Foundations of Functional Medicine: Episode 1

In this episode, Dr. Hartman of Richmond Integrative and Functional Medicine shares part of his, and his family’s, story that led him to pursue functional and integrative medicine training and to open his functional medical practice. He shares how adopting their children and handling the challenges of raising kids with special needs led to significant lifestyle changes and to a questioning of his own approach to practicing medicine. He also shares a glimpse at some of the dramatic changes that he and his wife observed in their children’s health and developmental progress.

In the second part of the episode, he addresses the question, “What is integrative and functional medicine?” Many people have begun to hear about it, but often still have questions about what it really means and how it is different, and similar to, conventional medicine. He explains that functional and integrative medicine is a patient-centered, systems approach that seeks to stretch beyond treating  and managing symptoms to discover the root causes of disease. He discusses how sleep, relaxation, exercise and movement, nutrition, stress, and relationships affect our health and how functional and integrative medicine view these factors as foundational to the pursuit of wellness and health. The ultimate goal is wellness, not maximizing medical interventions.

Foundations of Functional Medicine – Episode 001

In this episode, Dr. Hartman of Richmond Integrative and Functional Medicine shares part of his, and his family’s, story that led him to pursue functional and integrative medicine training and to open his functional medical practice.

Transcript

Host [00:00:08] Welcome to Foundations of Functional Medicine with Aaron Hartman, M.D. This is a podcast of Richmond Integrative and Functional Medicine. This podcast seeks to motivate individuals to reclaim their health through education, encouragement, and empowerment by reviewing the basic tenets of functional and integrative medicine, as well as discussing new advances shaping the future of health care in our country. To learn more about us, and keep up to date on other important health-related topics, visit us at www.richmondfunctionalmedicine.com.

Host [00:00:43] The following discussion is for educational purposes only and is not intended to diagnose or treat any disease or disease process. You should always discuss any medical treatments or interventions as well as changes in your health with your personal physician.

Dr. Hartman [00:00:59] I often get asked to explain what integrative and functional medicine are, especially in light of the newfound popularity, but before I do this, I’d actually like to go a little bit into my own personal, professional journey and how I got into this field of study. It all starts with my family. When my wife and I were married in 2004, she was a practicing pediatric Occupational Therapist, and she exclusively worked with kids with special needs. Her entire caseload consisted entirely of these super rare cases of children with things I’d never heard of. I’d never heard of them in medical school and never heard of them in my residency. It just was amazing to me that she would have case after case after case of a child with a diagnosis, and I’d never heard of most of them. They were pretty involved cases as well. This was intensified when we adopted our first daughter, Anna. Anna was actually one of my wife’s patients that she started taking care of when she [Anna] first got out of the hospital. She kind of fell in love with my daughter, and when my daughter’s foster home was closing, she needed a place to stay, and so my wife asked me if we’d be willing to open our home to this little girl and I said yes, and so we started to foster Anna. It was hard; a child with special needs is a lot of work. But we were up for the challenge.

Dr. Hartman [00:02:06] When Anna was about 14-months-old, her pediatric gastroenterologist recommended a feeding tube. What this is, is a little tube they put in the child’s stomach for the express purpose of pouring in formula so the child can grow. The reason for this was that Anna was less than the 5th percentile on a growth chart and hadn’t changed in a couple of months and her GI specialist thought that we gotta do something about this, so let’s put this feeding tube in. It didn’t feel right to me, and neither did it feel right to my wife. We talked about this and my wife told me how having a feeding tube can affect the speech development [of the] child. And that would be… that was a big deal, especially since my daughter wasn’t talking at this point in time. It can also affect crawling, walking, motor development and again, really, really big deal because at this point my time, my daughter could even sit up on her own. You’d sit her up and she’d just fall right over. So putting something in that’s going to affect her neurological development just seemed like a terrible idea to me. So we gently opted out of that. The pediatric physician did not take that very kindly. She talked with [our] nurse, was considering reporting us to Child Protective Services, and so my wife talked with the nurse. She actually had a really, really good relationship with the nurse because my wife had been working with multiple kids with special needs, and they actually knew each other from all those other children and nothing came of it. But this was the first time in my professional career where I directly went against doctor’s orders and did something totally opposite from what was recommended by the specialist. This healthy questioning of medical authority, so to speak, was strengthened when about six months later, my wife found a pediatric growth chart for kids with [cerebral palsy], and my daughter was right in the middle. She was at the 50th percentile. So my wife found this chart, yet the specialist had no idea this chart existed and that was another mind-blower for me. How is this possible that someone was recommending a potentially life-changing, life-altering surgical procedure that my daughter actually didn’t even need? The scenario, unfortunately, was to play out multiple times over the next several years. The following year, an ophthalmologist recommended eye surgery for my daughter because she has lazy eyes and they kind of move a little bit, very randomly actually, and they recommend this surgical procedure to help with her vision. The reality was, is that from my research, I’d learned that it actually probably wouldn’t help her vision at all. It was largely cosmetic. So my wife and I looked around for a second opinion, and we found a more seasoned pediatric eye doctor who had been doing this for 30 years. And they agree with us that the surgery itself for her would not improve her vision. It would help cosmetically, but as she develops, she might develop the eye problem again, and it wouldn’t really have any long-lasting value to her. So we opted out that surgical procedure and that was strike two for us. Unfortunately, that continued to happen every year or two where someone would recommend a surgical procedure for us, we’d research it, try something else, and eventually, we would not have to do that procedure. While all of this was going on, my wife had started looking into diet, nutrition, lifestyle changes for our family. She’d start changing out certain foods and putting other foods in getting rid of certain chemicals we had in our house for cleaning, etc. I was, you know, just along for the ride. I wasn’t going to buck too much. I wasn’t really into it that much, mainly because I grew up spraying everything. We’d had a little orchard in our backyard as a child and my dad would use Sevin and all kinds of bug sprays on our peach trees and apple trees and it never hurt me. But, I wasn’t going to buck my wife, and so while this is going on our family’s lifestyle is slowly changing. During the same time, I actually stumbled across some of the work of Dr. Amy Yasko, who is a specialist that works with kids with autism. What she does is she looks at the kids’ genes, tells what gene defects they have, and with nutrition and supplements will alter their gene expression. Her work is with autistic kids; my thinking was, could this help my daughter with another neurological issue, cerebral palsy? So, I spent six months researching this, learning about gene expression, how nutritional things can change gene expression, and then start implementing this stuff with my daughter.

Dr. Hartman [00:06:00] Another thing that really inspired me to go down this pathway was this was the first time I actually found out there might be something alternative I could offer for my daughter that actually might help her.  At this point in time, she was 4-years-old and getting a little older. There’s a very small neurological window where you can have big impacts on a child, and so the fire was kind of lit underneath me, so to speak, to really look into this, and I started to develop a passion for trying to find are there other things that actually might help my daughter? In 2011, I signed up for an integrative medicine conference in Florida with the Academy of Integrative and Holistic Medicine. I’d gotten their flyers before and just kind of put them in a pile with all of the other flyers. I wasn’t really interested before because, you know, you’ve got take a week off of work, and you take vacation time, and I wasn’t really interested in that, but at this point in time in my life, I determined this was probably going to be a good investment. Let me just go down to Florida and see what I can learn down there. And the conference to me was almost like going to medical school all over again. I’ve seen conferences listening to things for 6 to 8 hours a day of things I’d never heard of before. Listening to Dr. Gaby, who wrote the textbook of nutritional medicine, or Dr. Pizzorno who wrote the “Textbook of Natural Medicine” and just hearing things that seemed mind-blowing to me in a room with 700 other physicians from across the country. The thing that was astounding to me, that there’s this room of 700 other physicians, who some had practiced this kind of medicine for decades, and I had never heard of it before, either in medical school or in graduate school. This shocked me, I was hooked, and I just had to learn more. At the same time, we were adopting our second and our third child, each with their own unique health issues. When we got my son at [five] months of age, he had really bad asthma and eczema; his asthma was so bad my wife would literally sleep with him on her chest at night because she was scared he’d stop breathing in the middle of the night and she had to be there. His eczema was so bad that he would scratch at his skin and give himself a little… little cuts and ulcers on his skin from scratching. My other daughter had her own developmental issues. Yet, all of them have had major, major gains. My son no longer has asthma, no longer has eczema, and he only has occasional allergies when the weather changes. My oldest daughter, Anna, now walks with forearm crutches at the age of 13. She’s had no surgical procedures, even though she’s had about six recommended [for] her. And that’s quite a big feat for a child with cerebral palsy to make it to thirteen with no surgical procedures. None of my kids have had cavities, and between the three of them, they’ve only had antibiotics once. These would be considered great feats for a typical family; for a family of kids with special needs, these are extraordinary. While this is going on, I also fell across another piece of information and discovered the Institute for Functional Medicine in 2012. I dove right in. This was a huge accelerant for my learning process. In each of the training modules, I’d be in a group of professionals around the country learning from doctors from Harvard, Hopkins, University of Michigan, all of these really kind of big-name kind of places that are obviously very intellectual, hearing about things I’d never heard of before. How is it that so many people from so many prestigious institutions around the country that are saying things I never even heard of before? At each one of these modules, my fire would be lit and get fed and grow even more. I’d learn about pulsed electromagnetic field therapy at one of the conferences, which is a type of magnetic therapy—think about it as I pulsing magnet, so to speak. Sounds kind of weird, but they’ve been using this technology in Russia since the ’60s in Poland as well as other Eastern European countries for decades. Even horse trainers here in America will use it for their high-end racehorses to help treat their aches and pains and help them heal quicker. Yet, I’d never heard of it for use in humans, even though now there’s actually a device that’s FDA approved to treat depression, that is this exact same type of technology. I also learned about laser light therapy and then dove into that and studied that for about six months. That’s an interesting technology that they’re using in Canada right now to treat traumatic brain injury patients. Again, something I never heard of before, that one part of the world they’re using a fair amount. Each time I come across a new topic like this and dive in, it was another ‘Alice in Wonderland’ kind of thing where I got somewhere I’m like, wow, this world is truly in color [actually a ‘Wizard of Oz’ reference]. And I would learn new things, incorporate them into my family, into my daughter’s care. And it would kind of automatically bleed out into patient care. This was, for me, a nine-year process. As I was learning these concepts and expanding my own academic and professional training, I would start to offer them to patients who seem interested in these kinds of therapies. Patients whose diabetes hadn’t got really better or pain hadn’t gotten better. One of the patients I’m referring to had fibromyalgia for years, had seen multiple specialists in the Richmond area and was just on a lot of pain medications and didn’t feel any better. In one of the conferences, we had talked about peripheral electrical stimulation with a device called Quell which you can buy at Bed, Bath and Beyond. So it’s gotta be legit, right? So, we used it with her and three months later, 80 percent of her pain was gone. I was flabbergasted. This was absolutely amazing. It’s something I learned about at a conference and no one in my local area was actually using this. I continued to work with willing patients, but it was difficult. It’s really hard to apply this degree of complexity to someone in office when you only have 12 minutes of time. So in 2016, after finishing my certification in functional medicine, I decided to try another experiment. Let’s see if anybody in Richmond actually would be interested in this kind of medicine full force. So I built out a web site, put up the shingle for Richmond Integrative and Functional Medicine and launched that in January of 2017. It’s been nothing less of astounding and amazing. The journey has been quite unique. I’m actually quite overwhelmed by the response from patients as well as the general public. One thing I’ve learned in this whole process is there’s a huge unmet need for this kind of medicine, Individualized, personalized, yet grounded in the most up-to-date scientific literature. That’s led me to the next phase of my patient-centered educational career, and I’m now starting this podcast. My first goal in this process is to create a two-part series. Part one would focus on the foundations of functional medicine, which are also known as lifestyle medicine. In the functional medicine world, this is the foundation for any personalized health care program. The next part of the series would be to dive into the nodes of the functional medicine matrix. These are the systems, the way we think about disease or disease processes in the functional medicine world. And just to go through each one of those processes and explain them to people so they can understand how I think and how a functional medicine practitioner thinks. Then, depending on the response, I may continue to do the podcast, diving into more cutting edge type topics or simply just answering the most common patient questions or concerns. I’m not quite sure where this will go, but I’m excited to see where it leads.

Dr. Hartman [00:12:40] So the next thing I’d like to talk about is what is an integrative and functional medicine? Many people ask me what this new thing is. They haven’t quite heard of it. It sounds a little strange, a little awkward. So I’d like to spend the next few minutes and just talk about what these things are. My personal understanding of it has actually morphed and changed and evolved as my practice has evolved from back in 2007, when I first joined Family Practice Associates to 2010, when I started Virginia Research Center, to 2016 when I started Richmond Integrative and Functional Medicine. Each stage of my personal career has had this advancement in my knowledge base, so I’d like to start with integrative and functional medicine, not by describing what they are, but describing what they’re not. What integrative and functional medicine is not… First and foremost, it’s not unscientific. I hear this many times, people wonder, “Is this really true medicine?” It is. It’s actually the deepest and broadest kind of medicine. It’s based on our knowledge of pathophysiology. Different fields of medicine and science like epigenetics, which is the expression of our genes, not just our genes, or nutrigenomics, which are how nutrition affects the expression of our genes, or metabolomics, which is how our metabolism affects our health. These are all integrated into the concepts of integrative and functional medicine. And there are many pioneers in this field of medicine, whether it’s Dr. Mark Hyman at the Cleveland Clinic, Dr. Bredesen at the David Geffen School of Medicine at UCLA, who is probably one of the top Alzheimer’s researchers in the country. There’s Dr. Fasano at the Harvard School of Medicine, and he’s one of the top gut guys that actually discovered zonulin. If you ever heard of leaky gut, he is the physician who actually discovered the key that affects leaky gut. All these are thought leaders in the field that teach routinely in integrative and functional medicine and are actually helping push the ball forward in this field of medicine. The other thing about this field medicine, it’s not specialty-driven. Integrative and functional medicine is not isolating the silos of your heart or silos of your lungs or silos of your joints. It’s a systems biology approach that looks at the root cause. What that means is you look at how does everything interact with everything else? Examples of how this can look would be someone with chronic fatigue syndrome, for example. When I initially did my training, chronic fatigue was thought to be a psychological issue. It wasn’t thought to be a primary medical problem. Well, now we know that chronic fatigue syndrome and fibromyalgia are actually related to brain inflammation. So this systems biology approach would look at how does someone actually get fibromyalgia. Is it related to nutritional deficiencies, gene expressions, chronic infections, trauma, psychological issues, sleep disturbances, gut disturbances, and how all these can be looked at to then individualize care for a person. And in this systems approach, every single solitary person is looked [at] as a whole. It’s a true type of holistic medicine, so it’s not ultimately specialty driven. So what is integrative and functional medicine? This definition is a pretty standard definition, I’ll try to walk through it a little bit, but it’s a unified and holistic, patient-centered methodology of delivering medical care, with the goal of maximizing the individual’s wellness. So it’s unified and holistic. What does that mean? It means it looks at everything, the entire whole. It doesn’t just look at the heart or the lungs, it looks at the person’s history, it looks at the person’s personal beliefs, their cultural they’ve come from how their culture affects their perception of disease. All these things can play into an individual’s personal health. It’s patient-centered, which ultimately means it always comes back to the patient, not the physician looking at the patient, but the patient themself. And they’re delivering this medical care with the goal of maximizing the individual’s wellness. The goal is not maximizing therapies or maximizing utilities of procedures, it’s… the ultimate goal is the individual’s wellness, which means the individual has to be involved in their health care. It’s not simply diagnosing and treating, the person has to be a part of their own health care. And that’s what makes integrative and functional medicine unique. So when I say systems approach, what do I mean by systems approach? Systems approach again, it doesn’t just look at organ systems, it looks at these biologic systems. This includes assimilation, how you eat food and incorporate nutrition into your body, defense and repair is your immune system, how your immune system fights off infections, biotransformation, and elimination, this is how we detoxify our bodies. Energy is the mitochondria, if anybody has heard of the mitochondria or the powerhouse of the cell, this system looks at how we actually make energy at the cellular level, that then feeds out to tissues, to organs, and then your entire body. Transportation, it’s how do you get stuff around your body? How does your blood get stuff from point A to B? How does your blood get stuff from point A to point B? How does your lymphatics move out toxins? Communication comes down to hormones. How do your hormones interlink with your heart and your lungs? How does your testosterone, estrogen, and cortisol affect your sleep-wake cycles? And ultimately, the last one is structural integrity. This is joints, sinews, but also your interstitium. And interstitium is a fancy word for saying everything between cells. That’s something that’s often forgot[ten] about in a traditional medical model, but yet most of us is actually interstitium. Most of our body is actually the stuff between cells, not the cells themselves. So these systems will affect someone’s health, and so integrating these concepts can be really important for someone’s health. The other thing is that integrative and functional medicine takes the individual’s unique microenvironment into play. So what is microenvironment? Microenvironment is that unique environment that’s unique for you, for your time and your place in history, for your family, for your personal health history. That includes antecedents, which are things that led up to or pushed you towards whatever is going on in your health right now. Triggers may be things that pushed you over the edge, and then mediators are those things that keep your state of unhealth going forward. It’s important not just to know what’s going on, where you’re at now, but what got you there, what pushed you there and what maintains you there. And that’s not included in a traditional way of looking at illness. The last part about integrative and functional medicine is a strong emphasis on modifiable personal lifestyle factors. These form the foundation of functional medicine and these modifiable personal lifestyle factors are sleeping and relaxation, exercise and movement, nutrition, stress, and relationships. If you’re chronically stressed, it’s going to be hard to fix your stomach because cortisol is going to keep on giving you leaky gut. If you’re not exercising routinely, It’s amazing our bodies were designed or made to be out working eight to ten hours a day, and if you’re sitting in front of a computer all day long, it’s going to be really hard to help your body to heal, especially when we’re learning all of this great information about exercise being the best antidepressant, one of the best things to control diabetes and hypertension. Sleep; if you don’t sleep at night, there’s all kinds of things that can affect, including increasing your risk for certain cancers. So in functional and integrative medicine, this forms a foundation that we use to then inform the other layers or levels of looking at someone’s health. This comprehensive diagnostic model is kind of looked at as a tree. On my website, I actually did a blog post on this and I have a little tree diagram that describes the different levels of how we look at things. The way to think about it, if you can visualize this or see this diagram, the way we look at someone, it’s first like a tree, the leaves at the very outside are the symptoms someone has. They can have major symptoms, minor symptoms that can be suggestive of certain diseases, or you can have healthy signs or symptoms. You know, if you exercise and recover very quickly. The next level is actually the organ systems, which is our traditional way of looking at things. That’s your cardiology, which is the heart doctor. That’s your neurology, which is the nerve or brain doctor. That’s the pulmonologist or your lung doctor. After you get a sign or a symptom, you can think about things in an organ system that allows you good diagnoses. But this model goes deeper, closer into the middle of the tree you have the functional medicine matrix, which are those nodes I mentioned. The assimilation, the energy, transportation, communication. Next level below that, the antecedents, triggers, and mediators I mentioned; these are the actual trunk of the tree. The whole tree is held up by these. If you don’t have things that lead up to illness, things that push you over the edge with illness and keep you there, it doesn’t happen. Same thing with health. You have to have antecedents that lead up to a healthy life, triggers that you keep on doing to maintain your healthy life, and mediators that keep you there. But beneath all this, at the very bottom, the roots of this tree are your lifestyle and environmental factors. That’s again, sleep, relaxation, nutrition, stress, relationships, and exercise and movement. So when you look at a person from the functional medicine perspective, you’re looking at this entire comprehensive diagnostic model. Another way I like to think about traditional medicine versus alternative medicine as, in many ways, two sides of the same coin. Sometimes people refer to this model thing as a type of a Venn diagram. For those of you that are familiar with Venn diagrams, they’re two circles that interlock, on the one side is conventional medicine, the other side is alternative medicine. Conventional medicine is really, really good at acute issues. If you have an acute heart attack, acute stroke, you want to be at a hospital getting life-saving anticoagulation therapy. The one thing that traditional medicine is not that great at, which a lot of statistics show, is chronic health care. Someone who already has diabetes, heart disease, fibromyalgia, chronic pain, peripheral neuropathy. How do you manage all these complicated issues that interlock and are interwoven? Well, the alternative model looks at different things to help treat those that can actually help the patient that are more focused on the patient. Where these two worlds meet, you have the conventional medicine with all your data and science, the alternative model looking at other traditions and where the data and the other traditions meet—those nodes are the nodes of the functional medicine model. If you can imagine one big circle around all that, that would be holistic care, holistic integrative care. So you have this very comprehensive way of looking at individuals and their care. That is what integrative and functional medicine is. So hopefully this introductory podcast was helpful to wrap your brain around this. Next time I’ll be talking about diet, lifestyle, nutrition, and other of these basic key factors in individuals’ care and health.

Host [00:22:15] We hope you found today’s episode useful and informative. Please see the show notes on our website at www.richmondfunctionalmedicine.com in addition to many other resources and educational materials. We’d also like to invite you to subscribe to our podcast to keep up to date with new episodes. You can find us on Apple podcasts or wherever you listen to podcasts. Please also consider giving us a five-star rating and review so that others can gain access to this information. You can also find Richmond Integrative and Functional Medicine on Facebook and Instagram.

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