Tag Archives: functional medicine

How do I choose the right probiotic?

A reader writes…

“How do you go about selecting the right probiotic?  I’ve heard such conflicting information.  Some say that probiotics are useless, because you’re born with what you have and there’s no way to replenish.  What are your thoughts?”

My first thought is, who on earth is telling people there’s no way to replenish good intestinal bacteria?  Whoever it is, he or she is gravely misinformed on several counts.  First, we’re not actually born with any gut bacteria; we acquire it early on–first during a regular vaginal birth and next during breastfeeding.  (Those who did neither missed out on these opportunities and may not have adequate levels of good bacteria if they didn’t acquire it from other places.)

Next, it’s important to understand that our normal gut flora (beneficial or “good” bacteria) are constantly under attack.  These attacks come from anywhere: stress, processed foods, alcohol, tap water, soil, other animals, medications (especially antibiotics and antacids), other people, and lack of stomach acid, just to scratch the surface.

Why do we need these bacteria in the first place?  They carry out an extensive array of extremely important functions.  They help fight some major disease-causing bacteria; in fact, they help form most of our immune system!  They turn vitamins into their active forms so that our body can use them.  They help you absorb nutrients, including fats, carbohydrates, protein, vitamins, minerals, and others.  There’s even a growing body of evidence that suggests these bacteria may play a role in lowering cholesterol.

So, when we don’t have enough of these bacteria, the above benefits start to evaporate; the immune system becomes weak, other “bad” bacteria (as well as yeasts, fungi, and parasites) can become opportunistic and “install” themselves, you can become seriously deficient in multiple important nutrients, and if the recent studies are correct, your cholesterol may elevate.  Does any of this sound familiar?  It should.  Why?  Because most people are indeed missing much of the good bacteria they need.

So, we turn to probiotic supplements.  I would love to sit down with someone who doesn’t believe probiotics do any good and show them the before-and-after digestive analysis tests of my patients (with names protected, of course), and show them the growth of the colonies of good bacteria between the initial test and the subsequent follow-up.  The numbers of good bacteria do improve.  This is how I know the probiotics are working.

So how does one choose a good probiotic?  There are quite a few choices out there and unfortunately, not all probiotics are created equal.  The supplement industry is largely left to police itself without a lot of regulation, which has both advantages and disadvantages.  The bad news is, there are some that don’t do squat.  The good news is, there are many that are quite effective, and these companies are free to innovate and develop superior products, which many of them have done.

So how do we separate the “men from the boys”, so to speak?  There are two fundamental qualities to look for in a probiotic: a variety of species, and high, potent doses.

At your local health food store, most of the products contain anywhere from 3 to 5 species or so.  This is okay, but it’s not quite enough.  This is because your intestinal tract is essentially a small ecosystem.  There are literally billions, even trillions of different types of bacteria happily co-existing together, each of them occupying space and keeping each other in check, ultimately creating a delicate balance.  Supplementing with a 3-species formula won’t do much.  (Most formulas available only through healthcare professionals typically have much higher quality and potency than those available to the public at health food stores and other places.) The most diverse higher-quality* formulas we have found so far (and thus, the ones we use) contain 12 different species.  While that doesn’t sound like much of an improvement in the grand scheme of things, it seems to work quite well, each additional species having a compound effect.

Next, let’s talk potency.  Potency is measured in colony-forming units, or CFUs.  One CFU, theoretically, goes on to start its own entire colony.  It’s mind-bending to consider how many billions of microorganisms there are in just a teaspoon of probiotic powder.  The storebought brands tend toward lower dosages, somewhere around 5 to 35 billion CFUs.  The highest dose medical grade supplements we found (and incidentally, the ones we use) contain 100 billion CFUs…in a single quarter teaspoon.

And last but not least, as with all supplements, it’s important to avoid supplements that contain (or come from a factory that uses) gluten fillers (wheat germ, wheat flour, wheat proteins, food starches, etc), yeast, soy, egg, milk, corn, shellfish, and MSG, just to name a few.  This is because many (if not most) people actually have immunological hypersensitivites to various common foods, in which the body’s immune system perceives that food as a toxin and launches an attack against it, creating lots of inflammation and chronic, mysterious health problems.  Many storebought supplement companies may be contaminated with these common allergens, but most medical grade supplements specifically state that they are free of all of these substances.

Since our ability to maintain good bacteria balance declines with stress, age, and lifestyle, it’s good to take a high-quality probiotic as part of a maintenance regimen.  This is especially true after finishing a round of antibiotic treatment, such as that for an infection.

*There are other formulas that may contain up to 14 different species, but these are not potent enough to be considered medical food/medical grade supplements, which have the highest quality and potency.

In health,
~Dr. L. Sweeney
Functional Medicine, Functional Endocrinology, and Functional Immunology
San Antonio Family Alternative Medicine

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How to find a good Functional Medicine doctor, Part 2

In my most recent post, I started laying out some guidelines I use to help people find a good Functional Medicine practitioner.  To sum things up so far…

The most important aspects of a good Functional Medicine practitioner include holding a doctor license of some kind (doctors of all kinds receive similar training where it counts in Functional Medicine – all receive extensive Anatomy, Physiology, Endocrinology, Biochemistry, Embryology, Histology, Cytology, Biology, Lab Diagnosis, and more).  Doctors of all kinds can order and interpret diagnostic lab testing in nearly all states, whether he or she is an MD, DC, or DO.  There are indeed MDs and DOs who practice exclusively Functional Medicine without using medications at all, and there are indeed DCs (Doctors of Chiropractic) who practice exclusively Functional Medicine without ever doing a single spinal manipulation or physical rehab therapy session.

So now, let’s move on to a few more guidelines that can help separate the “men from the boys”, so to speak, and maximize your chances of finding a good practitioner that meets your needs.  Here are a few more important clues to look for:

Guideline #4: Look for mentions of diagnostic lab testing, when surfing the web or calling around.  Some websites will mention some of the tests the doctor will order.  Look for standard lab work such as CBC (Complete Blood Cell Count), CMP (Metabolic Panel), immune profiles, antibody testing, and thyroid panels.  Look for specialty testing such as salivary testing, hormone testing, digestive analysis, or stool testing.  Shy away from anyone who says they can test your neurotransmitters by analyzing your urine; those tests are NOT reliable, diagnostic, or accepted.  In fact, they have been disproven.  Shy away from anyone using muscle testing instead of lab testing.  A combo of muscle and lab testing is OK, but I would personally ignore any “diagnosis” or assessment given by muscle testing alone.

Guideline #5: When surfing the web (or calling the clinics), look for (or ask about) the depth of the paperwork.  They should put a lot of stock in the intake forms.  They should want to know your life story in terms of your physical, mental, and emotional health.  They should want to know ALL KINDS of things about you, as far as your lifestyle, your travel history, your birth, childhood, adolescence, adulthood, and more.  If what is posted on the web is very basic and there is no mention of additional paperwork to come, I would call the clinic and ask what kinds of questions and information the doctor wants to know.  Doctors practicing real Functional Medicine want to ask a lot of questions, and their receptionist should be able to tell you that.  Proper healthcare begins with an extensive gathering of information, and it’s not uncommon to see intake packets of 20 to 50 pages or more.

Guideline #6: Some Functional Medicine doctors list their preferred supplement companies online.  Word to the wise: many supplements, notably Standard Process, will inadvertently make their patients’ conditions worse, especially any autoimmune condition, because they contain wheat products.  Another word to the wise: Many supplements are either multi-level marketing companies (such as Juice Plus or some glutathione supplements), or they are affiliated with cults such as Scientology.  A Scientology-affiliated company can still make excellent products, but upon asking myself the question of whether or not I wanted to contribute financially to that type of organization, the answer was no.

Guideline #7: If they mention multi-level marketing companies (think Mona Vie acai berry juice, Juice Plus whole food supplements, Kangen water, or Nikken magnet products to name a few), I would personally shy away.  MLM products are generally fads that produce little to no results.  Some truly are good (such as the pH-based water); however, they tend to be overpriced and you may face some high-pressure sales tactics.  Many claim to have undergone testing or research, but typically the testing is useless because it is done in-house, and not by an objective, standard third party.  Thus, there’s a vested interest, which renders the scientific validity questionable at best.

Now…I’ll bring these next few things up because you’ll probably come across it in your research and if you’re like I was, you’ll wonder about the following:

  • Many Functional Medicine doctors do sell supplements in their practice.  Yes, this is ethical, as long as when they recommend a supplement, it is for a reason that benefits YOU, and it’s something YOU actually need.  Again, beware MLM supplements.  Google for a list of MLM companies; you may need to check several sources, as many MLM companies are newer and may not be on older lists.  Chances are if you see the product/supplement advertised on someone’s car/SUV, it’s an MLM.
  • Many Functional Medicine doctors do not file insurance.  (This topic alone will probably be discussed separately in the future.)  This is because insurance takes a lot of time and effort that the doctor would rather devote to your case instead of wrangling with bureaucrats.  Coverage for these types of services will depend on the policy you chose; doctors don’t know anything about the literally tens of thousands of policies out there.  Also, even if your insurance policy does not cover this type of care, that doesn’t mean it’s not valid or necessary.  Health insurance companies do not care about your health; they’re trying to minimize costs, even at your long-term expense.
  • Functional Medicine doctors should have no problem openly communicating with conventional medical doctors.  If they seem shifty about this, think twice.
  • Some Functional Medicine doctors may charge a fee to analyze your paperwork and review your records and history.  This is perfectly normal and legitimate.

This is by no means an extensive list – there are always other indications of a quality practitioner, as well as pitfalls to watch out for.  I’ll try to cover additional items as they arise.  For now, however, you should be armed with a little more information to begin your search.  Of course, the best bet is to ask around; although not many people are seeing a Functional Medicine doctor (yet!) you never know who may know someone. 🙂

What Functional Medicine is NOT, Part 1:

The term Functional Medicine has become a buzzword.  This is only a natural phenomenon; several practitioners have built lucrative Functional Medicine practices that are becoming well-known and receiving a lot of attention.  Practiced correctly, it truly is the next wave of medicine, or at least we can only hope.  Naturally, many practitioners want to catch the wave and “cash in”.

The only problem is, many practitioners who say they are practicing Functional Medicine aren’t really doing so.  They have attempted to bend the term to fit their practice, without really adapting or changing anything they were doing.

When practitioners use one term to mean several different things, the public gets confused.  So, since we already know what Functional Medicine is, I thought I’d ease the above situation by spelling out what Functional Medicine is NOT.

Truth #1: Functional Medicine is not bioidentical hormones.  In fact, bioidentical hormones are not even utilized in genuine Functional Medicine, because exogenous hormones (i.e. hormones that the body itself did not make, that come from the outside of the body) is, by definition, an allopathic treatment.  (That’s not to say that you don’t need them or they won’t do some good.  It simply means that someone who claims to be a Functional Medicine practitioner simply because they give you Armour instead of Synthroid to jumpstart your thyroid is full of baloney.)

Allopathy is the branch of medicine that most doctors practice – they seek to eliminate symptoms by introducing a substance that changes the body’s internal chemical environment such that it can’t sustain the disease or symptoms.  For example, the standard allopathic treatment for diabetes (high blood sugar) is to introduce insulin (which lowers blood sugar).  High cholesterol is treated with statin drugs that lower cholesterol.  In the allopathic approach, little thought is given to the cause of the problem; the focus is on eliminating symptoms through biochemical manipulation.

Back to bioidentical hormones… Bioidentical hormones may indeed be beneficial and they may be necessary.  They may also indeed be superior to synthetic hormones.  I don’t disagree with that one bit.  And Functional Medicine DOES aim to balance hormones, after all.  What I DO find problematic, is when a doctor says they practice Functional Medicine because they balance hormones using bioidentical hormones.  That is NOT Functional Medicine.  The litmus test is this: do I need a prescription to obtain any of the remedies the doctor wants me to take?  If the answer is yes, than it’s not Functional Medicine.  Pure Functional Medicine can (and should) be practiced without any pharmaceutical medications.  True Functional Medicine will approach a hormone imbalance by attempting to find out what’s wrong underneath the surface, by asking the question: WHY are the hormones out of balance?

Truth #2: Functional Medicine is not HCG weight loss or any other fad diet.  HCG, whether in the form of the actual hormone or a homeopathic essence, is also allopathic.  This topic will most likely get its own post, because there’s more to say about this than is appropriate for the scope of this post.  For now, suffice it to say that HCG hormones are also allopathic and possibly harmful.  True Functional Medicine will ask: WHY is the person overweight in the first place?

Truth #3: Functional Medicine is not a quick fix.  While I’ve personally seen some miraculous results in just a few weeks using only true Functional Medicine and nothing else, it takes quite a while to normalize and regulate body chemistry, especially using non-pharmaceutical options.  Medications are meant to force the body’s chemistry to change quickly, and they are very good at what they do.  Natural medicine is very good at what it does, too, but its process is much slower.

Truth #4: Functional Medicine is not just glorified nutritional counseling.  It’s an entire lifestyle modification program.  Dietary modification and specific supplementation are indeed part of the major backbone, but there is much more to the story.  Since most of today’s chronic health problems developed from multiple genetic and environmental influences, the complete solution that delivers the best results utilizes multiple neuro-metabolic therapies based on genuine diagnostic lab test results.

Testing, testing: Lab testing and Functional Medicine

A Revolution in Advanced Clinical Nutrition…

A segment of Clinical Nutrition began to evolve considerably–quietly–about 30 years ago.  Now, it has bloomed into a full-fledged, legitimate medical subspecialty.  We now know much more about the mechanisms behind chronic disorders than we did even 10 years ago.  We also now realize that pharmaceutical medications, while necessary at times, don’t usually offer much in terms of resolution or long-term relief/improvement for these conditions.  Irregular blood sugar, autoimmune disorders, nutrient malabsorption, gastrointestinal microbes, inefficient liver detoxification, and adrenal fatigue don’t necessarily respond all that well to medications.

Since many of these disorders mimic each other (sometimes very closely), it can be difficult to determine exactly what’s going on using symptoms alone.  This can pose a problem, because if there is any hope in making progress or getting relief, the right treatment approach must be followed.

For example, let’s say Betty has fatigue.  The first remedy that come to mind might be caffeine pills.  It sounds logical; if she’s tired, the idea of a stimulant probably appeals to her.  If she doesn’t like the concept of chemical stimulants, she might opt for a more natural route; a naturopath or herbalist may suggest Ginseng or something similar.  Functional Medicine, on the other hand, asks why she is tired, and considers all the possibilities.  Fatigue is a common symptom, with many causes – maybe her adrenal glands aren’t producing enough cortisol.  Maybe her thyroid gland isn’t producing enough T4, or maybe she has a sluggish liver or gastrointestinal tract and can’t convert inactive thyroid hormone (T4) to active thyroid hormone her body can use (T3).  Maybe she’s got a lingering virus.  Maybe her energy is being diverted toward immune system activity because she has seasonal allergies.  Maybe her blood cells aren’t carrying enough oxygen.  Maybe she’s got candidiasis (overgrowth of candida albicans, a problematic yeast); maybe she’s fighting a bacterial infection.  Maybe she she has a food intolerance (these can make people profoundly drowsy).  Or maybe she has low blood sugar.

Each of these possibilities is a completely different problem.  Ten people with fatigue may all share the same symptom, but have completely different reasons for feeling the fatigue.  If the underlying reason isn’t investigated, and the person assumes they have adrenal fatigue when really they have a low thyroid, and they begin taking herbs that boost adrenal function, then they’ve missed the thyroid issue and they fail to correct the problem…and the problem remains.  This begins to illuminate the reason why lab testing is crucial.

As I mentioned before, when most doctors order lab testing, they tend to stick only with what insurance covers.  What you may not realize is that the testing insurance will cover is bare-bones, hardly scratching the surface of what’s actually going on.  Essentially, it’s a screening tool for basic disease and that’s really about it.  The limited tests that are ordered and the way in which the results are interpreted does not do much of anything to accurately assess someone’s actual baseline health.

This is not to “bash” the medical profession at all or paint some kind of “us versus them” polarized picture that illustrates that Functional Medicine is everything while conventional medicine has no place.  Indeed, some of those basic disease screenings can be highly appropriate and unquestionably warranted.  However, those basic screenings are sorely limited in their ability to comprehensively assess someone’s genuine health, wellbeing, and quality of life.  And that is where Functional Medicine has a chance to shine…

Functional Medicine doctors will order comprehensive testing that evaluates multiple areas of body chemistry and multiple important functions that are hardly ever touched on in hospitals or regular clinics.  When we order testing a patient has never had, we find things other doctors have never found.  A good Functional Medicine practitioner will evaluate (at minimum) several areas during routine testing:

  • Nutrient metabolism
  • Cellular energy production
  • Oxygen delivery
  • Inflammation markers
  • Organ and gland functions
  • Infection screening
  • Status of certain nutrients
  • Blood sugar consistency, long and short-term
  • Intestinal microbes, beneficial and hazardous
  • Adrenal stress
  • Central Nervous System state

Another important tenet of Functional Medicine pertains to how the lab testing is interpreted.  Most doctors simply scan the lab test results, looking for anything that the lab has “flagged” as abnormal.  In order for a result to show up as abnormal, it must fall outside of the “normal” or “reference” range.  These ranges are set based on statistics.  They vary by lab and even by region.  Look around you; you’re being compared to your neighbors, your friends, family, and co-workers.  How healthy are they?  I don’t know about you, but being “normal” compared to everyone else isn’t exactly reassuring.

What Functional Medicine doctors do is look closer at the lab test results.  They are familiar with what healthy ranges look like and where a person’s body chemistry should be.  These doctors will find literally a dozen or so dysfunctional/abnormal results that labs and conventionally-practicing doctors will flat-out miss.

Many Functional Medicine doctors take yet one more step further, to analyze patterns between these abnormal results, to attempt to find a common denominator, because often, various dysfunctions are related.  It is indeed entirely possible that a person may have multiple dysfunctional processes happening at once, and it’s also possible that multiple symptoms may stem from one underlying disorder.  Functional Medicine practitioners spend a tremendous amount of time behind the scenes pouring over lab test results and conducting any necessary research.

In short, the rabbit hole that is human physiology can go far deeper than expected; Functional Medicine is the only discipline to ever rise to the challenge.

What is Functional Medicine?

The short answer is, Functional Medicine is the future of medicine, if we are to get well and stay well as a society.  It’s the direction in which regular medicine should have gone.  It should be used as the primary method of treatment, especially in cases that are not acute, infectious, catastrophic, life-threatening, or other emergencies.

The long answer is, the definition of Functional Medicine largely depends on who you talk to.

  • The Institute of Functional Medicine, arguably the leader and Gold Standard of the field, describes a science-based, patient-centered form of healthcare that recognizes biochemical individuality and favors active prevention.
  • A talented colleague of mine defines Functional Medicine as a complete lifestyle-modification program that evaluates physiology using extensive diagnostic lab testing and then corrects any imbalances found by applying specific, individually unique combinations of neuro-metabolic therapies.
  • Another talented colleague of mine mentions looking at everything (hormone balance, nutrient metabolism, immune system, and a plethora of other categories) all at the same time, leaving no stone unturned

Functional Medicine really is “all that” – in terms of the explanations given above, as well as being Just That Cool.

When I explain it, Functional Medicine can take on a few different personas that all relate back to the same Big Idea.  Various descriptions are as follows…

  • A highly-advanced version of Clinical Nutrition, taken to another level as practiced by a doctor, that bases its herbal and nutritional plans on comprehensive lab testing
  • A third type of healthcare that is separate from both conventional and alternative medicine branches we’re already familiar with, that utilizes the best of both worlds
  • An emerging medical subspecialty that combines conventional testing and natural therapies
  • A logical, scientific alternative for those looking for natural or holistic healthcare, perfect for those who don’t know where to turn or who to trust.
  • A scientific-yet-holistic of looking at the functions of the body and how they are inter-connected, identifying dysfunctions in key areas using lab tests, and then correcting them with a comprehensive lifestyle modification plan.

That last one is my favorite (couldn’t you tell?)

Functional Medicine really shines with chronic, complex disorders, especially the degenerative and/or mysterious.  I can say it is definitely worth the effort, commitment, and investment!  Most Functional Medicine practitioners know firsthand; many of the best doctors got involved with the field because of their incredible experiences.

We’re a product of the choices we have made every day.  Every day we have another chance to stay on our current path or choose something different.  What are you waiting for? 🙂

The Doctor behind the Blog…

Hi!  I thought I’d take a quick moment to introduce myself, because I think it helps to feel like you know the person behind the keystrokes.

Professionally

I’m a chiropractic doctor who practices Functional Medicine exclusively.  I don’t do any spinal manipulation or physical rehab.  Instead, I spend all day ordering and interpreting diagnosting testing and forming strategic approaches we’ll use to address the problems I find.  Nothing that I do is taught very thoroughly in the typical chiropractic medical school; all of the education I utilize comes from post-doctoral programs and continuing education.

Along with my chiropractic doctor degree, I also graduated with two BS degrees – one in Anatomy and the other in Health and Wellness.  I’ve also completed nearly 85% of a post-doctoral Functional Neurology specialty/diplomate program, and have begun a Certified Clinical Nutritionist course and of course, many courses in Functional Medicine topics, such as blood chemistry interpretation, endocrinology and hormones from a functional perspective, neurotransmitters and cognitive function, and an extended intensive that exclusively dealt with thyroid disorders, including autoimmune thyroid conditions.

I’m currently serving as a member of the American Chiropractic Association (ACA) and the prestigious Institute for Functional Medicine (IFM) and I’m about to become involved with the Texas Chiropractic Association (TCA) to help ensure that patients receive quality chiropractic care by positioning chiropractic as an evolved, scientific, logical, and dignified profession with integrity, skill, and compassion.

Personally

I’m a South Texas lady who advocates for what’s right and stands up for my patients.  I pour my heart and soul into my patient cases and seeking ever greater knowledge and understanding.  I consider my career one of my hobbies as well, but as I always advise my patients, I do remember to set aside some “me time”, where I read, walk (not both at the same time *grin*), blog, listen to music, watch movies, spend time with my cats and my family, and keep in touch with friends from all over.

I’m also just like most of my patients – a gluten-intolerant lady with a topsy-turvy immune system that resulted in a hypothyroid condition and brain fog, whose body stopped compensating.  I also had severe anemia and excessive adrenal stress, resulting in a pre-diabetic state.  To top it off, my system was ravaged with an intestinal bacterial infection and two separate types of intestinal parasite.

Like my patients, I’m getting better!  I’m amazed at the power of properly-used natural alternatives.  Life is good again.  And now, I’m immensely enjoying the observation of similar transformations in the lives of my patients.  We’re all works in progress, and health (and indeed life itself) is a journey…I say enjoy it! 🙂