I often joke that I am a “wholistic” doctor because I take care of patients with a “whole list” of problems. Typically when someone has multiple complaints and they ask their doctor about them, they get told, “We can only deal with one problem at this visit.” Or they get referred out to a half-dozen different specialists—one for the skin rash, one for joint pain, one for reflux, one for migraines, and so on. No one asks, “How is everything connected?” It’s no wonder that the average Medicare patient has six doctors and is on five medications.
The trick is to see the connections. When the seven systems are out of balance, illness occurs, whether it’s weight gain, diabetes, heart disease, cancer, or anything that may be on your “whole list.” The key is not to treat each thing separately, but to look for and treat the fundamental underlying causes.
In pre-diabetes, diabetes, and all other diseases, imbalances, symptoms, and illness occur because of just a very few things that cause disease.
In addition to single-gene genetic disorders, there are just five causes of all disease: poor diet, chronic stress, microbes, toxins, and allergens, all of which wash over our DNA causing changes in our gene expression, and turning off or on different genes and messages that affect our metabolism. The five causes interact with the seven key systems in the body. When those systems are out of balance, symptoms occur and doctors diagnose diseases.
And there are just a few “ingredients” needed to make a healthy human—real, whole, fresh food, nutrients (vitamins and minerals), light, water, air, sleep, movement, rhythm, love, connection, meaning, and purpose.
When you take out the bad stuff and put in the good stuff, the body knows what to do and creates health. Disease goes away as a side effect of creating health.
The approach functional medicine takes to disease is not a new treatment or modality or specialty or technique. It is not integrative or alternative medicine. It is the future of medicine—applying new discoveries in biology about how we really get sick and how we can create health. It is about treating your whole system, not the symptom. It applies the most advanced science in a practical clinical method in the service of our health. It is a way of thinking that focuses on the question of “why,” or the cause, and not just “what,” or the name of the disease.
The names of your diseases become irrelevant when we understand the causes. In fact, one factor can cause dozens of “diseases.” Take celiac disease—an allergic and autoimmune reaction to gluten. It can show up as rheumatoid arthritis, diabetes, heart disease, cancer, inflammatory bowel disease, depression, autism, osteoporosis, and more. On the other hand, one disease, such as dementia, can have many causes, including B12 deficiency, viruses, insulin resistance, and heavy metal toxicity.
Imagine that you go to the doctor and say you have no energy, you feel sad, helpless, hopeless, you can’t sleep, and you have no interest in food or sex.
Your doctor will probably say, “Oh, I know what’s wrong with you. You’re depressed. You need an antidepressant.” But “depression” is just a label we give to that collection of symptoms. It tells you nothing about what caused the symptoms.
The symptoms of depression could result from an emotional trauma; an autoimmune reaction to gluten that causes low thyroid function; vitamin B12 deficiency because you are taking an acid blocker that prevents its absorption; vitamin D deficiency because you live in Seattle; inflammation in your gut from taking too many antibiotics that kill the normal flora; a high body burden of mercury because you love fish; an omega-3 deficiency because you hate fish; or insulin resistance because you eat too much sugar. The diagnosis and treatment of each of those causes is very different. The same is true for obesity and diabetes and any of the thousands of symptoms labeled as “diseases” in our medical books.
We now have a system of classifying disease based on the location or geography in your body (heart, joint, stomach) and by symptoms. There are over 12,000 diagnoses now, and in the new classification system we will have 155,000 different diseases. This is nonsense. Functional medicine recognizes that almost all disease arises out of imbalances in the few key systems of your body (the seven steps) that occur when you have too much of something (toxins, microbes, allergens, poor diet, stress) or not enough of something (real, whole food, nutrients (vitamins and minerals), light, water, air, sleep, movement, rhythm, love, connection, meaning, and purpose).
Seeing the connections and teasing apart the real causes of disease is how I helped Evelyn.
Evelyn, a forty-eight-year-old woman, came all the way across the country from Northern Canada to get help, because after seeing twelve doctors over ten years and being diagnosed with twenty-nine different “diseases,” she didn’t get any answers or any better. She was over 237 pounds and had a BMI of 37 (35 is considered morbidly obese).
Evelyn had a “whole list” of problems that we found when we looked under the hood. Rather than organizing them by disease or medical specialty, by location or symptoms, we organized them based on understanding the body as a whole system.
All her symptoms were connected, but no one connected the dots. She had:
What she really had were some basic imbalances caused by her diet. She was eating too much gluten (an allergen), she had too much yeast and toxic bacteria in her gut (microbes), and she had several nutritional deficiencies. This triggered systemic inflammation, leading to weight gain and pre-diabetes, as well as an autoimmune disease of her thyroid, which had not been diagnosed.
I organized her symptoms by the seven key systems, and then figured out what was causing the imbalances.
She had Hormone/Metabolic/Neurotransmitter Imbalances:
She had Immune/Inflammatory Imbalances:
She had Digestive Imbalances:
She had Detoxification Imbalances:
She had Energy Imbalances:
And she had Nutritional Imbalances:
I started by treating the five systems within which she was experiencing imbalance, not all of her twenty-nine separate diseases.
We began by simply cleaning up her diet—she started a whole foods low-glycemic-load diet without gluten or dairy. We cleared out the bad bugs in her gut with antibiotics and treated the yeast with antifungals. I gave her some digestive enzymes and probiotics to help normalize her gut.
I then helped her get her hormones back in balance. I suspected she had a low-functioning thyroid even though doctors had told her that her tests were normal (I learned in medical school to treat the patient and not the test), so I gave her a low dose of Armour® Thyroid, a type of natural hormone replacement therapy. Her symptoms of premenstrual syndrome, heavy bleeding, and fibroids told me she had too much estrogen and not enough progesterone. So I gave her magnesium, vitamin B6, and hormone-balancing herbs. I also gave her support for improving her blood sugar and insulin with PGX (a super fiber), a multivitamin with extra chromium, biotin, and alpha lipoic acid, and I prescribed a high dose of vitamin D3 (5,000 units a day because she lived in Northern Canada).
Six weeks later I got her lab results back. They confirmed what I had thought—she had very high antibodies to gluten, which triggered inflammation and an autoimmune reaction in her body, including in her thyroid gland. She had high uric acid, which causes gout and results from too much sugar and high-fructose corn syrup.1 This is a classic sign of insulin resistance and pre-diabetes. Her blood tests showed very high insulin and blood sugar two hours after a sugar drink, and her sex hormones were out of balance. And she had very low vitamin D of 16 ng/dl.
At our six-week phone call, she told me she was doing great. I went down the list of symptoms expecting some ongoing issues, but after struggling for ten years, she had no more symptoms. None. No more fibromyalgia, chronic fatigue syndrome, brain fog, or depression; no more sinus problems or congestion; no more irritable bowel or reflux; no more migraines; no more PMS, heavy bleeding, or feeling tired and cold all the time. Even her psoriasis and rosacea had gone away. And as a nice side effect, she lost 21 pounds without even trying! The same things that make you sick make you fat, so when you address the underlying causes of disease, the weight loss is automatic.
Not all of my patients have a list as long as Evelyn’s, but the approach is the same: Focus on identifying and treating the underlying causes of disease and helping the body’s systems, and the disease (and weight loss) takes care of itself.
In each chapter in Part II, I provide quizzes to help you identify which systems in your body are out of balance. Is it your hormones, your gut, your immune system? Are you toxic? Which system is causing you the most problems? These quizzes are based on three factors:
Decades of clinical experience and testing of more than 10,000 patients
A review of thousands of scientific papers
Collaboration with many of the physicians at the forefront of functional medicine and science.
The quizzes will help you identify where you are out of balance and guide you to restoring balance in each of those systems.
Everyone who has diabesity will go on the basic foundational Blood Sugar Solution diet and lifestyle program as outlined in Part IV. However, depending on the answers you give in the quizzes in Part II, you may need to add a few extra “self-care” steps to personalize the program. You will do this in Week 6. If you do, follow the recommended personalization of your plan in Part IV. For the majority of you, The Blood Sugar Solution and a little self-care will solve your problems. You will be able to accomplish these steps on your own or with others through the online support program and guidelines for creating social support that is detailed in Part IV. You can learn more about our online community and access a set of free tools to help you through the program (including an online version of all the quizzes in Part II) at www.bloodsugarsolution.com.
A few of you may score in the “medical care” range on the quizzes. In this case, you should complete The Blood Sugar Solution basic and self-care program starting in week 6. Then retake the quizzes after another six weeks on the self-care plan. If your score still indicates “medical care” or you don’t see the improvement you’d like, it may mean you have deeper problems that require more diagnostic testing and medical treatment. In this case, I have provided a detailed online companion guide called How to Work with Your Doctor to Get What You Need. This guide, which you will find at www.bloodsugarsolution.com, outlines information on how to get the special laboratory tests needed to confirm or investigate suspected imbalances and guidelines for correcting these imbalances. I have also provided resources for you to find a doctor who is aware of or experienced in functional medicine and can be your partner in health at www.bloodsugarsolution.com.
I strongly encourage you to visit the website now and take advantage of all the information, tools, and community support available as you start on your journey to healing.
Now let’s explore the seven key biological systems at the root of diabesity, starting with nutrition.