As I write this I’m in Huntington Beach, CA attending a conference hosted by IFM (the Institute for Functional Medicine, in case you weren’t already aware of the acronym).
The title of this conference is “Reversing Cognitive Decline” and the central speaker is Dale Bredesen. Dr. Bredesen, a physician and UCLA researcher, has developed a program for the treatment of Alzheimer’s, which in and of itself is controversial because it is widely accepted that Alzheimer’s has not treatment. To illustrate, one of his first slides included the statement that “Everyone knows a cancer survivor, but no one knows an Alzheimer’s disease survivor.” Pretty grim.
But he has pretty compelling evidence to the contrary. Of course we’re not talking about late stages of Alzheimer’s; in fact early intervention coupled with a strong commitment to compliance on the part of the patient and their support system is considered critical to a positive outcome.
His treatment program dovetails perfectly with the functional medicine paradigm promoted by IFM and taught in their AFCMCP (Applying Funtional Medicine in Clinical Practice) modules, which, simply stated, is that no disease simply “appears” ex nihilo, but instead has antecedents, triggers and mediators; rather than a “name and medicate” process, it makes more sense to go upstream to the lifestyle, environmental, and yes, genetic factors that precede the appearance of the disease. By modifying those preceding contributors to the disease process, it may be possible to avoid the disease altogether. Examples of these “upstream agents” are chronic inflammation, environmental toxins, poor dietary choices (too much sugar, fat, etc.), alcohol abuse, smoking, lack of exercise, and on and on. A functional approach treats the actual name of the disease as almost irrelevant; what’s more important is the preceding agents named above.
The metaphor used today was “if the city of New Orleans discovers thousands of dead fish in the Mississippi River, they will go upstream to Memphis, St. Louis, Minneapolis or Pittsburgh to try to discover what killed the fish in their city. The cause may not be obvious, but somewhere upstream, something bad was released into the river to kill all those fish in New Orleans.” The same is true of disease: the initiators of the any disease may be a long way “upstream” but that’s where the focus of the clinician should be.
Back to Dr. Bredesen. He says Alzheimer’s is the name given to a complex process wherein the immune system (and specifically, the inflammatory process) has gone awry, and that the changes seen in the brains of Alzheimer’s patients is an attempt by the body to compensate and protect itself from this inflammatory process. There are at least 6 different general patterns (in Bredesen’s model) that precede (and eventually progress to) Alzheimer’s, including inflammation, hormonal imbalances, blood sugar anomalies, and so forth. If you look at them they all include inflammation either as a primary or secondary trigger.
Using this model, Dale has been able to show in multiple patients a dramatic increase in cognitive function in both subjective and objective measures for people with dementia. Even in the presence of significant cognitive decline, a majority of his patients have been able to recover virtually all of their mental functions over time.
Earlier this year I attended another conference where Dale spoke, and was followed by another friend of mine, Dr. Mark Houston. Mark is Director of the Hypertension Institute in Nashville (and also on Vanderbilt Medical School’s faculty). He was presenting a functional medicine approach to cardiovascular disease, and commented that, with the exception of changing the outcome from a cardiovascular event such as a heart attack to dementia, the mechanism of CVD was identical to that of the progression of Alzheimer’s. Interestingly the treatment was virtually the same as well.
This to me captures the essence of functional medicine. Depending upon the genetic predisposition of a particular patient, the exact same antecedents, triggers and mediators express themselves in one patient as cardiovascular disease, in another as Alzheimer’s disease, in another as cancer.
I think this is a much better way of approaching healthcare than our current “name it and medicate it” system of conventional medicine.