Lifestyle and Diet - the Miracles of Functional Medicine

Imagine if you will that people were aware of the fact that food was their best medicine and much in the way of prevention would occur from a healthful diet and lifestyle. Imagine too that drugs were reserved for very serious conditions and even then used with the purpose of acting as a temporary measure until the true root cause was identified and treated.

What would this world be like? I have a dream. This dream involves everyone being aware of the option of sane health care. I’m not so idealistic as to dream that everyone would utilize such a product, but that they knew that it was available and the benefits of it, would be a dream come true for me and it is that dream that drives me to do what I do each and every day.

A friend of mine just visited Tokyo, Japan. He loved his visit and one of the aspects that struck him most was how incredibly clean the city was. He commented: “I’d have eaten off the subway floor!” No doubt a bit of an exaggeration but he makes his point. Add this almost unbelievable cleanliness to the fact that this city positively teems with citizens and you begin to ponder how it happens. I asked him if he saw a lot of people who were responsible for keeping the city clean. (I was thinking of Disneyland where one constantly sees an employee sweeping and cleaning.) His response was no, but rather it seemed an ingrained habit of the people to maintain cleanliness. It’s a bit amazing when you think of it.

My friend continued to say that when he returned to his home in San Francisco he was almost sickened by the dirt of the city in comparison to Tokyo.

Of course this conversation had me quickly leaping to my favorite topic of healthcare and I began to dream my favorite dream – what would happen if we could alter our culture of health along the lines of Japanese cleanliness. While it’s overwhelming to think of “cleaning up” downtown San Francisco, what if everyone suddenly got the idea of keeping their surroundings clean? How long would it take to have a clean city?

Similarly if everyone got the idea of natural healthcare and the importance of lifestyle changes such as diet and exercise, how long would it take to have a healthier society? Fortunately this is not a rhetorical question. Some of my personal heroes from the field of Functional Medicine have some very exciting statistics to support my “dream”.

Listen to this from the following clinicians who posted this article a few months ago:

Rescuing Health Reform: Why Doctors Should Practice Lifestyle Medicine
September 15, 2009
Mark Hyman, MD, Dean Ornish, MD, and Mike Roizen, MD

Mark Hyman is Vice Chair of The Institute for Functional Medicine, Dean Ornish is Clinical Professor of Medicine at the University of California, San Francisco, and Mike Roizen is Chief Wellness Officer and Chair of the Wellness Institute at Cleveland Clinic

Recently, at a small gathering in Martha’s Vineyard, the economist Larry Summers spoke about the nation’s narrow escape from economic depression. Dr. Summers addressed the even larger impending risks to our economy if the costs of health care are not successfully addressed now.
He was asked how we could control these costs without tackling the root causes of the problem. The chronic diseases that affect 160 million Americans account for 78% of our $2.1 trillion in annual health care costs. Lifestyle and environmental factors –our diet, sedentary lifestyle, smoking, and chronic stress—are the most important underlying causes of these diseases.
But most believe that doctors don’t “do” lifestyle. Dr. Summers dismissed “lifestyle” as a community and public health issue that was already included in the current plan. He didn’t understand that physicians can and must do lifestyle medicine to effectively treat disease and dramatically reduce health care costs. Lifestyle factors leading to chronic diseases such as heart disease, diabetes, obesity and cancer are the domain of doctors and not merely a “public health problem.”

Lifestyle medicine is not just about preventing chronic diseases but also about treating them, often more effectively and less expensively than relying only on drugs and surgery. Nearly all the major medical societies recently joined in publishing a review of the scientific evidence for lifestyle medicine both for the prevention and TREATMENT of chronic disease. http://www.acpm.org/LifestyleMedicine.htm. There is strong evidence that this approach works and saves money. Unfortunately, insurance doesn’t usually pay for it. No one profits from lifestyle medicine, so it is not part of medical education or practice. It should be the foundation of our health care system.

For example, the recent “EPIC” study published in the Archives of Internal Medicine studied 23,000 people’s adherence to 4 simple behaviors (not smoking, exercising 3.5 hours a week, eating a healthy diet [fruits, vegetables, beans, whole grains, nuts, seeds, and low meat consumption], and keeping a healthy weight [BMI <30]). In those adhering, 93% of diabetes, 81% of heart attacks, 50% of strokes and 36% of all cancers were prevented.

“Prevention” therapies as written into current health care bills are public health and community based wellness initiatives, or payment for early detection of disease with mammograms, colonoscopies and other screening tests. As the Congressional Budget Office recently indicated, early detection without treating the major underlying causes of chronic diseases—our lifestyle choices—may actually add to costs.

While health insurance reform is important, it is insufficient. We must not only change who is covered but also what is covered to include personalized lifestyle medicine if we are to make current treatments more effective and less costly.

When the underlying lifestyle causes are not addressed, medications to treat chronic diseases usually have to be taken for a lifetime. If the causes are addressed, patients are usually able to reduce or stop taking these medications and often avoid surgery (under their doctor’s supervision).

Personalized lifestyle medicine is a high-science, high-touch, low-tech, low-cost treatment that is more effective for the top five chronic diseases than our current approaches. If lifestyle treatments were applied to all patients with cardiovascular disease, diabetes, metabolic syndrome (obesity), prostate cancer, and breast cancer, then net health care expenditures could be reduced by $930 billion over 5 years, according to analysts from the Cleveland Clinic. This will result in dramatically better health and quality of life.

On August 6, 2009, Senator Ron Wyden [D-OR] introduced new legislation, the “Take Back Your Health” Act (S. 1640) that includes payment for intensive lifestyle medicine as treatments, not just prevention. This legislation has bipartisan co-sponsorship by Senator John Cornyn (R-TX) and Senator Tom Harkin (D-IA).


So as you can see, not only is this dream shared by others, but it’s a dream that’s validity is already substantiated by research.

Please show your support for this in any way that you see fit, and as always, let me know how I can assist you in any way.

Visit us at www.RootCauseMedicalClinic.com. If you have questions or need any help, I’m here for you! Call 408-733-0400.

I look forward to hearing from you.

To your good health,

Dr Vikki Petersen, DC, CCN, CFMP


IFM Certified Practitioner

Founder of Root Cause Medical Clinic
Co-author of “The Gluten Effect”

Author of the eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”

Drug Giant Pfizer Announces Major Layoffs

“Pfizer may announce $2 billion in cost cuts including plant closings and slashing up to 10% of the work force when new chairman and CEO Jeffrey Kindler announces his plan next week for a strategic overhaul of the world's largest drugmaker.”

These were headlines earlier this week and it brought two thoughts to mind. First, 70% of all the medical “research” done in this country is funded by pharmaceutical companies.

Questions about such research began to come to our attention in 2004 when the FDA did some reanalysis of antidepressants and concluded that the drugs increased the risk of suicide in children.

Merck pulled its arthritis drug Vioxx off the market when it was discovered that it doubled the risk of heart attacks. Yet in 2000 the New England Journal of Medicine had published a study of the effects of Vioxx where the risks were very downplayed.

The industry promised to do better but more and more scientists are realizing that only part of their findings are published with the “more damaging” information being glossed over or left out completely. Dr Aubrey Blumsohn, a British bone specialist contends that Procter and Gamble published a report in his name that not only he didn’t write but one that he was suspicious wasn’t accurate. He later found out that 40% of the data he submitted after doing research on an osteoporosis drug was missing, thereby skewing the results.

Who is suffering from the side effects of these dangerous drugs? We are. I’m not advocating a no drug solution for everything, so please don’t try to pigeon-hole me into that category. But the facts are that drugs have side effects and often they are dangerous, which is why a drug should be used for a very short period of time while striving to discover and remediate the root cause underlying the problem. Known drug side effects can be factored into the equation of whether taking the drug is the best solution for a given time. But what about the dangerous side effects which are unknown because they were suppressed by the pharmaceutical company?

The second thought that came to mind is that our preoccupation with drugs and masking symptoms we don’t care for along with the huge profits which pharmaceutical companies enjoy, completely explains why gluten sensitivity and celiac disease is so under- and mis-diagnosed. There’s no drug to treat it! And if there’s no drug there’s not much interest generated from the medical community.

Where does that leave us, my friends? Out of the mainstream medical model, that’s for sure. But until my dream of changing the face of healthcare comes about, I don’t mind. I’ll continue to let more and more patients know that addressing the underlying root cause of their health problem is not only a method that makes sense, but one that works. And it is my hope that it becomes more widely available as we continue to prove its efficacy.

Visit us at www.RootCauseMedicalClinic.com. If you have questions or need any help, I’m here for you! Call 408-733-0400.

I look forward to hearing from you.

To your good health,

Dr Vikki Petersen, DC, CCN, CFMP


IFM Certified Practitioner

Founder of Root Cause Medical Clinic
Co-author of “The Gluten Effect”

Author of the eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”

We Still Have A Lot of Work to Do!

With The Gluten Effect’s publishing finally on the horizon, we’ve been contacting various groups who support those patients with celiac disease. It is my hope to educate those groups on the difference between celiac disease and gluten sensitivity such that we can help their family and friends who, while perhaps not celiac, may very well be suffering from the many problems gluten sensitivity creates.

While we have received many positive responses I chose to share the one “negative” response I received as an example of the pervasive attitude in the medical community which we have to overcome to help the millions of people suffering with gluten sensitivity.

Here’s the letter: (I have left out the person’s name and the specific group in order to respect confidentiality.)
Dear HealthNOW staff,

Thank you for your email. While I appreciate the importance Dr. Petersen places on the diagnosis of gluten intolerance, and her commitment to her patients, I must decline the request to add your links to our web site at this time.

We are affiliated with the Celiac Disease Foundation, and generally advise physicians and patients to follow the guidelines for celiac diagnosis and treatment recommended by university celiac disease centers, including those at U.C. San Diego, Columbia University, University of Maryland and University of Chicago. This approach appears to differ in significant ways from the one described on your web sites. For example, the use of Enterolab stool testing, and the dismissal of the intestinal biopsy as a misguided approach advocated by "several" clinicians, is inconsistent with our philosophy (8/26/08 entry in her blog).

While alternative approaches to diagnosis may prove fruitful in the future, we feel we will have the greatest impact in our local medical community at this time by using the resources of universities and peer-reviewed medical journals that mainstream physicians trust. We do, however, strongly support the use of integrative medicine in the treatment of celiac disease and gluten sensitivity.

There is a great deal yet to be discovered about celiac disease and gluten sensitivity, and I wish your colleagues well in the path they have chosen.


And here's my response:

Dear ________ (name left out to protect identity),

Thank you for your response. I would like to thank you for all the
good work you're doing in the field of celiac disease. Hopefully you will grant
me a few minutes of your time so that I can "state my case" for the work I'm doing with gluten sensitivity.

My upcoming book is heavily referenced and peer review literature is
among those over 400 references. Once such reference is from The
New England Journal of Medicine, October 2007 article by Peter Green,
MD.

Below are some quotes from the article and some comments from me.
"The diagnostic criteria developed by the European Society for
Pediatric Gastroenterology and Nutrition require only clinical
improvement with the diet, although histologic improvement on a
gluten-free diet is frequently sought and is recommended in adults
because villous atrophy may persist despite a clinical response to the
diet."

[In my experience of over 20 years I frequently see dramatic changes
in patient's health from a gluten-free diet despite a negative
intestinal biopsy. I believe the opinion of the above European
Society whereby clinical improvement on a gluten-free is sufficient,
is a trend that will soon be more prevalent here in the US.]
Serologic [Blood] Testing

"Typical indications for serologic testing include unexplained
bloating or abdominal distress; chronic diarrhea, with or without
malabsorption or the irritable bowel syndrome; abnormalities on
laboratory tests that might be caused by malabsorption (e.g., folate
deficiency and iron-deficiency anemia); first-degree relatives with
celiac disease; and autoimmune diseases and other conditions known to
be associated with celiac disease."

"The most sensitive antibody tests for the diagnosis of celiac
disease are of the IgA class. The available tests include those for
antigliadin antibodies, connective-tissue antibodies (antireticulin
and antiendomysial antibodies), and antibodies directed against tissue
transglutaminase,"

[Serologic testing of an IgA and IgG nature is what I utilize in my
practice and recommend for patients. Enterolab is mentioned for those
patients not local to our area who have doctors whom refuse to order
the serologic testing. While the limitations of the stool testing of
Enterolab are mentioned in our upcoming book, if it's the only
possible choice available, it may well provide the data a patient needs to make the important change to a gluten-free diet. And if that dietary change results in health improvement, it’s certainly worthwhile.]
"Although no studies have examined the number of biopsies required
for diagnosis, we believe that at least four to six endoscopic-biopsy
specimens should be obtained from the duodenum [small intestine], given the patchy
nature of the disease and the difficulty of orienting the small pieces
of tissue taken during biopsy for assessment of villous morphology."

"The spectrum of pathologic changes in celiac disease ranges from
near-normal villous architecture with a prominent intraepithelial
lymphocytosis to total villous atrophy. Pitfalls in the pathological
diagnosis include overinterpretation of villous atrophy in poorly
oriented biopsy specimens and inadequate biopsy sampling in patients
with patchy villous atrophy."

"Celiac disease occurs in nearly 1% of the population in many
countries. The diagnosis, which is straightforward in most cases, is
usually established on the basis of serologic [blood] testing, duodenal [small intestine] biopsy, and observation of the response to a gluten-free
diet. A poor response to the diet is common."

[This is the area where I know our opinions diverge but please hear me
out for a moment. There are 23 feet of small intestine and a biopsy
is attempting to identify small patches of villous atrophy. I have
many, many patients who are extremely gluten sensitive whom have been
told that they are absolutely fine to eat gluten. Why are they told
such a thing? Because their biopsy was negative. Are we really
helping our patients condemning them to lifelong suffering based on a
test of such a gross nature? I don't believe so. Much of the poor
response to diagnosis may very well occur because so much damage has
been done when a diagnosis is finally confirmed. By the time the villi
are flattened, often irrevocable damage has occurred to the digestive tract or some other organ system. Once autoimmune disease occurs, complete remediation is often not possible. Below Dr Green mentions the importance of early diagnosis. I don't believe that for the majority of people suffering from gluten sensitivity that early diagnosis is going to occur based on the use of intestinal biopsy alone. It’s too gross of a test for many patients and too insensitive at time to detect subtle changes of the villi. This is the very reason I utilize the testing I do, including the response of from the patient upon elimination of gluten from their diet. Early diagnosis is exciting because a patient discovers that they are gluten sensitive while they still have good functioning of their small intestine. A true early diagnosis should occur long before intestinal villi have been severely damaged. And that in sum is what I believe will be looked back on as our current greatest mistake - waiting for villous atrophy on biopsy before diagnosis is akin to waiting to diagnose risk for cardiovascular disease until the patient has suffered their first heart attack. As doctors we promise to do no harm. I believe we must seriously rethink and readjust our diagnostic criteria for diagnosing celiac disease and gluten sensitivity.]
"Increasing awareness of the epidemiology and diverse manifestations
of the disease, as well as the availability of sensitive and specific
serologic [blood] tests, especially among primary care physicians, will lead
to more widespread screening and diagnosis, which in turn will lead to
greater availability of gluten-free foods and efforts to develop drug
therapies that relieve patients of the burden of a gluten-free diet.
In addition, earlier diagnosis may lead to a reduction in the
complications of the disease."

Thank you for your time. I'd be happy to send you a copy of
our upcoming book, The Gluten Effect. And I'd would love to hear your
feedback.

Visit us at www.RootCauseMedicalClinic.com. If you have questions or need any help, I’m here for you! Call 408-733-0400.

I look forward to hearing from you.

To your good health,

Dr Vikki Petersen, DC, CCN, CFMP


IFM Certified Practitioner

Founder of Root Cause Medical Clinic
Co-author of “The Gluten Effect”

Author of the eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”