October is breast cancer awareness month. Usually, this means that women will be reminded to get their mammograms done. However, getting a mammogram is geared towards “early” detection, but not really prevention of breast cancer. In order to lower one’s risk for breast cancer, one needs to know what raises it in the first place.

Breast cancer these days is like an epidemic. It wasn’t like this decades ago. Our lifestyles and our environment have changed and contributed to the increase in the incidence of this disease.

The most common type of breast cancer is the type that has estrogen and progesterone receptors, and I will limit this article to that type of cancer.
Estrogen and progesterone are important hormones that should always be balancing each others’ effects at every monthly cycle and throughout a person’s lifespan. When estrogen becomes dominant compared to progesterone, which is a very common scenario in today’s environment, many bodily functions can change. Some of these estrogen-dominant changes in the breasts include breast pain and tenderness, fibrocystic breasts, and dense breasts on mammogram. In other parts of the body, estrogen dominance can present as heavy or prolonged menstrual periods, formation of fibroids, endometriosis, weight gain and swelling, oversensitivity, insomnia, anxiety, gallbladder disease, and many others. When estrogen’s dominance is prolonged (for many years or decades) and the body is unable to efficiently clear or detoxify its harmful metabolites from the body on a regular basis, cancerous changes happen to cells of hormone-sensitive organs like breasts, uterus, and ovaries. Thus, preventing estrogen dominance and increasing our ability to detoxify will help reduce our risk for these breast, uterine, and ovarian cancers.

What are the causes of estrogen dominance? Among them are use of birth control pills, use of estrogen (especially synthetic estrogen) without any or adequate progesterone, exposure to estrogen-like substances in the environment (e.g. plastics like BPA, pesticides, hormone-treated conventional meats, dairy and poultry, etc). Obesity, high stress, overconsumption of refined carbohydrates and sugars, nutritional deficiencies, suboptimal liver and gut function (like heavy alcohol use, constipation, etc.), sedentary lifestyle, and chronic inflammation of various causes in any part of the body are also scenarios where estrogen dominance can occur.

So, how does one lower their risk of breast cancer? Yes, you got it…by avoiding all the above scenarios! It is not an easy task, so here are a few simple tips:
1. Eat a lot of vegetables everyday, especially those from the broccoli family (kale, collard greens, cauliflower, brussel sprouts, broccoli sprouts, etc). Avoid refined carbohydrates, sweets, and pro-inflammatory trans-fats. Consume less conventional meats and dairy, buying organic, grass-fed, or free-range whenever possible. Know the “dirty dozen” fruits and vegetables, as they are loaded with pesticides, and ideally should be bought organic. Flaxseed, mushrooms, green tea are also excellent foods for lowering harmful estrogens.
2. Aim for ideal body weight. Excess fat, especially around the belly, produce extra estrogen. Get regular exercise.
3. Learn to manage stress, get enough sleep, avoid harmful substances like tobacco and unnecessary drugs.
4. If you are on any kind of hormone replacement, ask your doctor to check your hormone levels. The usual venous blood draw from your arm is not always the best test, especially if you are using a cream or a patch. I also recommend testing for estrogen metabolites in the urine, as a few of these are harmful and known to induce genetic changes that lead to breast cancer. If your doctor does not check these hormone levels and their urinary metabolites, I think you should find a doctor who does.

So, in this month of breast cancer awareness, do not just get a mammogram. Learn about your risk factors and how to lower them.

Zorayda J. Torres, MD

Did you know that about half of people who get heart attacks have normal cholesterol levels? And that if you have high cholesterol, merely bringing the numbers down with medication might have limited benefits? Yes, that is what the data is showing.

Cholesterol is an essential component of our bodies, and unless modified by certain factors, is not harmful. These factors – poor nutrition, hidden infections, stress and poor lifestyle, toxicities, hormone imbalances, and genetics – can bring on chronic inflammation, the common denominator that dictates the behavior of cholesterol and other substances in the body.
The “standard” cholesterol test that everyone gets is not a very accurate test. It gives calculated numbers and thus frequently underestimates the LDL or bad cholesterol, especially when the triglycerides are high.

The “advanced” cholesterol tests, like the VAP or NMR, are much more accurate, as they directly measure the bad cholesterol LDL particles and their sizes, the good cholesterol HDL subfractions and Apo(A), the very important LDL-P or LDL particle number, and the lipoprotein- little-a or Lp(a), a highly sticky cholesterol particle that is mostly inherited.
However, the “advanced” cholesterol tests still do not give you the best available estimate of your risk for a heart attack or stroke. In order to do that, markers of inflammation need to be tested for too.

Here are some of those markers in blood or urine, listed in order of worsening disease. (Pardon the highly technical words, but some people like knowing these details).
1. F2-Isoprostanes – one of the earliest markers of oxidative stress (or rusting) in the body, formed when arachidonic acid is attacked by free radicals; available as a urine test, and can improve with lifestyle changes.
2. Oxidized LDL – measures protein damage due to oxidation of the ApoB subunit on LDL or bad cholesterol. This is the initiating event for plaque formation; elevated levels are associated with development of a high risk condition called “metabolic syndrome”.
3. High-sensitivity C-Reactive Protein – reflects inflammation anywhere in the body, not necessarily just inside your arteries. If no clear cause for persistent elevation of hs-CRP is found, this may mean presence of blood vessel disease.
4. Urine microalbumin – reflects dysfunction of the endothelium, the single layer of cells that line the inside of your blood vessels; reflects presence of vascular disease.
5. Myeloperoxidase – an enzyme generated by white blood cells inside the blood vessel when the artery wall is inflamed or damaged; reflects plaque maturation and high disease activity.
6. Lp-PLA2 (or PLAC Test) – is an enzyme that reflects disease activity below or underneath the plaque in your arteries. High levels can mean high risk of plaque rupture which is the acute event that causes a heart attack or stroke.

 

The above 6 markers of inflammation and the “advanced” cholesterol tests are available and can be fully paid for by insurance, depending on your medical condition. A diagnosis of hypertension, high cholesterol, pre-diabetes, or other abnormal blood chemistry may be enough to pay for these (but ask your insurance to be sure). If you are at risk for heart disease (e.g. family history, smoker, obese, have other inflammatory diseases, etc.), you may benefit from these tests too.

Cardiovascular disease is a silent chronic inflammatory process that can present for the first time as a heart attack, stroke, or death. The best time to detect it is when you have a chance to modify your risk factors and avoid morbidity. Do not settle for a good report on a “standard” cholesterol test, even if you exercise or take a statin medication. Be pro-active and ask your doctor to order the “advanced” cholesterol test and other markers of inflammation.

Pain is one of the top reasons a patient seeks medical help. Pain is a protective reaction of the body that alerts us when something is not right. Pain is one of the manifestations of inflammation, along with redness, heat, and swelling. Causes of acute pain are usually diagnosed more easily and managed more effectively by conventional medicine. In contrast, chronic non-cancer pain, one that lasts longer than 3 months, is more complex, can have multiple causes, and does not always respond fully to conventional care and drugs.

As a functional medicine and internal medicine doctor, I have found that most of my patients have chronic issues, and chronic pain is usually one of them. This can be in the form of back pain, joint pain and degeneration, muscle aches and spasms, headaches, undiagnosed recurrent abdominal pain, etc. Furthermore, these are also commonly associated with fatigue, depression, anxiety, insomnia, eczema, brain fog, allergies, and other non-specific symptoms. All these symptoms are indications of persistent and chronic inflammation, of which there are usually many causes. This presents a difficulty in completely resolving the symptoms. Finding these root causes of persistent inflammation and chronic pains is my focus in my functional medicine consultation practice. In conventional medicine, the approach is usually finding the right drug or procedure to alleviate the pain. That approach is, of course, important, but unfortunately, the drugs commonly used, like acetaminophen, ibuprofen, steroids, and the expensive biologics (like Humira, Enbrel, Remicade, and others), have significant side effects especially if used long-term. They also do not address the underlying cause of persistent inflammation, and the degenerative inflammatory processes continue and eventually cause other diseases.

What are the common causes of chronic inflammation that I search for? Here is a short list:
1. Nutritional deficiencies and excesses. The standard American diet is commonly loaded with
refined carbohydrates and unhealthy fats, yet lacking in important nutrients like zinc, magnesium, omega-3 fatty acids, vitamin A and K, etc. This imbalance of nutrients promotes inflammation.
2. Infections/Microbes. Subtle infections in the intestines, gums, teeth, skin can cause chronic inflammation. At the same time, inadequate levels of good bacteria in our gut lining weaken our immunity and change our metabolism.
3. Food sensitivities. Gluten (protein present in wheat and other grains), dairy, and soy are among the most common foods that can induce low-grade chronic inflammation. These sensitivities are common and can result from poor diet and other environmental triggers. Unfortunately, conventional medicine does not usually test for these sensitivities.
4. Toxicities. Pesticides in our foods and environment, mercury from dental amalgam fillings, lead from multiple sources, are some of the most common causes of neurological deterioration and painful neuropathies. Tests for your body’s load of these toxins are available, and there are many ways to safely assist the body in removing these toxins.
5. Stress and poor lifestyle choices. Emotional and physical trauma, daily life stressors, smoking, lack of exercise, and inadequate relaxation, promote inflammation and thus contribute to pain.
6. Hormone imbalances. All the above causes can also negatively affect our organs that
secrete hormones, like the thyroid, adrenal, ovaries, testicles, pancreas, and others, leading to poor hormone production or action. Hormone imbalances further promote difficulties in our body functions, leading to more inflammation and pain.
7. Genetic susceptibilities. Some of us have genetic variations that allow build-up of toxins that cause inflammation and slow tissue repair. The good news is that some of these genetic weaknesses can be tested for and overcome through improved nutrition and high-quality supervised nutrient supplementation.

If you suffer from any chronic pains, there are things that you can do to help lower the inflammation and reduce your pains. Start by eating a healthier diet, with a lot more vegetables, fruits, healthy fats, and adequate but not excessive protein. Minimize consumption of refined starches and sugar, like sodas, packaged juices, cookies, donuts, and other unhealthy carbohydrates. Aim for ideal body weight, focusing on reduction of inches around the waist, as this excess abdominal fat produces pro-inflammatory chemicals. Find out what your nutritional deficiencies are and correct them. Avoid harmful chemicals that are commonly found in products that we use daily, like household cleaners, cosmetics, plastic containers, etc. The website of the Environmental Working Group, www.ewg.com, is an excellent source of information on these harmful chemicals.

As you can see, merely taking pain pills for an indefinite period of time without finding and addressing the factors that promote your inflammation and pain, is an incomplete approach to pain management. Working with a functional medicine practitioner, whose focus is to help you find the root causes of your chronic pain, will likely produce better long-term results that can benefit your overall health.

Zorayda “Jiji” Torres, MD, ABIHM, IFMCP

These days it’s impossible not to be concerned about our mental health. If you yourself don’t have symptoms of depression, anxiety, difficulty focusing, difficulty remembering, insomnia, and others, it is likely that you know someone who has. Mental health issues are on the rise, and is a major cause of disability.

I am a functional medicine specialist now, but when I was practicing conventional internal medicine only, I witnessed a lot of cases of anxiety and depression that failed to respond to prescription medications. Moreover, many of the patients who had depression, anxiety, attention-deficit disorder, memory decline, etc. also had other non-mental problems like irritable bowel syndrome, arthritis, chronic pains, fatigue, eczema, asthma, cardiovascular disease, diabetes, etc. So one wonders if, for example, the depression is a result of the medical problem, or vice versa. Are these mental health issues just confined to the brain, or are they just one of the manifestations of other dysfunctions in the body?

Our brain is an organ, just like the heart, liver, lungs and kidneys are. It gets affected by our overall health. As a functional medicine physician who looks for the hidden causes of disease, what are the things I check when there is a mental health issue in my patients? Here is my short list:

1. Nutritional deficiencies/excesses. Our food is not just a source of calories for energy. They also provide us chemicals that we need to manufacture neurotransmitters like serotonin, melatonin, GABA, dopamine, etc. The protein, fats, vitamins and minerals in our food provide the materials and support the enzymes that make these neurotransmitters. Overconsumption of refined carbohydrates and sugars can cause a cascade of unhealthy chemical reactions in the body that eventually affect the brain.

2. Gut health and microbes. There are numerous published studies showing a strong connection between the health of your intestines and your brain. The types of bacteria in your gut and the food you eat have major effects on what chemicals are created in your intestines, chemicals that eventually enter your bloodstream and affect your brain. Did you know that more than 70% of your serotonin, commonly known as the happiness hormone, is made in the nerve cells of your intestinal walls? Did you know that if you have a low amount of certain beneficial bacterial strains, that you may not manufacture enough of GABA, a calming neurotransmitter, and that if you have a large amount of yeast or certain unhealthy bacterial strains, that you may manufacture more of the “adrenaline” type of neurotransmitters, making you anxious, insomniac, and restless? There is plenty of research evidence showing that our gut bacteria have major effects on our emotions, behavior, and overall health. Unfortunately, traditional medicine has largely ignored that research. Most conventional practitioners are not even aware of them and do not check gut health when assessing patients with mental health issues.

3. Stress and Lifestyle. Stress increases inflammatory chemicals that have all been linked to depression, bipolar disease, autism, schizophrenia, and Alzheimer’s. Therefore, stress management skills are very important to learn and teach. Inadequate sleep and physical activity also contribute to difficulties with memory and mood.

4. Toxins. We live in a toxic world, whether you believe it or not. The questions are how toxic are you, and are you helping your body avoid and remove these toxins. One major category of toxins are the heavy metals, especially mercury and lead. Mercury is ubiquitous in our environment and is a great mimicker – can present as almost any chronic disease because it disrupts so many biochemical pathways. High body burden of these metals are easy to test for and are treatable.

5. Food sensitivities. Eating foods that one is sensitive to causes the gut to be inflamed and “leaky”, allowing for a dysregulation of the immune system, and widespread inflammation, including of the brain. It is important to find out if one has food sensitivities. The most common of these are gluten and dairy sensitivities.

6. Genetic difficulties. There is a common genetic mutation in a process called methylation, that predisposes one to depression, anxiety, bipolar disorder, autism, schizophrenia, and many other medical problems. Mutations that affect our methylation can be checked for using various laboratories, and we can actually circumvent these mutations’ bad effects thru nutrition and supplementation.

As you can see, a pharmaceutical drug approved for depression, anxiety, ADD, etc, may not be helpful if you have any of the above hidden causes of mental health issues. Seeking consultation with a Functional Medicine physician like myself may be what you need to reduce the burden imposed by this disabling set of health problems.

Zorayda “jiji” Torres, MD

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that manifests as abdominal pain or discomfort, spasms, bloating, gas, and abnormal bowel movements with alternating diarrhea and constipation. It affects up to 20% of adults and even children, and is usually a frustrating problem for those afflicted. The usual stool and blood tests, and even invasive tests like upper endoscopy and colonoscopy, are frequently unrevealing of causes.

IBS has multiple causes including stress, food sensitivities/allergies, repeated antibiotic use, parasites, insufficient beneficial gut bacteria, overgrowth of bacteria in the small intestine, and hormonal changes. Frequently, IBS cases start with a bacterial, viral, and parasitic infection, and then the symptoms continue but no cause is found on routine testing. Patient may suffer for months to years and eventually accept this condition as untreatable.

My practice of functional medicine greatly values the health of the gut so I seriously pursue cases of chronic IBS even if previous conventional tests have not yielded any helpful information. I order comprehensive digestive and stool analysis with parasite screening, usually on 3 days of stool samples, from special laboratory tests in the country. The yield with these specialized stool tests is so much better. In one study, Blastocystis hominis, a parasite, was found four times more in IBS patients, and symptoms resolved in 80% of IBS patients when this parasite was treated.

An entity that can cause IBS that is often overlooked is one called Small Intestinal Bacterial Overgrowth, or SIBO for short. SIBO is a condition in which abnormally large numbers of bacteria are present in the small intestine, and the types of bacteria in the small intestine resemble more the bacteria in the colon than those of the small intestine. Common symptoms of SIBO are gassiness and bloating, diarrhea, greasy stools, weight loss, and nutrient deficiencies (e.g. Vitamin B12, A, D and E, iron, thiamine, niacin). Causes of SIBO include low stomach acid, use of acid-blocking drugs, poor gut motility from diseases like diabetes, collagen vascular diseases, immune deficiency states, bowel surgeries, and advancing age. SIBO can lead to many health problems like food intolerances and sensitivities, uncomfortable bloating after meals, nutrient and fat malabsorption, inflammation like arthritis and neuropathies, chronic fatigue, and restless leg syndrome. Therefore, diagnosing and successfully treating SIBO is important. Diagnosis is not through stool tests but through breath tests that measure gases emitted after ingesting lactulose, a sugar solution. Treatment of SIBO is targeted to the underlying cause, and can include antibiotic therapy, herbs, prokinetic agents, removal of acid-blocking drugs (if safe to do), use of digestive enzymes and hydrochloric acid supplements, stress management, and dietary changes (like FODMAPs and SCD diets).

In conclusion, irritable bowel syndrome is a common entity that is frustrating for patients and conventional doctors to evaluate and treat as it has many possible but elusive causes. Hidden parasitic infections, imbalance or overgrowth of gut bacteria in the small intestines are among diagnosable and treatable causes. These conditions, left untreated, can lead to more health problems. Therefore, do not give up if you have irritable bowel syndrome and have not found answers even after exhaustive conventional medicine consults. Seek the opinion of a functional medicine physician like myself. I can offer you highly scientific tests that often yield more results, and treatment modalities that make sense and provide hope.

Colorectal cancer is one of the leading causes of cancer-related deaths in this country. The most definitive way to diagnose it is through a colonoscopy, by age 50 years, or sooner if you have family history, or other diagnosis like inflammatory bowel disease, or symptoms like a change in bowel habits, etc. It is good to diagnose the disease early to increase chances of survival and reduce the amount of surgery and chemotherapy needed.

However, getting a colonoscopy does not mean that you are preventing colorectal cancer from happening. It only means that you are trying to find it early, if you have it. So, what does one actually need to do to reduce their risk of this cancer?

There is sufficient evidence now showing chronic inflammation in the colon as contributing to colon cancer development. There is accumulating evidence too suggesting that the population of bacteria and other organisms living inside our intestines have a role to play in causing this cancer.

Did you know that an average adult has 3 to 4 pounds of microbes living on and in them? Called the human microbiome, this population of 100 trillion microorganisms live in our guts, mouths, nostrils, skin and elsewhere in our bodies. The majority of these microorganisms are in our colon and they vastly influence the health of that organ, and of the whole body.

If we have that huge amount of bacteria in our guts, how come we are not all sick? Well, many of these bacteria actually are beneficial to us. We need to have enough of them and cultivate their colonies as they keep the more harmful bacteria and yeast levels in check. And here is what’s important: these good strains of bacteria thrive on vegetable and fruit fiber! They ferment these digestion-resistant plant fibers into short chain fatty acids such as N-butyrate, acetate and propionate. N-butyrate is very important as it is the main energy source of colonic cells. Among its many actions, N-butyrate has been shown to beneficially regulate the colonic cells’ proliferation, leading to fewer pre-cancerous cells. Thus, by eating more vegetable and fruit fibers, we are cultivating the colonies of these protective strains of bacteria.

Gut inflammation from other causes (infection, food sensitivity and “leaky gut”, nutritional deficiencies, poor blood circulation, etc.), also contribute to the growth of less favorable strains of bacteria in the colon. These strains can produce chemicals that are toxic to our colon. However, studies have showed that anti-oxidant nutrients from foods like cruciferous vegetables, green tea, turmeric, garlic, flax seeds, apples, and many others, can help reduce our risk of colorectal cancer. On the other hand, red and processed meats, cheese, sugars and starchy foods, alcohol (especially in men), can raise our risk of this cancer. Physical activity also reduces risk, while obesity and sedentary lifestyle increase risk.

Therefore, while getting a negative report on colonoscopy is good news, one should still think of taking measures to reduce their colorectal cancer risk. If you have non-specific colitis, symptoms of irritable bowel (constipation, diarrhea, discomfort, etc.), are overweight, diabetic, sedentary, or suffer from chronic inflammation elsewhere like arthritis, autoimmune disease, etc., your risk for colon cancer may still be higher than average, despite a negative colonoscopy. You will need to make improvements in your diet and lifestyle, as mentioned above. You might also want to do a more comprehensive stool test to be better guided.

As a functional medicine specialist, I frequently order a comprehensive digestion and stool analysis through special laboratories, even for conditions that do not seem to primarily involve the colon, like autoimmune disease. These stool tests are much more comprehensive than the ones routinely done at hospitals and local laboratories. They can identify hidden causes of inflammation, which can promote cancer. For example, through these tests, I am able to check if patients have adequate levels of beneficial gut bacteria. I am able to see their N-butyrate levels, low levels of which are associated with poor colonic health. I am able to see certain unhealthy ratios of bacterial groups (Firmicutes/Bacteroidites ratio), which are implicated in obesity, diabetes, fatty liver, and inflammatory disorders. Culture for fungus is also done. If potentially harmful yeast is identified, this can be addressed through diet, use of botanicals or pharmaceuticals, depending on the patient’s overall immune status. Parasites are also tested for using both microscopy and an enzyme assay test. This test can be very useful for those with persistent diarrhea, mucus in stools, and even those with unexplained headache and fatigue. Many other biomarkers of digestion, absorption, and inflammation, are included in this comprehensive stool test. Concrete measures can then be taken to improve the patient’s gastro-intestinal health.

In conclusion, reducing your risk for colorectal cancer goes beyond just getting a colonoscopy. Exercise and a high-fiber diet are important. Getting a comprehensive stool test thru a functional medicine physician like myself, especially if you have chronic inflammatory conditions, may prove quite helpful in achieving optimal colon health and whole body wellness.

Coronary Artery Disease (CAD) is the single leading cause of death in the US and in industrialized countries. CAD develops when plaque builds up in the walls of the arteries, reducing blood supply to the muscles of the heart. A heart attack usually occurs when the plaque ruptures, causing sudden complete obstruction of the blood vessel, and the affected heart muscles die due to lack of oxygen.

Why does plaque build up in the first place? Most of us have heard of the traditional risk factors for CAD: advancing age, male sex, family history of CAD, smoking, hypertension, high cholesterol, and diabetes. However, what most of us do not hear about is that inflammation is the main process that causes these plaques to form! You might ask, inflammation where? The answer is, anywhere in the body! Yes, prolonged, recurrent, and frequently silent inflammation from various causes and places in the body damages the inner lining of our blood vessels called endothelium. This damage begins a cascade of events, eventually leading to plaque build-up.

Before I expound on this inflammation, let’s talk about cholesterol for a moment. Cholesterol is an essential fat that is used by the body to make hormones, vitamin D, bile acids, cell wall components, and others. Cholesterol helps neutralize toxins coming from the gut. When you have an infection, your total cholesterol level goes up. Because cholesterol deposits are found in plaque, it is blamed as the culprit but it is not. It is just another victim and sign of inflammation! Again, you may ask, inflammation where? Anywhere in the body! The coating that carries the cholesterol in our blood, called “lipoproteins”, can get “oxidized” by inflammation and become sticky, contributing to plaque build-up. So, just lowering your cholesterol number by taking drugs is not always the best strategy. The better approach is to lower or stop the inflammation, so the cholesterol does not become sticky and the numbers go down!

So now, let’s talk about this inflammation some more. Inflammation is a normal process that our body mounts to protect us from bad things – injury, microbes, allergens, etc. Short-lived or acute inflammation is usually not a problem. However, prolonged or chronic inflammation IS a big problem, and IS indeed a proven cause of coronary disease! To make things worse, most of these chronic inflammatory processes are silent! To understand this concept better, I will cite examples.

The food we eat can cause inflammation. In fact, the Standard American Diet (SAD for short), consisting of burgers, hotdogs, fries, pizza, cereals, pasteurized milk, cookies, and many processed foods, are pro-inflammatory. Each time we eat such a meal, our bodies become silently inflamed for 4-6 hours. Thus, eating 3 pro-inflammatory meals a day is enough to inflame the body for most of the day!

Poor lifestyle choices, like smoking, drinking too much alcohol, inadequate sleep, and lack of exercise also contribute to inflammation. Prolonged stress is another big cause of inflammation thru the action of cortisol.

As I am a functional medicine physician, and I specialize in finding the hidden causes of diseases, let me tell you about the lesser known, but common causes of inflammation, of coronary or vascular disease in general. I will enumerate some of them:

1. Hidden infections. I would say the most common sites are the teeth and gums, and the gut. Unhealthy gums and tooth decay have actually been shown to be highly associated with coronary disease! People with history of root-canal treatments have also been shown to have more coronary disease. The gut can easily hide a low-grade infection or infestation. Loss of enough good bacteria also allows the bad ones to predominate and weaken our immune system.
2. Food sensitivities. Foods like gluten-containing grains (wheat, rye, barley, etc.), dairy, soy, and others, cause inflammation in the gut, and eventually in other parts of the body. These sensitivities may present as gut-related symptoms like bloating, pain, or as non-gut-related symptoms like fatigue, achiness, depression, thyroid problems, arthritis, arrhythmias, etc. They cause autoimmune disease and vascular disease.
3. Toxicities, including heavy metals and other environmental pollutants. We live in a toxic world. Many of our produce and packaged foods are full of pesticides and additives that disrupt the actions of our hormones, and burden our liver. Heavy metals like mercury, lead, cadmium and arsenic, disrupt energy production in our mitochondria and are common causes of vascular and neurologic diseases. Dental amalgams contribute to your body burden of mercury.
4. Nutritional deficiencies and excesses. For the most part, we are an overfed but undernourished society. We eat too much sugar and starch, trans-fats, and not enough vegetables and fruits. Nutritional deficiencies reduce our ability to fight inflammation and repair damaged tissues. Excessive carbohydrate intake leads to insulin resistance, a metabolic state that promotes inflammation even prior to reaching the diagnosis of “diabetes”. Many drugs that are commonly prescribed also bring about vitamin and mineral deficiencies. A great example is magnesium and potassium deficiency from use of diuretics.
5. Genetic weaknesses. Some of us have difficulties in methylation and detoxification, making us more susceptible to inflammation than others. Some have genetically elevated levels of lipoprotein (a), a protein that can increase the stickiness of the cholesterol particle. These genetic weaknesses, and others, can be tested for and measures can be taken to reduce their impact on our health.

Now, that I’ve listed several hidden causes of CAD, it is no wonder why it is so prevalent. Our blood vessels are just innocent victims of infinite insults happening in our bodies!

Our current healthcare system is excellent in handling acute cardiac emergencies, using clot-dissolving drugs, stents, and surgeries. However, when it comes to chronic management of coronary disease, we often fail to halt the progression, what more reverse it. With a list of causes such as above, reversing it is clearly no easy task. M.D.’s or D.O.’s practicing conventional medicine are usually not trained to investigate these hidden causes, and do not have the time to address them, so they usually use pharmaceutical drugs and procedures, which can be life-saving. However, these drugs and procedures carry risks, are expensive, and do not necessarily stop disease progression, therefore the need for more interventions in the future. Functional medicine physicians, on the other hand, have had extra training to find and help the patient eliminate these hidden root causes of inflammation, therefore also reducing risk for future maladies. I say, if you have coronary or any vascular disease, you need to have both kinds of doctors to help you.

Happy Valentine’s Day!

If you look at a book of medical diagnoses, especially one that doctors use to code your visit diagnosis for insurance purposes, called ICD-9 book, you will find 14,000+ diagnosis codes. That’s a lot of names of diseases your doctor has to choose from to use as a label for what you have…and chances are, your doctor studied hard to learn those long Latin names in medical school, residency, and during board exams.

Now, the new medical code book, ICD-10, coming out for implementation in 2015, has nearly 5 times as many diagnosis codes than in ICD-9! That makes almost 70,000 disease codes! The reasons stated for this increase include: that the ICD-9 “is not sufficiently robust to serve the health care needs of the future”, and “content is no longer accurate and has limited data about patients’ medical conditions”. This is another proof that we are indeed getting sicker as a global society. Many countries have already started using the ICD-10 book. So, you can just imagine, with this new codes to choose from, how much tougher it will be for providers to document a patient visit and order tests and procedures for insurance approval! It certainly will not be easier, I think.

In contrast, what I am learning in Functional Medicine, is that there are only 6 main categories of insults to our well-being! Just 6? Yes, and they are:

You might say that the above 6 are broad categories and that there has to be more details that need to be looked at to arrive at the diagnoses. That is true, but Functional Medicine provides that map for me to navigate through complex histories, physical examination findings, and test results! Functional medicine is a new way of thinking that makes a lot of sense – that’s why it’s beautiful! The whole body is connected and we can often explain why one complaint is related to another, and why finding the root causes and eliminating them as much as possible can heal you in more than one organ system! Your whole body can actually get better!

We all know that chronic mental stress is not good for us. It does not make us feel good. But do we know how? I will give you one short explanation why.

Your sex hormones, estrogen, progesterone, testosterone, and DHEA all come from one parent compound called pregnenolone, which is manufactured from cholesterol. The chronic stress hormone, cortisol, also comes from pregnenolone. When the demand for cortisol is high due to repeated stress, most of the pregnenolone is shunted towards the production of cortisol, and less towards estrogen and testosterone production. The result of that can be hot flashes and loss of libido. Progesterone production is also diminished which initially can cause a person to be in an “estrogen-dominant” state. This high-estrogen, low progesterone state is associated with breast cancer, fibroids, and endometriosis.

So, mental stress alone can induce all these changes. If you add non-mental, physical stresses, in the form of food sensitivities (especially gluten and dairy), nutritional deficiencies, environmental toxicities, poor lifestyle choices into that mix, it is not at all difficult to have multiple hormone imbalances. The takeaway: find good ways to reduce all forms of chronic stress.

How many doctors might one patient see? Let’s count the possibilities …maybe (1) the gastroenterologist for GERD and bloating problems, (2) the ENT for recurrent sinusitis, (3) the internist for asthma, hyperlipidemia, depression, (4) the urologist for recurrent bladder infections, (5) the dermatologist for prior melanoma, (6) the eye doctor for cataracts and macular degeneration, and possibly more!

This is not an impossible list, and was not rare for an older adult in my previous practice to have. I remember how as the primary care physician, I would have to put together all the recent consults and review all the recent tests done elsewhere and recent medications added, just so I am updated. I also know that some of us doctors would not concern ourselves much with whatever else is going on in the organ systems that were not in our specialty. And our poor patients, despite being given the best new drugs (frequently too many) and treated using evidence-based mainstream medicine guidelines, would continue to have unpleasant symptoms, and worse, disease progression.

Such is one of the limitations of conventional medicine. Body organs are treated separately by different doctors as if they were unrelated, and the overall result is not always optimal for the patient.

On the other hand, Functional Medicine connects the dots and puts the story of the patients’ medical problems together. It is holistic, takes into consideration all your symptoms and does NOT say: “Oh that’s eczema, just talk to your dermatologist about it.” Functional Medicine digs deep and far into your history, experiences and exposures, from while you were in the womb and during childhood (if known), all the way to the present. Using this detailed history, targeted physical examination, and both conventional and special laboratory tests, it finds the layers of insults that led to your current state of health. The functional medicine doctor then puts together a very personalized plan for your recovery. That may include changes in nutrition, lifestyle, the use of specific nutritional supplements and prescription drugs, and the use of other non-conventional modalities to alleviate pain and other difficulties. Depending on the patients’ commitment and effort, the result can be an amazing improvement in many organ systems, reduction in need for more medications and procedures, and improved quality of life! For example, in the one patient example given above, after eliminating certain foods in the diet, he or she may eventually get off the acid-blocker drug for heartburns and experience much less bloating, have resolution of recurrent sinus infections and asthma, need less or no blood pressure drugs, get off anti-depressant medications and feel good, have less bladder infections, and have more energy and vitality! In other words, a functional medicine doctor is not a subspecialist, but a “superspecialist”, treating the whole person and crossing many specialties! By focusing on creating health and less on disease care, a functional medicine doctor can give a patient renewed hope for a better quality of life!