S. Jay Olshansky, PhD, one of the study’s lead authors and a population expert at the University of Illinois at Chicago, the effects of obesity-related diseases, including diabetes, heart disease and cancer, are expected to more than offset anticipated gains from medical advances in the next few decades.

Put another way: Our current approach to health is failing.

“We appear to be on the verge of a major shift in the duration of life in the United States,” Olshansky said in an interview with the Chicago Sun-Times shortly after the study’s results were released. “This is a public-health disaster waiting to happen, and we have brought it on ourselves.”

It’s no wonder, then, that the calls for proactive life-style change, preventive medicine and “consumer-directed healthcare” are growing louder. And we, the consumers in question, are responding. People are joining health clubs, taking yoga classes and meditating at unprecedented rates. Health- and fitness-related books and organic foods are flying off the shelves at mainstream stores. Parents are demanding better health-and-fitness education and more wholesome lunches in their children’s schools. And Americans are exploring alternative therapies in record numbers – even when they have to pay out-of-pocket. (According to the National Institutes of Health’s National Center for Complementary and Alternative Medicine, more than a third of U.S. adults have used a complementary or alternative therapy in the past year.)

In short, a growing number of us are taking a greater interest in (and responsibility for) bettering and maintaining our health. Instead of acting as passive recipients of healthcare – reactively managing diseases and symptoms as they arise – we are becoming more actively engaged in the process of improving, protecting and sustaining our own health and wellness.

Something Ventured, Something Gained

In the process of engaging and investing in our own health, we are learning a great deal. We are expanding our understanding of how our bodies work, and the factors that either support or erode wellness. We are seeing that personal lifestyle variables (such as nutrition, physical activity and stress) are often the deciding factors in our risks for disease – and our opportunities for vitality.

And yet, even as we embrace the notion of personal responsibility, we’re discovering that our health is also profoundly influenced by a network of larger social, cultural and environmental circumstances over which we may have limited individual control.

Suddenly, we’re thinking about how agricultural and industrial trends – as well as current food policies – might affect our ability to eat as well as we’d like.

We’re interested in how our culture’s lack of time and space for daily physical activity – and the green spaces, sidewalks and bike paths that support it – might be influencing not just our fitness, but our general well-being.

We’re becoming more aware that polluted water, air and soil can undermine even our best attempts at safeguarding our bodies.

We are also becoming less willing, individually and collectively, to tolerate the massive costs and waste associated with the current approach to healthcare – an approach so weighted toward clinical disease and symptom suppression that many have dubbed it “sick care” instead.

Today, perhaps more than at any other time in history, our culture is engaged in a redefinition of what it means to be healthy, and a rethinking of the priorities on which both our personal and collective health depend. So here, with a view to supporting that redefinition, are four areas ripe for reframing: food, activity, environment and healthcare.

1. Food

Back in 2003, when Yale University’s Kelly Brownell, PhD, published his book Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis and What We Can Do About It (McGraw-Hill), it was the first widely read critique of America’s “toxic food environment.” Since then, as a nation, we’ve done a considerable amount of thinking about how the aggressive marketing of unhealthy processed foods (and unhealthy food portions) have played a major role in creating our obesity epidemic.

Popular books like Eric Schlosser’s Fast Food Nation (Harper Perennial, 2005) and surprise-hit films like Morgan Spurlock’s Super Size Me have driven the point home to the center of middle America, and while our love affair with junk foods and fast foods may be far from over, it does seem that a great many of us are participating in a sort of mass consciousness-raising about how our collective food culture may be influencing our personal and collective well-being.

Meanwhile, in recent years, the demand for healthful and natural foods, particularly those free of harmful additives and produced in environmentally sustainable ways, has grown dramatically. U.S. sales of organic food have increased by nearly 20 percent each year since 1990, while conventional food sales have seen only 2 to 3 percent annual growth over the same period. Most major grocery stores, including Wal-Mart, have added organic food sections. And Kraft Foods, one of the nation’s largest food producers, has begun manufacturing organic products.

Interestingly, even as mass-market players are developing a taste for more nutritious and natural foods, many consumers are becoming more intrigued by the benefits of local and artisanal whole foods – the kinds produced by people, not mega-corporations. Interest in farmers’ markets, fair trade products and community-supported agriculture (CSA) groups has expanded substantially in the past several years.

Last year, Michael Pollan’s book The Omnivore’s Dilemma (Penguin, 2006), a lengthy and well-researched tome that tracks our food on its journey from source to plate, became a surprise bestseller. His essay “Unhappy Meals,” which appeared in The New York Times in January, was voraciously read and widely forwarded – despite its 12-page length.

For the first time in a long time, the most popular and influential dietary-advice books are all advocating for more or less the same thing: a natural, whole-foods, plant-based diet based on variety and balance – not caloric or macronutrient wizardry.

Perspective Shift

From: “If it looks good and tastes good, I’ll go for whatever’s put in front of me (particularly if it’s fast or cheap or it claims to be ‘low-cal’).”

To: “I’d like healthier, more wholesome choices to be easier and more accessible. I’m looking for deeper satisfaction and better nutritional quality from the foods I put on my plate.”

2. Activity

When Kenneth Cooper introduced the world to a new form of exercise with his 1968 book, Aerobics (Bantam), a Gallup poll found that only about 100,000 Americans were jogging. By 1984, 34 million people had put on their running shoes. Cooper’s book is now seen as a catalyst for the enormous change in how Americans view exercise – and that change is still occurring.

We now know that a sedentary lifestyle leads not just to excess weight, but also to a variety of serious health problems and disease risks. In a groundbreaking 1989 study published in the Journal of the American Medical Association, researchers at the Cooper Institute (a division of the Cooper Aerobics Center in Dallas) found that even minimal rates of exercising can reduce the risk of dying from any cause by 58 percent. Since then, a variety of studies have confirmed that exercise can improve mental clarity, mood, immunity, hormonal balance, quality of life and general vitality.

We’re getting the message. More people than ever are pulling on sweatpants with their long-term health in mind. A 2003 national consumer study conducted by American Sports Data Inc. found that the total number of U.S. health-club members had climbed to a record high of 36.3 million people – a 23 percent increase just since 1998. More of us are participating in running, spinning, biking, walking – and, of course, yoga. In 1998, 5.7 million Americans practiced yoga. Yoga Journal’s second annual “Yoga in America” survey suggested that that number leapt to 16.5 million by 2004, and that 25 million more intended to try yoga within the following year.

Perspective Shift

From: “Exercise is for fitness buffs and people desperate to lose weight. I’m too busy to work out – and besides, I’d rather watch TV.”

To: “Activity is an essential component of well-being and quality of life. Moving feels good and wards off stress and disease – so let’s find ways to move!”

3. Environment

We can do a lot of things right, but if we’re drinking toxic water, inhaling polluted air and eating food grown in compromised soil, we’re unlikely to enjoy a high level of vitality. The connections between environmental health and personal health are becoming clearer all the time.

Diminishing air quality due to coal and petroleum emissions is associated with an increase in respiratory ailments and cancers. Heavy metals, pesticides and herbicides, and industrial chemicals jeopardize our health by entering our water, air and food supply, then lodging in our cell tissues. Concerns about the neurological impacts of electromagnetic radiation are becoming more pronounced. And as the implications of human-caused climate change become better understood, the associated long-term threats to human health – from pandemics and infestations to water shortages – are becoming more evident.

Thanks to better coverage of such issues by the mainstream media, more of us are becoming aware that our health depends not just on our personal behaviors, but also on the larger physical and cultural environment in which we exist (see “See the Connection” in the April 2006 archives). Physicians, too, are becoming more aware of this fact.

At the University of Western Ontario, a program called Ecosystem Health considers patients within the context of their home, community, region, and beyond. The first of its kind in North America to be fully integrated into the medical curriculum, the program recognizes that human health is dependent on the health of the whole environment.

“The doctors of tomorrow must understand that health is not just described in terms of the physical and emotional health of the person,” says John Howard, MD, who led the program’s development. Health, he notes, should be defined in the broadest possible terms. “A healthy human must have a nurturing physical, political, social and economic environment. Since the environment will increasingly affect human health, ecosystem health must be a critical part of our future doctors’ training.”

Howard hopes future physicians “will enable their patients to be knowledgeable about the environmental issues affecting their health and will help their patients advocate for a healthier environment.”

Perspective Shift

From: “I have little control over the pollutants in my environment and whether they make me sick, so why should I change the way I’m living?”

To: “My health and the health of the environment are directly connected. I want to drink clean water, breathe clean air and eat food grown in clean soil. That’s why I’m choosing greener, more energy-efficient products, and riding my bike to work more often.”

4. Healthcare

Drive through any city, even small towns, and you’ll see alternative health clinics specializing in chiropractic, nutrition, acupuncture or naturopathy.

So-called alternative healing modalities aren’t really alternative anymore. These practices – often based on time-proven methods of preventive medicine – have become mainstream. (For statistics and deeper coverage of this issue, see “The Promise of Integrative Medicine,” available in the May 2006 archives.)

And there’s good reason for this. Healthcare consumers, providers and policy makers are all quickly waking up to the fact that conventional Western medicine – with its dependence on long-term pharmaceutical use and expensive interventions – is not serving the real needs of a population (and economy) in the throes of a chronic-disease crisis. In response, some of the best established medical institutions and most respected health experts are advocating for change – and making it happen.

The Institute for Functional Medicine (IFM) in Gig Harbor, Wash., is among the most promising beacons of hope on this horizon. Established in 1992, and overseen by an impressive collection of leading medical minds, the IFM (www.functionalmedicine.org) is committed to reeducating and reorienting medical professionals along more integrated, patient-centered lines – in keeping with the very best established science. Their clinical approach: identifying and addressing the root causes of complex, chronic disease in a specific individual, then resolving causal imbalances (not just isolated symptoms of those imbalances).

What this means, practically, is that functional medicine seeks not just to diagnose maladies and apply various prescribed treatments (such as symptom-suppressing drugs), but rather to sleuth out the underlying health challenges that those problems are expressing – all with the end goal of returning a patient to optimal health and vitality, not just managing his or her disease state.

Functional medicine concerns itself with “the unique interactions among genetic, environmental and lifestyle factors influencing both health and complex, chronic disease.” Looking at a patient with a skin rash, a digestive problem and joint pain, for example, a doctor of functional medicine would start by investigating whether there might be an underlying, common factor (such as inflammation) in all three conditions.

Then, rather than attempting to treat the three inflammatory problems separately, or simply dosing the patient with anti-inflammatory drugs, he or she might (through lab testing and inquiry) go looking for the root cause of the inflammation (such as a food intolerance, stress or heavy-metal toxicity).

Once the cause or causes are determined, the doctor would then work with the patient on removing or neutralizing those causes – whether through nutritional and lifestyle adjustments, conventional medical treatment, alternative treatments, or all of the above.

“Over 80 percent of the disease and dysfunction problems in this country are chronic and complex,” says Dan Lukaczer, ND, the IFM’s assistant director of medical education. “Conventional medicine needs to expand its repertoire and better address these chronic, complex diseases – and functional medicine can help it do that.”

Similar integrative approaches are being considered and increasingly embraced by a variety of medical institutions and organizations, many of which recognize that for individual behaviors to change, they will have to be directed and supported by new organizational, cultural and methodological paradigms.

What this means for regular folks: Choosing a healthy lifestyle, and getting helpful support with that, is likely to get a whole lot easier. And the more of us who demand higher-quality care and better outcomes, the more likely we’ll be to get them.

Perspective Shift
From: “If I get sick, I guess I’ll just go to the doctor and take the pills he or she gives me. And if the pills don’t work, there’s always surgery.”

To: “I’m in charge of building and maintaining my health. I want to work with expert partners who care about me, who can help me understand all the factors affecting my health, and who are invested in helping me achieve my natural state of vitality.”

Partners on the Journey

Clearly, as individuals, we have a great degree of control over many aspects of our health. But some components of our healthcare and the quality of our environment require collective action.

With the medical profession, business leaders and government all beginning to see the advantages of a more holistic, integrated and empowered approach to health, there’s no better time for us to begin the journey on our own personal path to well-being.

You can start by actively working to develop a healthier lifestyle, by thoughtfully researching your healthcare options, and by seeking out the rapidly expanding set of health-supporting resources that are right in front of you.

If you’re not seeing as much as you’d like, keep watching. There’s a better way of life on the horizon – and it’s moving closer all the time.

5 Entry-Points to Healthy Living 

How can you be more engaged and proactive in improving your health? Here are five tips:

1. Listen to yourself. It’s important to seek out professional health expertise when you’re ill, but it’s also important that you include yourself on your trusted list of health advisers. Your body has wisdom. Notice symptoms before they become acute. Be willing to make nutritional and lifestyle adjustments that address underlying health issues. If you sense a medication you’re taking is causing trouble, tell your doc.

2. Take the long view. When you consider your health, do you primarily think in the short term, looking for silver bullets to help you deal with problems and symptoms as they arise? Start thinking about the real long-term implications, risks and costs of a potential health downgrade or chronic disease. Conversely, imagine what a health-and-vitality upgrade could promise. Consider how you want to feel in five, 10 or 20 years. Start taking steps toward sustaining your good health, now.

3. See the whole picture. Health is made up of more than your body. It encompasses your mind, emotions, home, relationships, lifestyle and environment – all the places where you live, work and play. If one area of your life is suffering, the rest suffers, too. Strive for health and balance in all sectors of your life, and you’ll find the pursuit of physical health becomes easier and more rewarding by far.

4. Make healthy choices. Whether you’re shopping for groceries, scheduling your day or deciding how to spend your vacation, make high standards for health a top priority. Don’t settle for the path of least resistance or “what everyone else is doing.”

5. Create a healthier world. Start tracking some environmental factors that relate directly to your health, and take constructive action where you can. Advocate for cleaner energy, greener design, preservation of your local watershed. You have a voice – and a right to be healthy. Stand up and speak for what you desire.

WEB EXTRA!

Functional Medicine 101

Functional medicine is changing the way we think about our health. So to help you get a better grasp on what it is and how it’s affecting our current healthcare system, we talked with Dan Lukaczer, ND, the assistant director of medical education for the Institute of Functional Medicine in Gig Harbor, Wash.

Experience Life (EL) | What is functional medicine and how is different from conventional medicine?

Dan Lukaczer | I describe functional medicine as an integrative, science-based medicine that treats illness and promotes wellness by focusing assessment on the biochemically unique aspects of each patient, and them employing individually tailored interventions to restore physiological, psychological and structural balance. In essence, functional medicine looks at the underlying imbalances, and then tries to find what can be done to rebalance the individual’s system.

What we’ve done in conventional medicine all too often is look at symptoms and suppress them. As physicians, clinicians and consumers, we need to step back and look at the underlying issues and what we can do to resolve them. Functional medicine is really a way of thinking about medicine that is more integrative and more encompassing.

EL | Why is now the time for functional medicine?

Lukaczer | There are three things that are moving us toward functional medicine. First, there’s an economic crisis in healthcare — the way our system is run is bankrupting us. Though we are not all feeling the effects intensely right now, we will feel them in the next 20 to 30 years. Functional medicine will help us make the move from treating disease by suppressing the symptoms — with all those inherent costs — to being proactive on the front end so that we can prevent it in the first place, which will help change the economic situation.

Second, there’s a demographic change in society today. Baby boomers are getting older, and they want to spend their retirement years in a healthy, vital way. They’re looking for different answers to medical questions — they’re not going to take the same answers their parents took. They want better answers.

Third, there was not significant research on the efficacy of various complimentary and alternative therapies that are used in functional medicine — nutraceuticals, botanicals, acupuncture, mind-body-spirit therapies — 20 to 30 years ago. Now there is a lot of peer-reviewed, science-supported evidence that helps us understand these modalities and their effects on chronic diseases.

So these factors are coalescing to make this an important shift for conventional medicine. We’re close to a tipping point in looking at different ways to handle the looming healthcare crisis.

EL | What do you see in the future of medicine?

Lukaczer | I see functional medicine as an expansion of conventional medicine — a more integrated model. I see it as bridge to a more comprehensive way to handle complex, chronic disease. Conventional medicine plays an important role in helping us understand illnesses and disease and, clearly, in handling acute care, but the model needs to expand. Functional medicine can help it do that.

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