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The Long Run

By Michael Sharp, MD

Of course, the most important step in the diagnostic process is an in-depth history of the person. Not the history of the illness or the symptoms but of the person.

Michael Sharp, MD

When I began to study Chinese Medicine and then Functional Medicine I noted that the history taken from these perspectives is very different than the process used in allopathic medicine. The reason for this has to do with the goal. In mainstream medicine the search is for the diagnosis. If the physician can’t make a diagnosis the process is usually unsatisfying for all concerned.  In the other approaches to healing that I mention, the physician is on a quest of understanding. Since, in this model, illness is complex, multifactored, and dynamic, the history has to be very broad—looking for any factors that may have some influence on any pieces of the puzzle. As antecedents and triggers or ameliorating factors are explored, the nature of the breakdown becomes more understandable.

How much of the illness can be understood as nutrient depletion, how much is a disturbance of the stress hormone system, how much is toxin overload or breakdown in excretion? How much might be attributable to an increase in inflammation, or an imbalance in the immune system? In our practice many of our patients have fatigue as a symptom and so there are some aspects of the history that might point towards a breakdown in energy production—although it is much more common to discover a sleep disorder. Notice how these domains are rarely explored in the conventional medical history because they are not conventionally understood to be factors in illness in that setting. This is in spite of the overwhelming scientific evidence of their crucial role in the development of chronic illness.

Once the mainstream physician has made a list of the possible diagnoses there follows a number of tests that are meant to either confirm or rule out each of them. The purpose of the testing in this setting is so we can make a diagnosis. Again—if that doesn’t happen, we’re at a dead end. If we can make a diagnosis then we’re off to the races. “The races” usually being which medication is the right one for this situation. Not: What can I do to set this person on the road to healing?

Functional Medicine

The tests that follow the history in the case of functional medicine are ones that try to determine level of function of the different domains of our physiology. How well is the adrenal gland working, not is it diseased? How profoundly and in what ways is sleep disturbed, not is there or is there not sleep apnea? What parts of the complex process of digestion and absorption are failing?  Not what does the lining look like through an endoscope?

For most of the tests that are ordered in mainstream medicine there is a range of normal and values that are abnormal—values that fall out of that normal range. The range of normal is arbitrarily set as the range that includes 95 percent of the population. So, when you see the results, only those tagged as out of that range get attention by the mainstream doctor.

There is excellent evidence that about 50 percent of people have abnormally low magnesium levels. Meaning their magnesium levels are insufficient to support the many biological functions that depend on magnesium to maintain optimum health. But of course, if you have a magnesium level run by your doctor and it isn’t below the 2.5th percentile, he’ll tell you your level is fine.

It is rare to find a person in poor health who isn’t having problems with a number of their physiological processes. So even in the event the functional medicine doctor is able to identify many of them, the process isn’t over. At the beginning of the treatment process some decisions need to be made about where to begin and this takes interpreting the level of breakdown and the likelihood of responding to repair protocols. This is a process that, like the illness, is complex, multifactorial and dynamic. Not very much like prescribing a medication.

The line between normal and abnormal is quite stark in mainstream medicine and that may have unanticipated consequences in the nature of the relationship that evolves with that approach. Many of my patients tell me how judged and misunderstood they feel when the conventional medical doctor tells them all their tests are normal, black or white. Of course, there are settings, mostly acute illness, where this approach is indeed helpful and sometimes lifesaving but it may also be one of the reasons that approach is not so helpful for chronic conditions that develop over time.

To your health.