By Sarah A LoBisco, ND

One of the problems with modern day medicine is that treatment is tailored to a symptom and everyone with that symptom gets the same treatment protocol. The result is a health care system that spends the most in the world with some of the saddest statistics of efficacy. Although our life expectancy is lengthen by fancy machines that keep us breathing or pump our hearts, our quality of health is not one of vitality.

The problem with symptom, disease control  is that everyone has a different biological makeup, including their ability to excrete and metabolize certain medications and chemicals. Bear in mind, that the body sees any foreign substance as a chemical; therefore, drugs and toxicants in the environment are removed in the same manner.  As I wrote in a previous blog:

Genetic differences in enzyme detoxification pathways, including methylation and sulfation pathways, can cause some individuals to be more susceptible to environmental exposures than others. For example, someone who has a SNP, or single nucleotide polymorphism, in MTHFR (methylenetetrahydrofolate reductase), MS (methionine synthase), COMT (catechol-O-methyltransferase), Methyl-transferases, STM1, GSTP1 (glutathione transferases), Apo E 4 (apolipoprotein E 4), and/or Impaired Metallothionein function can create imbalances in clearance and a retention in toxins. These SNPs are actually quite common in the general population and their lucky owners are usually diagnosed with “psychosomatic illnesses.” The good news is that, with the new science of nutrigenomics, various nutrients in therapeutic doses can help to remedy the body’s slow detoxification capacity.

Conventional medicine has acknowledged this link between genetics and treatment for some time. It is known that various medications should be tested for individual genetic variations that cause the drug to be ineffective or toxic. The following exert from PLoS Genetics explains these SNPs and the drug, Warfarin:

We report the first genome-wide association study (GWAS) whose sample size (1,053 Swedish subjects) is sufficiently powered to detect genome-wide significance (p<1.5×10?7) for polymorphisms that modestly alter therapeutic warfarin dose. The anticoagulant drug warfarin is widely prescribed for reducing the risk of stroke, thrombosis, pulmonary embolism, and coronary malfunction. However, Caucasians vary widely (20-fold) in the dose needed for therapeutic anticoagulation, and hence prescribed doses may be too low (risking serious illness) or too high (risking severe bleeding). Prior work established that ~30% of the dose variance is explained by single nucleotide polymorphisms (SNPs) in the warfarin drug target VKORC1 and another ~12% by two non-synonymous SNPs (*2, *3) in the cytochrome P450 warfarin-metabolizing gene CYP2C9.

It doesn’t stop there with genetic differences.  Another mode of excretion and biotransformation is in the gut microbiome. Most people today have heard of the importance of taking a probiotic, but is natural medicine becoming one-size-fits all approach too? Possibily?

See, everyone has a different makeup of bugs in their gut, hence the there is no one probiotic for everyone. According to an article in Nature, differences in genotypes of bugs (enterotypes) effect drug  excretion and metabolism:

Abstract

Our knowledge of species and functional composition of the human gut microbiome is rapidly increasing, but it is still based on very few cohorts and little is known about variation across the world.

This indicates further the existence of a limited number of well-balanced host-microbial symbiotic states that might respond differently to diet and drug intake… highlighting the importance of a functional analysis to understand microbial communities.

Here are some more fun facts on the GI tract from the Metametrix Institute Blog:

  • The gut makes up approximately 75% of the entire body’s immune function. (If the GI tract is compromised, the immune system is, too.)
  • The microbiota (bugs) in our gut number in the trillions and may include over 500 unique species. (Many of these species are yet to be identified. By a margin of 10:1, our human cells are outnumbered by bacteria…be kind to your bugs, we surely don’t want to encourage a revolt!)
  • Each individual has his/her own microbial fingerprint. (Be on the lookout for more on gut enterotypes, which will help us customize individualized microbial treatment for patients in the near future.)
  • The gut produces just as many neurotransmitters as the brain. (This is a big tie in to mental/emotional dysfunction. As an example, over 97% of chronic fatigue patients fit diagnostic criteria for major depressive disorder; interestingly enough, over 50% also meet diagnostic criteria for IBS. Coincidence, I think not!)
  • Studies have linked increased anxiety levels to microbial infections in the gut. (Mouse studies have demonstrated that groups of mice with different microbial populations demonstrate very different motor activity and anxiety-like behavior. Ever overeaten some type of vittles and paid for it afterwards? Ever felt super sluggish and in dampened spirits afterwards? Here’s a study telling us why!)
  • The presence of food allergies has been linked to neurological disorders including depression, bipolar disorder, and panic disorder. (In cases of schizophrenia, patients who are also diagnosed as having celiac disease have experienced a return to health with compliance to a gluten-free diet.)

I am a firm believer in the kind of medicine should suit the patient, not in making the patient suite the treatment or drug.

Check out my link at Saratoga.com for a continuation of this discussion and  that highlights how functional medicine testing is important for various conditions, including Autism.

 

References:

Takeuchi F, McGinnis R, Bourgeois S, Barnes C, Eriksson N, et al. (2009) A Genome-Wide Association Study Confirms VKORC1, CYP2C9, and CYP4F2 as Principal Genetic Determinants of Warfarin Dose. PLoS Genet 5(3): e1000433. doi:10.1371/journal.pgen.1000433

M. Arumugam, et al.  Enterotypes of the Human Gut Microbiome. (abstract). Nature, May 12, 2011: 473(7346); 174-80.

Rachel Marynowski, ND. What’s Your Gut Mind. April 2, 2012. Metametrix Institute blogs. http://www.metametrixinstitute.org/post/2012/04/02/Whats-on-your-Guts-Mind.aspx?utm_source=April+2012%2C+Vol+7%2C+Issue++4+FINAL&utm_campaign=April+2012+e-nl&utm_medium=email

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7 Responses to Functional Medicine Testing…Why Test?

  1. Lin Murphy says:

    Hi Sarah, Another great blog. What does the testing consist of? Say… to decide what kind of probiotic would be best to take? Would you (a Naturopath) use muscle testing? or some other kind of tests? Keep up the good work. Lin

    • Dr. Sarah says:

      Lin,
      Thank you for your comment! I analyze traditional blood work from a functional perspective as well as use functional testing in my practice. Functional tests are blood, urine, or stool labs that analyze one’s unique biochemistry. Based on results, I can determine which supplements to use. These tests analyze not just the end results of blood levels, but how the body metabolizes, absorbs, and processes nutrients. They also help determine genetic differences, and assist in finding the root causes of imbalances and dis-eases.
      Probiotic choice can be determined by a stool analysis and through clinical intake. More information on Metametrix can be found at http://www.metametrix.com!

  2. Dr. Sarah says:

    From Dr. Hyman’s How to Fix Our Broken Health Care System, below are steps you can take to help spread the word and heal our health care system by training physician’s in this new model:

    At The Institute for Functional Medicine, we are creating a certification program to help train professionals so more people can see qualified practitioners of the new medicine. And we are also working on research at Harvard to prove to the scientific community the power of this model of care to address the 125 million people — that’s 1 in 3 of you — with chronic illnesses.

    I know that there are about 10,000 professionals who have joined our UltraWellness community and are reading this right now. I also know that there are over 200,00 other people reading this right now who know that the time has come for this type of medicine.

    But Jenny McCarthy can’t do this by herself, and the big secret needs telling. By working together, we have the power to create a tremendous change in our medical system.

    Here are the things we can do over the next year:

    1. Create a comprehensive on- and off-line certification program in Functional Medicine for professionals and create a scholarship program for students and faculty to get training.

    2. Get the Textbook of Functional Medicine in the hands of as many physicians, dieticians and health professionals as possible.

    Learn more at http://www.functionalmedicine.org/bookstore/product_detail.asp?id=441

    3. Create Centers of Excellence in Functional Medicine. This is a new model for clinical care and medical practice that can make this type of medicine available and affordable for everyone. Imagine clinics in your own community based on the principles of systems biology and Functional Medicine. We can help doctors and health professionals learn how to do this so that everyone can have a place to access this type of care.

    4. Develop a network of research projects and centers to advance research in this field as quickly as possible. This will allow insurance companies to be able to pay for it because they will see that Functional Medicine is not only more effective than conventional approaches, but it will save billions of dollars.

    The goal of The Institute for Functional Medicine is to raise $20 million over the next year to accomplish this. And the more we have the faster we can go.

    And you all can make it happen with very little effort.

    I don’t ask things of my community very often — and I am not asking for me, but for the millions of suffering people who could benefit if we come together and work to create change.

  3. Carlitos says:

    Depression medicine is very dangerous and does not help the problem, it can make people much worse and when they try to get off it some people go a bit nuts, a read an article about it recently that was quite alarming.a pill cannot get rid of depression, not really and not for good. the problem is in your mind, your thinking, psychology, you need therapy of some sort.depression has no quick fix, you have to sort out why your depressed and deal with it, learn new ways to think, sort out your mind and life that the depression is coming from.

    • Anonymous says:

      Carlitos,
      Thank you for your input. It’s true that coming off a depression medicine is hard for most and should be monitored by a practitioner who can support the process. Depression has causes that can be biochemical as well as emotional, and as a functional medicine practitioner, addressing them all is important for lasting change. When medication isn’t enough, it’s a good idea to find out why, such as if the medication is the right kind or if vital nutrients are needed to modulate the effect. The emotional and mind-body aspect is critical, as you mentioned.
      In health,
      Dr. LoBisco

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