Eating Humble Pie aka What Happens When You Forget the Tenets of Functional Medicine header image

Eating Humble Pie aka What Happens When You Forget the Tenets of Functional Medicine

By George Gillson MD PhD CCFP

Septembers’ posts are supposed to be about Immunity. Technically, this post IS about Immunity. Technically.

It’s also about pigheadedness.

Alert readers will recall that Augusts’ posts proffered my thoughts about lifelong health and fitness. The first installment talked mostly about fitness but was prefaced by the saga of the struggle between my immune system and various connective tissues in my shoulders and hips aka Polymyalgia Rheumatica (PMR). (Working out too hard and too often likely triggered the PMR.)

The conventional treatment for PMR, regarded as an autoimmune disease, is a sometimes-lengthy course of prednisone. This is what I said about prednisone last month:

“Conventional Medicine scratches its head, calls this condition Polymyalgia Rheumatica (PMR), says it’s idiopathic (meaning we don’t know what the hell causes it) and treats it with an extended course of high-dose prednisone. Prednisone is basically high octane, synthetic cortisol and is about four times as potent as cortisol. It is a great anti-inflammatory but is also immunosuppressive and catabolic, meaning it tears your tissues apart.”

Full disclosure: I also referred to prednisone as an: “unguided turbo-cortisol missile.”

Fairly early on, I saw my Family Doctor and we talked things over. He offered prednisone but I stubbornly decided to take my own Functional/Integrative Medicine approach to PMR, as outlined previously:

  1. Back way off on the intensity of workouts.
  2. Eliminate processed food/snacks, cut back on dairy, eat more veggies.
  3. Start testosterone supplementation
  4. Confirm low 24-hour total cortisol production via measurement of the principal urine metabolites of cortisol and cortisone. (Cortisone is the storage form of cortisol and can be readily converted back to cortisol as needed: in case you care.)
  5. Start on pregnenolone
  6. Experiment with low-dose oral cortisol aka hydrocortisone.

I did all that for at least a month or more. Guess what happened.

The inflammation just got worse.

Maybe I should have gone to a gluten-free diet along with the other things I was doing, as this is often helpful in calming down the immune system. Maybe I should have stuck with the program longer. I dunno. Long story short, I eventually reached back out to my doctor and asked for a prednisone prescription, partly because I was getting fed up and partly because I forgot about the Integrative aspect of “Functional/Integrative” Medicine. More on that in a bit.

When I finally got the prednisone, I was pretty embarrassed to find out that the starting dose was 15 mg, not “high dose” as I had said previously. (Of course, I could have found that out at the start with 2 minutes on Google but that’s a side issue.) The daily natural output of cortisol is somewhere between 20 to 40 mg and 15 mg of prednisone is equal to about 60 mg of cortisol. So that dose wasn’t the sledgehammer I thought it was going to be. To tell you the truth, I was afraid to take what I thought was going to be high-dose prednisone.

Within a couple of days of starting the med, my symptoms were 75% better and inside of a week they were gone. Then I realized what an idiot I’d been and exactly how much of a toll the inflammation had been taking on me. It was wearing me down on multiple fronts.  I might have to keep taking if for a while, to allow my immune system to “forget” what all the fuss was about. Time will tell, but basically, beyond remembering that life is good, I barely know I’m taking the stuff.

Too soon old, too soon smart, as the saying goes.

Anyway, there are numerous other lessons to be learned here. Well maybe not numerous lessons, but a couple for sure.

The first lesson is that if there’s someone you have known for more than forty years, and whom you have trusted as a wise Family Doctor for twenty-five years, you should probably do what they tell you to do straight away, instead of waiting for several months.

This is not my Family Doctor blog image

This is not my Family Doctor

We’ll get to the second lesson eventually. Right now I want to talk about definitions.

The term Functional Medicine (FM) is confusing: a lot of people use that term without really thinking about its definition. To me, it means that an FM practitioner tries to get to the bottom of things and asks these questions: What metabolic pathways are functioning and what ones aren’t: Why are some pathways broken: What can we do to reboot these broken pathways, once we find them?

The FM practitioner simply has a bigger toolkit than a Conventionally-trained physician. The toolkit contains elements of Naturopathic Medicine in that broken pathways will start working again when the right nutrients are supplied, when the stomach, liver, pancreas and intestinal walls are healthy and when toxic exposures are eliminated. FM looks at Genetics and uses some cutting edge tests that look at how your metabolism is working overall. FM can include other approaches: meditation, prayer, energy-based approaches, physical modalities, approaches from Chinese Medicine, Ayurvedic Medicine and other ancient healing traditions.

Here are some definitions of what constitutes a good FM practitioner:

A good FM practitioner doesn’t turn their back on mainstream medicine. This is why we call it  Functional/Integrative Medicine. It integrates the best of many approaches!

A good FM practitioner knows when other approaches aren’t serving the patient’s best interests, understands and respects the power of mainstream medications and uses them when indicated.

Like I said, I forgot that part.

: )

Thus ends my soliloquy and brings me to the second lesson, alluded to above, courtesy of Sir William Osler, famous Canadian MD, widely regarded as the Father of Modern Medicine and “one of the greatest diagnosticians ever to wield a stethoscope.”

Sir William, who could leap tall buildings with a single bound and defeat viruses with one steely glare

Sir William, who could leap tall buildings with a single bound and defeat viruses with one steely glare

The second lesson is short but sweet:

Osler was right when he said: “A physician who treats himself has a fool for a patient.”

He should also have added the following: “Any physician should know that their spouse will be the worst possible patient they could ever imagine dealing with.”

; )

P.S. I promise never to talk about Polymyalgia Rheumatica again. But I will talk about Immunity next post. I promise.

George Gillson MD PhD

Author: George Gillson, MD, PHD, CCFP
EvolveWell Medical Director