The Medicine of Why

Diseases don't exist. Now, why would I say that? Everybody knows that diseases are real. But the CEO of a major drug company recently said that in the future, there's going to be no more drugs for blockbuster diseases, only drugs for blockbuster mechanisms. Now, why did he say that? It's because he also knows that diseases don't exist, at least not in the way we think they do. Just like the world looks flat and isn't, diseases appear real, but they're just downstream from upstream mechanisms. I'm going to tell you about a way of practicing medicine that focuses on the mechanisms that are affected by our environment, washing over our genes, to create the downstream effects we call disease. Now, when I'm asked what kind of medicine I practice, I say functional medicine, and of course then I get asked, what's that? I say, well, it's the opposite of dysfunctional medicine. Now we've all experienced that. But what is functional medicine? It's a new map. It's a new way of navigating, a new GPS system to move differently through the landscape of illness. It's based on mechanisms and causes, not symptoms and diseases. It's personalized medicine. It's systems medicine. It's the medicine of connectivity. Functional medicine is the medicine of why. How do we find out why you're sick instead of just naming the disease that you have? Functional medicine is a systems biology based approach to personalized medicine that focuses on the underlying causes of disease. Rather than being super specialist, functional medicine doctors are super generalists where we examine everything about how things connect. How do we do this? Well, we use medical comprehensive histories and conventional testing along with various functional biomarkers or tests, and genomics to understand the landscape of illness, and to make decisions that address the mechanisms and the underlying causes of disease. This is a fundamental paradigm shift that forces us to redefine disease. It applies advances in systems biology in a practical, comprehensive, personalized approach to illness, and it addresses the underlying causes and the mechanisms that are common to all disease. This is the story of the future of healthcare. And I know that this is the future of treating chronic disease because I had an incurable chronic disabling condition. And most of you either have or know someone close to you who has a chronic disease. This is about your family, about those you love and care about. And it's your story. And it's my story. Here's me before, when I was sick 15 years ago, and here's me now. You see, before I worked as a family doctor in Idaho for four years, I delivered 500 babies, I ran the ER, I worked 68 hours a week, and then I worked in China for a year, and then I worked in an inner-city emergency room for two years, and from one day to the next, just like that, I was so sick I could barely function. What I learned in medical school didn't help me figure out what was wrong. I went from being vigorous and healthy and riding my bike 100 miles a day to barely being able to walk up the stairs because of mind numbing fatigue and pain. My brain stopped working. I went from dictating 30 patient histories without notes to not remembering where I was in the middle of a sentence. I developed severe bloating and diarrhea and psoriasis and allergies and swollen eyes and sores on my tongue and brain fog and muscle twitching and chronic pain. I couldn't sleep. I had no interest in sex. I couldn't focus and remember or enjoy life. It was like I was depressed and demented and had ADD all at the same time. Of course, I did what most of you would do. I saw doctors. I saw neurologists at Columbia, a rheumatologist at Harvard, a gastroenterologist, and a psychiatrist. None of them had answers, just prescriptions. Prozac, Valium, Ritalin, Provigil, Ambien, Advil, even Viagra. But is depression really a Prozac deficiency? Is ADD really a Ritalin deficiency? Is low sex drive a Viagra deficiency? For that matter, is high cholesterol a lipitor deficiency? I learned that I didn't have a drug deficiency, but imbalances in the basic functional systems of my body. These are like nodes in the network of our biological system. Here's a different way of looking at what happened to me. The body is a network of systems and all of them are interdependent and all interact and mine broke down so let me show you how. How did I get to this system's understanding? You see, we're all born with a unique pattern of DNA that is influenced by our lifestyle and the environment. Poor diet, stress, toxins, microbes, and allergens all wash over our DNA, leading to imbalances in the basic network of our biological systems. This is what leads to symptoms and what we call disease, but the roots are much deeper. These underlying causes of disease, as I said, diet, stress, toxins, allergens, microbes, These influence our genes and they lead to imbalances in this network of biological systems, our immune, digestive, hormonal, detoxification, energy, structural, and psycho-spiritual systems. So let me show you how my system became imbalanced and how I got sick. This is me in this picture. I'm at the center. I'm a type A overachiever. I had genetics that predisposed me to not being able to get rid of toxins. I live in China breathing coal soaked air which is full of mercury. I worked in the emergency room on a crazy schedule. I was going through a tough divorce. And then one day I got a gut infection from a parasite in a lake in Maine and suddenly my system broke down. I got sudden severe bloating and diarrhea which lasted three years. I developed mal digestion and mal absorption. I developed overgrowth of bacteria in my small intestine. I had an abnormal footprint of my whole gut ecosystem of the DNA in there which has huge impacts on our health. I had white blood cells. and my gut and inflammation. And then my immune system broke down. I developed psoriatic rashes and facial rashes and red raccoon eyes and tongue sores and food sensitivities. I even developed autoimmune antibodies and I had a low white count. And then my hormones became chaotic because everything was affecting my whole system. I had chronic stress and my circadian rhythm was upside down from the emergency room. I developed cognitive problems, memory concentration, mood problems, sleep problems. My adrenals and thyroid didn't work well. And of course, what I discovered was a lot of these were related to problems with detoxification. I had high levels of mercury from China and problems with my liver function tests. And I had low levels of glutathione. And all these things affected my biology in a way that drove my body not to create energy. And that's when I developed muscle pain and fatigue and twitching and high muscle enzymes. And my whole system was broken down. Of course that led to other problems like nutritional deficiencies, magnesium, zinc and vitamin D and all these things connected together. All these things were related to underlying imbalances in these systems that drove my biology into chaos and disease. Now here are some of the tests that showed my poor genes, my mercury levels, my gut inflammation and problem making energy in my cells. So what did I have? I got a whole lot of names, a whole lot of labels, a whole lot of diagnoses, a whole lot of what, but not a whole lot of why. I was told I had all these syndromes like chronic fatigue syndrome and irritable bowel syndrome and pre-autoimmune syndrome. Nobody asked one simple question, which is how was all this connected? What was at the root of this systemic breakdown? Then I met Jeffrey Bland and others at the Institute for Functional Medicine who were also trying to answer the question why. We created a model to capture and analyze the data, applying the latest science of molecular biology to answer the question why, and then to make clinical treatment decisions. Now as a physician, I knew I wasn't crazy or depressed, that something was deeply out of balance. And through the puzzle of my own chronic illness, a massive systemic breakdown of my immunity, digestion, hormones, my detox system, my mitochondria, which is my capacity to create energy, Through peeling the onion of my own chronic disease, through putting myself back together molecule by molecule, cell by cell, system by system, I slowly recovered and I discovered functional medicine. Now these are the basic principles I use to fix myself and thousands of other patients and can help us prevent, treat and even reverse the global epidemic of chronic diseases. Now I know you suffer too because nearly three quarters of Americans are overweight. One in two will have heart disease. One in three children born today will have diabetes in their lifetime. One in four will have major depression. One in five children will have a mood or behavioral disorder. And one in ten of us, over 65, will have dementia. Now, I had lunch recently with General Jack Keane, who told me that 70% of applicants for the military are unfit to serve. In 1946, the School Lunch Program was started because military recruits were too thin to serve. Now, in part because of our school lunch program, our children are too fat to serve. Now, I know that many of us also have a whole list of complaints that we all come to accept as normal. Sinus problems, reflux, bloating, headaches, joint pain, fatigue, trouble sleeping, low sex drive, you name it. The solution for your suffering and chronic disease is available to you today. We don't have to wait 20 years. It's a repeatable, reliable, teachable system. And we have all the tools today to optimize and enhance performance and health and to prevent and cure chronic illness. Functional medicine is a tool that's going to help us do that. It's a disruptive technology. It's an approach that will force us to completely redefine our notion of disease from descriptive based on symptoms to predictive based on mechanisms. It's a model of health care that dis-intermediates our current system while preserving what works and results in a system that provides better outcomes at lower costs. We all know we're in trouble and we have to do something different. Globally, by 2020, less than 20 million will die from infectious disease, while more than 50 million will die from preventable and often curable chronic diseases that result from our toxic diet, toxic stress, and our toxic environment washing over our genes creating this new human diseased phenotype. The biggest cause of death worldwide are not TB, AIDS, diarrhea, measles, and malaria, or respiratory infections, but heart disease and diabetes and cancer resulting from the top six worldwide causes of these problems: high blood pressure, smoking, high blood sugar, lack of exercise, obesity, and abnormal cholesterol. The World Economic Forum reported in 2009 that the global spread of chronic disease is one of the biggest threats to global economic development. Globally, we lose $2 trillion a year in lost productivity. 78% of healthcare costs over $2 trillion a year are driven by preventable chronic disease resulting from what we eat, our sedentary lifestyle, chronic stress, and environmental toxins. By 2082, at our current growth rate of disease and costs, our entire GDP will be consumed by healthcare costs. Cleveland Clinic actuaries estimated we could save $930 billion over 10 years by applying this new model of medicine to a few chronic diseases. But this is not just an American problem, it's a global problem. In less than a generation, we have seen China move from scarcity to obesity. In 2007, scientists estimated it would take 20 years for China to go from 20 million to 42 million diabetics. In less than three years, they went from 20 to 93 million people with diabetes and 148 million with pre-diabetes. Relying on medication is not the answer. The world's biggest blockbuster diabetes drug, Avandia, a drug that was supposed to prevent complications of diabetes like heart disease, actually resulted in 47,000 additional heart disease deaths since it was introduced in 1999. And 81% of Americans take at least one medication. We are raising the first generation of Americans to live sicker and die younger than their parents. Doing the same thing and expecting a different result is the definition of insanity. And our health care crisis is insane. But there is an approach that can change this frightening trajectory of disease and spiraling costs and it's called functional medicine. So let me show you a little bit more of how this model works in a little more detail. This is Clayton. He's every kid in America, a 12 year old boy with 11 different medical diagnoses who saw five specialists and took seven medications, actually eight. He struggled with ADD, asthma allergies, anxiety and anal spasms and that's just the A's. When he came to see me, he had a whole list of problems. That's why I call myself a holistic doctor. I take care of people with a whole list of problems. These days, a lot of us have a whole list of problems. And when we go to the doctor, we get referred out to a lot of specialists who all give us a different medication. One patient said she had a doctor for every inch of her and a pill for every ill. Now, These medications suppress, block, or interfere with your biological functions. These are the anti-drugs, the inhibitors, blockers, and suppressors, and most don't address the underlying cause of disease. When a patient has multiple diseases or symptoms or problems, we call these comorbidities, but they're not distinct or separate diseases. These are multiple symptoms and diseases that are all connected by similar or the same underlying mechanisms. Functional medicine is a way to understand the connectivity between separate diseases, a way to connect the dots between all your symptoms and your diseases. It's a way of thinking that's different. It helps us organize all the information in a person's story into a new map for chronic disease, one where everything is connected by common mechanisms. Clayton didn't have all these separate problems. He had a few common roots for all of them. He had inflammation. He had gut dysfunction, toxic overload, poor diet, nutritional deficiencies, hormone and neurotransmitter imbalances. Here's Clayton in the middle here. And you can see he had some issues. He had a lot of things that connected together. His digestive problems and nausea, stomach aches, anal spasms, itching, pain. He had antibiotics in his past, yeast overgrowth, an inflamed leaky gut. And he had allergies and asthma and eczema and postnasal drip and hives and canker sores and elevated antibodies to gluten. These were his immune imbalances. and he had detoxification imbalances with elevated lead and mold exposure and exposure to thimerosal. He had a lot of hormonal neurotransmitter imbalances with ADD and anxiety and insomnia and trouble with his handwriting and headaches. And he had nutritional imbalances that related to his poor diet and other stresses and his high sugar, high processed food diet and junk food diet. He had low levels of magnesium and zinc and vitamin D and E and omega-3 fats and Low B6 and beta-carotene, all of which are important for normal immune function, biological function, detoxification, and many other things. So this is the new map. This is the matrix of functional medicine. This picture is the image of how things connect and the new way of thinking about disease. So what did we do? We put him on an anti-inflammatory diet. We removed food allergens. We cleaned up his gut flora using antifungals and probiotics. We helped him detoxify from lead and we optimized his nutritional status, and we used medications and supplements and food to shift his biology to normal function and balance. We couldn't just do one thing, we had to treat everything because everything is connected. See, if you're standing on a tack, it takes a lot of aspirin to make it feel better. And if you're standing on two tacks, when you take one out, you don't feel 50% better. So we treated everything. Two months after being treated using this new map, Based on mechanisms and causes, Clayton was completely symptom free and off all his medication and he was doing great in school. But what was most striking to me was not that his asthma and his allergies and his ADD and his headaches and his stomach aches went away, but what happened to his handwriting. Here's his handwriting before I saw him and here is his handwriting two months after treatment. His brain started working again and went from incoherent and chaotic to coherent and connected and synchronous. What happened? How did his brain go from dysfunctional to functional? What was the underlying biology? How did his system reset and his body and his brain reboot? It's not magic, it's a method. It's teachable, it's scalable, it's doable in medicine today. You see, functional medicine is not a new treatment or modality or a specialty or technique. It's not integrative or alternative medicine. This is molecular biology. It applies the most advanced science in a practical clinical method in the service of health. It's a new way of thinking about the puzzle of chronic disease. It's a new set of lenses, a new map, a new way of organizing information, a new operating system based not on silos or specialties and all the ologies, but on systems and networks. See, we know that biology is a network or system at the molecular level. at the disease level and at the social and global level. The practice of medicine just hasn't caught up yet. This new science requires a system of application. Functional medicine is that system. Functional medicine, as I said, is the medicine of why. And conventional medicine is the medicine of what. What disease do you have and what drug should I take? The names of the diseases, however, become irrelevant as we understand the cause. In fact, One factor can cause dozens of diseases like celiac disease from eating gluten, which can show up as rheumatoid arthritis or inflammatory bowel disease or depression or autism or osteoporosis, while one disease like dementia can have many causes like B12 deficiency and insulin resistance or heavy metal toxicity. Our current approach to disease is based on categorical misclassification and etiologic imprecision. What that means is that we classify disease based on symptoms, not causes, based on diseases and not mechanisms. Instead of asking what disease does this person have, we should ask why is this person experiencing this constellation of symptoms at this time? What are the patterns that connect everything together? We all think that if you know the name of your disease, and there's about 12,000 of them that you know what's wrong with you. But the name is just a label we give to a collection of symptoms. It tells you nothing about why you have those symptoms. For example, you go to the doctor and you say you have no energy, you feel sad, helpless, hopeless, you can't sleep, you have no interest in sex or food. Your doctor is going to say, I know what's wrong with you. You have depression and you need an antidepressant. But depression is just a label we give to that collection of symptoms. It tells you nothing about what caused the symptoms in a particular individual. It could be an emotional trauma, or it could be an autoimmune reaction to gluten that causes low thyroid function, or B12 deficiency because you're taking an acid blocker that prevents B12 absorption, or vitamin D deficiency because you live in Seattle, or inflammation in your gut from taking too many antibiotics that kill all the good bacteria in your gut. or it could be a high body burden of mercury because you love fish or an omega-3 fat deficiency because you hate fish or it could be insulin resistance because you eat too much sugar. And the diagnosis and the treatment of each of those causes is very different. This is how we have to think differently about disease, about the roots and the mechanisms common to all disease. The doctors of the future, as I said, will be super generalists, not super specialists, they will understand how everything is connected. This is personalized medicine, this is systems medicine, this is the medicine of connectivity. My wife, Pierre, an orthopedic surgeon and I connected with a very different type of medicine when we went to Haiti three days after the earthquake in 2010 to help like many of you wanted to do. We landed in chaos with 1,500 patients strewn about the hospital grounds who'd been lying there without food or water or medical care for three days. We set up a makeshift operating room and we went to work. We had primitive Civil War tools to treat trauma and we did hundreds of amputations and surgeries with hacksaws, lit by headlamps, and we used vodka to sterilize our instruments. We did it because it was all we had. Now, of course there's a better way to treat trauma. I realized that when I was in Haiti that our current approach to diagnosing and treating chronic disease is like using hacksaws and vodka to treat trauma, there is a better way. This isn't just my story or Clayton's story, but this is a story being told in over 40 countries for tens of thousands of patients who have been treated with functional medicine. It's being explored in 31 medical schools and 13 residency programs around the country. In fact, at the Institute for Functional Medicine, we are oversold and adding extra trainings every year. This is a medical revolution. We have a choice. We can keep taking green pills and red pills and blue pills and going to a never-ending series of specialists when we get sick. Or we can step into 21st century medicine to understand the laws of biology and what this means for health and disease. We can connect the dots. Functional medicine is a disruptive technology that will overthrow the tyranny of the diagnosis. Applying functional medicine we can reverse the exponential rise in chronic disease and the economic burden that is suffocating our country and the world. Thank you.