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Functional Medicine IV

When I started this series on Functional Medicine, David Gorski suggested looking at Mark Hyman’s web page, which I had seen months before, but thought did not reveal much. That was a wrong. It shows a lot, and I suggest bloggers et al review it.

So I decided on a fourth “functional medicine” (FM) installment, in search of what it FM really is. On the Mark Hyman web page and in his Public TV monolog fund-raiser,  Hyman follows a seven point outline of what he believes Fuctional Medicine (“FM”) is. If one follows the 7 “keys” as he writes, optimum health, “ultra-wellness” happens. Here are the points:

  1. Environmental inputs
  2. Inflammation
  3. Hormones
  4. Gut & digestive health
  5. Detoxification
  6. Energy/Mitochondria/Oxidative Stress
  7. Mind body


Here is a brief excerpt from the environment section.

Environment:

It is like the health of the soil. To have healthy plants you must have soil with the right amount of organic matter, the right pH balance, the right amount of nutrients as well as water and light and air.

We are the same – we need to have a healthy soil or terrain in order to be healthy.

In fact, Lois Pasteur on his deathbed realized this – and it is the terrain, NOT the germ, that is the most important determinant of health.

This explains why giving zinc to malnourished children in the third world can reduce death from infections by over 75% – it doesn’t stop exposure to the bugs, but zinc boosts immunity, helping the children stay healthy.

So by believing in this “germ theory” of disease, medicine has ignored one of the most important scientific ideas of the last century – that our health is determined by the interaction of our genes and our environment.

Hyman errs in two general categories. First, he misleads through literature.  I reviewed the last five review abstracts on Pubmed and found reference only to increased limited infection susceptibility in children with zinc deficiency. Zinc intake follows generally protein intake. Supplementation studies in people with normal zinc levels and normal dietary intake were scarce. Supplement studies in children seemed limited to children in third world countries with borderline intakes and effects were limited to certain conditions, not all infections, and not all at the 75 percent level. In one review, Bhutta concluded, “The existing literature provides evidence of a beneficial effect of therapeutic zinc supplementation in the reduction of the duration of acute and persistent diarrhea. However, evidence for its impact on pneumonia, malaria, and tuberculosis in children under 5 years of age is insufficient and needs further evaluation.”  (Bhutta ZA., et al.  Food Nutr Bull. 2009 Mar;30(1 Suppl):S41-59)
Hyman gave no reference for his statement.

Yet there may be a role for supplementation in infants and young children whose intake is low in meats and Zn rich vegetables. Most human Zn intake comes from animal products, paralleling B12 – critters being micronutrient nutrient rich sources -  and although critters do depend on plant intake, which depends on soil content, the serial processes concentrate micronutrients for human intake. Kids can’t always be depended on to “balance” their intake.  However, there is hardly a clinical need for supplementation in modern societies like North Americans, which some readers might infer from Hyman’s statement. .

Second, Hyman erroneously claims that our standard way of looking at disease:  that one “gets” a disease or “catches” an infection is wrong. The correct way to see disease according to Hyman is to recognize that the above mechanisms are operating and interacting constantly, and that exposure and “imbalances” cause what we see as disease.

The problem with Hyman’s FM accusation against medicine’s conceptual formation of diseases is that we already incorporate such things as systematic interactions, and have for 100 years or more (internal milieu, etc.,) certainly since discovery of hormones and their feedback mechanisms, and the multiple functions of organs. Even deeper understanding followed the unraveling and understanding of cell membrane and nuclear receptors, intra- and inter-cellular signaling mechanisms, cytokines, hormones, and the genetic controls and external effects on all of them. Hyman makes one think that modern medicine knows little of normal and dysfunctional mechanisms, even though the newest biological drug are based on those same concepts. It’s just another “CAM” type straw man argument against “The System,” which somehow they construct as wrong, incomplete, reductionist, insensitive, and what have you.   

He also believes our classification of disease by symptoms and signs is wrong: that diseases should be classified by what is out of balance among the seven [or more?] conditions; that disease exists when something is wrong with the functions or interactions of the contents of the seven points.

But medicine already classifies diseases according to other criteria
such as hereditary, infectious, neoplastic, degenerative, etc. Or, described by organ systems - endocrine, nervous system, etc., as taught in medical schools for 100 years. When the mechanisms are not known, we describe the disorder as a syndrome - a recognized deviation of symptoms and signs. When the mechanisms are discovered, we use more physiological rather than descriptive definitions. Somehow this order of progressive knowledge encoded in classification escaped Mark Hyman’s medical learning curve.

In order for medicine to accept Hyman’s New Order of diseases, the proponents must come up with both the proof and the reasons exchanging what we already know for what he proposes. So far, that evidence does not qualify.

Hyman’s principles apply more appropriately to the “functional” conditions we call phantom diseases - chronic fatigue, chemical sensitivities, fibromyalgia, neurasthenia, some irritable bowel, and other depression-generated, somatiform disorders, plus those for which there exist only behavioral definitions: ADD, autism-like syndromes, etc.  Most of these conditions do not respond to specific therapies, but their human hosts tend to seek and respond to off-beat fringe, cultic methods and remedies and infomercials.  Sufferers and victims ally with non-specific, often pseudoscientific methods and therapists and that appeal to imagination, creative imagery, and sympathetic magic.
FM: tailored for dysfunctional and unhappy people.   

For the reeally curious, if one has not seen Hyman’s infomercial, here is a series of statements from a few segments as shown on public television. See how many you agree with.

  • “Sugar is poison.  Sugar addiction causes insulin resistance and depression 100 percent reversible by diet.”
  • “Thyroid disorders occur in 1/5 females and 1/10 males. All people need free-T3 & free-T4 tests and absolute T3, T4 levels.”
  • “Cornavirus (?) occurs in 1/3 people in the brain, causes brain swelling and depression. Also autism patients have “swollen brains.” “Treat the swelling and autism goes away.”
  • “Depression, and irritable bowel (IBS,) etc. mean the body is out of balance.”

Interval: Host Greg Sherwood states that following Hyman’s advice can “make incredible changes.” The UltraLife Solution is a revolutionary change in how we lead our lives. It’s medicine of the future.

Next segment: In FM we think about the root causes. FM gets to the roots of all chronic disease.  We find out how to connect the roots of 20 different diseases.  In one case, I simply removed gluten (wheat product) from the diet and added vitamin D and all her diseases disappeared: IBS, CFS, depression, ADD, and dementia.

(Point 4.) Fixing your digestion: Half the brain is in the head, the other half in the gut.  The brain and the gut have to talk to each other.  Serotonin is half in the gut, half in the nervous system.  A bloated inflamed gut produces a bloated, inflamed brain. Half of our immunity is in the gut. Absorbed toxins from diet get into the circulation and then to the brain. The liver gets overloaded [with toxins] and they then get to the brain. One patient with obsessive-compulsive disorder (OCD)  loved carbohydrates – she was intoxicated from bugs in the gut, got drunk from their secretions sky high levels of yeast with overgrowth in the gut. I gave antibiotics followed by pro-biotics. Bad bacteria had overtaken the good bacteria. [This is the core theory of candidiasis, another of the many erroneously named of the somatiform disorders. WS]

Toxins are everywhere. So, reduce exposure and protect your brain. 80,000 lb. of lead and 6 million pounds mercury are released /yr  - a total of 6 billion lb toxic chemicals. [This could be at least partially true - but the effects? WS] 600,000 babies have toxic levels of mercury. 3,000 chemicals exist around the home. One answer is to increase glutathione [an anti-oxidant in tissues].

The seven keys to ultra-mind: The major problem is mercury poisoning. In one instance we removed mercury fillings, increased the glutathione. We removed other metals, gave vitamins.

Boost energy metabolism. How to get the energy back: take CoQ10.

Calming the mind:

  • Stem cells are made/stimulated through the vagus nerve.
  • FM is “a new kind of medicine.”
  • For 250 you can get 2 books, 8 CDs 7 audio CDs
  • We talk about health, not disease.

An ad referred to treatments available through:

  • Metametrics.com,
  • Immunolaboratories, and
  • The right food tst.com.

I’d serve you all better by referring you to two web sites:

Robert Burton is a neurologist and novelist. Except for the example I recorded above, I don’t want to repeat what a competent critic already has written.   Look also at the Mark Hyman response and the 50+ letters that followed. Hyman’s response is a cornucopia of “alt/comp/Integ-med” nonsense jargon, false accusations, and unsupported claims. Note also the preponderance of letters favored Dr. Burton’s critique and were highly critical of Hyman and of KQED for using such infomercials. SBM and Harriet Hall’s post on Amen were mentioned in the letter exchanges.

So with this entry I finally see what FM really is – a non-scientific, ineffective, jingoistic, cultic approach to dysfunctional somatiform, non-disease conditions.

FM: Non-treatments for non-disease

Posted in: Energy Medicine, Herbs & Supplements, Science and Medicine

Leave a Comment (18) ↓

18 thoughts on “Functional Medicine IV

  1. overshoot says:

    Which character set is this? I’m seeing a host of 16-bit character codes that I can’t render, so it seems I need to get some new font settings.

  2. David Gorski says:

    The post looks fine to me. Try setting your browser’s text encoding to Unicode (UTF-8).

  3. woo-fu says:

    I’m seeing what overshoot is, viewing from the latest Firefox.

  4. Fredeliot2 says:

    The post is OK in Explorer but has strange punctuation characters in Firefox.

  5. Diane Jacobs says:

    This happened to me with blogger, on an iMac using Firefox. All the letters turned to squares.
    The laptop (Macbook Air, also Firefox) worked fine. I thougt it was just my computer, but maybe there’s a bug out in the internet.

  6. alison says:

    I’m looking at it in Explorer and there are little squares wherever an apostrophe should be. Weird.

  7. splicer says:

    I’ve tried several Homeopathic remedies to get rid of the boxes but as expected they didn’t work for this either.
    I was surprised to hear that this was being hyped on a PBS station like KQED.

  8. Danio says:

    Is there a good SBMesque source for me to find out more about the thyroid hormone claims mentioned above? I have a friend who has, I think, fallen for some woo after doctor shopping for someone who would tell her what she wanted to hear (i.e. something besides ‘your health problems are due to obesity’). The boogeyman of ‘Western medicine’ has been invoked by her new practitioner, and she’s submitted to a whole bunch of tests resulting in diagnoses of Hashimoto’s disease, ‘possible’ Addison’s disease, and ‘possible’ Celiac disease–resulting in the whole Gluten-free bandwagon. She’s thrilled to have answers that don’t involve a weight-loss regimen, and feels completely validated. I don’t want to be insensitive, but it just seems like a lot for a mainstream doc to miss.

  9. Diane Jacobs says:

    It must be a firefox thing, the boxes. I have Safari open, and the page reads fine. I also have Firefox open and the boxes are still there.

  10. DevoutCatalyst says:

    > I was surprised to hear that this was being hyped on a PBS
    > station like KQED.

    That’s a San Francisco thingy. I’ve never seen anything like this on the national feeds, nor the few affiliates available to me. Quality varies according to PBS member station. Think globally, complain locally.

  11. David Gorski says:

    If we could bag the discussion of the text glitches. There’s a problem, and we’re not sure how to fix it. Time to move on to the content of Wally’s post…

  12. Harriet Hall says:

    Still don’t know what caused the problem, but I edited the little boxes away. Had to guess at what was intended in a couple of places. Hope it reads well for everyone now, and as David said, we can get back to discussing the content of the post.

  13. Enkidu says:

    “Depression, and irritable bowel (IBS,) etc. mean the body is out of balance.”

    I have IBS, and what was out of balance were my neurotransmitters. :o)

  14. Wallace Sampson says:

    danio: The best set of reviews I know of on quacky thyroid treatments is on Steve Barrett’s quackwatch.com. Search *thyroid*. Scroll down a ways to get to the characters and various types of syndromes.
    Decades ago thyroid was blamed for common fatigue symptoms especially in women, the diagnoses being relative hypothyroidism, hypometabolism, subclinical hypothyroidism, and a few others. Then Hashimoto’s disease (not bothering to establish that diagnosis with biopsy, antibody measurements, and the clinical findings that accompany it.
    Both older and more modern (FM) claims include the high fractions of “normal” women and men who have “subnormal” thyroid function. Suggesting the idea that irrational, silly thought processes are the actual causes of vaccine phobia and related syndromes.

    DevoutCatalyst: KQED/SF and the two other PTV stations here have had pledge drive videolectures by Gary Null, Andrew Weil, Michael Roizen/ (Mehmet Oz?)/ Real Age, Christiane Northrup, and perhaps others I’ve missed. I “resigned” from KQED after its magazine supported the 1993 DSHEA bill and refused to publish a rebuttal. National Public TV recognized this problem but was faced with each local staton having authority to run its own schedule and fund-raising.

    WS

  15. woo-fu says:

    Someone just emailed me an article written by Dr. Hyman, presenting many of the same issues discussed here. It was a good prompt for commenting. I agree with many of the points Dr. Sampson makes, and, in particular, I appreciate his comparisons regarding toxicity and diet, past and present.

    Too often health gurus present themselves as simply giving away free health advice, for the good of the public, while hiding profit motives. There’s greater pressure than ever on standard medicine and pharmaceutical companies to reveal financial connections and incentives; however, the same standard has not been held for CAM. This gives CAM a free pass to criticize standard medical care while hiding their own possible biases or improprieties.

    The free advice given generally includes some commonsense recommendations, reduce your allergen load, eat well, exercise, etc. with one or two recommendations for specific techniques and/or supplements that one should consult the advisor to discuss optimizing individually. The freebies are bait and the individual consultation the hook for a proprietary formula to “better health.” This produces an odd mixture of individuals promoting CAM, particularly among the pros who must battle big pharma and corporate medicine on one hand, while sparring with one another at the same time for dominance.

    Although no one disputes the competition rampant in the medical profession, there is certainly more consensus regarding treatment approaches than we see with CAM. Practicing good science forges better doctors. On the other hand, in CAM, there are so many diverse practices and egos competing under the same alternative umbrella that many practitioners become rivaling gurus who practice secrets not revealed to the other obvious quacks.

    Dr. Sampson and I do disagree on a few points, however. As someone who deals with depression and other “phantom diseases,” I feel the characterization of such patients to be somewhat shallow here and suggest that changing to a more respectful tone might allow for a wider audience. The following quote seems to belittle rather than to seek to enlighten:

    “Most of these conditions do not respond to specific therapies, but their human hosts tend to seek and respond to off-beat fringe, cultic methods and remedies and infomercials.  Sufferers and victims ally with non-specific, often pseudoscientific methods and therapists and that appeal to imagination, creative imagery, and sympathetic magic.
FM: tailored for dysfunctional and unhappy people. ”

    I also disagree that a straightforward causal relationship exists between depression and the “phantom diseases” listed here. I’m not denying the impact of depression nor even that there may be a causal connection. I’m suggesting that the relationship among these conditions is more complex than implied and that treating the alleged primary condition, depression, does not necessarily have a corresponding effect on the other conditions.

    In my case, antidepressants made conditions such as fibromyalgia and IBS much worse, no matter what drug combo was tried. On the other hand, I did have success reducing fibromyalgia pain during trials of gabapentin and pregabalin. I had to pull off the medications due to side-effects, but they did work, when nothing else, modern or alternative, did much of anything, if not make the situation worse. This can’t be easily explained away as placebo, for then anything tried previously should have effected some sort of response. And if the relationship to depression were so straightforward, symptoms should have eased as emotions improved and stress reduced, which did not happen. Mine was a direct response of pain reduction associated with a drug that deals with nerve pain.

    Patients given psychiatric labels have to fight much harder to have their physical problems addressed. Many time-pressed physicians, when faced with chronic and complex medical issues, will note such a prior diagnosis and excuse a lack of good patient care with an assumption of psychogenic causes. One psychiatrist I know complained about this very bias against his own patients, admitting that, on occasion, he has felt compelled to commit patients, with their permission, not because he felt their psychiatric problems were the eminent danger but because he felt the mandatory complete physical associated with commitment would reveal important medical problems not being addressed by the patients’ GPs.

    Finally, whether or not one believes these are real physical problems does nothing to improve the patient’s experience of the symptoms. If, as suggested, these conditions are all in the head anyway, why would techniques utilizing the imagination be advised against for patients simply trying to ameliorate symptoms? I’m not suggesting that marketing of such techniques as modern science is to be excused without sound evidence, but as therapeutic art, as long as the side-effects are minimal, why not?

  16. jmm says:

    There is absolutely no evidence that chronic fatigue syndrome is a “dysfunctional somatiform, non-disease condition”. Comprehensive epidemiological surveying has shown that incidence rates, far from tracking typical CAM enthusiast, are highest in those under highest life stress, eg low income working single mothers. A link with depression has been thoroughly researched and debunked. Depression rates amongst cfs sufferers are in line with those seen with other major illnesses, consistent with cfs being the cause and depression the effect. Many cfs sufferers (including myself) have never suffered from depression. Subtle physiological abnormalities with cfs have been seen in countless studies, including high throughput gene expression.

    No wonder people seek out CAM when doctors like you label serious conditions “non-diseases”, despite all scientific evidence to the contrary. Just because the disease mechanism is not understood, that hardly makes something a non-disease. This is exactly the attitude that feeds CAM.

    Incidently, the closest marker of a predisposition to cfs is hypermobility. Despite being one of the few facts on cfs with a huge effect size, it has received little biomedical attention, presumably because it does not fit pre-existing models of “how disease works”. I don’t care about those models, I care about the hard data.

  17. CanadaGood says:

    I got interested in Mark Hyman’s academic qualifications. I can find nothing with his birth date, place of birth or citizenship.
    (He strangely has no current entry at Wikipedia).

    Some places on the Internet describe Mark A. Hyman MD as “graduated Magna Cum Laude from the University of Ottawa in Canada with a degree in Medicine”. But on own web site and LinkedIn he writes that he graduated “Magna Cum Laude” at “Ottawa University School of Medicine”.

    I note that “Ottawa University” is a small undergraduate college based in Ottawa, Kansas and the “University of Ottawa” is a major Canadian university with a “Faculty of Medicine” (not a “School”). I also know Latin academic awards are not normally given in Canada. Add all that up and I can’t help wondering exactly where and when Mr. Hyman got his medical education. At the very least this shows an inattention to detail.

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