165. Functional Medicine: A Solution to the Pill-for-Every-Ill Approach? A Conversation with Dr. Jeffrey Bland

Big levers of health. We've talked about that before. Well, today we're going straight to the source. Dr. Jeffrey Bland, the founder of functional medicine, is here with us today. Now, he won't like that I've called him that because he's so quick to share the stage with others. But were it not for him and his curiosity and way of thinking, so many of us wouldn't be here today. He's encouraging us to look at those big levers, the basic functions that our bodies and minds should have, to see how maintaining them can lead to a functional, healthy life. What it can mean for us is excellent health. So let's get to it. Welcome to the Wellness While Walking podcast. I'm your walking guide and health coach, Carolyn Cohen. Whether you've been walking or otherwise moving regularly or it's fallen off your schedule, I'll be to help you make your own wellness a priority. We'll plan for about a 30 minute walk each week and while you're ambling, I'll be rambling in your ear. We will talk about walking a bit, but also about wellness in the largest sense of the word, so that we can continue on a journey of a beautiful life of no regrets. Let's chat, learn, laugh and move in the most natural way possible and then get back to designing and living the best, most rewarding lives week each ever imagined. Hi, welcome to episode 165. Thanks for being here with me today. Before we continue, a reminder that I'm not a doctor or mental health professional and the content presented here is for educational and informational purposes only. Please make sure you check with your doctor before making any health or lifestyle changes. When I had the extreme honor of speaking with Dr. Jeffrey Bland, really a thrill of a lifetime. It was the first day of my feeling so sick, as I mentioned in an earlier episode, and by the end of our time together I really felt physically terrible. But at the same time I was so pumped up that I was going to get to introduce Dr. Bland to you. I love the story of how he came to the ideas behind the practice of functional medicine. And again, he won't ever have it. In terms of taking credit, he always shares the praise and the gratitude with a multitude of others, including even a doctor from the 1800s. And so even though we can learn about functional medicine from others, hearing how someone thought outside the box and was tenacious is always good for the soul. I mean, we might not come up with a new approach or a revisited approach. Let's say to medicine and to health. But we can take Dr. Bland's perseverance and creativity and teamwork and sheer kindness and depth of caring as an exemplar of what having those traits can mean for the world. Maybe not a way of thinking about health that'll change minds and health trajectories, but in our own way, maybe we too can think outside the box or ask why or see the big picture. So even though I felt really lousy during the conversation, I was also feeling so elated. Dr. Bland weaves a few great stories today, including telling us about the basic functions that we can expect and when they're not working well, how we can see disease develop. Sometimes he paints a really vibrant picture of health, not just as the absence of disease, but as something much more expansive. And another story he tells is about a patient and the progress she made in a short period of time.

Time.

There are a lot of gems today, but maybe listen for the little bit at the end about our not having to necessarily understand so deeply the piece parts, as he called them, that maybe these big levers are the thing. So, without further ado, the exceptional Dr. Jeffrey Bland. It's more than a little bit surreal to be sitting across the screen from Dr. Jeffrey Bland. Dr. Bland has been at the forefront of the development of the functional medicine movement and also ifm, which is its training arm. I don't know what my life would be had all of these things not fallen into place, such that functional medicine came to be for many of you. You know this. But after having been trained as a health coach and practicing for quite a while, I went back and got another training because I felt it was critical for me to do my job in terms of helping people make behavior changes to understand the functional medicine movement. So I am thrilled to have Dr. Bland here, and I will now welcome him to the podcast.

Oh, Carolyn, thank you. What a treat. And you know, I love so much the title of your podcast because for me, it, and we were speaking about this earlier, it is a fantastic metaphor for the journey that we're all on throughout the course of our life to create happiness, joy, exhilaration, and health. And it is a step at a time. It is a journey because life is a long haul. And so the question really is if we want to haul our life along for a lot of years, we want it to be a joyous, healthy experience. So how do we do that? It's not that a long haul is bad. Maybe a long haul is good. If we're hauling success with us through the course of our health Trajectory. And so my thinking about the word long haul syndrome is if we turn the syndrome into expression of good health, maybe it doesn't have the negative connotation and it starts off on a joyous journey of exploration.

I love that. And how fitting. And I would love to talk a little bit more about COVID itself. And also we will definitely touch on what you alluded to, which is having a long life, but also having an equally long health span. And so thank you for teasing that a little bit. So before we jump into the history of functional medicine and what people should know, I'm just curious, what are your non negotiable health habits? Even on your busiest day? What do you do to take care of yourself?

I think, and this may sound esoteric, but I, I believe it's, it's really important. It's the conscious reminder of the important role that I play in determining my own health. It's not like a tangential thing or it's not like out there as some esoteric, you know, concept. It, it is a driving force like in the Salinger book, Franny and Zoe. It beats with every beat of my heart. It is, it is who I am. I think about it, I try to live it. Now, that doesn't mean I 100% always do exactly what I know I should do, but because conscious of it, I think, and it's prime in my frontal lobes of my brain, it then guides me in my decision making about things that are on the path or could take me off the path. So I, I think it's, it puts the guardrails on the way I behave, even the way I execute in my life by having that as a conscious part of my, it's not just like, well, when I get around it, I'll think about my health. No, no, no, it's there with every beat of my heart.

Yeah, that's a wonderful reminder. And I think if we never bring that idea that we have control, so much control over our health to the day to day, it doesn't happen. You know, it's not something that you can keep putting off forever because those days will pass. You know, it's not that we can't make the best of something. Oftentimes there are, you know, once we have an illness or something else, we still can improve our health, but it's a lot easier to be at the forefront of that and be ahead of it. And we can do that when we remind ourselves every day that it's really important stuff.

Well, I think you said again something there that's really prescient. And I want to emphasize it. And that is, I think you can be a healthy, sick person or you can be a sick, healthy person. It's how you attitude, your connection to what you're going through in your life and your sense of control over it. So you may have, let's just use an example, a bad case of the flu and you feel horrible. But you also recognize that you're going to get better because you have certain recuperative capabilities and you have resilience, and you need to hold the line, do what you know is right. And it's not. Woe is you. You're the flying, and everything is broken apart. You have the capability of pulling yourself back. And I think that if you look at the literature on cancer patients, what you'll find is those patients that have a positive outlook and think of themselves as healthy, that just have cancer, they were healthy, and then they got the diagnosis of cancer. And so now how they use that, that positive sense of they have the ability to rejoin health and leave cancer behind. And I think that those things are all part of a very positive process of our physiology.

Absolutely. And it's really one of the underlying foundations of functional medicine itself. I am not trying to embarrass you, but you are widely known as the father of functional medicine. And I know you had a lot of different positions which probably all allowed you to be at the forefront of this movement. And you were actually urged to leave your classroom by none other than Linus Pauling so that you could have this bigger impact that you've indeed realized. Can you just speak a little bit to your career and how it did allow you to see that there was a missing perspective?

Yeah. Thank you. It's interesting. I'm just turning 77, which I hope that's a lucky roll of the die 7, 2, 7. But as I've kind of gotten older, I think most people, probably in this age group, you start reflecting back. You do nostalgia. People say even nostalgia ain't what it used to be. But I think that there are so many things that come up now. As I'm thinking back over this 77 really remarkable years that I've. I've met so many amazing people. I've traveled 6 million miles over these years and so forth. But I think that there is a couple of interesting reflections that I've tried to pass on to my kids and now my grandchildren about this. This life experience that I think is kind of general to all, and that is, I had no idea at age of 17 when I was starting in college, really what I was going to do, I, I, you know, I have the same concerns that I think probably most every 17 year old had. And that is, Jesus, my life going to be a waste is all this stuff going to school. What does it really mean? Where am I going to apply it? But I did have as my mother and I, she's now deceased, but during the years that I had the privilege of conversations with her, she said I always had this natural in curiosity and my curiosity was always around the question of why do people get sick not just as a cons of infectious organisms, but what differentiates a sick from a well person, a person with heart disease, diabetes, arthritis, cancer, dementia, from a person of the same age that doesn't have that from way early on. Chief thing was actually in grammar school when I started asking those questions and really thinking about, about it. So it was a driving kind of interest in mind and you know, I had this opportunity to be guided by some really remarkable, what I would call mentors over those years. It took this, this curiosity, I hadn't allowed it to be more channeled into saying, okay, if you, if you really want to know the answer to that question, you need to go here. And so I became, you know, interested in, in reading and reading in science and, and trying to figure out more about the mystery of the human body and how it interrelates with the environment in which the person is living. And so I think that was always with me throughout my undergraduate school and then later, you know, I went on into health science school and then a PhD and then became a professor. But this driving force always was to understand how we could apply this information to trying to decipher why people do get sick. And so I was always, I think, thinking upstream about the downstream process of disease. It was always upstream what's going on that leads to this downstream thing that we call a diagnosis. So I think that probably was the continuity of my, of my life. And then I just had the fortune of meeting some remarkable people that help guide me and keep me on, on that path and, and keep feeding my curiosity.

That's wonderful. Thank you. Just sort of as a quick take, do you mind saying a little bit more about how functional medicine is different from say both conventional medicine and integrative medicine approaches? And also about how you conceptualize health? That's a little different.

Yes. So I think over the years I started accumulating my own conceptual framework and I think we all do that as we get deeper and deeper. This is like Malcolm Gladwell's thing about what's an expert. You have so many hundreds, thousands of hours. As you put into something, you start seeing it differently and more deeply. And for me, those two years that I had as a postdoc. No, actually wasn't a postdoc, it was on sabbatical with Linus Pauling, were really probably the consequential formative transition for me that was in the early 80s, 81 and 2, in which my office just happened to be right next to Dr. Palme's office. So we had a lot of informal opportunities for conversation about all sorts of different things. But meeting he and his wife Eva Helen, gave me a sense that this construct of excellence and pursuit of excellence and how you, how you aspire and can achieve excellence requires a lot of dedication, a lot of focus. But the return is that you start to understand things much more deeply. So what, what really was a transition for me was studying molecular medicine. The concept that he really coined the term molecular medicine in his article in 1949 on sickle cell anemia. The first example of a molecular disease that had been kind of defined at the genomic and biochemical level. And so I got thinking, well, these conditions that are in our genes, you know, how, how prevalent are they that determine our health trajectory? And what became very clear was there are these inborn, very serious errors of metabolism, like sickle cell anemia is one of those inborn errors. But for most disorders that we experience, heart disease, diabetes, even cancer, arthritis, they're not single gene related disorders. And so you don't like inherit this disease. There are some maybe examples, like we think of the BRC2 genes that are associated with increased risk of breast and prostate cancer and ovarian cancer. But in most cases, these conditions that we experience today, these health conditions are not solely tied to hardwired aging. The more I studied this, the more I came to recognize in the 1980s that even this is before the Human Genome Project, that Probably less than 30% of diseases were defined by our specific genes that we inherited from our parents and our families. And the other 70% plus came from the information our genes got from the way we were living. And so that became an aha for me because it said, well, hold up, I can't change my genes. I didn't fill out an application card for my parents. Fortunately, I got good ones. But, but I can control this other 70% of things that are related to these modifiable factors based on how I live in this world and where I prefer to live and who I hang out with, because I think the social determinants of these conditions are important too. Do we hang out with people that all have negative, what I call anti evolutionary lifestyles? Because if we do, then it's very difficult for us to kind of break that model because we want to be part of the group. So, so who do we hang out, who we associate with? Are they people that like to exercise, be outdoors, do certain things, eat fresh foods, or the alternative.

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So I started to really study more in depth how these things ultimately translate into health and disease. And what I finally came to recognize is that all of these diseases that we have coded in the international classification of Diseases, icd, that all of those are manifestations of downstream events that occurred from upstream variations in how our genes were related to our environment. That you could not really find a single example. Well, maybe that's an exaggeration. What I would say is it would be very hard to find an example of a ICD9 or ICD10 disease classification that didn't have some upstream variability related to how that person was living, where they were living, what they were doing in their lives. And so with that, then I started to say, well, hold on then, upstream, what does that mean, upstream? What that means is that there must be early things going on that give rise to the downstream things that we call a disease. That disease didn't just occur at a bump in the night. People would say, well, Monday mornings after a vacation is the day with the highest incidence of heart attacks. Well, that is true statistically. Does that mean there was no heart problems until that Monday morning after a vacation? Probably not. There was probably something going on that just made that stress of the Monday morning after vacation go over the range of resilience. So then I started to say, well, that must have something to do with the function of the individual then upstream. Because function is a characteristic that as it gets compromised and depreciated over time, your reserves become reduced. And now things that you could accommodate and be resilient to no longer can you. And so your function is so compromised that now it produces an outcome that we call a disease. So then I said, okay, well then what are the functions that individuals have? If we were to broadly categorize functions, and I, I really thought that there are four quadrants or four types of functions you could talk about that all weave together to become our body's function. And those four types were our physical function, our musculoskeletal system, and how we move and operate mechanically in the world. And then there is our metabolic function, all these parameters that regulate the complex physiology of cells and tissues, organs and organ systems. And then there was the cognitive effect that interrelate to how we can think and project and retain ideas and synthesis concepts and do art and play music and all these things. And then lastly there is our behavioral function and how we behave, how we interact with our. Our world and those inhabitants of the world, that behavioral function. And if you looked at each one of those quadrants, those four quadrants in an individual, you might be able to define where some of their upstream issues were starting to develop that would lead un. Unchanged, would lead to a downstream thing that we call a disease. So I said, now hold up. Maybe then that defines a new way of thinking about health. Maybe health really should be defined not as the absence of disease, but the presence of function. Then if that's true, it begs the question then, well, then how do you measure function? We know how to measure disease. We have all of these parameters that measure disease very nicely with the diagnostic tools of today that we go to the doc and have done for us or done on us. But we, I recognize, didn't have a lot of knowledge about how to measure function upstream of disease. And so I said, maybe that's where I should spend my life. Maybe this is in the. In the late 80s. And what led into the discussion with my colleagues of the formation of the Institute for functional medicine in 1990 and the concept of functional medicine, only to find later that this concept had already been developed in the 1870s by Dr. Heinsworth. And I felt, well, gee whiz, I didn't come up with anything original. I just kind of revisited a concept that he was talking about as a dean of Birmingham Medical School in England in the Lancet in 1872. You know, obviously we had new tricks and new tools that we could use in the 20 now, the 21st century. But the conceptual framework was very similar to what he was talking about way back then in the 19th century.

Yeah, that was amazing. And I feel like we've done that quite a bit where we've forgotten what Hippocrates said. And then we come back to it. You know, like, we sometimes don't get it right at first, but I would say we've gotten it right. Now. Do you mind characterizing some of the terms that people might hear about when they're hearing about functional medicine such as root cause, you talked about upstream. Why is the concept of root cause important?

I think root cause is to some extent a synonym of upstream. This depends on your languaging and your kind of visualization. When we were sitting down early on to try to put a metaphor of a visual metaphor together or an iconic view of what functional medicine was. So this would have been the 1991. I think we had our first international meeting for functional medicine in 1991. We came to the same kind of visual image that's used very often, and that's the tree and what we. I remember this conversation vividly even today, now, more than 30 years ago, in which we, when we looked at a tree, I think I said something like, well, the tree has leaves, and the leaves demonstrate to some extent visually how healthy the tree is. And so we have leaf diseases of different types that you can see. If you're a arborist or you're a plant interested person, you can look in the leaves and say, oh, that plant's not healthy. And you know, maybe it needs to have fungicide or maybe it needs to have pesticides, or maybe it needs, you know. So we think about how to treat the leaf disease with a specific agent, but really the leaf health and how it's seen occurs as a consequence of the information it's getting through the stems and then the limbs and then trunk as a tree, and ultimately then where the tree is planted in through its roots and into the soil. And so you start thinking, well, just a minute, hold on. If we really wanted to understand the leaf, we need to go way down to the soil and the roots and ask, what's the information that's being trently, Is it friendly or is it faux? And so that metaphor then became kind of our iconic view of functional medicine. We considered the subspecialists of medicine, which are the subspecialists of disease, to be out there. They're leaf tenders for specialized types of leaf disease and they do a good job of that. But then we've got all sorts of other people. We've got arborists, and we've got botanists, and we've got people that are involved with soil health. And. And so eventually we go down to. I called it upstream or root causes. Root now is a good metaphor to the tree of where the upstream problems in the leaves occur. So that's, that's how I put that all together.

Thank you for explaining that to us. So I know that part of the situation that led to all of your Colleagues and you coming together was that in our current healthcare system, we tend to divide everything up. And so things are thought of maybe as a system, not usually as a network where everything's all connected, but maybe a system if we're lucky. And then those aspects of our physiology also dictate what kind of specialists we might go to when we're having symptoms or we've been diagnosed with a disease. So do you mind clarifying a little bit more about what systems medicine is, what this network is, and how this approach can help people understand or get treated for things not in a vacuum, not in a silo, but instead as a whole human.

Yeah, that's beautifully stated. You almost answered your question with the ways. The question, I think was beautiful. Let me give an example that I think exemplifies what you're just describing. I think I could produce probably many, many examples, but this one is quite dramatic and I think is good as a way of describing this. A number of years ago, I had a clinical research center in Cagaba, Washington and we saw over 2000 patients a year on different kinds of clinical studies that were related to the management of chronic health problems using the functional medicine model. We published a number of papers over the years and I had a remarkably talented group of clinicians, scientists working with me. We had about 35 people on our staff at the time and three of our doctors in the clinic. We had Dr. Bob Lehrman, Dr. Jack Kornberg, Dr. Joe Lamb actually, and also Dr. Dan Lucas was working with us at that time and we had started a study. This had been in the middle 90s. We started a study with autoimmune disease patients to see if we could find a functional medicine comprehensive approach towards managing autoimmunity. And we connected to a couple of rheumatologists in, in specialty medicine in our local medical community that were open minded enough to be willing to listen to us and, and to be interested in what. So one day I was in one morning, I was in my office and Dr. Jack Kornberg comes in. I can see he's very disgusted. And I want to just take a pause here. The world lost Jack Kornberg, just three years, very big loss, a remarkable big heart, big, big presence, big, wonderful person. But he came into the, into my office and yeah, it was a sad moment for our whole field. And he had the local morning newspaper, the Tacoma News Tribune newspaper, and there was a cover article that just had a photograph of two hands with a bunch of pills in the hands. They were, they were full of these different medicines. And he said, I am so disgusted. And I. I said, so, Jack, what? Why are you disgusting? He said this. Have you read the paper this morning? I said, no, I have not. He said, well, this is, this cover story is a story about this woman locally who has this very unusual autoimmune disease called erythromylgia that is so serious for her. She's a fairly young woman, according to the article, is in her late 30s. A mother, has three children and she's pretty much disabled and she's taking all these medicines and she's still not well. She's still not doing well. And he says, I am really disgusted because I know we can help her. And I said, so, Jack, not to be, you know, kind of resistant to your advocacy here, but, you know, there are like more than 80 different diagnosis diagnoses of autoimmune disease. And. And we've got no experience, as far as I know, any of us, with erythromylgia. And so this woman is very seriously ill. It would seem like this may be a little overly ambitious. Like we can't say we're experts in that subtype of autoimmune disease. And he said, well, I know we're not, but Jeff, remember that we've been managing these people in this particular study, that we're doing all sorts of different diagnoses, from Hashimoto's to rheumatoid arthritis to sle, and it seemed to be diagnostic independent because they're all getting better on our program and so why not erythromylagia? And I said, well, you're mounting a pretty good argument there. But there could be a medical legal implication here if we started saying that somehow we're going to manage it. And he says, no, I'm not saying that we should say that we're going to treat her condition. I'm saying that we ought to reach out to her and say that we have some adjunctive way of approaching her lifestyle that might be beneficial for how she's treating this condition. And I said, well, we'd have to make. If she approved doing that, we'd have to make contact with her rheumatologist, who turned out to be very well esteemed in at the. He was a academic at the University of Washington Medical School. Well, he convinced me that we should try to locate her and give her a call, which. Which he did and invited her in. And I recall when she first she decided that she would participate. She came in, we got approval for, from her physician to be involved with this lifestyle program. And when she came in the parking lot, where she parked, the visitor's parking lot, her space was right in front of my office. So I could see she got out of the car with her husband who came with her, and she was needed assistance to walk, you know, 100ft to the door. And she was very, very disabled. And in the first visit she was asked, as we did all individuals, if you had a magic wand, what would be her three wishes? And her three wishes were that she could go to the kitchen counter and prepare a meal. Because she wasn't able to do that. She couldn't stand long enough to do that. Number two is that she in the spring could go out and to plant her garden. And number three was that she could go with her kids to the mall to get walking shoes so that she could walk the mall with them because they wanted to look at some of the stores there. Those were her three big wishes. So to make a lot of now here by saying that she got in the indoor program, she really dedicated herself to a functional medicine approach. And she started really improving quite rapidly. And then she started being able to eliminate certain of these medications, these handful of things she was taking. Some of these were very, very strong medicines that she was taking. And she was able to start reducing them over time with the instruction of her physician. And then at something like, I guess she came in in November of the year. By March, she was at the counter making meals. She was out starting to get ready to plant her garden. And her kids had done chores to raise money to take her to the store to buy her running shoes or walking shoes. So this was, you know, we had a big celebration and there's a lot of tear eyes and this was like a big positive. So then she was left, you know, on her own. She didn't come back to us. That was the end of that treatment program for us or that management program. But then she reappeared in July of that same year. And now she walked briskly to the. And you know, this total different kind of whole body continents. And she was carrying something and she was carrying a large framed photograph, probably like 21 by 30 type size of her at the top of Mount Sigh, which is a mountain that's outside of Seattle that you can walk up to the top of. It's a very vigorous walk. I think it's a 3,400 foot elevation or about three miles. So it's quite steep. It's not like a climb, but it's a really challenging Walk, hike. And here she is at the top and she's holding a sign in this photograph that's written by her and she says on the sign, thank you, Dr. Jack Indiana, who are the Dr. Minick, who are two of her therapists in our program? Now I can tell you it only takes a couple of those in your life to make all the miles of travel and everything that I've been doing over my years make sense. And so that kind of speaks to what you're talking about that there are we can get mired down in subspecialties and differential diagnosis. Someone said to me once we can know more and more about less and less until we know everything about nothing. But maybe we need to move upstream and look at root cause and maybe there's unifying concepts that don't require us to be so intensely understanding all the piece parts that maybe the big things, the big levers are upstream.

Just like Dr. Bland and his colleagues, Dr. Kornberg and Dr. Minick had never treated the patient's exact disease before. For so many of us, improving our basic functioning can go a long way. We'll come back to this again next week and we'll talk a little bit about Dr. Bland's book, the Disease Delusion as well, because it's a really great roadmap for anyone who wants to take a functional medicine approach to health. But essentially helping our bodies and minds function as they were meant to is often a lot less intricate than we would guess. We do want to be able to measure function, and we'll talk more about that. But functioning well is based on basic foundational behaviors and social factors, as we heard, and also our environments. And this is really good news for all of us. So once again, before we go on too long, thank you for being here with me today. And maybe as we part ways for this week, I can ask you to think about some of the 70% of our health, those modifiable factors. What are we doing that's contributing to health writ large? And what might we be doing to change things upstream a little more so that our downstream effects aren't disease laden? I know I can be improving on many fronts and bringing that orientation that Dr. Bland talked about, which was staying on the path as much as possible by keeping health at the front of our consciousness. So let's do that together and I'll see you next time. A reminder that neither I, I nor my podcast guests are doctors or healthcare professionals of any kind. And nothing on this podcast or associated content should be considered medical advice. The Information provided by Wellness While Walking Whole Life Workshop and Bermuda Road Wellness, LLC is for informational and entertainment purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking any new health care regimen, including walking.