The Power of "Why?"

Primary care physicians see it almost every day. Patients come in complaining of fatigue. The exam is normal, labs raise no flags, and questions yield few if any clues.

At that point, with the time pressures of a typical office visit, it's tempting to tell patients to try to get more rest and perhaps write a prescription treating the symptom, hoping they will report an improvement on their next visit.

Functional medicine takes a different approach. This growing trend in patient care focuses on digging down to uncover the underlying root causes of symptoms. The results from this approach have been so well received that the Cleveland Clinic's Functional Medicine program has a two-year waiting list.

"We could prescribe an ointment for a rash, but sometimes we can learn more by asking why it's there. Could it be related to a gut problem that may have broader implications for the patient's overall health? Is it the first sign of a developing autoimmune disturbance that could be headed off with early intervention?" James Mcminn, MD said.

During his years as an ER physician, Mcminn became interested in health from a broader perspective. After seeing benefits in his own life from improving nutrition, becoming more active and reducing stress, when he opened his practice, he took a more holistic approach to help his patients do the same. At Harvard and now as an assistant professor at UAB, he has been passing on what he has learned to other physicians.

"I use traditional medicine when traditional gives my patients the best outcome. But integrative medicine gives me a bigger tool box so I can better personalize treatment to my patients," McMinn said. "Functional medicine takes this another step forward. Instead of just dealing with the complaint that brought the patient into my office, focusing on underlying root causes helps me identify issues that could be related to broader health concerns and possibly prevent problems that could be developing."

As an example of how he uses functional medicine in everyday practice at Mcminn Clinic in Homewood, he described a recent case.

"The patient came to our office complaining of fatigue," McMinn said. "She didn't have the energy to do the things she needed to do, and it was affecting her whole life. Fatigue is one of the most common complaints physicians hear, and it usually has multiple causes, which can make treating it effectively more difficult.

"I usually start with a good history, an exam and labs looking at metabolism, blood sugar, and electrolytes. In some cases, I may follow up with genetic or other testing if I suspect a particular problem.

"This patient had issues with sleep and nutrition, but what stood out in the labs was a low thyroid level. So, following the functional medicine trail, I asked the next question. Why? Why does this woman have a low thyroid level? I looked at her thyroid antibodies, and they were high. So, why are this patient's thyroid antibodies high? Digging deeper into her history, I found that she noticed the problem after taking antibiotics," Mcminn said.

"Antibiotics are known to affect the body's microbiome and kill off helpful bacteria, which allows harmful opportunistic bacteria and fungi to grow. In turn, this can lead to leaky gut syndrome. The increased permeability of the gut allows particles to enter the blood stream, which hyperactivates the immune system. As it turned out, the patient had three separate autoimmune disorders--thyroiditis, alopecia and PCOS.

"Thyroid medication and getting better sleep and nutrition did a lot. What made a big difference in how she felt overall was improving her gut health."

So how does Dr. McMinn help patients improve their gut health?

"Gut health goes both ways. Poor sleep and stress can impair gut health by affecting the vagus nerve and reducing motility. Patients with poor motility may need something to help. There are prescription medications that can help, but patients may experience side effects. This is one example of how having a bigger integrative medicine tool box to treat patients can make a difference. I've prescribed two different herbal cocktails that I have found to be effective and generally well tolerated by most patients.

"A key factor is what patients put in their gut. If they have food sensitivities or allergies, those can cause continuing irritation until those problems are identified and eliminated. Sugars and simple carbohydrates can be feeding a fungus and harmful bacteria. Patients may need to follow a specific diet and take probiotics.

"Physicians should also be mindful in how they prescribe antibiotics and in doing everything possible to protect the patient's microbiome and get it back to normal when the course of antibiotics has been completed," McMinn said.

McMinn also pointed out that there is a strong connection between gut health and mental health.

"There are ten times as many bacteria cells as human cells in the average human body, and some of those bacteria play an essential role in maintaining optimum levels of neurotransmitters and other biochemicals. The microbiome produces half or more of the serotonin circulating in the blood stream," Mcminn said. "If the microbiome is damaged, it can have a profound effect on depression, anxiety and other mental health issues.

"A mother who was at her wit's end, fearing that she was going to have to put her daughter in an institution, came to me to see if anything could be done medically. Her daughter was exhibiting symptoms of severe anxiety and depression. When her history showed that the symptoms had developed suddenly after she took a strong antibiotic, I started her on a comprehensive program to improve her gut health. The symptoms disappeared, and she was soon back to normal."

With January being resolution time, what advice does Dr. McMinn have for people who want to have a healthy year?

"Look for opportunities to be active. Unstress your mind--try meditation, yoga, prayer--whatever works for you. Outcomes are what is important. Make sure you are getting plenty of vitamin D--and avoid sugars and simple carbs. Those are the roots of all too many problems," McMinn said.

"And always ask the next question. Why?"

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Functional medicine, integrative medicine, wellness, health resolution, microbiome, gut health, fatigue, James Mcminn MD, Micminn Clinic, UAB