Welcome to Functional Medicine Update™ for October 1998. This issue focuses on the theory, practice, and delivery of functional medicine to improve patient outcomes. The best application of functional medicine is to disorders associated with aging, so I will focus on the application of functional medicine for healthy aging.
By the year 2020, an estimated 20 percent of the U.S. population will be 65 years of age or older. The greatest growth will be among those who are 85 or older. In the absence of a new paradigm of health management, if the health histories of these “oldest old” match those of their parents, the disease-care delivery system will be bankrupted. Functional medicine, when integrated with other approaches, could improve the efficiency, reduce morbidity, and “rectangularize the survival curve” (to borrow a term from Dr. James Fries), leading to healthy aging by extending the health span of individuals.
A functional medicine-based program to promote healthy aging could include many components. Among them are the following: diet and nutritional tailoring; nutrient enhancement to meet individualized needs as defined by genetics; exercise training; stress management; promotion of structural integrity; environmental modification; counseling on purposeful living; and normalization of intercellular communication. This eight-point program incorporates the functional medicine principles. Notice that I did not mention diagnosis in that
These eight concepts impact function in a variety of ways. They affect physiological, cognitive, emotional, and physical function. I will focus on mitochondrial function and the oxidative stress that increases one’s risk of developing age-related diseases. Additionally I will examine the risk of increased protein glycation, or the combination of glucose with proteins in cells and in the extracellular milieu, creating glycated proteins with modified function. This characteristic is associated with accelerated biological aging in all animal models studied.
Chronic inflammation is another physiological process associated with aging. Another dysfunctional process involving defects occurs in methylation or the transfer of methyl groups (the carbon with three hydrogens that is transferred through biochemical pathways related to folate, B12, B6, and methyltransfer agents like betaine). And, it is important to discuss the issue of reduced detoxification ability and compromised immune and neurological function. We will examine these functional parameters on a mechanistic level (mitochondrial function and oxidative stress, alteration in protein glycation, chronic inflammation, defects in methylation, and reduced detoxification ability and its relationship to modified immune and neurological function.)
This information is part of an article I wrote, which was published in a recent issue of Alternative Therapies.1 You can request a reprint by calling our offices, at (800) 843-9660
Clinician of the Month:
David Jones, M.D.
JB: The Clinician of the Month interview is one of the best features on Functional Medicine Update™. We have interviewed individuals who have shared their clinical experiences, acumen, insights, and news-to-use for functional and nutritional medicine. This month present our second interview with David Jones, MD. He received the Second International Functional Medicine Linus Pauling Award in 1997. Dr. Jones is a family practitioner in Ashland, Oregon. He has pioneered the integration of traditional and functional and molecular medicine concepts in the interest of quality care.
For the past few years, Dr. Jones has been director of Prime Care, the largest independent physicians association group in southern Oregon. He has had the opportunity to see how what he considers “good medicine” can be practiced in the managed-care environment of the late 20th Century. Dr. Jones will discuss what is going on in his medical world through his IPA involvement and his work as a private physician, and how those practices reflect general trends in medicine. Dr. Jones, welcome back to Functional Medicine Update™. Would you tell us how things have been going for you since you received the Linus Pauling Functional Medicine Award in May of 1997?
DJ: It’s as busy as ever. I continue to wear three hats, the first and primary one of which is that of a clinician. The second and third take equal amounts of time. The IPA and its influence have grown. We now have an umbrella organization, of which I am president, called Prime Health, as opposed to Prime Care, which is a doctor organization. We work with hospitals to maintain the quality of medical care in the valley we serve. We represent 70 percent of the medical care providers, and we have the largest hospital system as well as the hospital system in Ashland, which is a neighboring community.
The third part of my professional life is functional medicine. Since I received the Linus Pauling award, I have been trying to help define what functional medicine is truly about and what distinguishes it as a body of ideas and a medical system of health care.
JB: It’s very interesting that you should bring that up. Anyone listening to this tape is at least nominally associated with functional medicine. The feedback we receive from listeners, however, indicates that many of them are still trying to understand what functional medicine is. I recently had a conversation with a medical doctor in New England, who was only superficially familiar with our definition of functional medicine. It is, as you know, the field of health care focused on the assessment and early intervention into the improvement of physiological, cognitive, emotional and physical function. His comment was that functional medicine is a “gimmick;” that there is really nothing special about it. It doesn’t provide any unique perspective and is, therefore, a term with no real substantive, operational value. Could you help our listeners understand what functional medicine means for you and in the context of his comments?
DJ: Originally, we used the terms “complementary” and “integrative” medicine. We adopted the term “functional” because, from our point of view, it more accurately described the focus of our attention on medical care. For me, functional medicine bridges the invaluable scientific information we have gained in our universities, medical schools, and research centers. It applies that scientific information clinically, and combines it with the insights that come from clinical experience, which are often embedded in what are called holistic, complementary, or alternative views.
It’s been my opinion from the very beginning that we make a mistake when we use the term “alternative.” That term supposes there is an either/or. My belief is that we are constantly attempting to take what is best for our patients from wherever we find it. Functional medicine is really an umbrella term. We are really looking for optimal function.
In the beginning, we talked a lot about preventive medicine. We discussed the concept of an individual organism in the flux of a very complex environment. In that context, we wanted to optimize the chance of that system to stay in homeodynamic balance.
As time has passed, we have realized that prevention is one aspect of functional medicine. The basket we weave to hold concepts we work with in the clinical world encompasses the functionality and dysfunctionality that occur at different phases of every person’s life.
Definable, rational key concepts help guide that viewpoint. They are “sensible” in the way we sense the world and how we communicate with one another through our senses. I will enumerate those concepts, because it’s important that we understand the foundation of functional medicine.
DJ: One key principle is biochemical individuality. That is based on genetic and environmental uniqueness. As the science of molecular medicine has developed, it has become very clear that each person is a unique unit on a unique path. Dr. Roger Williams was the first to enunciate this concept, and it was further developed by Garrod and then by Dr. Linus Pauling. Defining where that path is taking the person is incredibly important. The historical part of a person’s life, his or her own personal history, is very important. Where did the person function well, and in what context did her or she not function well?
- Bland, JS. The use of complementary medicine for healthy aging. Alt Therapies.1998;4(4):42-48.
- Jang D, Murrell GA. Nitric oxide in arthritis. Free Rad Biol Med. 1998;24(9):1511-1519.
- Cao M, Westerhausenlarsen A, Niyibizi C, et al. Nitric oxide inhibits the synthesis of type-II collagen without altering Col2Al mRNA abundance- prolyl hydroxylase as a possible target. Biochem J. 1997;324:305-310.
- Manfield L, Jang D, Muirrell GA. Nitric oxide enhances cyclooxygenase activity in articular cartilage. Inflamm Res. 1996;45:254-258.
- Pravachol is not metabolized by cytochrome P450 3A4 to a clinically significant extent. Bristol-Myers Squibb Co. Princeton, NJK. D3-A275. Issued April 1998.
- Wu C. Putting the squeeze on grapefruit juice. Science News. 1998;153:295.
- Liska DJ. The detoxification enzyme systems. Alt Med Rev. 1998;3(3):187-198.
- Folsom AR, Nieto FJ, McGovern PH, et al. Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins. Circulation. 1998;98:1-7.
- Kuller LH, Evans RW. Homocysteine, vitamins, and cardiovascular disease.Circulation. 1998;98:1-4.
- Grumbach K, Coffman J, Vranizan K, Blick N, O’Neil EH. Independent practice association physician groups in California. Health Affairs. May/June 1998:227-237