Functional medicine identifies and addresses the underlying causes of disease, using a system-oriented approach that engages the patient and health professional in a therapeutic partnership. It is a patient-centered approach to medicine and disease, looking at the person as a whole, rather than just focusing on individual symptoms. A great deal of time is spent on eliciting a comprehensive history from the patient, and then looking at genetic, environmental, and lifestyle interactions that influence health and disease. We are all born with a certain gene set, but the choices we make and the exposures we experience can directly influence our susceptibility to disease or whether or not we achieve optimal health.
Kristi Hughes, ND, a presenter at the recent Integrative Health Symposium in New York City, discussed a food-first approach to intercepting metabolic syndrome, hypertension, cardiovascular disease (CVD) and dyslipidemia. At the core of the presentation was the question, “Does food matter when it comes to heart health?”
The ABCD evaluation
At the heart of functional medicine and the treatment of metabolic syndrome, high blood pressure and dyslipidemia, among other health conditions, is the initial evaluation. The ABCD method covers:
thropometrics – taking specific measurements like waist size, BMI, blood pressure, pulse and using bio-impedence to assess body fat.
omarkers – Using blood work and lab tests including CBC, lipid profile, fasting blood sugar (FBS), and insulin levels for objective disease diagnosis.
inical indicators - A thorough examination of the mouth, skin, cardiovascular and peripheral nerve systems.
et, nutrition and overall lifestyle journal (that the patient shares) – how, when, why, what the person eats, sleep patterns, thyroid symptoms, and then assessing what is contributing to ongoing disease(s) or symptoms.
The goal of the ABCD evaluation is to identify possible:
- Vascular immune dysfunction
- Oxidative stress
- Metabolic dysfunction
The above four findings correlate with specific diseases or increased risk of certain health conditions. Based on findings and the ABCD findings, the practitioner will then initiate a therapeutic program. At the core of the treatment protocol is the recognition that food is energy, information, connection and medicine. Food is clearly our primary fuel and what we choose to eat directly influences and alters cellular function. We also have social connections through food which cannot be ignored, and food is also medicine, for example, probiotic-rich yogurt can improve our gut microbe balance, omega-3 fatty acids can support heart health and help to limit diabetes, the fiber from berries and whole grains can help to manage blood sugar and cholesterol.
Poly-pills or poly-meals to treat poly-illsThe average American suffering with metabolic syndrome, hypertension and dyslipidemia is likely taking a statin, one or more anti-hypertensive medications, aspirin and possibly folic acid. Experts in the field of nutrition know that along with weight loss and exercise, a Mediterranean-style diet, the DASH diet and foods like antioxidant-rich fruits and vegetables, almonds, dark chocolate, small amounts of wine, fish and garlic, among other foods and herbs can positively impact these disease. Research shows that adherence to recommendations for daily intake of produce, fish, and omega-3 rich foods can reduce the risk of CVD by as much as 20-30% and also result in reduced mortality and increased lifespan.** In functional medicine, promotion of a healthy diet is considered a cornerstone in the prevention of heart disease.**** Food alone can result in medical transformations**
While functional medicine does recognize that environmental toxins can cause a host of ailments, and other stressors including lack of sleep and high levels of anxiety can instigate disease, the discipline emphasizes using diet first as therapy and then, of course, using traditional medications and other therapies when necessary.
The cardio-metabolic food plan can be personalized, but its core features include a comprehensive, tailored food list that takes into account:
- Specific macronutrient percentages (proteins, fats, carbohydrates)
- Fiber goals
- A calorie specific goal if weight loss or weight gain is necessary
- Serving size information
- The “don’t list” of trigger foods to avoid because they impair gut microbe balance, or instigate disease risk or frank diseases (sugars, trans fats, highly processed and refined foods, charred meats, fast food, and sweet drinks)
Many foods offer therapeutic impact like pre and probiotic foods, fish oil and omega-3 fatty acids, anti-inflammatory foods, and herbs like turmeric, so these foods may feature prominently in the tailored eating plan. Since there can be other ongoing health issues, in addition to CVD, metabolic syndrome and hypertension, the whole person approach to nutrition might address goals including: weight gain, weight loss, relieving joint pain, improving immune response, reducing asthma, depression, irritable bowel syndrome, skin conditions, among other symptoms and diseases.
A mostly plant-based diet for CVD: A metabolic resehere’s been plenty of research to support the use of a plant-based diet to support cardiovascular health. Fruits and vegetables tend to be mostly low in calories, full of fiber, high in nutrient density and low in sodium. Consuming five or more servings daily is associated with a lower risk of CVD. A high intake of fruits and vegetables is also associated with lower blood pressure. Soluble fiber and plant-based sterols may also have an LDL-lowering effect. A Mediterranean-style diet rich in vegetables, olive oil, legumes, whole grains, fruits, nuts, spices and herbs, with modest amounts of poultry and fish, very low amounts of meat, dairy, and low to moderate amounts of wine has been shown to help to lower blood pressure and markers for cardiac disease. The Lyon Diet Heart Study showed reduction of mortality, CVD and neoplastic disease with adherence to the Mediterranean Diet.
These dietary recommendations can help to reduce waist size, improving HDL, improving triglyceride levels, lower systolic and diastolic blood pressure numbers and improve glucose profile. Along the way, inflammation is reduced, cravings and food addictions typically resolve, blood sugar stabilizes, the gut microbiome is balanced and overall health improves.
The functional medicine prescription
In addition to the cardio-metabolic food plan, a functional medicine prescription will also offer sleep and exercise recommendations, stress management, supplements and medications when indicated. This program can intercept CVD, metabolic syndrome and hypertension, as well as prediabetes and diabetes. All you have to do is “buy into” the reality that food can heal or cause disease. Your dietary (and lifestyle) choices DO largely determine your health.
Sources: Circulation Institute of Functional Medicine