Tag Archives: Frank Lipman

Incremental Medicine + Functional Medicine = Good Medicine

 

Atul Gawande, MD

Photo by Aubrey Calo, photographer, Harvard School of Public Health

 

 

Atul Gawande is a surgeon and well regarded writer on public health issues. He was awarded the Lewis Thomas Prize for Writing about Science from The Rockefeller University in 2014. This Prize honors  “the rare individual who bridges the worlds of science and the humanities — whose voice and vision can tell us about science’s aesthetic and philosophical dimensions, providing not merely new information but cause for reflection, even revelation.” (The Rockefeller University, 2014)
Gawande practices General and Endocrine Surgery at Brigham and Women’s Hospital and is a Professor of Surgery at Harvard Medical School as well as a Professor in the Department of Health Policy and Management at the Harvard School of Public Health.
I’m writing about him today after reading his article Tell Me Where It Hurts: Our medical system rewards heroic intervention. When will we grasp the power of incremental care?  In The New Yorker‘s January 23 2017 issue. (I’m usually at least a few weeks behind.)

 

Source: The New Yorker

 

Gawande eloquently makes the case for switching our health care system’s  focus away from relying on heroic specialty care once we’ve develop medical conditions to ongoing, incremental care by primary-care docs to keep people healthier in the first place:
“We have a certain heroic expectation of how medicine works. Following the Second World War, penicillin and then a raft of other antibiotics cured the scourge of bacterial diseases that it had been thought only God could touch. New vaccines routed polio, diphtheria, rubella, and measles. Surgeons opened the heart, transplanted organs, and removed once inoperable tumors. Heart attacks could be stopped; cancers could be cured. A single generation experienced a transformation in the treatment of human illness as no generation had before. It was like discovering that water could put out fire. We built our health-care system, accordingly, to deploy firefighters. Doctors became saviors.
“But the model wasn’t quite right. If an illness is a fire, many of them require months or years to extinguish, or can be reduced only to a low-level smolder. The treatments may have side effects and complications that require yet more attention. Chronic illness has become commonplace, and we have been poorly prepared to deal with it. Much of what ails us requires a more patient kind of skill.” (Gawande, 2017, p. 39)
Source: www.ncsl.org

 

Studies have demonstrated “that states with higher ratios of primary-care physicians have lower rates of general mortality, infant mortality, and mortality from specific conditions such as heart disease and stroke. Other studies found that people with a primary-care physician as their usual source of care had lower subsequent five-year mortality rates than others, regardless of their initial health. In the United Kingdom, where family physicians are paid to practice in deprived areas, a ten-per-cent increase in the primary-care supply was shown to improve people’s health so much that you could add ten years to everyone’s life and still not match the benefit. Another study examined health-care reforms in Spain that focussed on strengthening primary care in various regions—by, for instance, building more clinics, extending their hours, and paying for home visits. After ten years, mortality fell in the areas where the reforms were made, and it fell more in those areas which received the reforms earlier. Likewise, reforms in California that provided all Medicaid recipients with primary-care physicians resulted in lower hospitalization rates. By contrast, private Medicare plans that increased co-payments for primary-care visits—and thereby reduced such visits—saw increased hospitalization rates. Further, the more complex a person’s medical needs are the greater the benefit of primary care.” (Gawande, 2017, p. 40)
“In this era of advancing information, it will become evident that, for everyone, life is a preexisting condition waiting to happen. We will all turn out to have … a lurking heart condition or a tumor or a depression or some rare disease that needs to be managed. This is a problem for our health-care system. It doesn’t put great value on care that takes time to pay off. But this is also an opportunity. We have the chance to transform the course of our lives.
“Doing so will mean discovering the heroism of the incremental. That means not only continuing our work to make sure everyone has health insurance but also accelerating efforts begun under health reform to restructure the way we deliver and pay for health care. Much can be debated about how: there are, for example, many ways to reward clinicians when they work together and devise new methods for improving lives and averting costs. But the basic decision has the stark urgency of right and wrong. We can give up an antiquated set of priorities and shift our focus from rescue medicine to lifelong incremental care. Or we can leave millions of people to suffer and die from conditions that, increasingly, can be predicted and managed. This isn’t a bloodless policy choice; it’s a medical emergency.” (Gawande, 2017, p. 45)
I highly recommend reading the entire article.

 

 

FUNCTIONAL MEDICINE

If we were to take Gawande’s argument for incremental care over heroic rescue care one step further and add a shift to Functional Medicine instead of what has come to be called Conventional, Traditional, Allopathic or Western Medicine,  then we’d really be on the right track to regain our health and save a bundle on health care.
Functional Medicine treats the patient, not the disease. It looks at the underlying causes of diseases and conditions in a particular person then works on rebalancing the body to return the person to full functioning.

 

Source: Pinterest

 

The seven basic principles of Functional Medicine are:
  • Science-based medicine that connects the emerging research base to clinical practice
  • Biochemical individuality based on genetic and environmental uniqueness
  • Patient-centered care rather than disease-focused treatment
  • Dynamic balance of internal and external factors that affect total functioning
  • Web-like interconnections among the body’s physiological processes also affect every aspect of functionality.
  • Health as a positive vitality, not merely the absence of disease.
  • Promotion of organ reserve.
  – (American Academy of Anti-Aging Medicine, 2017)
Source: www.iyogaposes.com
“Here lies the clear distinction and definition of Functional Medicine. Instead of asking, ‘What drug matches up with this disease?’ Functional Medicine asks the vital questions that very few conventional doctors ask: ‘Why do you have this problem in the first place?’ and ‘Why has function been lost?’ and ‘What can we do to restore function?’ In other words, Functional Medicine looks to find the root cause or mechanism involved with any loss of function, which ultimately reveals why a set of symptoms is there in the first place, or why the patient has a particular disease label.” (Cole, 2012)

 

Source: Integrated Wellness

 

Another description of Functional Medicine – with an example of how he uses it – from one of my favorite practitioners, Frank Lipman, MD:
“Functional Medicine is a true combination of Chinese Medicine, Western Medicine and scientific research. It combines the philosophy of balance and how to restore function from Chinese Medicine and the knowledge of biochemistry and physiology of Western Medicine with the latest scientific research about how our genetics, environment and lifestyle all interact with each other. Functional medicine focuses assessment and intervention at the root levels of metabolic imbalance and is an evolution in the practice of medicine that addresses the healthcare needs of the 21st century by focusing on prevention and uncovering the underlying causes of serious chronic disease. Instead of just suppressing symptoms, it deals with the root causes of disease and is less concerned with making a diagnosis and more concerned with the underlying imbalances, which are the mechanisms of the disease process.
“For instance, in the last 2 weeks, 3 people came to see me complaining of reflux and all had been given Nexium by their Doctor. But for one of them, the cause was his diet and eliminating the foods that caused the problem did the trick. For the second person, giving her probiotics and nutrients to heal the lining of the gastro-intestinal system helped and for the third person, giving him HCL, yes you read correctly, giving him Hydrochloric Acid tablets to help digestion helped. All 3 had different causes and needed to be treated accordingly.
“As opposed to Western Medicine, Functional medicine treats the patient and not the disease. In addition, it provides a framework for the practice of medicine that uses all the tools of healing, both conventional and alternative, to address the whole person rather than an isolated set of symptoms. I have studied Acupuncture and Chinese Medicine which taught me to see the body from a holistic perspective. Now Functional Medicine gives me a framework to combine this with a Western understanding of the body.” (Lipman, 2009)

 

Source: Washington Wellness Center

 

REFERENCES

American Academy of Anti-Aging Medicine. (2017). What Is Functional Medicine. See: http://www.a4m.com/fellowship-anti-aging-overview-what-is-functional-medicine.html

Cole, W. (2012). The 5 Principles of Functional Medicine. See: http://www.mindbodygreen.com/0-6014/The-5-Principles-of-Functional-Medicine.html

Gawande, A. (1/23/2017). Tell Me Where It Hurts: Our medical system rewards heroic intervention. When will we grasp the power of incremental care? The New Yorker. See: http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care

Lipman, F. (2009). WHAT IS FUNCTIONAL MEDICINE? See: https://www.bewell.com/blog/what-is-functional-medicine/

The Rockefeller University. (4/1/2014). Surgeon and writer Atul Gawande awarded Lewis Thomas Prize. Newswire. See: http://newswire.rockefeller.edu/2014/04/01/surgeon-and-writer-atul-gawande-awarded-lewis-thomas-prize/

 

 

 

© Copyright 2017. Joan Rothchild Hardin. All Rights Reserved.

 

DISCLAIMER:  Nothing on this site or blog is intended to provide medical advice, diagnosis or treatment.

Alzheimer’s & Factory Farmed Meat

 

 

Aerial View of a Factory Farm Where Animals Are Raised for Food

(Source: prairierivers.org)
(Source: prairierivers.org)

 

 

Here’s a list of the top 10 causes of death in the US. Alzheimer’s is in there at number 6 (Nichols, 2014):
  1. Heart disease
  2. Cancer
  3. Chronic lower respiratory disease
  4. Stroke
  5. Accidents
  6. Alzheimer’s disease
  7. Diabetes
  8. Influenza and pneumonia
  9. Kidney disease
  10. Suicide

 

(Source: www.lib.usf.edu)
(Source: www.lib.usf.edu)

 

 

In 2014, approximately 5.2 million Americans had Alzheimer’s disease, including about 200,000 people under 65 with early-onset Alzheimer’s.
In 2013, 15.5 million family and friends provided 17.7 billion hours of unpaid care to people with Alzheimer’s and other dementias. If they’d been paid, the care they provided would be worth $220.2 billion – nearly eight times McDonald’s total revenue in 2012. (Nichols, 2014)
You’ll see in a minute how that particular comparison is especially apt.

 

(Source: nutri.com)
(Source: nutri.com)

 

Research shows a link between a pathologic protein called TDP-43 and neurodegenerative diseases like Alzheimer’s, Parkinson’s, and Lou Gehrig’s (ALS). TDP-43 protein has the same effect on the brain as infectious, toxic proteins which cause the brain degeneration seen in Mad Cow and Chronic Wasting Diseases, two types of bovine spongiform encephalopathy.
Evidence of the connection between the pathologic TDP-43 protein and Alzheimer’s include (Mercola, 2015):
  • From 25-50% of Alzheimer’s patients have evidence of TDP-43 pathology in their brains.
  • Brain autopsies of Alzheimer’s patients with evidence of TDP-43 were 10 times more likely to have suffered cognitive impairment at death than those in whom TDP-43 wasn’t present.

 

 

Mad Cow Disease  (the human version is called variant Creutzfeldt-Jakob Disease) is a form of bovine spongiform encephalopathy. It is transmissible,  progressive, degenerative, and fatal to cows and humans.

(Source: www.rawfoodlife.com)
(Source: www.rawfoodlife.com)

 

Mad Cow Disease (the human version is called variant Creutzfeldt-Jakob Disease, or vCJD)) is acquired from eating cattle raised in densely confined animal feeding operations (CAFOs) – also referred to as factory farms. Cattle are natural herbivores but on factory farms they’re fed a diet that includes bone meal and animal byproducts made from other cows and factory farmed animals.
Mad Cow can spread rapidly and broadly when bone meal and waste products from  diseased animals  contaminate feed that’s given to thousands of other animals in different locations. (Mercola, 2015)
Scientists now think Alzheimer’s may be a slower moving version of Mad Cow Disease and the consequence of the factory farm practice of adding cannibalized  animal parts  and byproducts to the herbivores’ feed.  When humans eat the meat of animals infected with TDP-43 protein, TDP-43 can infect and damage our brains too.

 

(Source: wakingupvegan.com)
(Source: wakingupvegan.com)
The vast majority of meat we consume in the US – from cows, pigs, sheep, chickens, and turkeys – is grown on CAFOs. On these big farming operations, the animals live packed inside buildings and are fed a completely unnatural diet of genetically engineered grains (containing the pesticide glyphosate – a serious problem in its own right) mixed with antibiotics (to keep the animals from dying from the effects of the  unnatural diet they’re fed and the unsanitary conditions they live in), along with bone meal and other animal byproducts.

 

 

(Source: www.fairwarning.org)
(Source: www.fairwarning.org)

 

 

 

 

 

THE ROLE OF TDP-43 IN ALZHEIMER’S

The Mayo Clinic recently conducted an important study which demonstrated a clear connection between TDP-43 in the brain and Alzheimer’s Disease.
A description of the methodology and findings:

Since the time of Dr. Alois Alzheimer himself, two proteins (beta-amyloid (Aβ) and tau) have become tantamount to Alzheimer’s disease (AD). But a Mayo Clinic study challenges the perception that these are the only important proteins accounting for the clinical features of the devastating disease.

In a large clinico-imaging pathological study, Mayo Clinic researchers demonstrated that a third protein (TDP-43) plays a major role in AD pathology. In fact, people whose brain was TDP positive were 10 times more likely to be cognitively impaired at death compared to those who didn’t have the protein, showing that TDP-43 has the potential to overpower what has been termed resilient brain aging. The study was published in the journal Acta Neuropathologica.

Mayo Clinic researchers studied brains of 342 patients who had died with pathologically confirmed AD and divided them into two groups based on the presence or absence of the protein TDP-43. The protein was found in 195 or 57 percent of the cases.

“We wanted to determine whether the TDP-43 protein has any independent effect on the clinical and neuroimaging features typically ascribed to AD and we found that TDP-43 had a strong effect on cognition, memory loss and medial temporal atrophy in AD,” says Mayo Clinic neurologist Keith Josephs, M.D., the study’s lead investigator and author. “In the early stages of the disease when AD pathology was less severe, the presence of TDP-43 was strongly associated with  cognitive impairment. Consequently, TDP-43 appears to play an important role in the cognitive and neuroimaging characteristics that have been linked to AD.”

The study also found that patients who suffered from greater cognitive impairment and medial temporal atrophy at the time of death had greater TDP-43 burden and had the protein in a greater number of brain regions.

“This is why we believe that TDP-43 pathology could help shed light on the phenomenon of resilient cognition in AD and explain why some patients remain clinically normal, while others do not, despite both having similar degrees of AD pathology,” says Dr. Josephs.  “Our findings suggest that in order to have AD and be cognitively resilient, TDP-43 must be absent, so it should be considered a potential therapeutic target for the future treatment of AD.

This study was funded by the US National Institute of Heath (NIA) Grants and supported by the Mayo Clinic Alzheimer’s Disease Research Center.

– Anastasijevic, Mayo Clinic, 2014

 

Mayo Clinic Neurologist Keith Josephs, MD

(Source: intheloop.mayoclinic.org)
(Source: intheloop.mayoclinic.org)

 

Mayo Clinic neurologist Keith Josephs, MD,  the study’s lead investigator and author, describes the research and its results in this video posted to YouTube on 23 April 2014:

THE MAYO CLINIC’S TDP-43 AND ALZHEIMER’S STUDY

 

 

MAD COW DISEASE, A MAN-MADE PLAGUE

The Center for Food Safety, after the 2012 Mad Cow outbreak, noted:

Formally known as Bovine Spongiform Encephalopathy (BSE), “Mad Cow Disease” is a persistent food safety concern in the U.S. and abroad.  BSE occurs when cattle are fed rendered meat products made from other dead, disabled or diseased cattle or sheep as a feed supplement — or when chickens are fed rendered animals and their manure is mixed into cattle feed.

Tissue from infected cows’ central nervous systems (including brain or spinal cord) is the most infectious part of a cow.  Such tissue may be found in hot dogs, taco fillings, bologna and other products containing gelatin, as well as a variety of ground or chopped meats.  People who eat meat from infected animals can contract the human version of the disease, known as variant Creutzfeldt-Jakob Disease (vCJD).  The disease slowly eats holes in the brain over a matter of years, turning it sponge-like, and invariably results in dementia and death.  There is no known cure, treatment or vaccine for vCJD.

Center for Food Safety seeks to end dangerous animal feed practices that threaten human health and the safety of our meat supply, such as feeding rendered animals to other animals.  We urge the CDC to classify vCJD as a reportable disease so occurrences can be tracked and to work to plug the loopholes that still exist in FDA and USDA regulations.

– Center for Food Safety, 2015

 

 

Factory Farmed Cows Eating Medicated Grain Feed

Source: www.theparliamentmagazine.eu)
Source: www.theparliamentmagazine.eu)

 

 

Mad Cow Disease is a man-made plague created by factory farming. In cattle, the Mad Cow incubation period before the animal becomes visibly ill is thought to be about five years. In humans, it can be latent for a decade or longer before manifesting as vCJD. (Center for Food Safety, 4/25/2012).
It’s now illegal to feed beef-based products to cows. However – the beef industry is still allowed to use a feed called “chicken litter” consisting of  rendered dead chickens, feathers, chicken manure, and spilled chicken feed … and chicken feed contains cow meat and bone meal. So factory farmed cows are still eating parts of other sick cows – and Mad Cow Disease is still around.
Loophole number two: Cattle byproducts are also allowed in the feed of pigs, chickens, and turkeys.   And, under current laws, the byproducts of those pigs, chickens, and turkeys are allowed in the feed of cattle. (Mercola, 2015)

 

 

On left: A brain infected with vCDJ, riddled with holes due to tissue destruction.

On right: Normal brain tissue at a lower magnification.

(Source: http://trynerdy.com/?p=936)
(Source: http://trynerdy.com/?p=936)
The symptoms of vCJD (staggering, memory loss, impaired vision, and dementia) are quite similar to the symptoms of Alzheimer’s – and there’s no known cure.

 

 

 

 

TDP-43 AND OTHER NEURODEGERATIVE DISEASES

TDP-43 can also lead to other neurodegenerative diseases, such as Parkinson’s or Lou Gehrig’s (ALS) instead of to Alzheimer’s. The particular disease which develops may depend on which area of the brain the proteins attack. (ALZFORUM, 2014)

“Pathological TDP-43 appears to follow a set route through the nervous system, and what that route is depends on the disease at hand. Two new papers in Acta Neuropathologica add TDP-43 itineraries for Alzheimer’s disease and frontotemporal lobar degeneration [FTLD] to a previously published staging scheme for amyotrophic lateral sclerosis.

“While the starting points and paths taken differ, the disease-specific routes suggest that TDP-43 travels from neuron to neuron along axonal highways… The TDP-43 stages fit with the ongoing theme in neurodegeneration research that these diseases are progressive not only over time, but also in space, as pathological proteins spread throughout the nervous system…

“Overall… the FTLD pathology progressed from the front of the brain to the back. This contrasted with the ALS staging system, which began in the motor cortex at the brain’s apex and moved downward and forward from there.”

– ALZFORUM, 2013

 

 

(Source: imstartx.com)
(Source: imstartx.com)

 

 

 

 

 

GRASS FED VS FACTORY FARMED MEAT

If meat is part of your diet, it’s wise – for many reasons – to eat pasture raised, grass-fed animals when you can.

 

(Source: www.cfandhealthy.com_
(Source: www.cfandhealthy.com)

 

 

It’s good for the animals too. Wouldn’t you prefer walking around outside in the fresh air, feeling healthy, with the sun warming your back, eating food you can easily digest instead of being constrained inside in artificial light and filthy conditions, eating food and chemicals that makes you sick?
(Source: naturalpasturesbeef.ca)
(Source: naturalpasturesbeef.ca)

 

 

Almost all meat served in restaurants in the US is grown on factory farms.
From –
(Source: diet.gtatoplay.com)to –

(Source: www.dailymail.co.uk)

to –

spicy-thighs-cooked-2

 

 

This is what Functional Medical doc Frank Lipman has to say about eating grass-fed vs CAFO-raised cows:

To save money, factory-farmed cows are fed corn (which is cheap and often genetically modified) instead of the grasses they’re meant to graze on. Corn makes the cows sick, so they’re given antibiotics. These meds also fatten the cows – so the system “works” from a business perspective. If you eat factory-farmed meat, you’re ingesting sick animals, plus loads of antibiotics. Buy only grass-fed meat, and whenever possible, get it at a local farmers’ market from small farms.

– Lipman & Claro, 2014

 

(Source: www.eathealthybeef.org)
(Source: www.eathealthybeef.org)

 

 

“Dairy products aside, when past and present meat consumption are factored in, there is three times the risk of developing Alzheimer’s in meat eaters as opposed to vegetarians.”

– Broxmeyer, 2005

 

 

(Source: www.jvs.org.uk)
(Source: www.jvs.org.uk)

 

 

For more information on Alzheimer’s, see Alzheimer’s, Gut Bacteria & Music.
For more information on glyphosate and genetically engineered foods, see Moms to EPA: Recall Monsanto’s Roundup.

 

 

REFERENCES

ALZFORUM. (11/23/2013). The Four Stages of TDP-43 Proteinopathy. See: http://www.alzforum.org/news/conference-coverage/four-stages-tdp-43-proteinopathy

ALZFORUM. (1/24/2014). TDP-43 Routes Mapped in Alzheimer’s, Frontotemporal Dementia. See: http://www.alzforum.org/news/research-news/tdp-43-routes-mapped-alzheimers-frontotemporal-dementia

Anastasijevic, D. (2014). Why Some With Alzheimer’s Die Without Cognitive Impairment, While Others Do? Mayo Clinic. See: http://newsnetwork.mayoclinic.org/discussion/why-do-some-people-with-alzheimers-disease-die-without-cognitive-impairment-while-others-do-223585/

Broxmeyer, L. (2005). Thinking the unthinkable: Alzheimer’s, Creutzfeldt-Jakob and Mad Cow disease: the age-related reemergence of virulent, foodborne, bovine tuberculosis or losing your mind for the sake of a shake or burger. Medical Hypotheses, 64:4,699-705. See: http://www.ncbi.nlm.nih.gov/pubmed/15694685

Center For Food Safety. (4/25/2012). Press Release: California Cows Unhappy About Mad Cow Disease. See: http://www.centerforfoodsafety.org/press-releases/706/california-cows-unhappy-about-mad-cow-disease#

Center for Food Safety. (2015). About Mad Cow Disease. See: http://www.centerforfoodsafety.org/issues/1040/mad-cow-disease/about-mad-cow-disease

Hardin, J.R. (11/30/2014). Alzheimer’s, Gut Bacteria and Music. See: http://allergiesandyourgut.com/2014/11/30/alzheimers-gut-bacteria-music/

Hardin, J.R. (5/30/2014). Moms to EPA: Recall Monsanto’s Roundup. See http://allergiesandyourgut.com/2014/05/30/moms-epa-recall-monsantos-roundup/

Lipman, F. & Claro, D. (2014). The New Health Rules: Simple Changes to Achieve Whole-Body Wellness.

Mayo Clinic. (2014). TDP-43 and Alzheimer’s. Video. See: http://articles.mercola.com/sites/articles/archive/2015/06/04/alzheimers-disease-cafos.aspx

Mercola, R. (2015). Might Alzheimer’s Disease Be “Foodborne”? See: http://articles.mercola.com/sites/articles/archive/2015/06/04/alzheimers-disease-cafos.aspx?e_cid=20150604Z1_DNL_art_1&utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20150604Z1&et_cid=DM78202&et_rid=979877762

Nichols, H. (2014). What are the top 10 leading causes of death in the US? Medical News Today.  See: http://www.medicalnewstoday.com/articles/282929.php
Walker, L.C. & Jucker, M. (2015).  Prionlike Disease Processes May Underlie Alzheimer’s and Parkinson’s: A chain reaction of toxic proteins may help explain major neurodegenerative diseases—and could suggest new treatment options. Scientific American, 24:1. See preview at: http://www.scientificamerican.com/article/prionlike-disease-processes-may-underlie-alzheimer-s-and-parkinson-s/

© Copyright 2015 Joan Rothchild Hardin. All Rights Reserved.

 

DISCLAIMER:  Nothing on this site or blog is intended to provide medical advice, diagnosis or treatment.