What I Wish Everyone Knew About Chronic Disease
Over 20 years ago, I co-founded The Institute for Functional Medicine. I wanted to shift the disease-centered focus of medical practice to a more patient-centered approach, to address the whole person, not just an isolated set of symptoms. Today, more than 100,000 clinicians have taken part in our functional medicine programs and training. Dramatic scientific discoveries have given us the power to prevent age-related debilitation and illness, but not enough people get this information. Here's what I wish everyone knew about disease:
1. What we think of as a “disease” is actually an imbalance of one of the body’s core physiological processes.
While it may be convenient to lump together symptoms and call them “diseases,” that isn’t the way to address what's making us sick. It's not the way to think about medical care in the face of a changing pattern of health problems as we live longer lives — but lives that are increasingly limited and burdened by subpar health.
There are seven core physiological processes that affect all of the body’s organ systems, and imbalances can occur in any and all of them. These imbalances are the source of most chronic illness. Here are the seven core processes:
- Assimilation and elimination
- Cellular Communications
- Cellular Transport
We know an event in one system can affect something else in another system; we even know that an improvement in one system may adversely affect something in another system.
Functional medicine practitioners are looking for imbalances — either within the different components of a physiological system or between systems. Find and address the physiological process that is out of balance, the theory goes, and you finally deal with chronic ill health. That’s how to make your symptoms go away.
2. No two people have the identical disease.
A colleague of mine, an extraordinary and compassionate MD, once said, “If you’ve met one child with autism, then you’ve met one child with autism.”
It's a simple but profound statement. What’s more, it's a concept that is very applicable to all chronic disease. Your heart disease is not the same as mine. Everyone with type 2 diabetes is not just like everyone else with type 2 diabetes. People with rheumatoid arthritis or Alzheimer’s disease are not all similar to others with the same diagnosis.
All of these so-called diseases are dysfunctions of each individual’s physiological functioning; they are due to varied causes, and they demand treatment approaches as different from one another as are the individuals.
3. Genes are NOT — in and of themselves — the cause of chronic disease.
Certainly genes are important in influencing our health, but there is simply no such thing as a "chronic-disease gene," as was once assumed. “Inherited” does not mean “inevitable.” Genes influence how we respond to our environment and to our own individual behaviors in what's called “genetic expression.” Our genes get messages from our interactions with our environment and our lifestyle choices, and they translate those messages into cellular instructions; these instructions are what then control our health and disease patterns.
4. It isn’t your chronological age, but your biological age that counts.
There's a popular myth in our culture that chronic disease is a natural consequence of aging, that the longer we live, the more chronic ailments we'll get and the more severe they will become as we age. This is simply not true.
Chronological age comes down to something called "organ reserve." It's like a savings account of extra biological capability that we can draw on when we need to — say, when we confront trauma, injury, or stress. As we age, we lose organ reserve. There’s simply less in the account, which means there is diminished function to draw on in times of need.
The rate of speed at which we lose this reserve is what more or less shapes our individual process of biological aging, and it has been shown that people lose organ reserve at different rates and therefore age differently. We all know 50-year-olds who are biologically 70. They feel old, look old, act old. It's also possible to be chronologically 70 with the biological age of the average 50-year-old.
If we could reduce the loss of organ reserve as we grow older, we could slow our biological aging and reduce the amount of unnecessary chronic illness we experience. Not only could we increase average life expectancy, we could also lengthen our time of vigor and shorten our time of infirmity or disability. How do we do it? Lifestyle behaviors.
5. Remember: Science knows less than you might think about the long-term effects of some medications.
Polypharmacy is the practice of simultaneously taking a number of different drugs to treat a range of symptoms of an ailment. If you suffer from more than one ailment — from diabetes and arthritis, for example — the polypharmacy multiplies even further. What happens as a result? One outcome is that the disease or diseases continue to progress over time.
As they do, the symptoms become more severe and more medications are required to alleviate them. In effect, these patients become lifetime consumers of medications that were expressly designed — and approved by regulators — to be used for a limited time only so they could get on with their lives.
How do pharmaceutical drugs work? They literally block or inhibit certain overly active metabolic steps associated with the symptoms of the disease. The problem is that the sometimes a drug blocks a specific biological target that's important for normal functioning in other places within the body.
Your blood pressure may be going down, but keeping it down knocks out your sexual potency. Your ulcer may be under control, thanks to your antiulcer drug, but it may be causing anemia. Or your arthritis pain may now be manageable due to the powerful anti-inflammatories you’re taking, but those same anti-inflammatories may be contributing to your risk for kidney disease. And who knows what other impacts blocking those specific enzymes may have elsewhere in your body’s systems?
In fact, in many cases, we know all too well. Far from getting on with their lives, patients may literally be undermining their lives as they continue to take the medications because they become increasingly susceptible to adverse drug reactions.
This does not mean that there is no value in taking specific medications to manage the symptoms of chronic illness. However, it's best to use fewer drugs, at the lowest dose possible to manage the condition, and for the shortest time possible.
6. Diet, environmental, and lifestyle choices can be effective therapies for chronic disease management.
Food is information, and everyone has to eat. Likewise, everyone has a lifestyle, and certain aspects — like how much you exercise, smoke, and drink — can be managed directly. But not everything can be fully controlled. For instance, there can be toxins in your home or work environment that are not easily removed. And genetic uniqueness plays a big role — a lifestyle, diet, and environment that are optimal for one person might be poison for another.
For decades as a biochemist, I have conducted my own research into creating personalized health programs, and I have studied the research of many others. In my book, The Disease Delusion: Conquering the Causes of Chronic Illness for a Healthier, Longer, and Happier Life, I have screened, sifted, and synthesized a diverse base of information to offer a guide for tailoring a personalized program that will lead to optimal outcomes.
Here are just a few examples of modifiable dietary, environmental, and lifestyle choices:
- Specific foods affect the secretion of substances from the digestive system and in so doing can influence the risk of various chronic diseases.
- The most common symptoms of toxicity are related to nervous and immune system dysfunction.
- Various environmental chemicals, some constituents of food such as gluten, certain types of intestinal bacteria, and a number of pharmaceuticals can cause chronic inflammatory diseases.
- Phytochemicals in certain plant foods and botanical medicines have been shown to reduce chronic inflammatory conditions.
- Food processing removes many of the important regulatory substances that positively influence cellular communication.
- Specific antioxidants such as vitamin E, selenium, vitamin C, coenzyme Q10, lipoic acid, and N-acetylcysteine can protect against mitochondrial damage.
- Cross-training exercise that alternates aerobic and anaerobic conditioning helps to strengthen mitochondrial function and improve cellular energy production.
7. You need to know if your doctor specializes in health care or disease management.
New research is creating the opportunity to be successful in preventing and treating chronic diseases.
In a successful therapeutic relationship, doctor and patient work together to create health, rather than treat disease.
To determine if your doctor is focused on health care or disease management, here are five questions you need to ask:
- Does your doctor discuss your diet, activity patterns, work place environment, and stress patterns with you?
- Does your doctor do a comprehensive health history including all of your signs and symptoms?
- Does your doctor ask you whether your overall health has changed over the past year?
- Does your doctor discuss connections with you about how your various signs and symptoms might relate to a specific cause?
- Does your doctor discuss a personalized lifestyle medicine program for you?
Chronic diseases are increasingly becoming conditions we have to live with; they're common and complex, with numerous hard-to-specify causes but no single origin. More and more of us are living with these diseases, and it's an expensive proposition.
In fact, unless we implement drastic change, the numbers tell us we are all on a headlong course toward a frail, sick old age in which we'll spend much of our time going to doctors and popping pills.
It doesn’t have to happen. We can take charge of our health to set the stage for a veritable revolution in health care.