Functional medicine is a new nutritionally based treatment that deals with the management of many common chronic illnesses, including fibromyalgia, chronic fatigue syndrome and rheumatoid arthritis.

The functional medicine approach is centered on the principle that restoring proper cellular metabolism, through reducing toxin levels and lowering oxidative stress to the body, will allow normalization of mitochondrial respiration, cellular energy production, and ultimately to a reduction of the signs and symptoms of chronic disease.

The functional medicine philosophy springs from the premise that a breakdown of the intestinal lining occurs due to the long-term ingestion of food and water-based toxins. This is aggravated by the use of common prescription and over-the-counter drugs such as antibiotics and NSAIDs (i.e. aspirin, Tylenol, and ibuprofen). This leads to a hyperpermeable of the intestinal mucosa, or leaky gut syndrome. The healthy intestinal lining is very selective about what it allows into the blood stream. It allows nutrients while holding back larger chemicals and toxins. Leaky gut is when the intestinal lining fails to act as a selective barrier, allowing food-based toxins and partially digested food proteins into the blood stream. The result is an increase in food allergies and increased toxic load. This increased toxic load will, over time, lead to increased stress on the liver and its ability to adequately detoxify these substances through phase I and II pathways. This in turn will ultimately result in even higher levels of tissue toxicity.

Increased tissue toxicity is thought to be a major trigger for mitochondrial dysfunction. Since the mitochondria are the only source of energy for the cell this results in an inability of the body's cells, including the muscle cells, to efficiently use oxygen dependent aerobic metabolic pathways. These pathways account for the majority of the body's 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).

The process begins by determining intestinal health and the functional reserve of the liver and its detoxification abilities. This is commonly done with the help of patient symptom questionnaires, and functional laboratory studies, such as the complete digestive stool analysis (CDSA) for detecting markers of digestion, absorption, and colonic flora.

Detoxification ability of the liver can be accessed via the caffeine clearance and conjugation metabolite challenge tests, which evaluate phase I (cytochrome P450) and phase II (conjugation) liver detoxification pathways. These tests are not performed by standard clinical laboratories, but are available through specialized laboratories that offer functional testing.

Once the data is collected, a treatment program is selected, which may include specific nutrients to correct any intestinal hyperpermeability (leaky gut syndrome), or liver inadequacies.

"Four R" Approach to Gastrointestinal Restoration Remove: Eradicate any pathogenic microflora, yeast and/or parasites with natural or prescription agents suggested on the CDSA (i.e.berberine/goldenseal, garlic, Artemisia, citrus seed extract, uva ursi, etc.). Eliminate known allergenic foods and/or follow a modified elimination diet by avoiding dairy and gluten containing foods, and emphasizing fresh non-processed foods. Replace: Provide pancreatic multi-digestive enzymes and HCL if appropriate, particularly if markers of malabsorption are present on the CDSA. Reinoculate: Administer lactobacillus acidophilus, bifidobacterium and probiotics such as fructooligosaccharides (FOS) and inulin. Repair: Provide nutrients to support gastrointestinal mucosal integrity. After intestinal issues have been effectively corrected, upregulation of liver detoxification pathways can be accomplished by providing nutrients which are used in phase I biotransformation and phase II conjugation pathways. 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 bio transformed intermediate molecules, which increase oxidative stress on the body.

This should all be combined with a diet, which emphasizes fresh foods, and eliminates 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.

Detoxification or the art of Functional Medicine

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