Ep 136 – Pursuing Health Pearls: Functional Medicine: Getting Started Guide

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Functional Medicine: Getting Started Guide


One of the most common questions we receive is about how to get started with functional medicine. Whether you are a health care practitioner looking to learn more about functional medicine and how to incorporate it into your practice, or a patient looking for an aligned health care practitioner, we hope to answer a lot of these questions in this episode of
Pursuing Health Pearls.

 

What we’re doing isn’t working

Today in the United States, six out of every ten adults has at least one chronic disease, and four out of ten have two or more. Chronic conditions account for seven of every ten deaths in the United States, and together with mental health account for 90% of our $3.5 trillion annual healthcare costs. Our healthcare system has been designed around providing life-saving care for acute problems, but when it comes to chronic disease it is poorly equipped. The current standard approach relies on using primarily pharmaceutical medications to slow the progression of disease and manage symptoms rather than addressing the root causes which are often rooted in lifestyle.

 

What is functional medicine?

Functional medicine is a model that empowers patients and practitioners to work together to address the root causes of disease and promote optimal wellness. This model recognizes the unique genetic makeup and experiences of each individual and uses these along with the latest medical and scientific research to inform personalized treatment plans. This is a model that we have found to be much better suited for addressing chronic diseases from obesity, to type 2 diabetes, autoimmune diseases, mood disorders, and many more.

 

The foundations of health

The functional medicine framework aims first to ensure our bodies have the necessary ingredients to facilitate health, which include: sleep and relaxation, exercise and movement, nutrition, stress management, and meaningful relationships. When these key ingredients are not present or out of balance, the stage is set for disease or dysfunction to creep in. Many times, just improving these factors will result in the resolution of symptoms and disease. Regardless, making sure these things are in place first so that the body has the necessary ingredients for healing is important in order to allow for more advanced testing and/or treatment to be most beneficial. 

 

A few examples

To illustrate the difference between conventional and functional approaches, let’s discuss a few examples. In the conventional system, a cluster of symptoms is diagnosed as a disease, and then the standard-of-care treatment is prescribed. For example, if you have a rash it will likely be given a name based on its appearance (for example, “eczema”). You will then be prescribed a treatment that has been shown to improve this type of rash (for example, moisturizer or steroid cream). The rash may improve with this treatment, could come back when the treatment is stopped.

 

On the other hand, a functional approach would look at the rash as well as any other symptoms you may be having and put them into context with your prior environmental exposures, lifestyle behaviors, and unique genetic makeup asking, “what is the underlying cause of this rash?” A multifaceted approach would then be recommended to identify and eliminate this root cause with a goal of optimizing the body’s functional and permanently resolving symptoms.

 

It’s important to note that one underlying cause may manifest in different symptoms or diseases in different individuals due to their unique genetics and biology (i.e. gluten sensitivity may cause diarrhea in one person and a rash in another). Likewise, one symptom may have a variety of different root causes (e.g. depression in one person may result from a nutrient deficiency, while in another could be due to excess stress or isolation).

 

In a conventional approach, a patient with a rash, diarrhea, and a headache might see a dermatologist, a gastroenterologist, and a neurologist and receive three different diagnoses and three different treatments. A functional medicine approach, on the other hand, would take all of these symptoms into consideration and search for a root cause that would link all three while optimizing the body’s function through nutrition and lifestyle factors.

 

Functional, integrative, and lifestyle medicine

Another question we are frequently asked is about the difference between functional, integrative, and lifestyle medicine. This is a whole topic in and of itself, but for now here is one analogy we like to use. 

If someone was diagnosed with depression:

  • A conventional approach would be to prescribe an antidepressant medication.
  • An integrative approach would be to prescribe a supplement called St. John’s Wort.
  • A lifestyle approach would be to prescribe exercise, nutrition, sleep, meditation, and relationships.
  • A functional approach would be to ask: “Why is this person depressed?” and craft a treatment approach in response to the answer.

 

As this analogy illustrates, functional medicine is a framework for assessing health and disease and is agnostic to the treatment approaches used, whether they are based in conventional, alternative, or lifestyle approaches. 

 

Functional Medicine Resources For Patients

#1 A Primer

To deepen your understanding of functional medicine and how it might help you, we recommend reading or listening to Disease Delusion: Conquering the Causes of Chronic Illness for a Healthier, Longer, and Happier Life, a book written by Dr. Jeffrey Bland, the “father of functional medicine.”

 

#2 Find a practitioner

If you decide you’d like to move forward and work with a functional medicine practitioner, we recommend using the Institute for Functional Medicine’s Practitioner Finder to locate those who practice in your geographic area. This practitioner finder features those who’ve completed the Institute for Functional Medicine’s (IFM) five-day introductory course and are members of IFM. Those who are noted as an “IFM Certified Practitioner” have completed six additional training modules and passed a rigorous examination. Do keep in mind, much like CrossFit affiliates and coaches, functional medicine practitioners come from a variety of backgrounds and experiences. Practitioners range from MD and DO physicians, to nurse practitioners, physician’s assistants, chiropractors, naturopathic doctors, dietitians, health coaches and others. Functional medicine is not one-size-fits-all and each practice and practitioner will be different. We’d recommend checking out their websites or inquiring about a free consultation to better understand the scope of practice and services offered. 

 

#3 What to expect

Again, each practice will implement functional medicine in its own unique way, but here are some things you may expect to see:

  • An pre-visit questionnaire asking you about everything from your family and birth history, to courses of antibiotics as a child, to stressors and environmental exposures over your lifetime
  • An in-depth first visit reviewing your health timeline and symptoms you are currently having
  • A heavy emphasis on lifestyle change including dietary and exercise interventions, meditation, and stress management
  • The use of advanced testing and supplements as part of an individualized plan 
  • Many practices (though not all) operate on a cash basis outside of insurance, due to the increased up-front time investment necessary to utilize this approach
  • Each practitioner may have a slightly different role. For example, some may specialize in treatment of GI-related symptoms while others may have expertise in brain health. It’s important to clarify your practitioner’s role up front. You should also ask whether they will act as your primary care doctor, or whether you should continue to go to your primary care physician for certain needs.

 

#4 Keep learning

If you’re interested in furthering your knowledge of concepts related to functional medicine, you may be interested in listening to the podcasts below:

 

Functional Medicine Resources For Practitioners

 

#1 Get your feet wet

For exposure to the foundations of functional medicine and nutrition, we recommend these free online courses offered through the Institute for Functional Medicine. Each take 1-2 hours to complete and should give you a good idea of the framework that functional medicine offers.

 

#2 Do some reading

For anyone interested in functional medicine, we feel that the two books below are must reads. They will give you a better understanding of how functional medicine fits into the bigger picture of our healthcare system and provides a much-needed solution for chronic disease:

 

#3 Deepen your learning

For ongoing learning, we recommend these resources:

 

#4 Taking it to the next level

For those interested in using a functional medicine approach in your day-to-day practice, we recommend these two programs 

 

Functional medicine is the tip of the spear of modern medicine. With genetic, biochemical and environmental individuality in mind, it aims to address the root causes of disease and optimize overall health and function. It takes from the old and new, conventional, holistic, and alternative, and incorporates the latest advances in genetic and pharmaceutical science to create a framework that might just be able to save us from the tsunami of chronic disease we are facing today. We hope you’ll use some of the resources above to explore functional medicine further for your own health or practice. 


Disclaimer:
 This post is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.


Ep 135 – Immune System Strength with Dr. Leonard Calabrese

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“What we’re talking about is systemic, low-grade inflammation where the body’s barometer for this inflammatory response is turned up just modestly.  This contributes to a whole host of diseases.  Diseases of chronic inflammation that range from type 2 diabetes, obesity, cardiovascular disease with heart disease and stroke, neurodegenerative disease, fatty liver– which is now epidemic in our society– as well as autoimmune disease.  So, now these diseases which are non-communicable– you can’t catch them– they are the leading cause of death on our planet right now and they’re being driven by chronic, systemic low-grade inflammation – Dr. Leonard Calabrese

Dr. Leonard Calabrese, is a rheumatologist, immunologist, and doctor of osteopathic medicine.  He is the head of Cleveland Clinic’s Section of Clinical Immunology and manages the Clinical Immunology Clinic.  After graduating from the Kansas City University of Medicine and Biosciences, Dr. Calabrese completed his internal medical training at Cleveland Clinic, followed by a fellowship in rheumatic and immunologic disease.

Over the course of his career, Dr. Calabrese has authored more than 300 publications and become an internationally recognized HIV/AIDS and hepatitis C researcher.  He is also passionate about utilizing lifestyle factors such as diet, exercise, sleep and stress management to reduce inflammation, control disease, and bolster immunologic function.  Based on growing scientific evidence that environment and behavior play a large role in immune function and gene expression, Dr. Calabrese is leading the charge in educating physicians and empowering patients so that they can feel confident in using wellness behaviors to help strengthen their immune function and improve their overall health and happiness.

Dr. Calabrese and I recently sat down to chat about the basics of the immune system and what practices we can implement in our day-to-day lives to reduce inflammation and lower our risk of chronic disease.

In this episode we discuss:

  • Dr. Calabrese’s medical background and what drew him to immunology
  • How the field of immunology has changed over the years
  • The role of our immune system: how it interacts with our body and our environment
  • How the immune system can become overactive
  • What inflammation is, and what causes contributes to it
  • What we can do to reduce our inflammation
  • Diet, intestinal permeability and their effect on the immune system
  • The role of diet, exercise, sleep and stress on the immune system
  • Social genomics and how we can influence which genes express themselves
  • Dr. Calabrese’s thoughts on the impact of gratitude practice
  • Habits that Dr. Calabrese implements in his own life to manage stress, diet, exercise and sleep
  • Dr. Calabrese’s vision for the Immune Strength program and how he hopes to help patients on a broader scale
  • Three things Dr. Calabrese does on a regular basis that have the biggest positive impact on his health
  • One thing he struggles to implement that could have a big impact on his health
  • What a healthy life looks like to Dr. Calabrese

You can follow Dr. Calabrese on Twitter and via his CME courses.

Links:

Related episodes:

Ep 22 – Brigid Titgemeir on Functional Nutrition

Ep 42 – Against All Grain’s Danielle Walker on Advocating, Healing and Celebrating

Ep 78 – Lifestyle & Brain Health with Dr. David Perlmutter 

Ep 103 – What to Eat When with Dr. Michael Roizen

Ep 105 – Sleep, Stress and Brain Health with Dr. Nate Bergman

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.

Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.


Ep 134 – Pursuing Health Pearls: Coronavirus

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Given that the coronavirus seems to be a major topic of conversation these days, we thought it would make for the perfect topic for our first edition of Pursuing Health Pearls. These are short, ideally 10-15 minute podcast episodes (although this one was a bit longer!) meant to offer succinct, high-yield info on common health concerns. You can listen to the episode in audio format, or you can read a more detailed write-up in the blog post below. 

In this article, we’ll first shed some light on what coronavirus is, how it is transmitted, who is at highest risk, how we can decrease our risk, and what to do if you think you are infected. Then we’ll talk some numbers about the scope of the outbreak and try to put it into context with other major public health concerns.

It’s important to note that our understanding of the coronavirus is evolving day by day. The information in this blog post and accompanying podcast are accurate as of this writing but will likely change with time. The information presented here has been gathered primarily from the CDC and WHO, and we recommend you use these as well as your state or local health department for the most up-to-date information as the outbreak continues to evolve.

In this episode we discuss:

  • What is COVID-19?
  • What are the symptoms of COVID-19?
  • How is it transmitted?
  • How do I decrease my risk of infection?
  • Who is at highest risk?
  • Should I be worried about traveling?
  • What should I do if I think I am infected?
  • How big is this problem?
  • Approaching chronic disease with the same concern as coronavirus

What is COVID-19?

Coronaviruses are a large family of viruses that are common in humans and in different species of animals including camels, cattle, cats, and bats. In rare cases, animal coronaviruses can infect humans and then spread through person-to-person transmission. Some previous examples of this include SARS-CoV (discovered in 2002 in China, which causes Severe Acute Respiratory Syndrome) and MERS-CoV (discovered in 2012 in Saudi Arabia, which causes Middle East Respiratory Syndrome), both known to cause severe respiratory disease. Both of these viruses have been contained and to date, sustained global spread has been avoided.

By now you likely have heard of the novel coronavirus which has been named SARS-CoV-2.  The disease it causes has been named “Coronavirus Disease 2019,” or COVID-19 for short. The origin of the virus was likely animal-to-human transmission in Wuhan, Hubei Province, China at a large seafood and live animal market. Subsequently, person-to-person transmission has been confirmed and now cases have been identified in over 100 countries around the world. On January 30th, the WHO declared the outbreak a “public health emergency of international concern.”

 

What are the symptoms of COVID-19?

Symptoms of COVID-19 are similar to disease caused by other respiratory viruses. The most common symptoms include:

  • Fever
  • Cough
  • Shortness of breath

Other symptoms may include headache, muscle soreness, fatigue, sore throat, headache, and diarrhea. Also similar to other respiratory virus diseases, COVID-19 may range from mild disease such as a cold to severe pneumonia, respiratory failure, or septic shock resulting in death.

 

How is it transmitted?

The coronavirus spreads from person-to-person contact, with respiratory droplets being the main mode of transmission. Contact with droplets from the mouth or nose can lead to infection. The virus may also spread through surfaces – it’s thought that touching an object that the virus is on and then touching one’s mouth, nose, or possibly eyes can also result in transmission. The highest risk for spread occurs when a person is symptomatic, and symptoms may develop anywhere from 2-14 days after exposure.

 

How do I decrease my risk of infection?

Following prevention measures recommended for other similar respiratory viruses such as colds and the flu is the best way to decrease your risk of infection with the coronavirus. These measures include:

  • Avoiding close contact with people who are sick (stay at least 6 feet away)
  • Covering your cough or sneeze with a tissue, then then throwing it away
  • Avoiding touching your eyes, nose and mouth
  • Cleaning and disinfecting frequently touched objects and surfaces
  • Staying home when you are sick except to get medical care
  • Washing your hands often with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after touching your face. If soap and water are not available, an alcohol-based hand sanitizer with at least 60% alcohol is recommended.
  • The CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19
  • There is currently no vaccine to protect against COVID-19

 

Who is at highest risk?

Currently, those at greatest risk of infection include:

  • Those who have had prolonged, unprotected close contact with an individual with symptomatic, confirmed COVID-19
  • Those who live in or have recently been to areas with sustained transmission including China, Iran, Italy, South Korea, and Japan

Those at greatest risk for developing severe symptoms from a coronavirus infection include the elderly and those with chronic medical conditions such as lung disease, heart disease, or diabetes. Individuals with these risk factors are advised to stay at home as much as possible and avoid crowds, and make sure they have access to several weeks of medications and supplies in case they need to stay home for prolonged periods of time.

Not a lot is known about the impact of the coronavirus on pregnant women, but extrapolating from what we know about other similar viruses (SARS and MERS), pregnant women may be at higher risk of developing severe symptoms if infected than the general population. There has also been increased risk of pregnancy loss with these viruses and increased risk of birth defects is seen with high fevers in the first trimester of pregnancy. Pregnant women should avoid others who are symptomatic and engage in the usual protective actions discussed above.

 

Should I be worried about traveling?

The CDC and US Department of State have issued travel warnings to certain countries, which are updated regularly on their websites.

Currently, the CDC is recommending avoiding all nonessential travel to China, Iran, South Korea and Italy, and entry of foreign nationals from China and Iran has been suspended for the time being. Elderly adults and those with chronic medical conditions are advised to consider postponing travel to Japan as well. In other countries where the risk of transmission is more limited, usual travel precautions are in place.

Several companies such as the Cleveland Clinic and Google have issued travel bans for their employees in attempt to do their part to control the outbreak.

 

What should I do if I think I am infected?

If you have been in close contact with someone who has COVID-19 OR you have recently traveled to an area with ongoing community spread (China, Iran, Italy, South Korea, or Japan) AND you develop the symptoms listed above, call your doctor or notify your state or local health department right away.

If your symptoms are mild, you may be advised to stay home and be monitored virtually to avoid spreading the virus. If you have more severe symptoms, you may need to be evaluated in a healthcare facility, but you should still call your doctor first so they can be prepared to prevent the spread of infection to other patients and health care workers. The CDC recommends that those who may be infected do not leave home except for medical appointments, and a face mask should be worn before entering the medical facility.

 

How big is the problem?

As of March 9th, there have been 109,577 reported cases of COVID-19 globally, and 3809 deaths. This means that there is a 3.5% case fatality rate, or 3.5% of people that we know to be infected with the disease, have died. However, as it is early in our understanding of the outbreak, it is likely that there are many more people infected but we are not detecting them because they are experiencing mild symptoms. A larger number of cases would lower the death rate, so it’s possible we will see this number go down with time.

Comparing COVID-19 to two other coronaviruses, SARS and MERS, we can see that the COVID-19 outbreak is already much more widespread, although seems to have a lower death rate:

 

We can also compare COVID-19 to another widespread respiratory virus that we encounter each winter: influenza. As of March 9th in the US, there are a total of 423 cases of COVID-19 and 19 deaths. In comparison, there have been at least 34 million cases of influenza detected and 20,000 deaths in the US so far this year. Most of the cases of COVID-19 so far have been detected in California and Washington. So overall, the immediate risk of infection in most of the US is currently very low, and the number of people currently afflicted pales in comparison to influenza which is a viral illness that contributes to a huge amount of morbidity and mortality every year.

Comparing the spread of COVID-19 to other public health concerns, such as chronic disease, also helps to shed some light on the magnitude of the problem. Currently about 1.21 million people in the US have cardiovascular disease, and 859,000 people die each year of heart disease and stroke – that’s ⅓ of all deaths! Many of the chronic diseases we face today that ultimately lead to heart disease and stroke – hypertension, obesity, type 2 diabetes, hyperlipidemia, metabolic syndrome, fatty liver, chronic kidney disease – can be prevented and/or treated through lifestyle factors. These factors include regular activity, healthy nutrition, stress management, good sleep, and avoiding substances such as tobacco and alcohol. Although these diseases affect a huge proportion of our population, because they are slow to develop over years and decades, they don’t seem to raise the same level of concern as we currently have over COVID-19.

Given the information we have to date, it’s likely the coronavirus will continue to spread and more cases will be identified. By practicing basic respiratory infection precautions and doing our part to stay informed and take the outbreak seriously, hopefully we can work together to prevent this from becoming a global problem. Currently, the risk of transmission in most countries around the world, including the US, is very low and those who are generally healthy are expected to develop mild-moderate symptoms. Let’s also use this outbreak as a reminder that every year the flu affects and kills huge numbers of people, and if we bring the same level of concern and precautions to every flu season that we have now, we may be able to prevent unnecessary suffering and deaths each winter. Additionally, the epidemic of chronic disease we are experiencing, although much more insidious than the evolution of COVID-19 over the past several weeks, is one we have a lot of control over and a lot of potential to reverse if we can bring a similar level concern to that we have raised for the coronavirus.

 

Disclaimer: This post is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.


Ep 133 – A New Chapter for Pursuing Health with Dr. Dani Urcuyo

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This question also leads us into some big announcements that we have, because we realize that there is a huge gap between all the information that you’re getting from the fitness world and the wellness world out there, and medical care.  And we’ve been living in both of these worlds.  We’ve been living in the fitness world through CrossFit, we’ve been living in the medical world through our training for the past ten years, and we see that there’s a huge gap, and we feel like that is really our purpose and our position is to fill that gap, to bridge that gap.  So, that being said, today we are launching a brand new website which is bringing together all of the different things that we’ve been working on over the past few years in such a way to help bridge that gap.” – Drs. Dani Urcuyo & Julie Foucher-Urcuyo

Daniel Urcuyo is a board certified family physician and has completed his training with the Institute for Functional Medicine.  He graduated from the University of Michigan with a degree in Microbiology and completed his medical school and residency training at the Cleveland Clinic.  Dani is also a CrossFit Level 1 Trainer, co-founder of the TRAIN with Julie Foucher program, and a former CrossFit Games team competitor.

Dani also happens to be my husband and the person who introduced me to CrossFit! We first met in college (over an episode of Grey’s Anatomy!), and as we progressed through our medical training, we both shared a frustration with the inability of our conventional medical system to address the root causes of disease.  After witnessing the power of lifestyle to improve overall health via our time in CrossFit affiliates, we knew we wanted to practice a different kind of medicine: one that harnesses the power of lifestyle and is rooted in communities.

In this episode, I’m excited to give you a peek behind the curtain to learn more about Dani as we talk about how we met, answer listener questions, and make a big announcement about the improvements coming to Pursuing Health and our vision for the future!

Included in this episode:

  • Dani’s background: his culture, his family, and his little-known talents
  • What drew Dani to medicine
  • How Dani and Julie met, including how he introduced Julie to CrossFit
  • What led Dani to select family medicine after initially planning to pursue transplant surgery
  • His experience competing at the 2011 CrossFit Games
  • Dani’s experience working with SteadyMD
  • Dani’s perspective on the CrossFit Health movement and the ongoing networking events CrossFit hosts for doctors
  • How to know if your doctor understands your fitness and performance goals, and how to find a doctor whose values are in line with your own
  • Julie & Dani’s big announcement: Pursuing Health
  • Dani’s morning routine
  • What you can expect from our new website, Pursuing Health: the Morning5, Train for Life, TRAIN with Julie Foucher, recipes, stories from individuals using lifestyle to overcome challenges, discount codes and more
  • How the podcast will be growing and expanding
  • Why it’s so important to Dani & Julie to avoid influence from industry
  • An opportunity for listeners to support the podcast and receive special benefits
  • How Julie and Dani uphold their relationship despite busy schedules
  • What fostered Dani and Julie’s interest in health and drive to pursue it
  • The opportunities they have created for each other
  • Three things Dani does on a regular basis that have the biggest positive impact on his health
  • One thing he struggles to implement that could have a big impact on his health
  • What a healthy life looks like to Dani

You can follow Dani on Instagram.  You can follow Pursuing Health via our new website and on Instagram.

Links:

Related Episodes:

Ep 07 – Dr. Mark Hyman on Functional Medicine, the future, and community

Ep 66 – Cleveland Clinic CEO Dr. Toby Cosgrove on Lifestyle, Healthcare, and Persistence

Ep 111 – A New Model for Primary Care with Dr. Ken Rictor

Ep 116 – How Healing Work with Dr. Wayne Jonas

Ep 118 – The State of CrossFit with Coach Greg Glassman

Ep 120 – All About Keto with Dr. Dom D’Agostino

Ep 125 – Bridging the Gap Between the Hospital and the CrossFit Affiliate

If you like this episode, please subscribe to Pursuing Health on iTunes and give it a rating. I’d love to hear your feedback in the comments below and on social media using the hashtag #PursuingHealth. I look forward to bringing you future episodes with inspiring individuals and ideas about health every other Tuesday.

Disclaimer: This podcast is meant to share the experiences of various individuals. It does not provide medical advice, and it is not a substitute for advice from your physician or health care professional.