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| Jeffrey Bland, PhD, Director, Institute for Functional Medicine. |
JACKSON HOLE, WY—Welcome to the functional medicine revolution.
“We are on a tremendous threshold in terms of how we conceptualize health and disease, structure and function, and how nutrition fits into all of that,” said Jeffrey Bland, PhD, at a week-long course entitled Food as Medicine, sponsored by the Center for Mind-Body Medicine and the University of Minnesota.
For the past decade, Dr. Bland and other leaders of this emerging science have been quietly transforming the ways physicians think about health and medicine by re-grounding the reductionistic disciplines of biochemistry and genetics in a broader holistic context described by ecology, mind-body medicine, and general systems theory.
The fundamental tenet of functional medicine is that nutrition is a major determinant of gene expression, and by extension, physiologic structure and function, said Dr. Bland, who began medical training in the 1960’s, but took a long detour into biochemistry. He is now director of the Institute for Functional Medicine, Gig Harbor, WA, the nation’s premier research and training center devoted to this new branch of medicine.
Food Is Information
Functional medicine essentially begins with a fresh answer to a simple question: What is food?
“You can look at it in so many different ways,” said Dr. Bland. “Biochemical and metabolic principles; organoleptic properties; organic versus nonorganic; psychological and symbolical aspects of foods; metaphysics; hedonic aspects.” The revolutionary new concept underlying functional medicine is the recognition that food is information.
“Nutrition is providing the body with molecules of information. It speaks to the body.” The other cornerstone concept is simply recognition of the astonishing variability in the phenotypic expression of a particular genotype, and the degree to which this can be influenced by what an individual chooses to eat.
Dr. Bland believes it is high time to move away from the simplistic calorie counts or relative percentages of macronutrients that have dominated medical thinking about nutrition. The key is to look at the informational content of someone’s food: what is the diet instructing the body to do, and how can those signals be changed to promote better health?
“Nutrients speak to our genes. If the genes like what is going on they produce bliss. If they don’t like what’s going on they generate hostility, stress, increased cortisol, the uncoupling of phosphorylation reactions.” Receptor sites on cells are antennae; they receive molecular signals from outside the cells and these signals alter gene expression.
A diet heavy on fast food—the so-called Standard American Diet (SAD)—is essentially an “alarm message,” with very high-impact, Dr. Bland explained. Fast food contains a lot of simple sugars without fiber, so there’s nothing to create a timed-release of the sugars. It is just a very fast infusion of sugars, which creates an alarm response message.
Over time, a continuous diet of high-caloric, high-glycemic fast food not only produces dyslipidemia, it also promotes insulin resistance. The huge load of Omega-6 fatty acids and trans fats in fast foods increases production of pro-inflammatory cytokines. This is a cardiovascular risk beyond the obvious risk associated with high lipid intake.
Talking to the Genes
According to Dr. Bland, the dialog about genetics in medicine has been stultified, with conventional discourse centering on identifying how specific diseases are linked to specific single-gene loci. In most cases, to say a condition is “genetic” is the intellectual equivalent of throwing up one’s hands and accepting that little can be done.
In reality, all of the clearly “gene-identified” diseases account for less than 5% of all diseases recognized by Western medicine. Most of the biggest killers do not have single gene links. Dr. Bland, who served as director of research at the Linus Pauling Institute, working closely with Linus & Helen Pauling, stressed that cardiovascular disease, type 2 diabetes, and most forms of cancer are poly-genomic, and reflect how environment and behavior combine with genotype to produce phenotype.
“Genes are pleomorphic, characteristics are polymorphic,” he explained. There are multiple genes for specific enzymes that produce and act differently under different conditions. “It is not a one-gene, one-protein system as we have been taught. The key question is: How do we bathe our genes with experience?”
Conventional wisdom holds that cancer is a genetic disease, that essentially, it is deterministic. But Dr. Bland pointed to recent work at the Karolinska Institute in Sweden involving nearly 45,000 pairs of identical twins. If cancer were largely genetic, one would expect a high degree of concordance in incidence of cancers among the twin sets.
The data showed that for most types of cancer, genetic factors accounted for only 20–30% of the cancer risk, and at best accounted for no more than 50%. Environmental factors, on the other hand, accounted for up to 70–80% of the risk. The principal environmental influence was diet, not environmental toxins (Lichtenstein P, et al. N Engl J Med 2000; 343(2): 78–85). “It is all modifiable and influenceable by what we choose to eat,” said Dr. Bland.
Homeodynamic Health Care
Functional medicine posits that structure and function at the molecular level determine structure and function on the organ system level. “Biochemistry is topological information science,” said Dr. Bland. “It is 3-dimensional. The molecules of life are coalesced information from stardust. The atoms that make up the molecules represent energy coalesced with high informational content. These molecular aggregates are not random. They are topologically very specific and very unique. Get the structural relationships right and the proper functioning will follow.”
Health and disease are functions of biosignalling, from the interactions of single molecules to the interactions between species in the ecosystem. The origins of cancer, diabetes, heart disease, and many other diseases are dysfunctions or malfunctions of signalling networks.
When it comes down to it, the body regulates four things very carefully: glucose levels, CO2/O2 balance, electrolyte balance, and redox potential. These four, said Dr. Bland, are the cornerstones of all physiology. If any of these go too far out of balance, there is a breakdown of some sort. As president of Metagenics, one of the nation’s leading nutraceutical companies serving health professionals, Dr. Bland has been involved in developing supplement formulas based on the principles of functional medicine.
He believes the word “homeostasis” is misleading. “To stay physiologically fit and facile, you need a high degree of molecular freedom. The more diversity of biochemical and physiological response, the more stable the system will be overall. We should be talking about homeodynamic regulation, not homeostasis. It is the homeodynamics that produce the appearance of homeostasis.”
In practice, functional medicine aims to recognize each patient’s unique homeodynamics, to discern how these processes are out of balance, and to optimize them with individualized nutritional interventions. “We are entering the era of personalized medicine, not White, Anglo-Saxon, 35-year-old male medicine,” Dr. Bland insisted. Individualization is essential. “There are no protocols. You need to weave the web for each particular patient. This medicine is not ‘Keep It Simple, Stupid’ medicine. It doesn’t work with simple, one-size-fits-all protocols.”
While it offers a host of novel therapeutic approaches for the management of specific conditions, functional medicine is, at its root, a totally holistic paradigm.
According to Dr. Bland, “the idea of specific, discrete functional syndromes is an artifact of specialized medicine. It reflects how medicine thinks, not how diseases evolve. We are not a set of disparate organs, like a collection of chapters in a medical textbook. We are interactive, holographic and time-dependent systems.” Functional medicine offers a practical approach to working with the dynamic systems that comprise a human life.
The Food as Medicine course will be offered once again in early 2003. For more information, contact Sandy White at the Center for Mind-Body Medicine, Washington, DC, 202-966-7338 or via email: swhite@cmbm.org.
