Functional medicine is a framework for tackling health issues and an approach to optimizing health that contrasts sharply with today’s “standard of care” medicine model. In this episode we look at assessing the body via the functional medicine framework and your detoxification system.
Where “standard of care” excels at dealing with acute health crises, like car accidents injuries and deadly pathogens and infections, functional medicine has grown to tackle primarily chronic health issues.
The argument for a future where we turn increasingly to functional medicine is that:
- where traditional medicine seeks to manage disease (e.g. pharmaceutical therapy or surgery), functional medicine seeks to identify and resolve the causes of disease.
- Where traditional medicine seeks to place you in a ‘disease category’ (e.g. multiple sclerosis), functional medicine takes a personalized approach.
We’ll get more into what these mean in the episode.
Today’s guest is Jeffrey Bland, PhD who is often referred to as the “Godfather of Functional Medicine“. He has been working for over 25 years in the pursuit of what today is functional medicine, he has over 120 peer reviewed papers on nutritional biochemistry and medicine, is the co-founder of the Institute for Functional Medicine founded in 1991, has served on many boards of health and nutrition companies, a highlight of which was serving as Director of Research at the Linus Pauling Institute where he worked directly with Linus Pauling for a time.
– Jeffrey Bland, PhD (Godfather of Functional Medicine)
Jeffrey is also the author of “The Disease Delusion: Conquering the Causes of Chronic Illness for a Healthier, Longer, and Happier Life“. This is a book I found to be a great read to understand the functional medicine framework and how it looks at the mechanisms for chronic disease and optimum health. I highly recommend it, in particular if you are a physician or if you personally are plagued by chronic health issues.
The show notes, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!
- How functional medicine differs from traditional medicine in its approach (5:00).
- A concrete example of how functional medicine looks at disease: Multiple Sclerosis as a personal disease with many different causes (7:10).
- What changes when you stop focusing on the effect (the disease) and start looking for the causes (13:00).
- How people typically get led to the world of functional medicine – and what the root causes of illness are (17:10).
- Do all headaches have real causes that can be investigated, understood and resolved? (21:10).
- How the functional medicine framework puts you back in control of your health no matter the cause (23:30).
- The birth of the functional medicine framework (the 7 core physiological processes), how it was designed and how it has stood the test of time (26:10).
- In practice: What you can expect from a visit to a functional medicine doctor – what they’ll ask, what they may test, what process they will go through with you to diagnose and resolve your health issues etc. (30:00).
- Example biomarkers, labs and tests used commonly in the realm of functional medicine. (36:30).
- Detailed look at the detoxification process within our bodies (one of Jeffrey’s 7 core physiological processes from Functional Medicine) (36:30).
- Are “Healing Crises” or “Detox Symptoms” necessary in detoxification or during health issue resolution? Or it something we should avoid? (52:00).
- How ‘fasting’ can be counterproductive to the detoxification process (53:30).
- The specialized set of labs and tests that are used by functional medicine practitioners (56:00).
- Jeffrey’s perspective on the future of medicine and what he sees as a “revolution in healthcare” currently taking place including (A) “omics” revolution (genomics, proteonomics), (B) internet and social media and (C) big data analysis (59:00).
Biomarkers and Frameworks
- “Antecedents, Triggers, Mediators, Signs and Symptoms”: Functional Medicine framework that starts the process with a questionnaire or enquiry from the physician aiming to identify possible items from this list to look into in more detail with tests.
- MECE (Mutually Exclusive, Collectively Exhaustive: A framework tool mentioned by Damien that is used extensively in the management consulting world to effectively define and solve problems.
- hs-CRP (high sensitivity C-Reactive Protein): A marker of inflammation from blood labs that Jeffrey remarked as a useful tests as an early step in some cases.
- Hba1c (Glycated Haemoglobin): A proxy measure used to assess your average blood sugar over a period of time. Since haemoglobin is part of the red blood cells it is exposed to blood sugar over the lifetime of the red blood cell, thus giving a measure. As such this measure is used to identify blood sugar control issues. Levels of 5% or higher can be indications of blood sugar disregulation.
- Triglycerides: A measure commonly reported in lipid panels that provides an indication of the excess calories coming into your body and getting converted into fats. High triglyceride levels indicate blood sugar management issues.
- HDL (High Density Lipoprotein): Often referred to as the good type of cholesterol, this marker comes with your typical cholesterol panel. Higher levels of HDL are generally better as they are cardioprotective.
Blood Sugar Regulation Measures
Links to Resources
Jeffrey Bland, PhD and the Functional Medicine Movement
- JeffreyBland.com: Jeffrey’s personal site with his bio and his monthly interviews series in functional medicine amongst other things.
- The Disease Delusion: Conquering the Causes of Chronic Illness for a Healthier, Longer, and Happier Life: Jeffrey’s recent book outlining the Functional Medicine approach and the philosophy that many diseases are not permanent, but fixable, as they represent specific failures of bodily systems that can be addressed.
- Jeffrey S. Bland, PhD published studies: Jeffrey’s PubMed reference with a selection of nearly 40 of the over 120 studies he has worked on.
- Personalized Lifestyle Medicine Institute (PLMI): The institute through which Jeffrey spreads information about and promotes his view of personalized medicine and the idea that “categorized diseases” like multiple sclerosis have many different origins, and need to be addressed by cause, not by disease category.
- The Institute for Functional Medicine: The organization that provide training and certification for functional medicine physicians. More information is available on the approach as well as for physicians interested in learning more. You can also search their database for a functional medicine practitioner here.
Supplements and Treatments
- N-Acetyl Cysteine: Mentioned as a supplement that helps to support detoxification (note: it does this via helping to increase glutathione levels).
- Sodium Citrate and Sodium Bicarbonate: Jeffrey mentioned these as approaches to ‘alkalinizing’ the body’s cells and thus helping improve detoxification. Another supplement that works similarly is Potassium Citrate.
- Coenzyme Q10 (CoQ10): Jeffrey mentioned the role of CoQ10 as a detoxification support.
Other People, Resources and Books Mentioned
- Damien mentioned some of the main functional medicine lab testing companies including BioHealth, Genova Diagnostics (GDX) (recently Metametrix also mentioned was merged with GDX), and Doctor’s Data.
- Health Stores in Los Angeles mentioned: Erewhon and Whole Foods Market.
Full Interview Transcript
[Damien Blenkinsopp]: Great, Jeff, thank you so much for joining us on the podcast this morning.
[Jeffrey Bland]: My deep pleasure. Thanks so much, I’m looking forward to the discussion.
[Damien Blenkinsopp]: Yeah, your book is great. I really appreciate it. It really gives a great perspective on a number of things, a different perspective than most people are used to seeing. So the first thing I wanted to go into was functional medicine. What is the difference between functional medicine and contemporary medicine, the medicine we are used to when we are going to hospitals and primary care doctors and so on? How would you define the differences?
[Jeffrey Bland]: Well Damien, I think that’s a very good question and it really asks of us what is the elevator speech if you have only got a couple of floors in an elevator to describe the difference of how you would do it. And we have grappled with this question for some time and I am not sure I have completely gotten it down, but let me give it a try. The medicine that most of us are familiar with is insurance reimbursable kind of traditional hospital based or clinic based health care, that in which I was trained in and most docs today were trained in. It is focused on the disease, the primacy of disease, and so it is all about the diagnosis and then finding the appropriate treatment for that diagnosis.
The diagnosis is really related to a clinical series of presenting signs and symptoms so the patient comes in with whatever their complaints are. The doc reviews those complaints, they do whatever lab tests might be suggested from those complaints, and then from that name a title of a disease is finally given from which then reimbursement can occur and therapy can result, generally pharmacotherapy with some kind of drug or drugs and surgery. That, however, doesn’t ever really address the question of where these things came from, what is the cause of these conditions. so often we end up being able to treat effectively the signs and symptoms of it’s outcome, the disease, without treating its cause.
Functional medicine is all about the cause, it’s not about what you call it. It’s all about how you got there. So the most important thing for a functional medicine provider is to understand what we would call the journey that led to a diagnosis to treat the cause and not the effect, whereas medicine today I think is more involved with calling what the final destination is and treating its effect rather than its cause.
[Damien Blenkinsopp]: Great, and if we could take a concrete example I think that might help to clarify it for some people. One of the diseases that is defined by the world of primary care and so on is multiple sclerosis, right? So that’s a disease condition and there are a number of drugs and things around available to treat that. How would functional medicine look at that? What are the differences in the way you would look at multiple sclerosis?
[Jeffrey Bland]: I think that’s a really excellent example, actually. That fits right into this discussion very nicely and in fact it is actually one of the examples that i use in the book The Disease Delusion to help the reader to kind of understand the difference between the functional medicine approach and a traditional diagnostic pharmacology approach.
So a functional medicine practitioner, when they would see a person who has been diagnosed with MS would first ask the question in their mind – what do we know about MS? We know that multiple sclerosis is a member of the autoimmune family of disease. These are the diseases that are characterized with the body’s immune system attacking itself, attacking the body itself and leaving the collateral damage.
In the case of MS the body’s immune system is attacking the nerves. And specifically the insulation of the nerves, which are the myelin sheaths, the things that coat the nerves that are kind of like insulation on a wire that is plugged into the wall socket. It is the insulation on your nerves and it protects the wire, the nerves, from being damaged or having problems with transmitting electricity like you would have in the socket of a light.
And so when your body’s immune system attacks the insulation of your nerves, the myelin, it starts to lead to kind of a short circuit of the nervous system, just as if if you lost the insulation off the wire and it goes to your lightbulb, you might end up short-circuiting that and maybe sparks would fly out or you would catch the curtains on fire or any number of collateral damage could occur from losing that insulation. And so the treatment of choice is to give an individual who has that diagnosis of MS, drugs that are designed to try to block the effect of that immune reaction against your nerves, so it would be certain kinds of anti-inflammatory drugs or drugs that prevent the insulation of the nerves from being further damaged.
The functional medicine approach, however, would be to ask why is that person having the loss of the insulation on the wires of their nerves? What was the cause of this? And the first kind of assumption that many people have is well, that must be in my genes. Gee whiz, I have family members that have autoimmune disease or I have a family member that might have even have had MS. It must be my genetic inheritance. However, when the data is looked at as it relates to that specific disease, MS, like so many other of the autoimmune diseases, there is a very weak linkage between genetics and MS.
It is not a hardwired genetic disease. So it may have a weak linkage to certain immune relationships that give rise to autoimmunity, but it is not a disease where we can say this is a cause, this is caused by your genetic heritage. Therefore there must be another factor or factors, and this is where the functional medicine detective story emerges, because a functional medicine practitioner would then say let’s look at all the various factors that have been identified in the medical scientific literature that are associated with the cause of an immune system attacking the nerves. And this could be things like toxic chemicals, it could be things like heavy toxic elements like mercury or cadmium.
It could be things like reactions to certain food proteins that your body sees as foreigners, one of which would be gluten. It could be the result of insufficiency of specific vitamin factors, particularly vitamin D, which has been studied extensively by Michael Hollick, Dr. [Heeney 00:11:20], and Dr. [Holub 00:11:22] as it relates to vitamin D insufficiencies. Or it could be associated with situations that relate to the exposure to what you would call xenobiotic chemicals, certain agents that activate the immune system, including certain members of the drug family which certain individuals have immune response to and it becomes seen as a foreigner that the body’s immune system then starts attacking the nerves. So there is a whole laundry list of various agents that might trigger the immune system of a person who is considered normally healthy to now start developing an immune reaction to their nerves.
So rather than just jumping in and giving a person something that blocks the inflammation, the functional medicine provider would start going through as a detective might – the Sherlock Holmes of the etiology of the condition, asking could this person that has this condition have these problems? Could they be suffering from too much mercury? Could they have too much cadmium? Could they be suffering from exposure to certain chemicals? Could they be taking certain pharmaceuticals that activate the immune system? Could they be vitamin E deficient? Do they have certain food allergies like gluten that are inducing this immune response?
Then from that detective approach that the kind of examination, a tailored, personalized program for that individual’s own forum of MS would be developed, rather than just treat them as a person with MS like you would with any other person with that diagnosis, you now design a program based on their specific, unique presentation that is focused on managing the cause and not just the effect. And those results, when you deliver that model in clinical practice, can be extraordinary. It can be miraculous.
We have seen literally hundreds of patients over the years that I have been involved with the clinical research and overseeing clinical research centers and when patients come in with various forms of MS or various forms of autoimmune disease and how there are conditions once you identify the cause and not just the effect can be completely turned back and you go into remission. So that is a different model.
[Damien Blenkinsopp]: Yeah, thank you very much for that. So if I kind of retake it and see if you can say if this is accurate or not. Traditional medicine is looking at the effect and it is trying – the effects, and the symptoms you have. they are trying to categorize a number of diseases that they have on record. They have a hundred different diseases, cancers, multiple sclerosis, Parkinson’s, and all these things which have been categorized according to symptoms, a list of symptoms, whereas when we are coming from the functional medicine side we kind of ignore that for the moment and we say okay, just because they have these symptoms we don’t know what the actual cause is.
So we are going to do a number of different tests and we are not going to make any assumptions about what is actually causing this until we have done some investigation and the idea is that we can find any number of causes and they could end up at the same symptoms due to the mix of genetics, epigenetics, and the other processes going on in our bodies. But they can arrive at the completely different ending, the symptoms, from completely different causes. Is that an accurate representation of what you just said?
[Jeffrey Bland]: Yes, I think very much so and I think for the listener it is important to know that the number of diseases within the diagnostic handbook are literally thousands of different diseases. And often a doc might feel that their job is over once they have got a good diagnosis because then they can dial up a specific pharmacotherapy. But within each of those diagnoses, no matter what the name is, whether they have diabetes or arthritis or MS, every person with that diagnosis, that specific diagnosis, presents slightly differently.
They have a different reason that it gets worse and it has progression. So in the absence of personalizing treatment to the individual need and focusing on the cause and not the effect, you don’t get the optimal outcome. And that is the functional medicine revolution, looking at the person as a unique individual and personalizing their treatment program appropriately.
[Damien Blenkinsopp]: Right, thank you very much. Another aspect I wanted to see and what a value that I see in a functional medicine encounter where I came into contact with it from my personal story is because it is the story of categorization of systems there are many people that fall through the cracks, however, because their symptoms aren’t acute enough so they don’t meet a diagnostic criteria.
For example, an MRI wouldn’t show the white blips used for multiple sclerosis in those kinds of scans, for example. Or they are not meeting those diagnostic criteria which falls neatly into one of those categories and they maybe have some symptoms which are considered that everyone should have these days. For example, everyone complains of headaches and everyone has a bit of fat around their stomach these days and they find it hard to get rid of and they blame it on a number of things.
So my own personal story is that I kind of fell through the cracks because I didn’t fit into any categories and I know there are many people who do that. And we finally end up at functional medicine, and functional medicine seems to say we can try and resolve any condition that you have from a basis of looking at a list of potential causes and it is supposedly a comprehensive list of things that can go wrong in the body and working its way through that.
So is that another way to look at it? I know a lot of people kind of end up at the functional medicine road end of medicine because they have kind of fallen through the cracks or they have some chronic condition which doctors aren’t addressing properly. Is that a fair assumption as that is how most people arrive at functional medicine and also if you are able to in fact pretty much attempt to resolve any kind of symptoms or anything that is not working correctly in the body?
[Jeffrey Bland]: Yes, and again I think you really pointed to a major issue within the way that our healthcare system works right now, which is basically a disease-care system as we know it. It is not so much focused on health as it is the treatment of disease. So when a person has broad ranges of chronic symptoms that cut across many different organ systems, it could be fatigue and pain and low energy and cognitive dysfunction and gastrointestinal problems and alternating constipation and diarrhea and sleep disturbances and depression.
They may come with a whole laundry of different chronic systems and depending on what doctor you see, they are all going to try to drive those symptoms into a specific diagnosis and it is going to be based on their background. So they are going to find the disease that they are most comfortable with to use that as a name that they are going to apply to that cluster of symptoms that the patient presents with because they have to get a disease diagnosis so they can get reimbursed. So they are going to call it something. Well the something they call it may not be nearly as important, as you have said, as how the patient got there. And what were the various factors in their lifestyle and their environment that were really creating this complicated disturbance in the physiology that has caused their chronic illness?
It is not a disease as much as it is a disturbance that is caused by the mismatch between their genetic uniqueness and their environment. And if you don’t start asking those questions then you never really get the answer. What you do is you end up with kind of a round robin of different doctors with different treatments that treat different treatments with different drugs to suppress pain or inflammation or suppress sleep problems or to block stomach acid. What is unique to those is you are basically uncoupling the smoke detector, you are not treating the fire i the room. You are uncoupling the signs and symptoms that were there really to tell you there is something going on that needs to be addressed.
So the functional medicine model often is very attractive to a person who has a history who has a lack of success with the traditional disease diagnostic and treatment model because it just hasn’t been successful in managing the range of their clinical problems because they have never asked the right questions. And it turns out that if you look at the kinds of conditions that are dominant within our society today they are these chronic conditions. In fact, over 75% of healthcare expenditures in our system today are spent for the management of chronic illness – not acute disease, but chronic illness. Yet, when you go to have a chronic illness managed it is often managed with drugs that were used for acute care. They are not really drugs that treat the cause of the chronic illness, they are drugs that are treating the acute symptoms and not treating its cause.
So I think we have a very big mismatch of what patients would like and what the treatment approach that they are getting, where it is being applied. And that is where functional medicine has a big role to play.
[Damien Blenkinsopp]: Yeah, great, thank you. So just to give the audience a bit of an idea about this, would you say that headaches are resolvable? Is that the type of chronic condition that we – I have had some strange headaches when I got ill a few years ago and they sent me to a psychologist. And in the world of functional medicine I know that happens to a lot of people, or they keep getting the answer that everyone kind of has headaches and it is not resolvable. And I think headaches are a very common thing, a common complaint today. And a lot of people are going to pharmacies and taking medications for this.
Do you think this is something that is resolvable, like in 90% of the cases, with the functional medicine approach? Or at least there is a good percentage of those that can find some kind of cause behind that and it is not normal to just have headaches?
[Jeffrey Bland]: Well again, I think that is a wonderful example. You are picking some great examples. Headaches is one of those conditions that is a sign or a symptom and not a disease in itself that has many multiple functional contributions that lead to what we call headaches. So it could be a magnesium deficiency, it could be a vitamin B6 deficiency.
It could be, again, another relationship to a food or environmental sensitivity or toxicity of types. It could be related to a problem with the microbiome, that bacteria are producing toxic secondary byproducts that have an effect on the function that we see ultimately as a headache. It could have to do with the vascular effects that are associated with the lack exercise. It could be due to hypertension because the person is taking the wrong kind things in their diet and lifestyle that are increasing their blood pressure and putting them on a vegetable-based diet and lo and behold their headaches go away.
So a functional medicine provider would look at this list of potentials and start making a differential diagnosis of that individual patient or an assessment as to what their specific causation might be of their headache, and work with them not just giving them a headache treatment remedy and drug to again, uncouple the smoke detector of the headache and to treat the cause of that condition. When, in fact, that occurs, i don’t have a specific percentage I could give you but I would say for sure the vast majority of chronic headache sufferers will be in remission. Their headaches have been demonstrated to go away. So I think this is another great example of a clinical presenting sign and symptom that through a functional medicine systems biology approach it can lead to remediation because you treated the cause not just the effect.
[Damien Blenkinsopp]: Right, and what I love about the philosophy is that it kind of puts control back in our hands because we are saying that there is always some cause of what is happening and it is not just that in conventional medicine they will put it down to genetics or something that is not addressable. Often in functional medicine the locus of control comes back to us and it just says that we have to find the cause. If we can find the cause then we can fix it, no matter what is going on with the human body and causing these symptoms. Is that a fair reiteration?
[Jeffrey Bland]: Yeah, absolutely, exactly. If I was to try to kind of distill down the whole focus of my book The Disease Delusion, that is really what it is all about, returning the power to the individual for the control of their health. I think a lot of people have had their health kind of hijacked from them because they feel it’s either a consequence of their genetic lineage that they had no control over or it’s their doctor that is control their health. In essence what we have learned since the deciphering of the human genome in 2000 is that actually we control, each one of us controls how are genes are expressed. And the way that we think, act, believe, behave, rink, eat, exercise, sleep, have relationships with other people, think of ourselves as valued parts of society.
Those all have direct impact on how our genes are expressed and regulate how we look, act, and feel. So I think this is a hugely empowering age in which we live, in which the individual becomes much more important than they were in the previous period of society when we were all part of massification of society where we just wanted to be part of the average. Now, the power of the individual has become very, very important and we can give people the tools to not become doctors, but to understand themselves well enough that they can start navigating through life in such a way to design their own health program that is contrasted to their own disease treatment program, which comes from the doctor.
[Damien Blenkinsopp]: Excellent. So in a minute I would like to give us a little bit more a practical or quantified focus – we often talk about quantified aspects here – about how to make use of labs and data and functional medicine to identify the causes that you are talking about. But first of I just wanted to look at that basically you have a framework in your book The Disease Delusion, and it is this framework for saying these are all the potential causes of problems. The framework that you describe, is that the basis of functional medicine today? Or is that coming from you? Could you give us a bit of an overview of where that framework is? I think it’s really great, a lot of the aspects of it – I haven’t seen them described in that way before.
I think it seems like what we would say in consulting language – MECE was mutually exclusive and comprehensive, basically, so it covers everything. It is a very nice framework, I can say, from my consulting background. But just from your perspective, where does that come from? Is that something recent or is that something that has been used in functional medicine for a while? Is that something that you are hoping that will be used more and more going forward?
[Jeffrey Bland]: Yes, thank you. The way that this functional medicine concept was actually birthed was through 1989 and 1990 my wife and I hosted meetings about a week long each in Victoria pretty strongly on Vancouver Island where we invited about 30 or 40 of the top opinion leaders that we had met from different fields to kind of sit down quietly over a period of a few days with a whiteboard and address the question – what would be the best possible medical system that you could conceive of with your experience from the different disciplines they represented. Let’s not talk about reimbursement and let’s not talk about fair financing, let’s just talk about theoretically what would this system look like.
And from that to your exploration emerged the concept that we would develop a system that really looked at the individual and how they, over time, had altered function and we had different diagnostic criteria, different assessment tools, and we would be able to, earlier on, be able to understand when a person is heading at a trajectory towards a disease well before they become a cancer patient or a heart disease patient or a diabetic patient or whatever it might be. And that led us into asking what would be then the types of things we would want to know of that person so we would be better able to, early on, understand their trajectory towards not-optimal health.
And we started looking at the scientific and medical literature and this group of people were pretty good and understanding what was going on within the discoveries that were being made and we eventually started putting references and articles together and stacking them in different piles to see if they fit into different kind of what we call ‘buckets.’ And from that eventually emerged the fact that these conditions that lead to altered function that later became diseases as a person progresses towards more severity could be characterized into seven different buckets. And we call those the seven core physiological processes. And over the now-subsequent 25 years since that time lo and behold those buckets were pretty close to the way things have evolved in science and in medicine over the last quarter century. So those buckets included detoxification, they included immune defense, it included hormone signaling, they included gastrointestinal function and included structural relationships that included bioenergetics. Each one of these seven core physiological processes, by the way, I have described in individual chapters in my book.
Then we developed questionnaires for the patient that were associated with presenting clinical symptoms and signs that were associated with the dysfunctions in each of those seven areas. And to help the person to better understand where were their strengths and where were their weaknesses, and that formalism became then the functional medicine assessment program and approach. And obviously over the last 25 years it has become much more sophisticated and much more well-defined and well-understood. But I am quite amazed and what we birthed or germinated in 1989 and 1990 that has really proven out over the last quarter century to actually be very applicable to clinical intervention and to improving outcome in patients with chronic illness.
[Damien Blenkinsopp]: Great. I didn’t realize the structure of the framework had been around that long. I assumed it was actually maybe something that you had come up with pretty recently because as you say, it echos all the current themes of research and everything that is currently going on in it. So in terms of the process that you go through, if you could give us a very high view of what happens when you go to see a functional medicine doctor with some complaints that you are not sure of – is it a very typical process? Like, do you start with the questionnaires, you said, to kind of identify the different parts of that seven piece framework that goes wrong? Can you walk us through the kind of top level of what would happen if someone went to functional medicine?
[Jeffrey Bland]: When you go to kind of your traditional disease-focused practitioner, the whole drive is to try to get a differential diagnosis, try to get a name that you can put on your condition. And that’s different than the functional medicine practitioner. They may obviously be interested in a diagnosis if a person has one, but their approach will be different from the beginning in that the approach is to look at the antecedents, triggers, mediators, signs, and symptoms. Now, what does that mean?
Antecedents are the preceding factors in that person’s life that may have given rise over time to the clinical condition and the problems that they are experiencing. And that has to do with looking at your genetic background, looking at your family history, and looking at various kinds of things that may have happened earlier in life, it could be illnesses, surgeries, and just a really good what I call historical, history and physical, as well as bringing genetic information into the story and other aspects of their environment and lifestyle habits. That is antecedent.
Then the next question is what are the triggers that are triggering your antecedents? Those kinds of signs and symptoms that you are presenting with, the things that brought you to see a healthcare provider. Most patients, when they are most people and they feel perfect, they don’t wake up and say, ‘Oh gee, I ought to go see one of my health care providers because I feel so good today and I ought to find out why.’ But they come because they have a series of complaints. So the triggers could do things like maybe an automobile accident or maybe a severe trauma that you have had, a psychological trauma with a partner, a spouse, or a child. It maybe be an infection. It may be that you just were put on a certain medication, that you are having an adverse response to it. Maybe an environmental exposure so these are the triggering agents that then are the exacerbators, like the straw that broke the camel’s back.
The triggers then produce a series of what we call mediators in the body. Mediators could be different hormones, it could be inflammatory cytokines, it could be different types of things that relate to our body’s immune response that you can measure through laboratory testing. So these mediators are your body’s response to the triggers that laid on top of your antecedents. And then those then produce your signs and symptoms of different severity, duration, and frequency. The evaluation of that whole story that I have just described, antecedents, triggers, mediators, signs, and symptoms, gives rise to an understanding of the patient’s story. And the patient’s story is the most important part of this whole differential assessment that the functional medicine provider uses. Now, maybe that story will ultimately lead you to say that we can call the story diabetes. But it is diabetes of a unique type that is unique to that person, that needs their own type of intervention because of 100 diabetic patients there are 100 different stories with the same diagnosis.
So this is how one would come about developing a relationship with a functional medicine provider versus an individual that might just say, ‘Oh, you have diabetes. Okay, so you’re going to get metformin and you’re going to get Actos. That’s the drugs of choice.’ In this case, we are looking at a much more deep and broader relationship between why your blood sugar and insulin-related glucose problems are presenting based upon your own antecedents, triggers, mediators, signs, and symptoms.
[Damien Blenkinsopp]: And having been through this process myself, I would say that something that comes across very different from the first part is that the question I was put to first when I went through the process was I was asked when was the last time you felt completely well? And I think the answer to that comes back very differently to when you go into a traditional doctor’s office and I had to think back and I was like, ‘Well, actually, this has been going on for over ten years. There were some tiny things that were going wrong many, many years ago.’ So I think that is an interesting question and it really starts the whole discussion on a completely different level. Is that the typical question that would be asked.
[Jeffrey Bland]: Yes, I think you will notice in my book that the first questionnaire in the book asked that very question – do you feel your health has changed significantly within the last year? That is a very, very important question because it helps us to understand the trajectory towards change, the change in health which is related to functional change, which is related to there is something going on that your genes didn’t change in that year. Something happened to how your genes are expressing their function. And then we start asking the questions from there. So yes, that is a very first-level, important question.
[Damien Blenkinsopp]: Great, thank you very much. Now, how does this connect with what we call more quantified aspects of this in terms of lab tests or any other diagnostic tools. Is there a typical first stage in looking at lab tests? Are there kind of favorite areas of testing of functional medicine? What kind of things would you say are important in functional medicine when it comes to the testing aspect?
[Jeffrey Bland]: Well, I think this is a little bit like the layers of an onion. We start off with the easiest and the least expensive things first, which is a good assessment using the antecedents triggers, mediators, signs, and symptoms approach that is unique to functional medicine. You can do that by questionnaires and these are kind of pen and paper pieces of information and many of those questionnaires have been included in my book and also what I call physical assessment. And their functional medicine provider is very skilled in understanding how to assess nutritional inadequacy with presenting signs and symptoms and how to assess different immune-related dysfunctions so you have a good physical and history evaluation and start there. That is the least expensive and the least invasive.
Then the next level would be to say okay, we have identified certain areas, let’s call it a gastrointestinal area, where you have got recurring irritable bowel syndrome or you have got all upper GI dyspepsia where you have reflux disorder or something of that nature, so you have certain kinds of information around a particular area of the body that is experiencing problems and you want to get more information about what is the nature of that functional difficulty. Now, you would go into more detailed testing.
So for GI problems you might do a stool test to evaluate whether there are funny bacteria that are producing what we call dysbiosis and causing inflammation of the of intestinal tract, you might do a certain type of blood test looking at different types of inflammatory agents like high-sensitivity C-reactive protein, which is a marker of inflammation. So you then start to put together a series of questions as a practitioner that would be the questions that you think are most important as you try to decipher that patient’s individual problem, always remembering that you want to keep the cost of your assessment to the lowest level possible so you don’t throw the whole kitchen sink and you start to layer on the testing as you are making your discovery. And you may have if it is a very complicated, sophisticated case, it may require more testing and you may have to do fatty acid testing, amino acid testing, immune testing, and there may be all sorts of heavy metal testing. So there could be a whole range of different things you layer on, depending upon how sophisticated the problem that person is presenting with.
[Damien Blenkinsopp]: Thank you. Are there any particularly, amongst functional medicine providers, any particularly popular areas of testing or specific tests that you may have seen provided more value over time and then are kind of your go-to tests which you tend to find more information there and find them more useful?
[Jeffrey Bland]: Yes, I think there are. I think that you could start with probably the most common and also one of the most informative and that is to test glucose tolerance that person has. And this is how insulin is working in their body. So this would be, starting with a simple blood test of blood glucose and what is called hemoglobin A1c, to see if they have a problem in managing their blood sugar and managing their insulin reactivity in the body, and they probably would also want to measure in their blood what’s called triglycerides and we would want to measure HDL, the so-called good cholesterol. But that portfolio of tests that was specific to insulin would help us to identify whether that person might have an insulin resistance and a glucose intolerance. So if they had an elevated blood sugar, they had an elevated hemoglobin A1c, they had an elevated triglyceride and a low HDL, we would say, ‘Oh, now that is a person that has a form of what is called metabolic syndrome and we would want to start managing their therapeutic approach, the functional approach based upon the fact they are insulin resistant.
For another person, it might be that they are presenting with, as I mentioned, a long history of gastrointestinal-related problems. So in that person we would be more interested in maybe focusing on doing what is called a comprehensive stool analysis to look for things that are going on in the digestive system that are related to dysbiosis, inflammation, and food or toxic response. For another person, it might be that they have headaches and cognitive dysfunction and dysphoria and kind of depression symptoms and low energy. And we might think that sounds like a person that is more likely to be toxic so we would want to do something related to toxicity testing and probably do assessments of their liver’s ability to detoxify foreign chemicals.
All of this, by the way, I have described in the book in different chapters as to how you put this together. But based upon the presenting signs and symptoms that a person has, it helps guide the individual as to what the specific quantified information they would want in order to make their assessment.
[Damien Blenkinsopp]: Thank you very much for that and I would like to take a bit of a case example with detoxification because I think this is an area in which traditional medicine tends to address less and functional medicine tends to consider more strongly and look more at. So it would be nice to, as you say in your book, you go into each of the seven areas in a lot of detail. And you give a lot of good case studies, which is very helpful to connect to what is going on there. So in a detoxification case what kinds of things that you were just talking about, liver tests and so on, what kinds of things would you look at first to understand if someone had a level of toxicity of toxic burden that they had to deal with and that was potentially causing their symptoms?
[Jeffrey Bland]: I think there are two types of testing that are done for toxicity and its relationship to the body’s ability to detoxify. The first is to look at the presence of toxins in the body and there are a variety of different types of testing protocols or tests themselves that actually measure the level of things like [inaudible 00:41:25] or heavy metals like cadmium or mercury or lead or arsenic or aluminum that can induce toxicity. So these would be examining the presence of toxins in the bladder, in the urine, or in the sweat or fatty tissue. And the other type of test is to look at the individual’s ability to detoxify and our detoxifying system is controlled principally by two very unique enzyme systems that are present in our body. One are called the [inaudible 00:42:00] enzymes and the other are called the conjugase enzymes. And they reside to a great extent in the liver but they are found in virtually every other tissue in the body as well, including the gastrointestinal tract where these enzymes sort of clamp on to these foreign substances and to detoxify them and be able to eliminate it in a nontoxic form, even in the urine and the stool, to get them out of the body. And people have a significant difference in their detoxifying abilities from person to person. this has to do with both differences in their genes and their genetic ability to detoxify. One might have what we call a fat detoxifier effect for certain chemicals. Another might have a slow detoxifier effect. And secondly it has to do with how they have treated their detoxifying systems. In other words, have they eaten the right foods with the right nutrients that are necessary for the support of those detoxifying systems? Nutrients like magnesium, the B vitamins, Co-enzyme Q-10, N-acetyl-cysteine – these are nutrients that are known to be very important for support of our detoxification system.
So the detoxifying ability of our body is really related to how much toxin are we exposed to and what is the relative effectiveness of our detoxifying system in the body to get rid of them? And so we can have too much exposure or too little detoxifying ability, both of which leads to a state of chronic toxicity. I call it metabolic poisoning. And this condition is not so obvious that the person is acutely toxic, like you would have from a poison like strychnine, but the symptoms are often seen by what I call chronic both immune and nervous system toxicity. These are the two most sensitive functions of our body to toxicity. One is our immune system and the other is our nervous system. So the signs and symptoms that are seen with chronic metabolic toxicity are focused around neurological symptoms.
So this has to do with depression and sleep disturbances and foggy brain, where a person can’t think clearly – low energy and various forms of cognitive dysfunction where they can’t manipulate numbers or quick ideas as effectively as they used to. With immune toxicity it has to do with an immune system that is kind of working against itself. You have inflammation present and you also have increased rates and various risk to infectious organisms, viruses, and bacteria, so that the combinations of those symptoms often is associated with this cellular toxicity for which then the appropriate detoxification program for that patient that is based upon their own unique case can lead to extraordinary benefit and improve their function.
[Damien Blenkinsopp]: Thank you very much because I think also the area of toxins and detox – if you are working in a health store today – I am in LA and places like [Air One 00:45:14] or Whole Foods, there is a whole range of detoxification supplements. There are aspects of the products in the shops like alkaline water and so on. There are a lot of products now that are focused on helping to detox, but I feel like there is a fair amount of a lack of rigor in a lot of the scientific basis for a lot of these.
One of the areas that I have heard you talk about at the detox summit, which I thought was particularly interesting, is the topic of alkalinity, which comes up a lot. There is a lot of alkaline water that is sold in shops, for instance. And it is said that if we take in more alkaline we make our bodies more alkaline, and it helps us to detox better. What is the scientific basis for that and is it actually true? What kind of things can be done in reality if it is effective to actually make that change?
[Jeffrey Bland]: Alkalinity is related to the balance between acids and bases in the body. And for those individuals that are not necessarily up on their human physiology our body, in its natural state, if you look at the blood it is slightly more basic than it is acidic. It has what is called a pH, which is a measure of acid and base characteristics, and if it was perfectly balanced it would be a pH of 7, that is neutral. A number higher than seven means it is slightly more alkaline and a number lower than seven means it is slightly more acid. The lower the number goes, the more acid, and the higher the number goes, more alkaline. And the body’s pH is around 7.37 in the blood, which is slightly alkaline, slightly higher than neutral, which is seven.
The situation in terms of chronic illness is that often cells or tissues have pH that is lower than 7.37, meaning they are shifted towards a more acid side slightly, not into what we call metabolic acidosis, which is an acute situation that can be life-threatening, but just a slight shift in the alkaline balance. And this is a consequence of a whole series of metabolic effects that shift the pH of cells slightly towards a more acid side. When I say slightly towards a more acid side what I really should say is a less alkaline side.
The detoxification of the process that occurs within cells in the liver and other tissues requires a pH and a balance that is more close to 7.37. It likes that more alkaline state for optimal detoxification function. If a person has a poison in their cells, that poison often shifts their cellular pH to the more acid side, less alkaline. And there are many studies that in poison centers that have shown that if you administer an alkalizing agent to that person, and this could either be done intravenously or orally, meaning given something by mouth like sodium citrate or sodium bicarbonate, these are alkalinizing substances and it will then improve their detoxification ability.
Now, in the case of chronic metabolic toxicity you don’t need to use – and obviously administration into your blood of an alkalizing agent – but an alkalizing diet can be very, very helpful and these are basically vegetable-based diets. Animal-based diets tend to have an acid residue and they tend to be acidifying. Vegetable-based diets rich in plant foods tend to have an alkaline residue and tend to be alkalizing. And so you can use plant foods, a plant food diet and more vegetables and fruits in alkalizing or you can also use supplementary alkalinizing substances like sodium bicarbonate or sodium citrate, other things that will slightly shift your body’s balance more towards the alkaline state. And that will help improve your detoxification ability.
[Damien Blenkinsopp]: Great. So a couple of clarifications on some of the things that you spoke about there. You were talking about the blood pH 7.37 and if we wanted to measure this slight acidity change that you spoke about, is it possible run lab tests on the cell pH and the tissue pH? You were talking about those verses blood, which I believe blood is always kept roughly at 7.37 and it doesn’t actually change and it is just the cells and the tissues that actually change. Is it possible to quantify that and is it a very slight change or are we talking about 7.1, 7.2? So it is kind of like a [inaudible 00:50:02] test to understand that?
[Jeffrey Bland]: Yes it is, and I am talking here about very slight changes. More acute or more dramatic changes are associated with life-threatening conditions because your body needs to stay within a very close range in its pH in order to function, or the muscles can’t work correctly and the brain can’t work correctly. Your heart can’t fire correctly so if you change too much in your pH you can have very, very serious problems. So we are talking about very small shifts in cellular pH. As it relates to technology, yes, there are research technologies and there are probes, cellular probes, that can be used to measure intracellular pH. But these are not standard diagnostic pieces of equipment.
So most of the time an assessment of pH is really built on clinical signs which can be things like muscle cramping or things like in the case of moving acidosis you have people whose breath changes, it becomes sweet and acidotic. You have people who have difficulty with chronic pain that is often associated with a slight shift in pH. You know about lactic acidosis that we call the muscle pain and fatigue-related problem that occurs in the marathon and heavy exercise. There is chronic lactic acidosis that is associated with this as well as chronic muscle pain. So these are more common types of things that I think one uses for assessing pH balance versus using a specific diagnostic laboratory procedure.
[Damien Blenkinsopp]: Great, thank you for that clarification. The other important aspect I have seen about alkalinity is there is a lot alkaline water for sale now in a lot of the shops. From your perspective, does that help to change the cellular pH? Is that beneficial at all or is there no science behind that?
[Jeffrey Bland]: Well, I haven’t seen a lot of good research on it. I mean, a lot of these things that we see that are being sold commercially – I have a theory of interest but in practice there is no real clinical data to support their expense. And when we start looking at some of the cost and benefit relationships, the cost is reasonably high and the benefit is not so obvious. So I am a little bit skeptical of some of these claims that are being made.
[Damien Blenkinsopp]: Thank you very much. Another important topic and one that has always been relatively confusing to me on my journey of getting better is healing crises, or detox crises. Supposedly when we are detoxifying sometimes we have to go through this period of feeling worse in order to feel better. What is your perspective on that?
[Jeffrey Bland]: Yeah, I think that is another very interesting observation, having been involved with this field of metabolic detoxification now for the better part of 30 years and published many papers and seen literally thousands of different patients under controlled studies in detoxification over those 30 years. I have come to the recognition that the concept of a healing crises we ought to drop the term ‘healing’ and just call it ‘crisis.’ There is no such thing as a healing crisis. When you are in crisis if you have acute symptoms that is not a good thing. That is the body saying you are overdoing it.
A properly designed detoxification program does not produce a crisis. It may produce transient symptoms, it may produce a feeling of spaciness on the second or third day, ravenous hunger for a couple of days until you get your body adjusted. It may even have things like joint pains and headaches that occur, but these are not a crisis. They should be easily manageable and if they are not then that program that you are using for detox is inappropriate and it needs to be modified.
[Damien Blenkinsopp]: Thank you very much. What kinds of things could bring this on? Through my journey I was going through a lot of healing crises until actually I came across you talking in the detox summit. I finally got the answer to this question which I had been asking a lot of people for a long time about these healing crises, and if it is necessary or not. It makes it very hard to understand if you are getting better or if you are getting worse, so I think it is very confusing for a lot of people on their journeys, no matter the condition.
So in terms of where this comes from, since I learned about this – I don’t get healing crises anymore and it is really great. It is obviously a great benefit to the patient, and it keeps them more motivated as well. And from your perspective where is the healing crisis coming from? Is it something specifically that hasn’t been addressed and needs addressing? Are there a couple of routes that need addressing or is there some simple way of looking at that?
[Jeffrey Bland]: I think so. the model that I have used, which I believe is factually correct, is that a person who is overloading their body’s detoxification system through a detox program, meaning that they are releasing more toxins from stored fat tissue or within the body than their detox system can manage, now what they are getting is an amplified toxicity. It is actually their body is now toxic because they are not able to manage the toxins that they are releasing. And so the way that you prevent that is to slow the release of toxins and to increase the body’s detoxification program or detoxification ability.
That is why I am not a big believer in fasting as a focus for detoxification. Because I think in fasting you get into nutritional depletion and that then lowers your body’s detoxification ability and makes you more vulnerable to the toxins that you are releasing to produce toxic symptoms. So the approach that we developed starting back in the early 1990s through the studies that we did was to make sure a person is getting augmented levels of the specific nutrients that are necessary for supporting the phase one and phase two detoxification processes and obviously getting proper fluids so they are flushing out these materials and not storing them in their body, these liberated toxins, and that they are taking in adequate calories, particularly in the way of specific protein that is necessary to support the proper detoxifications.
So it is not a fasting, it is what I would call a modified detoxification, clean, nutrient-rich dietary program. What that leads to over the course, in our experience, of 14 to 20 days is an extraordinarily successful with lower adverse signs and symptoms in the patient or the person getting clean. And when they get clean, they know it. They think clearly, the act clearly, the sleep better, they have more energy, the chronic pain is reduced. If you have never been through that it is hard to describe those feelings to a person until they have done it. It is an amazing experience.
[Damien Blenkinsopp]: Great, thank you very much. Rounding off the interview now and thank you very much for your time. It will be very great to get these details on the basis of your book. There is one thing about functional medicine that I have found as I have been kind of going through my journey is that there are lots of different providers of tests today. There are lots of different labs with Doctor’s Data, Metametrix, Genova Diagnostics, BioHealth – there are many different providers at the moment. And it seems a little less regulated than traditional medicine where – I mean, everything seems to go to [Lab Corp 00:57:19] or some other big lab that may be a bit more standardized. And the measures on the tests are also different.
So I think for many people that can be – for instance, if you go to several different functional providers, functional medicine providers, they are maybe going to favor different tests and so on. So could you talk a little bit about the journey of functional medicine in terms of using lab testing and where you think it is going and what kind of stage it is? Do you see it as anything that needs to happen going forward in terms of standardization or anything like that?
[Jeffrey Bland]: Yes, I think obviously many of these tests that we are talking about or we have alluded to are especially tests – it doesn’t mean that they are unregulated and they don’t have standards of identity, it just means that they are not in the standard and customary tests that all physicians use, like you would have if you went to your doc and had a physical exam and they did a blood test and you had 30 different things in your blood analyzed. Those would be kind of your standard things. So these are more specialized tests that are used within the functional medicine practitioner environment. And this is one of the reasons that I really think it is very useful for a person if they move down this road and as they get more into tuning up their health that they have a functional medicine provider as their ally because these are things that have been skilled in the art and have been trained to know what to use and how to interpret these tests and not to just assume that testing just for testing’s sake is beneficial. It is the right test for the right person or the right set of circumstances, and then the right interpretation of the results.
So my belief is that testing is part of the functional medicine model but it is not the functional medicine model in itself. Much of what you can learn about a person doesn’t need testing, it needs the right way of asking the questions. And that is what I have tried to bring out in my book. The questions you ask determine the answers you get. If you never ask the questions you are never going to get those answers. So it is all about the asking about the patient’s story, understanding the patient’s story, in which then specific tests become part of a defining of I guess taking the hypothesis to understanding so that you can design a specific program for that person. It is going to meet their need and lead to the health outcome that they are desiring.
[Damien Blenkinsopp]: Great, thank you very much for that. So looking forward is there anything that you are excited about, say the next five or ten years, about the use of biomarkers in functional medicine? Do you see any opportunities in the future where it will be more like looking at epigenetics or anything new on the horizon that might help functional medicine practitioners to get better diagnoses or help people better monitor their health and so on? Is there anything interesting you see ahead or that you would like to turn up in the future?
[Jeffrey Bland]: Absolutely so, and this is actually a wonderful place to kind of bring our discussion to a close because really I think it is real time. We are in a health revolution right now that is second to none. This is equivalent in its extraordinary discovery periods to that of the turn of the last century when the origin of infectious diseases was discovered as caused by microbes. And then from that therapy antibiotics were developed, which really transformed healthcare. We are having that same extraordinary revolution in thinking right now and it is around how we are going to manage chronic illness based upon these characteristics of dysfunction. And there are three intersecting changes that are occurring right now that I think are absolutely revolutionizing this field.
One we have talked about and that is the ‘omics’ revolution – genomics, proteiomics, metabolomics, that really allow us to analyze certain aspects of how are genes are expressed and how they are able to be induced to produce good health through activating our resilience genes. And every one of us has some areas of our genetic weak spots. Unfortunately most of us have – in fact, I would say everyone, has resilience genes that can kind of neutralize our response if we turn on our resilience genes. So I think that this particular period that we are undergoing right now in discovery is helping us to understand what are those characteristics and how do we measure them? Soon virtually everyone will be able to have a full gene analysis done, the full genomic analysis, for the cost of a normal lab test, probably somewhere in the range of less than a thousand dollars and eventually for a few hundred dollars. And that will ultimately become insurance reimbursable and we will all have the ticker tape of our genetic information.
That, coupled with the internet and social media where information is now being communicated, transferred, and analyzed in ways never before so that it gives power to the person to own their own genetic information, their own personal health information. And then lastly, big data now in the cloud with what is called informatics that is allowing these huge amounts of new data to be made available to people to be analyzed in such a way that it becomes sensible and a person knows what it means, not just a bunch of ones and zeros but actually operational and instructive about a person’s own personal health program.
Those three things, which we used to think were way out in the future are now happening in real time. The wearable devices that we have like FitBits and Jawbones and so forth and the new devices that are coming out to measure all sorts of biometrics and how that data that each one of us generates about ourselves each day goes to the cloud and gets analyzed and comes back to us and helps us to assess what we need to do to be healthy throughout the course of our life. It is a disruptive innovation that is changing healthcare. And we are all living through it right now. We have a generation of kids that are all social media savvy. They are very comfortable with sharing things that their parent’s generation never was willing to share about their health and their genes. And all of this is transformative.
Within the next ten to twenty years the rules of the road that we have lived with upon doctor’s owning information and everything is about disease diagnosis and all of that is going to go away. We are being replaced with a whole new system that will emerge underneath us with the kids that are growing up in the video game revolution and social media and the age of genomics. That will be transformative.
[Damien Blenkinsopp]: Well thank you Jeffrey, that sounds like a very exciting future and that fits very well with what we talk about often on this show. So it is certainly what I am excited about as well. Thank you so much for your time today, Jeffrey. I know you are a really busy man and I really appreciate your many, many decades of experience in coming on this show and sharing your opinions with us and your ideas.
[Jeffrey Bland]: I appreciate it very much and I hope we have given some good information to your listeners. Thanks a million.