Gastrointestinal Disorders from a Functional Medicine Perspective
Functional medicine is an emerging medical paradigm for treating chronic medical disorders, i.e. those that are present for more than 3 months. While there are many forms of “functional medicine”, I am referring to that form developed and promoted by the Institute of Functional Medicine in Gig Harbor, WA. It is science-based and views the body as having web-like interconnections. Functional medicine approaches the problem of diagnosis, treatment, and prevention of chronic medical disorders by assessing imbalances in eight areas. The “Eight Imbalances” are:
- immune surveillance,
- absorption and barrier integrity,
- structural integrity,
- oxidative/reductive hemodynamics,
- inflammatory process,
- detoxification and biotransformation,
- hormone and neurotransmitter regulation,
- and psychological and spiritual equilibrium.
Each of the eight imbalances has associated with it antecedents (predisposing factors such as as genetics) and triggers (events which activate predisposing factors).
Some of the most common triggers are food proteins which are inappropriately absorbed. Functional medicine, therefore, is closely involved with nutrigenomics which combines nutrition and genetics. Nutrigenomics is especially important where it may be impossible to eradicate a genetic defect without severely damaging the breed of dog. In those situations, understanding the relationship between food and genes may make it possible to avoid triggering certain diseases. The functional medicine approach begins with a search for triggers which may be initiated or are perpetuated by a disorder. Triggers may be microbial organisms and their associated byproducts, toxins, drugs, stress, and food proteins.
The power of the functional medicine model is that it allows one to assess disorders that are multifactorial. Functional medicine is not obsessed with making a diagnosis. Identifying and correcting imbalances in the functional medicine matrix allows for treatment and prevention of disorders that are difficult to understand using the conventional medical paradigm. Any disorder of the GI tract will involve food, microbes, the immune system, digestive enzymes, and stomach acid. It may be that only one factor has to be directly addressed, but one must be aware of the others and know when to intervene.
Consider, for example, small intestinal bacterial overgrowth (SIBO).
Obviously, intestinal microbes are involved and must be addressed. Sometimes this can be done simply by discontinuing probiotic supplements when lactobacilli are the problem.
In other cases it may be necessary to implement a hypoallergenic diet.
Then, there are cases in which stomach acid must be supplemented and still others that require antibiotic therapy.
Conventional veterinary specialists are proposing to call SIBO antibiotic responsive diarrhea. This unfortunate change will result in further confusion because many cases of SIBO do not require more than antibiotics, which when used inappropriately often cause yet further imbalance. Much confusion results when medicine is disease-centered rather than patient-centered. Conventional medicine diagnoses SIBO by finding “increased numbers of bacteria in a sample of intestinal fluid”. Functional medicine makes the diagnosis either by comprehensive stool analysis or comprehensive urine organic acids analysis which identifies microbial byproducts in the dog’s urine. The conventional approach is much more expensive, time consuming, and painful for the patient.
The functional medicine matrix constantly reminds one that all chronic disorders are systemic and not limited to one organ system. It sees both the trees and the forest. This is particularly relevant in dealing with allergies. Conventional medicine views allergies as a problem which originates in the lungs because of exposure to and reactions to pollen. Functional medicine views allergy as an imbalance in immune surveillance and inflammatory process. Using the matrix, a functional medicine practitioner identifies inflammation wherever it may be occurring by not assuming a problem is confined to one organ system. Since two thirds of the immune system is in the GI tract, that is where most inflammation occurs- including that associated with “allergies”. Effects are produced in other organs by mediators which originate in the GI tract.
Given the centrality of the GI tract, it makes sense to begin patient assessment by evaluating gastrointestinal function. The first step is to run a food allergy panel. This is a blood test which measures immunoglobulin E- IgE- antibodies against common foods. Conventional veterinarians consider the test controversial. Their complaint is that the results are not consistent from one patient to the next. If one is patient-centered rather than disease-centered, one realizes the difficulty is interpretation. I, for instance, do not follow the lab’s recommendation as to interpretation of the test. By observing my patient’ response to diet changes, I have developed my own interpretation. It has worked well in several hundred patients with problems including allergies, diarrhea, vomiting, dermatitis, SIBO, EPI, IBD, ankylosing spondylitis, arthritis, etc. Functional medicine views each patient as biochemically unique. I am not concerned if the patient does not fit the model, my goal is to make it more functional.
Having determined and implemented a hypoallergenic diet, the patient is re-assessed. If function has not been restored or optimized, one looks for further imbalances. This is done by comprehensive urine organic acids profile, urine amino acids profile, comprehensive stool analysis, or hair analysis as indicated. Functional tests assess the biochemistry of the individual, intestinal flora and functionality of the GI tract, and toxic load of the patient. For the most part, imbalances are treated with nutritional supplements in amounts much larger than used in conventional medicine. They are dosed according to the patient’s needs determined by testing or clinical experience. Pharmaceutical agents might also be used if that is the best treatment for the patient. For example, severe SIBO usually requires antibiotic therapy. The process is essentially the same irregardless if one suspects a particular disease such as SIBO, EPI, or IBD.
Prevention of the type of gastrointestinal disorders and allergies is a matter of identifying triggers in normal individuals. Just because something is genetically coded does not mean it will be expressed. Expression depends on genes being turned on or turned off. For example, the giraffe does not have a long neck because it has a gene for “long neck”. Rather in the giraffe the “neck” gene is left turned on longer than in short necked animals. Triggers are identified by appropriate testing. Remember that when it comes to triggers, food is the 800 lb gorilla in the room.
Given our present understanding of gastrointestinal function , I recommend that all puppies be started at weaning on probiotics, colostrum, multiple vitamins, omega fatty acids, and a simple food. A simple food is one with limited ingredients- preferably one with one protein and one carbohydrate. Probiotics help establish and maintain normal flora. Colostrum helps maintain normal flora and it modulates the immune system- and maybe helps restore normal secretory IgA function. A simple food reduces the number of food antigens the immune system is exposed to. The typical food allergy pattern is low level hypersensitivity to many foods rather than a high level to a few foods. At four months of age, puppies should have a food allergy panel run and diet changed accordingly. The food allergy panel should be repeated every 2 years- sooner if symptoms occur. A comprehensive urine organic acids profile should also be run to assess and correct any imbalances (excesses or deficiencies) in vitamins, amino acids, and minerals. This test should be repeated when there is any significant change in the dog’s functionality.
Textbook of Functional Medicine by D. Jones, MD et al.
Gastrointestinal Dysregulation: Connections to Chronic Diseases by L. Galland, MD
Textbook of Natural Medicine by J. Pizzorno, ND & M. Murray, ND