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Jun 17, 2019

Functional Medicine FAQ's

by Dr. Dan Kalish

Functional medicine frequently asked questions

What really is functional medicine is a pretty frequently asked question. Functional medicine is shrouded in mystery and complexity. We talk about Cytochrome P-450 pathways and the Mechanistic T of Rapamyocin at functional medicine conferences. The complex language around functional medicine makes it seem more abstract then it really is.

Growing up in Berkeley, California my family and all the families in my immediate surroundings were hyper-intellectuals to say the least. My favorite bumper sticker I saw when I was 8 or 9 years old was “Eschew Obsfucation”. Of course I had to go home and look up what it meant, point is we were even as young kids steeped in the language of the academy. The language of content area experts. My closest friends parents included world experts in mythology, seismology and economics. Between my two very closest friends dads one was the leader of the World Without War Council, a liberal anti-war think tank and the other was a top physicist at Livermore-Berkeley Labs (brought us the atomic bomb) who was involved in the most advanced weapons systems development the world has ever known.

Therefore I grew up, little Danny Kalish, (show picture from childhood with Warriors T-shirt) being forced to understand how to interpret complex information expressed by people who really knew what they were talking about. In the functional medicine community we find the upper level thought leaders are either of a strong scientific bent and can be difficult to understand if you don’t have advanced training. There are a few top leadres who rather than pushing the science forward instead “get the word out” by communicating through best selling books, social media and the like. So there is some messaging going out to the general public but often it’s designed to sell things from air filters to supplements to saunas so it can get confusing how to separate the real and important things from those that are related to the commercialization of functional medicine and health in general.

So when in comes to most frequently asked questions (FAQS) in functional medicine we have to qualify the question. There are technical, complex and intellectually stimulating questions we can ask and answer like for example what is the relationship between magnesium and glutathione in the development of food allergies and toxin clearance. Then there are FAQS like why can’t I eat gluten without feeling sick. Both these FAQS have the exact same answer, but one is highly technical and requires expert knowledge to even begin to address and the other is a practical, rubber meets the road type inquiry. Understanding the complexity of functional medicine is not required in order to benefit from functional medicine. You can stop eating gluten and feel better without getting why it’s working.

Even just attempting to describe what functional medicine IS can be challenging, expressed in either a complex litany of physiological heuristics or as a “here’s what we do” type of answer. Let’s look at each of the functional medicine FAQS from both perspectives so as to appeal to you who are more technically minded and those of you bottom liner, need to know types of people.

FAQS. Does functional medicine work? That begs the question what is functional medicine. Well, functional medicine is defined as being made up of three key components, 1) focused on finding the root cause and addressing health issues at the root cause or origin level; 2) being systems oriented, meaning we look at the body as a set of integrated systems co-existing for the betterment of each other, much like a car combines an electrical system, a coolant system and a exhaust system to propel the vehicle forward and 3) focused on the patient therapeutic encounter, that translates to sitting down with a doctor should be a “healing” experience, not a stressful, rushed one. My personal definition of functional medicine is to view functional medicine as a combination of treatments and diagnostics: treatments coming primarily from natural healing methods most of which have been around for thousands of years and are best described as naturopathic medicine and diagnostics coming primarily from lab based assessments for three key body systems: neuro-endocrine, GI and detox.

So does functional medicine work? Yes and no. On one level it works perfectly. If you are thirsty does drinking a glass of water “work”. Yes. We all know water quenches thirst. Not too many people would argue with that. If your “disease” is primarily rooted in a factor that is lifestyle driven like lack of sleep, poor diet or lack of exercise then does correcting that lifestyle factor “work”. Yes. Obviously. I think that’s actually one of the main problems with functional medicine is that it’s so obvious that we get suspicious that it could work, intuitively people think “it must be more complex than this.” But no, it’s not. You are thirsty, water works. Every time? Kind of. Unless you’re “thirsty” for a beer. Or unless your “thirst” is really a sign of being an undiagnosed diabetic. But, yes, in general water works.

Heart disease is rooted in high fat diets, lack of exercise, lack of vegetables, emotional stress combined with a dash of genetic propensity. So then does functional medicine “work” to reverse heart disease. Ask Dr. Dean Ornish. He’s devoted his entire life to proving that lifestyle change reverses heart disease. A low fat vegetarian diet combined with exercise like yoga and stress reduction like meditation has been proven to reverse heart disease. This should not be surprising. Really the fact that Dr. Ornish had to conduct decades of research to prove that lifestyle changes could reverse a disease caused by lifestyle changes is pretty ridiculous and shows the level of absurdity the health care treatment debate has sunk to in our current times.

But, this is a totally different frequently asked functional medicine question, does functional medicine work for diabetes? In other words can functional medicine cure diabetes. Well, nothing can cure diabetes. Diabetes is rooted in lifestyle changes with a dash of genetic propensity. Eating poor quality food, not exercising and being exposed to metabolism destroying environmental toxins will trigger the processes of blood sugar instability and insulin resistance that culminate in a diagnosis of diabetes. I’ve personally witnessed Dr. Diana Schwarzbein, an extremely gifted endocrinologist, reverse diabetes by treating it at it’s root cause. Again, if lifestyle gets you into a disease process lifestyle change can reverse the disease. It’s not really curing anything. If I had a patient that was getting horrible headaches every bloody morning (that’s a British curse word not a reference to bleeding from the head), anyhow, if I had a patient that was getting a bloody headache every morning because she was hitting her head against a solid oak door repeatedly and I diagnosed her as having repeated TBI (traumatic brain injury, everyone loves a diagnosis) and then I prescribed a complete cessation of the hitting of the head in the morning (lifestyle reversal) did I then “CURE” the headaches. Bloody well no! But are the headaches gone? Right they are! Bloody well right!

We are hitting are heads against doors and walls day in and day out. Every bite of toxin laden food, every day you stress out about whatever you stress out about, every day you do not exercise, every day you do not eat vegetables with every meal, every day you drink caffeine and alcohol to excess, every one of those days is a hit. Boom boom boom. Then enough hits over enough days and the headaches start. Then you go to a neurologist to get a work up and the MRI shows bruising of the brain so a medication to protect the brain against bruising is prescribed and when that stops working a few years later your doctor considers surgery, maybe cutting some of the pain sensitive nerve paths? It’s insane what we are doing now. No diagnosis no treatments no cures. Just stop hitting your head and the pain will stop quickly. Stop the lifestyle factor that is triggering your health problems and the body will quite quickly and expertly heal.

So, back to the central frequently asked question, yes functional medicine works because it’s primarily lifestyle medicine and the diseases of our times are primarily rooted in lifestyle factors as triggers.

Another frequently asked question then is: hasn’t it been proven that many supplements are dangerous to take and isn’t it true that there are no double blind placebo controlled studies to prove the efficacy and safety of functional medicine. My doctor says it’s dangerous.

Is functional medicine risky. Well, as mentioned in answer to the previous FAQ I think you could figure this one out yourself. But for the sake of over explaining this I’ll give a good example. The most popular supplement taken in the United States is the essential fatty acid usually called fish oil capsules, an omega 3 fatty acid. It can improve mood and reduce depression and it very dramatically reduces inflammation.

Fish oils are dangerous, right? Ok, this one is true and not true. As a simple example. If you are tested on a lab as being low in omega 3 fatty acids and you take a supplement containing high quality, uncontaminated omega 3 fish oils (ones without mercury) then you will feel better and become healthier. You’ll even look better because these essential fatty acids make your skin look younger. However if you are walking around with sufficient omega 3 fatty acids and you take a high dose of fish oil for a long time things can go bad. Many commercially available fish oils contain contaminates like mercury. So right off the bat that will make you less healthy. But that is specifically tied to the manufacturing practices of the companies that make fish oil cheaply and can’t take on the extra expense of pulling the mercury out because they need to hit a certain low price point.

As if the potential for mercury poisoning wasn’t enough, extended periods of high dosages of omega 3’s will force an enzyme in your body called delta-6-desaturase to act on the fatty acids in the omega 3 supplement and this same enzyme acts on conversion of what are called omega 6 fatty acids so tons of 3’s over time will deplete some of the 6’s in your tissues. These omega 6’s are used for regulating your immune response and inflammatory response through something called prostaglandins. So, omega 3’s taken by the wrong person in the wrong does for a really long time can be harmful. Omega 3’s taken irresponsibly can trigger immune and inflammatory problems. Just what you are taking them to prevent.

However this type of phenomena is not limited to supplements. If you drink a glass of water when you are thirsty it is generally a healthy thing to do. If you continue to drink a lot of water for hours AFTER YOU ARE NO LONGER THIRSTY you can develop something called hyponatremia which can actually kill you. It’s pretty phenomenal that you can kill yourself by drinking too much water. Obviously you and I both, probably don’t know anyone who has died this way, it’s not very common although it does happen at marathon events like the Boston marathon or NY marathon every few years. Point is we don’t go around condemning the people who drink water responsibility just because a few people abuse water to the point it is dangerous. So drinking when you are thirsty and drinking the right amount equates to taking omega 3’s when you test deficient based on lab work and taking them for the right amount of time (until your levels normalize). That is safe. That is healthy.


Why doesn’t my regular doctor practice functional medicine or even know what it is?

The practice of medicine is just that: conventional physicians are trained to treat disease though the prescription of medication and if needed through the use of surgery. There is no belief in or focus on the efficacy of what is now being called lifestyle medicine. The idea of getting patients to make lifestyle changes that require huge alternations in behavior has been something conventional medication has assidusously avoided for decades. The ignoring of the benefits of exercise, healthy food, meditation and sleep has led to a vague disdain for these ancient and traditional healing methods. Why exercise when you can take diet pills or have bariatric surgery? Why stretch out and strengthen your core muscles when you can have back surgery? Why meditate when you can medicate with anti-depressants and anti-anxiety drugs? Why eat green vegetables daily when you can take blood pressure medications? Why eat fiber containing foods like beans and whole grains like oatmeal when you can take cholesterol medication? It’s not the fault of the MD’s prescribing these drugs. Doctors don’t go to medical school with the aspiration and hope of helping people by over prescribing drugs that are largely ineffective and often risky. The system we have all created has led to this dark period of health care delivery.

Allowing drug companies to completely take over the dissemination of information through co-opting all the major medical journals and medical societies, by allowing them to release grossly inappropriate advertising on television, by allowing them unlimited profiteering opportunities. Letting our main governmenetal regulatory body, the FDA, be run by drug company executives. It’s like a group of five year olds let loose without adults in an ice cream shop. Of course it’s a mess. People need boundaries and rules and we have not provided insurance companies, hospitals, drug companies or doctors with anything but an open checkbook for the last 50 years. It’s important to note this is a relatively recent problem. Prior to WW2 the pharmaceutical and health insurance industry’s barely existed.

So back to the question, why doesn’t my doctor know about this stuff. Well, in a normal world they would. In a world where medical education is dominated by companies that are profiting from selling every increasing amounts of drugs to ever sick people there is no room in medical education for root cause training. What is the root cause of heart disease? What is the root cause of diabetes? These are the questions NEVER asked in medical education at the present time so the answers found in functional medicine are never even addressed in conventional medical training.

Doctors are however hitting a breaking point themselves. They are experiencing high levels of emotional burn out, depression and anxiety. They are for the most part unhappy with their long work hours, relatively low pay and extraordinarily high level of responsibility. They are, by and large, human. And humans can only handle so much before then collapse. Most doctors now are at a level of professional dissatisfaction that is disturbing as their state of mental health disallows them from providing the highest level of care we would all hope for. It’s time for us to support our physicians and their plight and to work together to figure out a better way to train doctors and a much better way to deliver the type of care so desperately needed now by an ever sicker, more depressed, fatter and less vibrant population.

What are the most important supplements to take every day?

There are many choices of supplements to take and any supplement taken at too high a dose can be problematic. However, one can take a few select items that are needed by almost everyone and be safe and have increased health and vitality at the same time. Here is my personal list of what I do.

Daily 1 tablespoon of ground flax seed. Ok it’s not technically a supplement but it pretty much acts as a medicine. Flax is high in essential fatty acids and while being pretty food like is really so powerful I think of it more as a top flight supplement. Buy whole flax seeds and grind them either once a week or fresh every day in a coffee grinder. You can also by them ground up already but the freshness provided by grinding them yourself each day provides a much higher quality nutrient profile and is worth the couple of seconds it takes to grind them up. You can also use flax oil in salad dressings but a lot of people don’t like the taste. For the ground flax seeds you can add them to a smoothie, mix them in a little cranberry juice or water or sprinkle them on oatmeal. One favorite in my house is dipping apple slices in the ground flax, makes a yummy snack.

Benefits include improving immune function, brain function, mood, better fat burning (who doesn’t want that!), preventing inflammation and the list goes on. They are really cheap too.

Magnesium. I take at least 200mg of magnesium a day. You can combine it with calcium which is also important but if that’s too much to deal with magnesium by itself is critical. Get a good brand that is only sold through physicians and that has “chelated” magnesium. This means the magnesium is bound to a single or a group of carrier molecules and it greatly improves the amount of the magnesium you will absorb. Magnesium citrate is good, magnesium glycinate is good, some of the companies might just put magnesium chelate on the label. It too is not that expensive. Don’t buy super cheap magnesium, often the label will say magnesium oxide. It’s good for some things but not for daily use.

Magnesium helps make energy in the cells, is very relaxing (and energizing at the same time), it’s critical for muscle function and without magnesium your brain cells would literally explode (not in good way like on the show Limitless, in a bad way like anxiety and can’t sleep bad). Most of us are low in magnesium and if you’re not low in magnesium 200mg a day won’t do anything harmful.

Digestive enzymes. If you over eat or have trouble digesting then enzymes can really help. Don’t take them every day for a long time. Couple months here and there is fine or just a couple times a week when your digestion needs a little kickstart. I’m not saying I’ve ever eaten too much pizza and then taken enzymes but…

Probiotics daily are a no brainer. We have stacked the deck against our healthy gut bacteria. Antibiotics in the food supply, antibiotics we take for infections, excess sugar and high stress levels all this adds up to creating problems with the microbiome, that mass of good bacteria in the gut. Not every single day, take them sporadically (pun intended) and vary the strains you take because part of a healthy microbiome is diversity.

Dr. Dan Kalish

Dr. Dan Kalish

Founder of the Kalish Institute
Dan Kalish, DC, IFMCP, is founder of the Kalish Institute, an online practice implementation training program dedicated to building Integrative and Functional Medicine practices through clinical and business courses.