8 Things To Do Before Seeing a Functional MD
I am constantly amazed by the healing power of the body and the resilience of humans. When I read about the never-ending assaults on the body (microbial, toxic and emotional) it seems a miracle that there are any humans left on earth. Nonetheless here we are, though often less than we could be, burdened by chronic un-wellness.
If you are looking deeper, beyond the prevailing narrative, realizing there must be more to life than being on ten pharmaceuticals by the age of thirty, you may be considering seeing a Functional MD. You may hope to get a test to get to the “root cause” of your ills. This then hopefully leads to treatment and a cure.
No matter what the root cause turns out to be (if this is found), no treatment is effective unless the foundation is strong. Often, all that is needed is to give the body its best chance and, voila, the cure happens.
We MDs, clump the symptoms of un-wellness into boxes largely to help us feel that we are making a difference — depression, eczema, social anxiety, insulin resistance, irritable bowel syndrome, autoimmune disease, chronic pain syndrome. With chronic conditions being multifactorial and often complex, one dimensional labels become of little value. Most often the general medical treatment on offer for chronic conditions is (from a functional perspective) woeful.
Generally, there are three actions the body can undertake when responding to an assault on its equilibrium: inflammation, oxidative stress and immune activation. These are crucial when fighting a microbial assault such as malaria or Covid 19, but if the assault never ends (e.g. poor sleep), the inflammation and oxidative stress continue and the immune system becomes dysregulated.
Furthermore, Homo sapiens are accustomed to changes in environment. Sometimes there is lots of food and sometimes none; sometimes it is cold and sometimes it is hot. Trying to live in a constant climate of comfort, food availability and distraction is making this species weak.
This is the playing field that you and your functional MD will be looking to level.
A quick word on hormones as an introduction to numbers 4 and 5.
The hormonal system in the body is known as the Endocrine System. While we tend to think of hormones as Estrogen and Testosterone, there are hundreds of other hormones in the body. The definition of a hormone is a compound that is produced in one part of the body and then acts on another part. The part that makes the hormones, is often referred to as a gland e.g., the thyroid gland. The thyroid gland make thyroid hormone that works in all the cells of the body, even the ones in our toes.
Other hormones include insulin, cortisol and melatonin. They all have widespread effects.
When something interferes with the production or function of a hormone, this is called an Endocrine Disrupting Chemical (EDC) or Hormone Disrupting Chemical. The two terms are used interchangeably.
Many of the same chemicals are now also being referred to as Obesogens, as they promote obesity.
What you can do
When I see clients, who are burdened by disease, the recommendations and interventions range from simple to very complex. Regardless those who have made a start, do better, more quickly. It also frees up time if I do not have to explain what a seed oil is.
You have heard it ad-nauseam, but it is true. What you put in your mouth is thought to be the most powerful epigenetic influence, turning genes on and off, leaving you either with healthy levels of inflammation, oxidative stress and immune activation, or not.
At least know what a carbohydrate, protein and fat is; know what ultra-processed food is (hint: it usually comes in a packet and has a long shelf-life). Get intimate with your food. Find a new vegetable and learn how to prepare it; don’t buy it sliced in a bag to pop in the microwave. Touch, smell, taste your food.
Get hungry. Do you know what this feels like? No one ever died of hunger (vs starvation). If you are never hungry, you don’t know when your body needs to eat and when it does not.
Here is a basic, simple nutritional framework to start with.
2. Movement / Exercise
Please don’t sign up for Tough Mudder or a marathon just before seeing a Functional MD.
This is tricky, as optimum types and durations of exercise vary. However, the following is a general rule of thumb.
If you are sedentary, just start to move here and there. You know the drill: take 1 flight of stairs before you take the elevator, walk the email, get off public transport earlier than your closest stop, set your timer and move away from your screen every hour (your eyes will love this too).
As a general rule when starting exercise, if you are overweight (BMI >25), start with walking on the flat at a brisk pace. You want to be slightly puffed but not panting. For those who like to track everything, this pace of exercise is known as Zone 2, where you keep your heart rate between 65 and 75% of your maximum.
A treadmill is fine but nowhere near as good as walking outside.
Please don’t sign up for Tough Mudder or a marathon just before seeing a Functional MD. They are more than likely to tell you to cancel. Now is not the time and intense training could make you sicker.
3. Sleep hygiene
Another broken truism. Poor sleep is a very common reason people come to see me. We live in a 24 hour world with every excuse to keep us awake. At least do the following before booking that appointment:
· Turn off screens for 60–120 minutes before bed. Yes you can use f.lux and blue blockers but generally using a screen is stimulatory and not relaxing. How often does that rom-com happy ending keep playing around in your mind as you try to sleep?
Rediscover the joy of books and the turning of pages. Ideally you would use a low red light or even candle-light to read by. If you can no longer see, it is time for bed!
- Definitely, no coffee or tea after noon and even earlier if you are really struggling.
- Cut the booze. It affects your deep sleep and your recovery. Recovery can be measured by Heart Rate Variability. I have an Oura ring which measures resting Heart Rate Variability and have proven for myself this aspect of even a single alcoholic drink multiple times.
- Keep your room cool.
- Wear a sleep mask that blocks out all light. Yes, our ancestors slept under the stars and the moon, but they did not sleep under the glow of the white lights of street and domestic lighting. The wavelengths of modern lightening is seriously affecting our health.
4. Loose the fragrance
I realize that I am going to somehow have to break it gently that those feel-good products are adding to illness. This does not always go down well.
Fragrance, not just in perfume, but in all care products and household cleaners is another assault the body has to react to.
However, these products are common Hormone Disrupting Compounds or EDCs. They affect our hormones, increasing some and decreasing others and everything in between, making a right mess of the beautiful hormonal system in H. sapiens. EDCs are associated with obesity, insulin resistance, infertility, and hypertension amongst other chronic diseases, as well as affecting fetal and childhood development.
It is thought that these chemicals may also affect our mitochondria, where we make our energy. If tiredness and excess weight are why you want to consult a Functional MD, you would be wise to start with losing the fragrance.
From my perspective, there is that awkward moment when a client enters the room, layered in clouds of perfume. Perfume that is floating on top of the make-up, hair products, fabric softener (yes, I can smell that coming into the office), and nail varnish. It is then, I realize that I am going to somehow have to break it gently that those feel-good products are adding to illness. This does not always go down well.
I get this is how you may express yourself, how you institute self-care, but it is making you sick. How you feel when you are no longer constantly detoxifying from a chemical soup of hormone disruptors, will be way more satisfying than getting your nails done.
5. Ditch the plastics and the non-stick coatings
Plastics are bad for us and bad for the environment. This includes plastics wrap (even food grade), take-out containers and plastic water bottles. Even if we reuse these, decreasing the toxic load on the environment, they remain bad for our health.
Bisphenol, of which BPA is the most well-known, started life as a synthetic Estrogen compound, along with Diethylstilbestrol. BPA grew up and became a plastic and Diethylstilbestrol grew up and become the notorious drug that is linked with hormonal cancers in the daughters of women to whom it was prescribed, as well as being associated with a host of other negative health effects.
Diethylstilbestrol has been largely removed from usage, but Bisphenols are ubiquitous in the environment. Not only are they found in plastic products but are also a component of PVC, which lines many water pipes, the plastic lining of canned products and thermal receipt paper. Bisphenols can be ingested, inhaled or absorbed through the skin.
Do not be fooled by “BPA-free” plastics. BPA is often substituted with BPS, which is probably worse.
- Sex hormone disruptors, interfering with the way hormones, especially estrogen, work in both men and women.
- Obesogens, disrupting hormones involved in metabolism and insulin regulation, as well as encouraging fat cell growth.
- Involved in increasing cortisol and negatively affecting thyroid, liver and heart function.
Non-stick coatings are strongly associated with thyroid problems.
These types of chemicals partially exert their effects by affecting the signaling between cells and signaling to and from DNA. Tiny amounts, well below the safety level, have been shown to have significant health effects. Furthermore, it has been estimated that an individual may ingest up to 90 thousand microplastics every year.
The Endocrine Society has good information on this vast topic.
6. Get sun without the damage
For those with health conditions associated with sun damage, your Functional MD can advise on the appropriate exposure.
You read that correctly. The sun is the earth’s energy supply. We are here because of the sun. When we take in energy as food, this energy has come from the sun. How then could the sun be bad?
Yes, too much too soon creates significant oxidative stress which can lead to disease. However, more and more evidence (if we ever actually needed any) is emerging about the benefits of sun. These benefits go way beyond the synthesis of Vitamin D and are often separate but linked to the actions of Vitamin D. These benefits include:
- “Setting” the clock genes in the skin, helping to support circadian rhythm throughout the body, which in turn is central to the healthy functioning of all our organs. This is why recommendations on sun exposure at dawn, midday and dusk so often find their way into self-help blogs.
- Releasing endorphins, those feel-good chemicals in the brain which help to guard against depression.
- Increasing nitric oxide which is important for blood vessel health and thus blood pressure.
- Improving immunity.
- Improving brain function.
Wearing sunscreen will of course prevent these benefits. In general, sunscreen is bad for us and bad for the environment, being associated with loss of coral reefs and with hormonal changes in fish.
Start low, go slow but get them rays.
7. Dental health
The mouth has been described as “the intersection of medicine and dentistry and the window into … general health”
There is a strong correlation between lack of dental health and chronic disease. This is especially true for diabetes where a two-way relationship exists. Treating the gingival disease improves diabetes and vice versa. The evidence for other conditions is less strong, but just as likely and thought to be related to inflammation. A low-grade ongoing infection hiding in a root canal, may be fueling the inflammation, oxidative stress, and immune dysregulation of chronic disease.
There is very limited intervention that a MD can take as far as dental health is concerned but it is one of the crucial aspects of overall health. Ideally a Functional Dentist would be seen in tandem.
8. Consider how you want to be
“How you want to be” does not include: not fat, not tired or not depressed. That is how you do not want to be.
We are so caught up in our diagnoses that they become part of us. “I have diabetes” seems to be used as an identifier, similar to “I have brown eyes.”
Our brains focus on what it is we are thinking about. Want to buy a black pick-up and all you see is black pick-ups.
How we want to be is obviously different for each of us and changes as we go through life. For some it may be to live freely and with ease; to some it may be to be physically able to play with their children. Having to admit these thoughts to ourselves can be confronting, but I believe it is necessary for healing.
I suggest a simple daily journal entry starting with: What if… e.g. What if I was energetic enough to rejoin the local sports club.
Life and health are complex, but the human body is amazing. There is always hope. You do not need to do everything on this list. Making small changes, gives your body small signals. These signals may then result in your body ramping back on the inflammation, oxidative stress and immune dysregulation to allow healing.
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