December 6, 2019

Unconventional Medicine by Chris Kresser

The Big Idea: Most chronic disease is preventable, and much of it is reversible, if a comprehensive, individualized approach, called “Functional Medicine,” is followed.

Ch 1: Leo’s Story

Most doctors, and by extension patients and the public, have no idea that mental and behavioral disorders can have physiological causes.

Ch 2: From Band-Aids to True Healing

Book: Nourishing Traditions by Sally Fallon

Ch 3: If Not Now, When? If Not You, Who?

Ch 4: Chronic Disease, A Slow-Motion Plague

Our lifespans have increased.

The projected decrease in life expectancy has been attributed mostly to the explosion of chronic diseases like obesity and diabetes in children.

As recently as the 1950s and 1960s, obesity was rare.

One in two Americans now has a chronic disease, and one in four has multiple chronic diseases.

The U.S. spends $3.2 trillion a year on healthcare. This is equivalent to 18% of our GDP.

50 million Americans (one in six) have an autoimmune disease.

Alzheimer’s is now the sixth leading cause of death in the U.S.

One in 45 children now has autism spectrum disorder.

Ch 5: Three Reasons U.S. Healthcare Is Destined to Fail

There’s little motivation for insurance companies to embrace treatments that would ultimately shrink spending on health care.

Pharmaceutical company’s work and products may be more focused on making money.

Two-thirds of medical research is sponsored by pharmaceutical companies.

This is not evidence-based medicine, it’s reimbursement-based medicine.

There are three much deeper reasons that healthcare in the U.S. is doomed to fail:

  1. Our modern diet and lifestyle are out of alignment with our genes and biology.
  2. Our medical paradigm is not well-suited to tackle chronic disease.
  3. Our model for delivering care doesn’t support the interventions that would have the biggest impact on preventing and reversing chronic disease.

Human beings lived most of our history eating a hunter-gatherer diet and living a hunter-gatherer lifestyle.

Our ancestors walked an average of 10,000 steps a day.

Conventional medicine is structured to address trauma, acute infection, and end-of-life care, not to keep people healthy.

Seven of the top ten causes of death are chronic diseases.

Unlike acute problems, chronic diseases are difficult to manage, expensive to treat, and usually last a lifetime.

Another reason that conventional medicine hasn’t been successful is that it focuses on suppressing symptoms rather than addressing the underlying cause of disease.

“The wise physician treats disease before it occurs,” according to the Traditional Medicine proverb.

The average visit with a PCP in the U.S. lasts for just ten to twelve minutes.

Patients get to speak for only twelve seconds on average before being interrupted with advice from their physician.

Ch 6: The Toll, How Conventional Medicine Affects Healthcare Providers

Both doctors and patients feel dissatisfied with how little time gets spent on doctor-patient visits.

After inflation, primary care doctors earn somewhat less today than they did in 1970.

Almost half of physicians are thinking of quitting medicine, cutting back hours, switching to concierge medicine, or taking other steps to limit patient access.

Ch 7: A New Model, The ADAPT Framework

It’s not normal for human beings to develop chronic disease.

A Functional Medicine approach is focused on preventing and reversing, rather than simply managing, chronic disease.

An ancestral diet and lifestyle reflects the recognition that we are evolutionarily mismatched to our environment and that this mismatch is the primary driver of chronic disease.

The ancestral diet and lifestyle — though extremely effective in most cases — was often not enough to completely reverse the patient’s health problems and restore optimal function. So Functional Medicine offers a more comprehensive toolset.

Ch 8: The Paradigm Shift, Functional Medicine as True Healthcare

Conventional medicine is mostly about trying to bail water out of the boat without fixing the leaks.

Functional Medicine seeks to get to the bottom of things. It looks for the underlying cause of disease.

At the core of the model is the relationship between the Exposome, our genes themselves, and the way our genes express themselves over time.

Pathologies are the underlying mechanisms that give rise to diseases and syndromes.

A disease is more clearly defined and characterized than a syndrome because it has specific signs and symptoms and the causes are more clearly defined and understood.

A sign is an objective indication of a disease or syndrome that can be observed during a physical examination or through laboratory testing.

Symptoms are the subjective experiences that the patient might report to the clinician.

After analyzing the Exposome layer, we examine pathology.

Conventional medicine is well-suited for dealing with acute, infectious disease, trauma, and injuries. However, it falters in addressing chronic disease, which is the biggest health problem we face today.

Within conventional medicine, pharmaceuticals are the primary treatment for almost 90 percent of all chronic conditions.

Conventional medicine is not truly healthcare — it’s disease management.

Functional Medicine, on the other hand, is designed to promote health.

A patient’s behavior is one of the biggest, if not the biggest, contributors to chronic disease.

Conventional medicine views the body as a collection of separate parts.

Specialists infrequently consult with each other or acknowledge the important connections between the body’s various parts.

Functional Medicine is often much more affordable than conventional medicine, largely because it seeks to prevent and reverse disease, rather than just manage it.

Although the upfront cost may be higher, Functional Medicine would save an enormous amount of money over this patient’s lifetime, because it would prevent diabetes before it occurred in the first place.

Conventional medicine tends to be more allopathic in its approach, and relies almost exclusively on drugs and surgery. Although most doctors acknowledge the importance of diet and lifestyle, the model isn’t structured to support patient change in those areas.

Drugs and surgery can cause serious side effects and complications, including death.

Medical care is the third leading cause of death in this country.

Cleveland Clinic was the first major organization to recognize the power of Functional Medicine. They tapped Dr. Mark Hyman to create a Center for Functional Medicine within Cleveland Clinic.

Dr. Bredesen addresses dementia and Alzheimer’s disease from a holistic—functional—perspective. When a patient comes to see him, he doesn’t simply administer memory tests. He investigates the patient’s gut function. He measures their blood sugar. He examines their diet and their nutrient status. He considers heavy metal toxicity, mold, and biotoxins. He analyzes methylation. He looks at detoxification.

Dr. Terry Wahls was diagnosed with multiple sclerosis. She wrote The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles.

In Functional Medicine, we start by asking why the couple is having trouble getting pregnant. The possibilities include nutrient deficiency, thyroid problems, sex hormone imbalance, inflammation, insulin resistance and blood.

We almost always start with the foundational layer — diet, lifestyle, and environment. That’s especially true for chronic illnesses.

Ch 9: Realignment, Matching Our Environment With Our Genes

Humans evolved in a vastly different environment than the one we’re living in now.

Our genes are hard-wired for the twenty-four-hour light-dark cycle.

Modern diseases that countless people suffer from today, like heart disease, diabetes, and many autoimmune diseases, are nearly nonexistent in hunter-gatherer populations.

When hunter-gatherer cultures have access to even the most rudimentary form of emergency medical care, like a clinic half-a-day’s hike away, they live lifespans that are roughly equivalent to our own, particularly if they’re living in a relatively secure, peaceful environment.

Epigenetics is probably much more important than the genes themselves, in terms of determining our susceptibility to chronic disease.

For 77,000 generations, the human diet consisted primarily of meat and fish, some wild fruits and vegetables, nuts and seeds, and some starchy plants.

Ancestral populations generally got at least seven to eight hours of sleep a night.

Hunter-gather societies walked an average of 10,000 steps a day.

Ancestral humans lived in close-knit tribal and social groups, with multiple generations.

Ancestral humans generally “worked” about three to four hours a day.

Chronic inflammation is insidious; it often affects multiple tissues. If someone is eating an inflammatory diet and living an inflammatory lifestyle, that could cause a wide range of symptoms.

Ch 10: The 21st Century Practice, A Collaborative Model

The conventional system is buckling under the weight of misaligned incentives, broken payment models, inefficiency and bureaucracy, and a paradigm that is not well-suited to address chronic disease.

Many clinicians are choosing to move to a cash-only or a cash-plus-insurance practice.

Insurers are beginning to recognize the value of telemedicine; video conferencing is now reimbursed in many states, and others are moving in that direction.

One area of dissatisfaction and pushback among doctors is with electronic health records (EHRs). Initially, there was a lot of enthusiasm for EHRs, but the way they’ve been implemented in conventional medical settings has been horrific.

Ch 11: Regarding Evidence

Two-thirds of medical research is funded by pharmaceutical companies.

Abilify, for example, is one of the best-selling drugs in the United States. It was originally developed as an anti-psychotic, and is approved for schizophrenia, bipolar disorder, depression, and autism spectrum disorders.

The humility to admit when we’ve been wrong is essential to good science. Unfortunately, in the conventional medical paradigm, this willingness and humility have often been replaced by groupthink, arrogance, and a stubborn attachment to the status quo.

What does the research say about Functional Medicine?

The gold standard of conventional research — the randomized clinical trial — isolates just one variable, then tests the effect of that variable; all other elements of the study are kept the same. The randomized clinical trial is practically the antithesis of the philosophy of Functional Medicine, which seeks to tailor layered treatment plans to individual patients.

Attending conferences and continuing education classes can help doctors stay current, but those conferences are often sponsored by a drug company.

Unfortunately, much of the research we’ve formerly relied upon was never replicated.

The latest research often takes time to reach practicing clinicians—and their patients.

Ch 12: ADAPT in Practice, Four Common Conditions

Most commonly prescribed drugs are just palliative — in other words, they offer some relief for symptoms but don’t address the underlying cause.

In a conventional model, the doctor would simply issue his or her recommendations: “Okay, eat better. Exercise more. Do this protocol.” The patient would walk away and then likely struggle or fail to follow through.

Patients need to recognize that the system is set up to support and subsidize drugs.

Ch 13: ADAPT in Practice, The Practitioner’s Experience

Ch 14: ADAPT in Practice, The Patient’s Experience

Although Functional Medicine will almost certainly prove more cost-effective than conventional medicine over time, right now out-of-pocket expenses are higher for Functional Medicine because of the lack of insurance coverage.

It’s worth noting that conventional care can be enormously expensive for patients since it relies heavily on medications, surgery, and other expensive procedures. Insurance provides some relief but doesn’t always cover these expenses — and when that happens the results can be disastrous. One in five Americans struggle to pay medical bills each year. Three in five bankruptcies are due to medical expenses.

Ch 15. The Future of Medicine

The factors that most predict your health are your wealth, education, and lifestyle — not your access to healthcare.

Today, we spend 86 percent of our healthcare dollars on treating chronic disease but just three percent on public health measures.

The launch of Cleveland Clinic Center for Functional Medicine has served to open many people’s eyes to the potential of this model.

Dr. Mark Hyman, the clinic director, travels all over the world to educate people about Functional Medicine.

Ch 16: Next Steps: Three Things to Do Now

Ch 17: Resources for Practitioners & Patients

Institute for Functional Medicine (IFM)

Kalish Institute

RobbWolf.com

DrHyman.com

SaraGottfried.com

Paleo f(x)

Revolution Health Radio

The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline

The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles

Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain — for Life