The "Sentinels" of Functional Medicine

    Karan Gupta
    05.10.18 01:49 PM Comment(s)

    Dr G discusses the most important parameters of FM treatments

    There are 4 "sentinels" that every successful Functional Medicine doctor (and patient) should be aware of.


    The 4 sentinels are the kinds of physiological damage that we see in just about everyone, and we see this more often than not. Number 1 is that everyone we’re working with is inflamed. If we don’t stop the inflammation, it means trouble. Number 2 is that everyone we’re working with is in catabolic physiology. It means they’re breaking tissues down. In normal physiology, we take the food that we eat and convert it into energy with the Kreb cycle and we get about 34 ATP with this. When we’re in catabolic physiology, we’re using amino acids for our fuel supply which gives us a net loss of 4 units of ATP every time we generate energy through the Cori cycle.


    Catabolic physiology is devastating and it has 2 characteristics: you burn through a ton of amino acids because you’re using them for fuel, and that you’re in a constant breakdown state. You’re going to be physically exhausted because you’re making energy in a really inefficient way. When you’re inflamed, you also need a lot of amino acids to make anti-inflammatory cytokines ... everything that inflammation is, is made to a large extent from proteins and amino acids, so there’s a huge burn rate on amino acids from both these. The third one is insulin resistance. It may be subtle on the labs, but almost everyone that we work with has some problem with processing carbs.


    Sometimes insulin resistance is severe and it’ll show up on the test; other times just the blood sugar is unstable. The fourth one is that everyone we’re working with has oxidative stress. These are 4 constants that we can count on.


    Remember the 4 variables that everyone has that we’re struggling with: they're inflamed, they’re catabolic, they have insulin problems, and they have oxidative stress. 

    By the way, the Organix test measures all of these problems which is why I request all my patients to get this test done.


    The other thing I want to focus on is the 4 different types of treatment. We’re looking at the underlying causes, the physiological damage, body systems and symptoms. As practitioners, we have these 4 variables. The underlying causes are toxins, infections, emotional stress etc. Physiological damage is oxidative stress, inflammation, acidity ... the things that happen body wide when there’s an underlying cause. Eventually that trickles down to body systems – adrenals, gut, detox, and then the person has symptoms. When we’re designing treatments, we can address any one of these or all 4 at the same time. If someone’s brain is inflamed and they’re anxious and depressed, we could give them amino acids to treat the symptoms. We might want to address body systems like the adrenals. We might also want to address the inflammation directly itself by giving an anti-inflammatory supplement like curcumin. If the underlying cause is a neurotoxin, we want to detox the person.


    We might have a patient who’s depressed. We figure out the toxins are causing a lot of inflammation, that’s trashed the adrenals and they have a brain marker showing inflammatory reactions that are affecting brain chemicals. We can detoxify them, use curcumin for anti-inflammatories, treat the adrenals and treat the brain all at the same time.


    On the patient side, there are 3 things – pains, gains and life goals. I spend the first 15 minutes talking to the patient about their pains – whatever their complaints are. I also want to look at their gains. A gain might be, what would happen if these headaches went away? What would happen if you didn’t have fatigue anymore? Maybe you would apply for a new job. Gains are things that happen because we make the pains go away. We want to elucidate them in the very beginning of the patient process, so that it’s not just about relieving symptoms but about people achieving what they want to on a day to day level.


    Life goals are the big picture stuff – are they going to start a non-profit, are they going to back to full time work, are they going to do something on a spiritual level? Once in a while patients push back on this, but usually they’re happy to talk about their life goals. If you were 100% better and healthy, what would you then do? I lay all this out in the beginning. In between is this fit or connection. I have an agenda of treating these things here, the patient has an agenda here and I need to make a fit ... if their underlying cause is a toxin and I know that treating the detox pathways is going to make them sicker, I might put this on hold. The underlying cause treatment might be something that I do next year. I can deal with that when they’re off the antidepressants, when their adrenals and gut are working well. Without ignoring the underlying cause, we’re just saying that’s next year’s project. This year, we’re going to work on symptoms, body systems and getting you less inflamed. A lot of times, underlying causes get shelved for a year because we have so many variables to deal with in the beginning. If you try to detox them and that makes their symptoms worse, that’s not a good fit. Our agenda as functional medicine doctors might be to deal with the underlying cause, but you’re not meeting the goals of that particular patient. The art of doing this work is to get what we need done, but in a way that suits the patient as well.


    Gains are things like "What would you do if you felt good, in a short term kind of way?" I’m not interested in working with people who are just going to sit around and watch TV when they’re healthy. That’s a waste of my time, so I want to know their life goals. Part of my job when they’re better is to remind them about it ... I’m involved with people not only when we’re dealing with their pains and gains, but I keep on going with them when they’re doing their life goal work. This is the fun part of the practice, working with people when they’re healthy, when they’re starting to make use of that and make a difference in the world. It’s also good from an economic perspective because patients stay around. They’re staying around not only until their migraines are gone, but they’re staying around until they’ve achieved their life goals that you helped them lay out in the first consult. I find this works really well in providing a higher level of patient service, as well as from a business perspective.