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Functional Medicine for Long-Term Healing

by Anne Hendren Coulter, Ph.D.

Jeffrey S. Bland, Ph.D., has had an active role in the promotion of natural medicine for more than 30 years. For the past 20 years, he has focused on the role of nutrition in healing. He is currently involved in research that seeks to define the relationship between nutrition and genetic expression.

The Interview

Anne Coulter: You. were among the first health care professionals to .promote natural medicine as a viable alternative or adjunct to traditional medicine. How did you first become involved in the field?

Jeffrey S: Bland: My mother came from Southern California and. believed in natural medicine. She was raised seeing a naturopath, not medical doctors. She was diet- and nutrition-conscious. When I was in graduate school studying health sciences, she reminded me not to be brainwashed about the benefits of new drugs and that I should remember that the major advances in health were in sanitation, hygiene, and nutrition. She told me that patients needed to know this and she hoped that I would bean advocate of natural health. I deferred to her good opinion but was still excited about the advances in modem medicine.

When I graduated several years later with my doctorate in clinical biochemistry, my second son died of SIDS [sudden infant death syndrome]. This raised questions about what I could have done to prevent this, about why modem medicine could not diagnose or treat this disorder. These questions started me on the path that I've followed for more than 30 years. I decided that if, in my life, I could help one family avoid an infant death, I would have made good on my education.

After that, a series of fortuitous circumstances connected me to people with different opinions about health. My first graduate student chose to work on vitamin E, something I knew nothing about. Our work skyrocketed me to fame as the "doctor who has found the secret of aging." This was a media exaggeration, but it launched my career as one who promoted health and nutrition.

I was invited to speak and .conduct broader and broader research on the origin of chronic illnesses such as heart disease, diabetes, osteoporosis, chronic fatigue, fibromyalgia, and digestive disorders. I became the most productive researcher at the staff at the University of Puget Sound [Tacoma, Washington], had the biggest research group, and had the most grant money.

Then, in 1977, I took over the directorship of the Bellevue-Redmond Medical Clinic-the Iatest nutrition and preventive medicine laboratory in the Seattle metropolitan area. We had four medical doctors, two naturopathic doctors, two chiropractors, and a staff of about 35. The head doctor was Dr. Leo Bolles. He was the first M.D. in the state of Washington to convert a traditional pathology-focused practice to a nutritional medicine practice. He was one of my many mentors.

In 1983, as a result of this practical work and my .own research, I was invited by Dr. Linus Pauling Ph.D. and Dr. Emile Zuckerkandl to come to the Linus Pauling Institute of Science and Medicine* and to direct one of Dr. Pauling's research laboratories. I went on sabbatical at the Pauling Institute for 2 years.

This work precipitated a life change. When I returned in 1984, I .did not go back to the university. I decided to focus on educating doctors about how to implement nutrition into their practices. I traveled throughout the world speaking to practitioners about the role of nutrition in promoting good health. That was the start of this new career. I have been on this path for the last 20 years.

AC: In 1991, you started the Institute for Functional Medicine (IFM). How did it come into being and what does it offer practitioners?

JSB: By 1990, I had amassed nearly 2 million miles of air travel. Speaking to groups internationally. My wife said, "I like all this but why not extend your productive lifetime and bring people to you. Develop a world-renowned institute where doctors could come for training." This led to the establishment of the Institute for Functional Medicine. IFM is an organization that serves a need for doctors looking for a place to find skills that they don't get in their postgraduate training: training in nutrition, lifestyle, and environment as it relates to medicine. We try to provide that postgraduate training. Physicians receive CME [continuing medical education] credits for attending the weeklong program. They work with 20 faculty on a case-based presentation for a week. It's called the Applied Functional Medicine and Clinical Practice Program.

People go away thinking it was like going back to school but with the added advantage of doing it with colleagues who have been in practice for many years and share their mutual


AC: I have always wondered how you developed the name "Functional Medicine." Could you give us the history behind this?

JSB: That is an interesting question. We published a magazine entitled Complementary Medicine in the 1970s. We observed that "complementary" and many of the other terms out there, including holistic and alternative, bring with them a certain type of baggage. They split people off. It does not diminish the lines between the two types of practice; rather it creates separation.

I was trying to find a term that everyone could rally around. I asked myself: "What does no doctor want to be called?" No doctor wants to practice dysfunctional medicine, so that must mean that every doctor wants to be a functional medicine physician. Additionally, "functional" has a number of other connotations that refer to the kind of medicine we practice. Not only, in its historic sense, as rehabilitative medicine like that used in geriatric medicine, but also as it relates to the range of loss of function that occurs before the onset of pathology. Someone doesn't just have a heart. attack on Monday morning and die. He or she had something that has reduced cardiovascular function over time. The culmination of that is the heart attack. Similarly for cancer, diabetes, arthritis, these are not just events that occur as a mystery. We don't ask the right questions early on as to what the preceding factors were to the loss of function. By looking at precursor markers and early warning stages and alteration of physical and emotional function, we're able to presage the onset of more serious injury. So our focus is on personalized preventive medicine, rather than on public health preventive medicine, like seat belts, immunizations, Pap smears, and cholesterol screening. What we're dealing with are the individual characteristics of what makes' people what they are. They carry in their genes their own unique needs. The functional medicine concept is for the individual, rather than for the mythical 70-kg average individual that never exists in clinical practice.

AC: Is functional medicine a type of genetic analysis?

JSB: There's a genetic underpinning. Each person carries the marriage of genetic uniqueness and the environment he or she has lived in. The future of medicine is in analysis of our phenotype. Medicine is focused on patient-centered assessment looking at antecedents and genetic underpinnings. Practitioners analyze emotional trauma, antibiotics, infection, toxins, and mechanical injury that lead to release of mediators-cholesterol, C-reactive protein, various types of cytokines, neurotransmitters, and prostaglandins in the body-that, in turn, give rise to symptoms that vary in intensity, frequency, and duration. What we look at is the etiology of an alteration in function, rather than naming it and blaming it through the primacy of diagnosis. We look for the root cause of the dysfunction in functional mechanism . Functional medicine is more focused on the physiological mechanism leading to dysfunction than the diagnosis.

AC: This sounds similar to tenets of Chinese medicine, naturopathic medicine, and other medical disciplines that were once thought to be marginal. Did you come to this "philosophy" of medicine

through personal experience or through a consolidation of information from other fields?

]SB: I think it's a combination of the unique experiences I've had. I was at the right place at the right kind and was fortunate to meet Dr. John Bastyr, Dr. Linus Pauling, Dr. Roger Williams and others some of the founding fathers of natural medicine. I was in both the clinical and academic worlds where I s~ functional medicine being applied successfully in patients with chronic illnesses.

And, lastly, my 30 years of research, described in my several hundred research papers, has revealed that the outcomes of functional medicine are reproducible and backed by good science. I have developed a mechanistic view based on peer-reviewed articles published in top-rated, peer-reviewed articles that offer proof that many chronic illnesses can be explained and treated through careful questioning of the patient, the first step of a functional medicine practice. And yes, much of what I have considered is evident in other medical systems. We learn very little hat is new. We learn old things in new ways. We recontextualize them. I'm a pretty good chronicler of old things said in new bays. There's so much out there that comes from the minds of really wise people. We need to go out, relearn it, and review it in the context of current pathology.

AC: According to Robert Rountree M.D., one of the instructors at the IFM, one of your most important contributions to the natural medicine field is that you delineated in exquisite detail exactly why the microecology of the gut is so important and how specific nutrients and probiotics work. Could you elaborate on this?

JSB: The gastrointestinal [GI] tract is more than just a piece of plumbing. It has some remarkable effects in regulating immune system. The late Dr. Elie Metchnikoff of the Pasteur Institute co-wrote a book about the GI tract's effect on illness- The Prolongation of Life,** translated from French in 1903. His research indicated that people with chronic illness had fairly significant GI problems. By re-instilling proper GI function, they were able to restore their health. This is the one of the founding tenets of naturopathic medicine. American naturopathic medicine was built an that premise. Since then; the field of immunology has emerged to recognize that nearly 60 percent of the immune system is clustered around the GI tract, meaning 75 percent of antibodies are produced by cells around GI lymphoid tissue that surrounds the digestive system. Over the course of life, the average person will consume more than 50 tons of food that has to be broken dawn far absorp tion into the body. Same are nutrients; same are toxins. Toxins are further increased with bacterial presentation. There are 3.5 pounds of living organisms in the GI tract that are there as a result of symbiotic; parasitic processes. They produce their own waste products that have to be properly processed in the immune system and intestinal tract.

If the gut immune system is not working, the immune system throughout the body is malfunctioning. When there are toxins in the intestinal tract and the liver, which is not working effectively to clear the toxins, then the brain gets a toxic message. People in the hospital with hallucinations are said to have a condition associated with alteration of intestinal function with bacterial toxic release as well as reduced liver function, which produces altered brain function.

AC: With advances in functional medicine can you predict, through analysis of GI function that someone will develop a specific disease?

J8B: We're not yet to that disease specificity. If the GI system is failing it may be increasing the risk of arthritis or inflammatory disorders and may affect blood sugar control. What disease an individual may get depends on his or her genetic susceptibilities, but it will be aggravated by this dysfunction.

AC: Can you reverse this condition?

J8B: It doesn't get rid of the genetic tendency. But if there is genetic tendency in the absence of the phenotype, who cares? Good health may reverse susceptibility to illness. Perhaps you are at risk far heart disease, but it is possible you might never get it.

AC: In other words, you hold t with a healthy gut, it's possible one might never get a cong~ ital disease?

JSB: Absolutely: That's one of the five fundamental foundations of functional medicine. If you correct the precipitating factors, it lowers. the expression of the disease that you are worried about, be it cancer, heart disease, etcetera.

AC: What are the five fundamental foundations of functional medicine?

JSB: They are simple, commonsense approaches to medicine and are as follows:

(1) Correct the precipitating factor and control oxidative stress.

(2) Get rid of the sources of chronic inflammation, including altered GI function.

(3) Manage properly the nutrition of the folate cycle (folic acid, vitamin B-6 and
vitamin B-12.

(4) Regulate hormones pertaining to stress (hypothalamus, pituitary

and thyroid access, and regulation of gonadal hormones).

(5) Manage insulin and its control blood sugar.

AC: Can all this be done naturally? Or will it be necessary to use synthesized medicine?

J8B: It would depend an the practitioner. There may be some practitioners who are very comfortable mixing and matching natural medicine with conventional medicine to produce the best outcome. Others would stay with natural means; others with conventional approaches.

AC: What do you do?

JSB: I use the best tool far the best purpose. If all you have is a hammer then everything is a nail . We try to give practitioners a tool kit that they can have to the best approach to the patients in times of need. It really is an integration of the right tool at the right time.

AC: Are there occasions when l you will fall back on conventional medicine to help a patient?

JSB: Oh, yes. Because, if for no other reason it's useful to understand the physiological mechanism underlying disease. It important to know whether intervention is necessary Using this information, we can develop programs to help people with chronic illness.

AC: In addition to .teaching at IFM, you give a lecture series. Tell us about that.

]SB: Yes. In January 2004, I will begin my 29th lecture series. This series will focus on inflammatory diseases, specifically arthritis/ heart disease, and disorders of inflammation associated with menopause.

AC: Are there summaries of the 28 others?

]SB: Yes, I publish a book for each series. These books are available through the IFM bookstore.

AC: You indicated that you are the president and chief science officer of Metagenics. What does this entail?

]SB: Metagenics supports our teaching and research efforts. It is a company that develops nutraceuticals and medical foods to help practitioners manage their patients/ complex and chronic health problems. Metagenics products are sold exclusively through licensed health care practitioners. Some of these practitioners attended our seminars where we point out the usefulness of nutraceuticals in a patient's diet.

AC: Do most dietary plans require the use of nutraceuticals?

]SB: No. We try to teach patients what to buy in markets that will be most useful for their conditions. They may need selective supplements in higher concentration of nutrients to get the best benefit from that program.

AC: You have made a very conv incing case for becoming a functional medicine practitioner. However, there may still be doubt about this system. Why would a practitioner learn this system?

]SB: If, in the end, a physician is called to service to create healthy people, not just fix things that are broken, then every doctor needs to be a functional medicine doctor. If all they're

doing is '"Band-Aid and bailing wire" repairs of patients, these same patients will come back later with other problems. Doctors are supposed to be health care practitioners that don't just treat disease, but that make patients healthy, make them well. Well is more than absence of disease.

*EDITOR'S NOTES: The Institute is now called the Linus Pauling Institute and is located at Oregon State University in Corvallis, Oregon.

**Metchnikoff E, Llyich L, Mitchell PC. The Prolongation of Life: Optimistic Studies. New York: Springer: 2003 [transl. from French].

About the Institute for Functional Medicine

Institute for Functional Medicine
4411 PT Fosdick Drive NW, Suite 305
Gig Harbor, WA 98335
Phone: (253) 858-4727 or (800) 228-0622
Fax: (253) 853-6766
Web Site: www.functionalmedicine.org

The IFM attempts "to improve patient outcomes through prevention, early assessment and comprehensive management of complex chronic disease."*** To facilitate this, the IFM offers courses indicating how functional medicine can be applied and conducts research into the wider applications of functional medicine. The Institute maintains contact with health care policymakers, practitioners, educators and researchers to increase their knowledge about and use of functional medicine.

In an effort to address the cost of health care necessary to maintain a healthy aging population, the IFM trains physicians and health care practitioners to recognize early pathology and to treat underlying disease, not symptoms. The organization educates clinicians about ways to encourage lifestyle changes for patients, offering them suggestions for nutritional and dietary intervention.

The IFM offers symposia that "Apply Functional Medicine to Clinical Practice." These symposia are designed to teach practitioners how to apply functional medicine in their daily practices to treat diabetes, irritable bowel syndrome and inflammatory bowel disease, menopause, rheumatoid arthritis, allergies, and other disorders.

The faculty for these symposia includes Dr. Bland and a number of specialists from fields in obstetrics, family practice, neurology, and other specialties, as well as Ph.D. chemists and nurse-practitioners.

***Online document at www.functionalmedicine.org

-Alternative & Complementary Therapies, February 2004