Защо се нуждаем от функционална медицина?

• В нашето общество се наблюдава рязко увеличаване на броя на хората, които страдат от сложни, хронични заболявания such as diabetes, heart disease, cancer, mental illness, and autoimmune disorders like rheumatoid arthritis.
• The system of medicine practiced by most physicians is oriented toward acute care, the diagnosis and treatment of short-duration trauma or illness that requires urgent care, such as appendicitis or a broken leg. Physicians apply specific, prescribed treatments, such as drugs or surgery, that aim to treat the immediate problem or symptom.
• Unfortunately, the acute-care approach to medicine lacks the proper methodology and tools for preventing and treating complex, chronic disease. In most cases, it does not consider the unique genetic makeup of each individual or factors such as environmental exposures to toxins and the aspects of today’s lifestyle that directly influence the rise in chronic disease in modern Western society.
• There’s a huge gap between research and the way doctors practice. The gap between emerging research in basic sciences and integration into medical practice is enormous, as long as 50 years, particularly in complex, chronic illness.
• Повечето лекари не са достатъчно обучени да оценят основните причини of complex, chronic disease and apply strategies such as nutrition, diet, and exercise to treat and prevent these illnesses in their patients.

Как се различава функционалната медицина?

Функционалната медицина включва�разбиране на произход, профилактика и лечениена сложно, хронично заболяване. Отличителните белези на подхода на функционалната медицина включват:

• Patient-centered care. Functional medicine focuses on patient-centered care, promoting health as a positive vitality beyond just the absence of disease. By listening to the patient and learning his or her story, the practitioner brings the patient into the discovery process and tailors treatments that address the individual’s unique needs.
• Functional medicine is an integrative, science-based healthcare approach. Practitioners of functional medicine look upstream to consider the complex web of interactions in the patient’s history, physiology, and lifestyle that can lead to illness. Each patient’s unique genetic makeup is considered, along with both internal (mind, body, and spirit) and external (physical and social environment) factors that affect total functioning.
• Integrating best medical practices. Functional medicine integrates traditional Western medical practices with what is sometimes considered alternative or integrative medicine, creating a focus on prevention through nutrition, diet, and exercise; use of the latest laboratory testing and other diagnostic techniques; and prescribed combinations of drugs and/or botanical medicines, supplements, therapeutic diets, detoxification programs, or stress-management techniques.

Functional medicine is more than just a different approach to healthcare; it is an entirely different philosophy about how we provide and consume healthcare. I can honestly say that in my practice, I don’t treat diseases, but rather patients, some of whom have diseases and some do not. I focus on normalizing the underlying physiology and restoring healthy function through nutrition and lifestyle changes.

People often have significant symptoms and they feel sick, but they don’t meet the technical requirements for a particular diagnosis. This means they don’t get any treatment in many offices, but this is just the beginning for my patients. I work with my patients to discover the dysfunctional patterns that lead to their symptoms, and then develop strategies to correct these patterns and restore optimal health. 

The functional medicine approach to treating chronic disease is based not on one agent or modality as a curative or palliative solution. It is holistically centered on the principle that restoration of proper cellular metabolism, through reducing cumulative toxic load and oxidative stress to the body, will allow normalization of mitochondrial respiration and cellular energy production, ultimately reducing the signs and symptoms of chronic disease. While many nutritionally-oriented doctors realize that standard nutritional support protocols alone benefit mild to moderate chronic disease cases, more severe cases often require a more comprehensive functional approach.

This functional medicine philosophy and approach were initially developed for clinical use in chronic fatigue patients with excellent results. Because of the commonality observed in many chronic conditions, it has been used over the years with great success in other disorders, including fibromyalgia, rheumatoid arthritis, and autoimmune disorders.^1-8 The seminal work of Bland, Rigden, Cheney, and others in treating chronic fatigue syndrome has served as a successful template, and this approach is now used in treating a broad range of chronic diseases^1-7.

The functional medicine philosophy is centered on the premise that a breakdown of the intestinal mucosa by the chronic ingestion of food and water-based toxins, and the use of common prescription and over-the-counter drugs (such as antibiotics and NSAIDS), can lead to dysbiosis and a hyperpermeable intestinal mucosa, or leaky gut syndrome. This intestinal hyperpermeability can result in the intestinal mucosa failing to act as a selective barrier. This leads to crossing food-based toxins and partially digested food proteins through the intestinal mucosa and into the systemic blood supply. The eventual result is an increase in food allergies and increased toxic load. (вижте Фигура 1).

This increased toxic load can, over time, lead to increased stress on the liver and its ability to detoxify these substances through phase I and II pathways adequately. This will ultimately result in increased systemic tissue toxicity.

Increased tissue toxicity is thought to be a major trigger for mitochondrial dysfunction, which results in the body’s cells, including muscle cells, being unable to utilize oxygen-dependent aerobic metabolic pathways efficiently. This accounts for the majority of ATP production. Decreased cellular ATP production can account for many (if not all) of the symptoms and signs associated with many chronic disease states, such as chronic fatigue syndrome (CFS) and fibromyalgia (FMS).

Increased intestinal permeability can also result in partially digested medium to large food proteins entering the blood supply and acting as antigens. The resulting antigen-antibody complexes seem to have an affinity for the synovium of articulations. This results in an inflammatory response in the joint linings commonly seen in arthritides such as rheumatoid arthritis (RA). The main therapeutic agents used initially by standard medical physicians in the treatment of RA are (ironically) NSAIDs. NSAIDs, according to the PDR, result in increased intestinal permeability. Is it possible that the traditional allopathic therapy for arthritis has only resulted in palliating the patient’s symptoms, while exacerbating the disease?

Therefore, the functional medicine therapeutic strategy is centered around repairing the intestinal mucosa, correcting any intestinal dysbiosis, providing substances to the body to aid tissue detoxification, reducing oxidative stress, and ultimately promoting a return to normal cellular metabolism. Assessment begins by determining intestinal health, the liver’s functional reserve, and its detoxification abilities. This is commonly done with the help of patient symptom questionnaires, such as the metabolic screening questionnaire, and functional laboratory studies, such as the lactulose/mannitol challenge for evaluating intestinal permeability, and the complete digestive stool analysis (CDSA) for detecting markers of digestion, absorption, and colonic flora. The detoxification ability of the liver can be assessed via the caffeine clearance and conjugation metabolite challenge tests, which evaluate phase I (cytochrome P450) and phase II (conjugation) liver detoxification pathways (вижте Фигура 2). These tests are not performed by standard clinical laboratories, but are available through specialized laboratories that offer functional testing.⁹

След като данните бъдат събрани, програма за лечение (вижте Фигура 3) is selected, which may include specific nutrients to correct any intestinal hyperpermeability (leaky gut syndrome). Individual nutrients such as L-glutamine, purified hypoallergenic rice proteins, inulin, pantothenic acid, and antioxidants can be used. However, formulary medicinal food 10,11 is usually much easier and more clinically practical. Digestion and absorption difficulties suggested on the CDSA can be treated with the temporary use of pancreatic enzymes and HCL (if indicated) in patients without gastritis or ulcers. Dysbiosis, a term used to describe an imbalance of colonic flora, can be addressed by administering Lactobacillus acidophilus and probiotics such as fructooligosaccharides (FOS).

Any pathogenic bacteria, yeast, or parasites detected on the CDSA should be treated with the prescription (or natural) agents suggested by the sensitivity tests on the CDSA. These may include nonprescription substances such as berberine, garlic, citrus seed extract, artemisia, uva ursi, etc. Bland, Rigden, Cheney, and others describe this program of gut restoration as the “Four R’ approach. ^3-4.

„Четири R“ подход за възстановяване на стомашно-чревния тракт

Премахване: Eradicate any pathogenic microflora, yeast, and/or parasites with natural or prescription agents suggested on the CDSA (i.e., berberine/goldenseal, garlic, artemesia, citrus seed extract, uva ursi, etc.).

Eliminate known allergenic foods and/or follow a modified elimination diet, avoiding dairy and gluten-containing foods and emphasizing fresh, non-processed foods.

Замяна: Provide pancreatic multidigestive enzymes and HCL if appropriate, particularly if the CDSA shows markers of malabsorption.

Реинокулиране: Administer lactobacillus acidophilus, bifidobacteria, and probiotics such as fructooligosaccharides (FOS) and inulin.

Ремонт: Provide nutrients to support gastrointestinal mucosal integrity, such as L-glutamine, antioxidants, glutathione, Acetylcysteine (NAC), zinc, pantothenic acid, medium-chain triglycerides (MCTs), fiber, etc.

After intestinal issues have been effectively corrected, upregulation of liver detoxification pathways can be accomplished by providing nutrients that are used in phase I biotransformation and phase II conjugation pathways. These may include individual nutrients such as N-acetyl cysteine, methionine, cysteine, glycine, glutamic acid, glutathione, and antioxidant nutrients (вижте Фигура 3). However, using a specifically designed formulary, medicinal food products are much more practical and efficient to use clinically.

Patients with elevated phase I cytochrome P450 enzyme activity and slow phase II conjugation activity should be treated with antioxidant therapy before detoxification begins. This slows the production of highly toxic biotransformed intermediate molecules, which increase oxidative stress on the body.

This should be combined with a diet emphasizing fresh foods and eliminating processed and allergenic foods. This will reduce the patient’s dietary toxic load (exotoxins), while the intestinal program will reduce gastrointestinal-derived toxins (endotoxins). Following a modified elimination diet, which eliminates the ingestion of gluten and dairy-containing foods, and discontinuing as many drugs as possible, will also help during the detoxification process.

Източници

1. Bland J, Bralley A: Хранителна регулация на ензимите за детоксикация на черния дроб, J Appl Nutr 44, 1992.
2. Rigden S: Изследователско проучване-предварителен доклад за проучването на CFIDS: Advances in diagnosing and treating the Chronically Ill, 1991, Сиатъл.
3. Rigden S: Ентерохепатална реанимационна програма за CFIDS, CFIDS Хрон Пролет, 1995 г.
4. Cheney PR, Lapp CW: Ентеро-чернодробна реанимация при пациенти със синдром на хронична умора: пирамида от хранителна терапия, CFIDS Хрон Есента, 1993 г.
5. Lanfranchi RG, et al: Фибромиалгия, хронична болка и синдром на пропускливите черва. Днешният Chiropr, Март/Април:32-9, 1994.
6. Rowe AH: Алергична умора и токсемия, Ан алергия 17: 9-18 1959.
7. Pressman AH: Метаболитна токсичност и нервно-мускулна болка, ставни нарушения и фибромиалгия, J Am Chiropr доц Септември: 77-78, 1993.
8. Gantz NM, Holmes GP: Лечение на пациенти със синдром на хроничната умора, Drugs 36(6):855-862, 1989.
9. Диагностична лаборатория Great Smokies: 63 Zillicoa St, Ashville, NC 28801, 1-704-253-0621, www.gsdl.com.
10. HealthComm International, Inc., Изследователски център за функционална медицина, пощенска кутия 1729, Gig Harbor, WA 98335, 1-800-843-9660, www.healthcomm.com.
11. Metagenics, Inc., 971 Calle Negocio, Сан Клементе, CA 92673, 1-800-692-9400.

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