When we heard yet another account of a patient being given a conventional medical diagnosis, only to be sent away from the consultant’s office because there was nothing to be done except wait till the organ in question failed completely, it got us pretty heated. Especially because in this case the diagnosis was for an autoimmune thyroid condition, for which, in the functional/integrative/natural medicine world there is an awful lot that can be done to stop the gland from failing completely, if caught early enough. This person was told that her GP would monitor function on a yearly basis, which we know in the UK amounts to a TSH and T4 test, and would send her back to the endocrinologist when her thyroid fails. And that was that. No management, no strategy, no education, no hope.
In this article we look at autoimmune thyroid and another two common conditions that aren’t well understood, well managed or resolved within mainstream medicine, but for which there can be extremely good outcomes using appropriate natural – health creating – medicine. Whilst it would be so much easier, there is rarely ever a single magic bullet, be it a drug or supplement, that will do the job. These complex conditions usually have multiple mediators and triggers, combined with individual genetic predisposition, affecting the whole body, not just the part that is expressing the loss of normal function pathologically. Multifactorial diseases need multifactorial approaches and that’s where we should be seeing a marriage between conventional and integrative health professionals to ensure the best possible outcomes for sick or at-risk people.
Health crisis - no clear solutions for complex conditions
Modern medicine has historically worked well for simple conditions with single causes, e.g. antibiotics to treat infectious diseases. However, these approaches are not always that successful long-term, as evidenced by the increasing rates of antimicrobial resistance (AMR). Dr Clayton Dalton, at Massachusetts General, reminds us how collateral damage from poorly thought actions was responsible for wiping out many indigenous species in New Zealand in the 1800’s. The Brits brought in rabbits for fun and sport, forcing the New Zealanders to bring in ferrets to hunt the rabbits, which were running amok and destroying the land. However, the ferrets, not unsurprisingly, didn’t restrict their diet to only rabbits. Powerful medicines have much the same effect in terms of collateral damage inflicted on the complex human ecosystem by patented, new-to-nature drugs that are produced to have a single or limited therapeutic targets, but often lead to chaos elsewhere in the body.
As a general rule, the more complex the causes of a disease, the less success there tends to be with drug-based approaches. This is typical of the problems we face as a society for diseases like obesity, Alzheimer’s, cancer, type 2 diabetes (T2D), and many autoimmune diseases (e.g. Crohns’, rheumatoid arthritis, Hashimoto’s, autoimmune thyroiditis, Graves’, etc). The problems only worsen when someone has more than one disease (comorbidities). In the UK, the NICE (National Institute for Health and care Excellence) guidelines (that provide the tramlines within which medical doctors in the UK have to work) for obesity and T2D avoid 100% non-pharmacological, yet clinically evidenced, solutions.
Cancer, arthritis, Parkinson’s disease, hypertension, depression, the common cold, and many other diseases have symptoms that can be ‘treated’ with medicines. But they cannot be ‘cured’ according to current medical textbooks. Even Allen Roses, in his position as worldwide VP for genetics at GlaxoSmithKline, made himself famous overnight by appearing on the front page of the Independent newspaper back on 8th December 2006, saying, “Our drugs don't work on most patients”. That was over 13 years ago, yet not much has changed.
Three multifactorial conditions that respond well to integrative approaches
We’ve written a lot about obesity and T2D which is why you don’t see them in the list below, similarly for Alzheimer’s disease. The conditions below are becoming endemic in the Western world. A common thread is that many of these conditions are preventable and reversible if caught early enough and addressed appropriately. Our view is that a diagnosis shouldn’t be the end of the road, but a cul de sac that allows an about-turn to retrace steps in order to take a different direction with new, educated, understanding.
NAFLD is the umbrella term for the whole spectrum of fatty liver diseases, whereas NASH describes the metabolic disorder in the liver that’s driven by the triple epidemic of obesity, T2D and dysbiosis. It is the disease that famously deprived us of the British singer and musician George Michael, on Chrismas Day 2016. Affecting a low percentage of those with NAFLD, NASH is the more serious of the two, but it’s unfortunately often silent until it’s too late, requiring a liver transplant. NAFLD is said to be reaching ‘pandemic’ proportions and is the main cause of chronic liver disease both sides of the Atlantic. In the UK, doctors are given more information on how to diagnose the conditions, but then only basic, woefully inadequate and outdated diet and lifestyle modification advice in terms of treatment. There is no effective drug treatment available for either.
Fatty liver disease is a metabolic, diet and lifestyle mediated disease, so it responds well to modification with diet and exercise (min 150 mins per week), as well as targeted supplementation (choline, berberine, pre and probiotics, curcumin and NAC for example). Excess fructose (think high fructose corn syrup and fruit juices), processed and ultra-processed foods, and too little exercise coupled with insulin resistance, can cause a dysregulated metabolism that leads to a dysfunctional liver in many people. Choline and phosphatidyl choline are needed to ship fat out of the liver, but are often in very short supply with highly processed, poor diets. With fatty liver disease, 5% or more of the liver is replaced by fat, which renders it unable to carry out normal liver functions. In essence, the liver turns to foie gras.
Instead, assessing genetic predispositions, diet and lifestyle, metabolic resilience and function, blood sugar handling, inflammation and alcohol consumption are all part of a multifactorial strategy. As with all chronic conditions, working on the gut to eliminate dysbiosis is critical in resolving a fatty liver given that endotoxins are transported straight to the liver from the gut. Functional medicine guru, Dr Robert Roundtree, recounts a successful resolution by simply resolving his patient’s small intestine bacterial overgrowth (SIBO). Weight loss will naturally confer a loss of fat in the liver, although this needs to be significant e.g. 5-10% of body weight to be effective.
CONDITION 2: Autoimmune thyroiditis
There are now more than 80 described autoimmune diseases (AID) and more that often exist alongside AID. In the US, nearly 24 million are affected, and thyroid disease affects a staggering 20 million Americans. Putting this in perspective, The US National Institutes for Health (NIH) estimates that cancer affects up to 9 million and heart disease up to 22 million. Unsurprisingly, thyroiditis is epidemic elsewhere too, including here in the UK, yet many are unaware that they have a major health problem brewing. Our opening reflects that there isn’t much that conventional medicine has to offer AI thyroiditis patients until their gland fails and they need drug or surgical intervention. In the UK, there are no NICE guidelines for AID, only for a few specific diseases e.g. thyroid, rheumatoid arthritis and lupus erythematosus.
But why such an epidemic of thyroid dysfunction? From an evolutionary perspective, the thyroid is seen as the ‘permissive organ’ that binds it and the immune system in an infinite and delicate synergistic dance through life. The thyroid gland is the ‘master controller’ of metabolism. Chronic low-grade inflammation, poor dietary and lifestyle choices, early life trauma and prolonged stress are all toxic to the thyroid gland. But as the accelerator and brakes of our metabolism, the thyroid is vulnerable when other systems lose function, particularly when the immune system demands more energy to deal with chronic inflammation. Ignore the red flags and the risk of developing an AID rises dramatically.
Key red flags in particular to address relate to the health and integrity of barrier function e.g. skin, mucous membranes and gut permeability; genetic predisposition and triggering events e.g. infections, toxins, food sensitivities, viruses (particularly Epstein Barr), stress and trauma, illness, obesity etc. Our diets, lifestyles and environments today are creating a perfect autoimmune storm that our bodies just can’t cope with. But listen to the warning signals and take appropriate health creation steps and it’s possible resolve the dysfunction. This is something that qualified and experienced functional or other natural medicine practitioners with extensive experience can help you with, recognising that any dietary, supplementation and lifestyle solution will need to be personalised to the individual.
CONDITION 3: Irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO)
For many people these conditions can be so severely debilitating that leaving the house and living a normal social and work life can be very challenging. Yet, there are still too many doctors labelling these conditions as psychosomatic. Sufferers have to deal with bloating, cramps, diarrhoea and constipation, pain, bowel urgency and just generally feeling uncomfortable in their own bodies. If acknowledged, then the conventional view is that it’s incurable, although lifestyle changes can help over time. As far as the UK’s NICE guidelines go, they’ve been revamped to include a low FODMAP diet and a reduction in insoluble fibre like bran.
However, if we’re talking health creation, then two big culprits for IBS are food sensitivities (e.g. gluten, dairy etc) and an overgrowth of bacteria in the small intestine (SIBO), which love sugary and starchy foods. Digestive insufficiency caused by a lack of enzymes or stomach acid, deficiency of minerals such as zinc and magnesium, dysbiosis in the gut (parasites, yeasts, overgrowth of bad bacteria) and heavy metals can all be factors.
This is by no means a definitive list, but sufficient to show that it’s not impossible to address the contributing factors with a personalised nutrition and lifestyle protocol. Neither IBS nor SIBO have to remain incurable or lifelong. Functional tests that can be helpful include stool tests, IgG food allergy tests, blood tests and breath tests (particularly if SIBO is suspected). Stress is also a key trigger that can be better managed by simple mindfulness and breathing exercises, alongside plenty of sleep and finding joy in life again. Once again, there are natural medicine practitioners who have devoted much of their lives to resolving such issues – all largely unrecognised by the medical mainstream.
Self-empowered rather than doctor-directed
Effective treatment strategies for metabolic and autoimmune conditions always work best when a systems biology approach is used to assess seemingly disconnected links between genes, organs, biochemistry, symptoms and underlying causes. Central to any solution is dealing with the chronic inflammation that underpins these and all chronic diseases. Solutions need to focus as much on the internal as the external environment, and take into account the genetic, biochemical and environmental background of every individual. Personalised lifestyle medicine is the future – yet it still sits outside the mainstream, largely because it provides few opportunities for drugs, still the mainstay of the medical establishment.
Health creation, no matter the modality, requires an holistic, whole body approach that’s personalised and that works in synergy with the person as they journey through their disease and back to wellness. And it is a journey. One that involves a personal commitment to the multiple strategies needed to return to optimal function and health. It’s not for everyone, but everyone should be given the opportunity to decide that for themselves.