When I go online to see what people are saying about functional medicine, I see that they seem confused by the term “root cause”.
They say that all medicine is oriented to finding the cause of your concerns and resolving it. For example if you go in to see a doctor and you complain of urinary discomfort, they will look for an infection, or some other cause, and treat you accordingly.
Are they right? Is all medicine “root cause” medicine?
Well it depends if your illness is acute (has lasted only a short time) or chronic.
If your illness is chronic, such as a rising blood pressure that has now exceeded the threshold for “abnormal”, your doctor will check a blood test, recommend you eat less salt, and put you on a medication. That is because conventional medicine considers that hypertension is most often “idiopathic”.
Idiopathic is a Greek word meaning “sickens itself”, from (idio-, self, and –pathic, illness). Hypertension sickens itself. That is absurd, of course. So in medical school I refused to use that word, and substituted another Greek word, “cryptogenic”, which means that the origin (-genic) is hidden (crypto-).
To practice root cause medicine you begin by believing that there’s a good chance you can find the hidden origins of diseases that conventional medicine believes are “cryptogenic.” The reason root-cause medicine is so valuable is that if you can find the root cause, you stand a better chance to reverse the illness (not just manage it).
So if a patient comes in with joint pains, and he or she gets ibuprofen, or curcumin, if that is all that gets done, this is not “root cause” medicine. The patient didn’t have a curcumin deficiency. The patient will be more comfortable on curcumin, but if you are practicing functional medicine, you will not stop there.
LOOK FOR A CAUSE
You will target inflammation and there are many ways to do that. You will take a full history, to see how this pain came about, and that will give you a clue as to whether you should try first to change the diet, teach stress reduction, recommend rest or exercise, or target something more obscure like coenzyme Q10, leaky gut, thyroid problems, insulin issues, heavy metals, and so on.
Once you find, say, leaky gut, you still have not found the root cause. Why does he have leaky gut? This could be a variety of things from diet to stress, to poor probiotics.
And if it’s stress, what is the root cause of that? You have to consider your patient’s early life history, and investigate perhaps trauma work or therapy.
So, how do you know when to stop looking for underlying causes? How do you know you are dealing with a root cause? I’ve made up an acronym to remind me of the main root causes that may not have deeper underlying causes: G-FLAT
FLAT are events, or external inputs: Food, Life events, Actions and Toxins
“Genetics” may include for example MTHFR: by giving people with a slow variant of the MTHFR gene a surplus of folate (sometimes through food, sometimes with supplements) we compensate for a genetic problem.
We only have a few genes we know how to bypass, but we can help the body modify the expression of hundreds of genes by targeting inflammation genes with lifestyle or nutraceuticals (even better, according to recent research, with both).
“Germs” refers to causes like Lyme disease and chronic viruses that can be participants in patients’ chronic conditions.
External inputs are the most common issues. They include the following:
- “food” includes inflammatory food, like too many grains, meat, or salt
- “life events” includes trauma, either psychological or physical
- “actions” includes lack of sleep, repetitive motion, lack of exercise
- “toxins” include processed foods, and environmental toxins
Of course, illness arises from the interaction of these factors, but first we have to strip the situation down to these essential elements, and then devise a plan of action.
It may take many steps to uncover the root cause, and you really want a motivated patient and a patient and persistent provider.
So make sure you go all the way to G-FLAT!