The Functional Medicine Approach to Metabolic Conditions
A narrow but useful view on understanding how we work is to see us as just a bag of chemical reactions. All our thoughts and actions can be understood as a series of biochemical reactions going on primarily within the cells of our body. This magnificent symphony of molecular actions and reactions is highly complex but beautifully orchestrated. The conductor for the symphony is the process that involves the reading of our genetics and translation of that code into the production of proteins called enzymes that control every biochemical transformation in us. These chemical reactions allow us to sense our environment through vision, hearing, taste, smell, and feeling. These sense organs send biochemical signals to our brain which processes the information through another set of biochemical reactions, interprets them based on memory which is also chemical in nature, and takes action through the activation of our muscles- also a chemical reaction! In the background are a host of other reactions that control digestion and nutrient absorption then dissemination through the circulatory system along with oxygen from the lungs to feed and energize all the biochemical reactions taking place in all the cells. There is a biochemical detoxification and elimination system involving the cells themselves along with the lymphatic system, liver, gut, and kidneys. Then there are the biochemical reactions that run our immune system and the communication system that coordinates all of these activities called the endocrine system – our hormones.
This process is what is referred to when we talk about our metabolism. Breakdowns in the functioning of our metabolism underlie all illness and although at the Plum Spring Clinic we classify the conditions we treat into 6 categories, we could really simplify that system and say we treat conditions of metabolic breakdown.
How does our metabolism breakdown? There are three interrelated domains where our system can go wrong: genetics, toxins, and nutrient depletion.
Many, maybe most, and possibly even all of our illnesses can be seen as, in part, a function of poor genetic code. In the past, the medical field had a simplified view of the role of genetics – you had good genes or bad genes. The expression of the goodness or badness was primarily a consequence of how the two sets of genes you had,one set from each parent, interacted with each other. Now we know that a gene is a code of repeating letters that varies in length perhaps slightly over a thousand on average but with a large variation. That code can vary from person to person – usually by a change in just one letter – that is called a Single Nucleotide Polymorphism or SNP (pronounced “snip”). Saying someone has a SNP in a gene is a fancy way of saying there is a one letter difference in the code.
The code is used to make many proteins – and as we said, many of them are used to make the proteins that make the enzymes that control our biochemical reactions. A SNP in the code might change the structure of the enzyme to make it more efficient – or the SNP might make the enzyme slightly less efficient. These differences in efficiency account for the highly individualized risk for many diseases.
So if our genetics are fixed and the genetics account for illness risks – how come some people with the same genetics get a disease and others do not? We believe the most important factors are the exposure to toxins and the availability of nutrients. When we speak of toxins we include psychological toxins because we know that stress has a powerful effect on our biochemistry primarily through its effect on stress hormones, our gut, and our immune system. The effects on these systems can in turn decrease our ability to nurture ourselves and protect ourselves from toxins. There is an added effect of stress on our behaviors that may lead us to make poor choices in food, substance use, exercise, and sleep patterns.
What about the enzymes that run our metabolism? They are vulnerable to the effect of toxins and they also rely on the presence of cofactors – molecules that actually make the enzymes work more effectively. Most of the enzyme cofactors are simple nutrients like magnesium or vitamin B12.
A person with a SNP that decreases the effectiveness of an enzyme that makes serotonin combined with exposure to a toxin that also decreases the effectiveness of that same enzyme may still be able to produce enough serotonin to maintain a good mood. But over time that person’s ability to digest well may be compromised by the combination (serotonin is a powerful agent in maintaining healthy digestion) such that they are unable to absorb enough magnesium to maintain production and the person drifts into an anxious and worried state. Magnesium is known to be an important cofactor in the production of serotonin.
So you see how our metabolism is dependent on genetics, toxins, stress, and nutrient availability. At the Plum Spring Clinic when we engage with you to determine the underlying cause of your health breakdowns we always want to probe these factors. Much can be learned by a holistic, functional medicine history when taken by someone trained in connecting pieces of a person’s family, medical, and social history to the development of symptoms suggesting where the breakdown actually lies. Functional medicine testing often permits us to further define the breakdown. This also explains why we include stress; nutrition; and toxin exposure and elimination as primary factors on helping get the metabolism back on track.