Too often I see a lot of functional medicine practitioners providing well-intentioned information (e.g. on social media site, summits, etc), but this information often induces fear in the audience. Fear is commonly used to motivate action, but more often than not it can paralyze people, or lead people down a path of extreme diets, victim mentalities, and loads of unnecessary supplements.
How can we, as practitioners, avoid the fear (and drama) when educating patients?
Here are a few clinical tips:
- Genetic Tests: Ever had anyone say “I’ve got MTHFR”? As genetic testing of SNPs (single nucleotide polymorphisms) is increasing in use and “diagnosis”, it is SO important to remember that genetics are blueprint instructions for the body, and we have no way of testing if these genes are turned on or off. Instead, patients who undergo genetic testing can turn on or turn off genes through lifestyle and “epigenetic” choices.
- Lab results. I will always say this, but we need to treat the patient and not the labs. Do the labs correlate with the patient’s symptoms? If not, remember that reference ranges are NOT the optimal range, that labs are a static moment in time (i.e. cannot diagnose dynamic functioning of the body), and that labs are NEVER perfect.
- Exposure to Toxins (pesticides, heavy metals, glyphosate, GMOs, industrial chemicals, etc): Yes, toxins have the potential to create disease. No, not everyone will get disease from the toxins. But this is where the analogy of the “toxin bucket” comes into play: we are all born with “buckets” that fill up with toxins over time. The body (and our lifestyle choices) can decrease the burden, but we will never be able to completely empty the bucket. HOWEVER, as long as the bucket is not overflowing, we will not experience the negative effects of the toxins. Focus on talking to patients about decreasing the exposures and building a resilient immune system – don’t focus on eliminating all sources of toxins.
- Food choices: Patients are often told to avoid certain foods “100%” of the time – but aren’t told why or for how long. Talk to a patient about why certain foods are avoided initially, why they need to be avoided for at least 3-6 months (based on the half life of IgG), and how healing can occur by avoiding these foods. Tom O’Brien has a great “holes in a roof/boat” analogy… And let the laboratory data, medical history, and/or symptom resolutions support the long-term food choices for an individual.
- Supplements: It’s easy to get caught up in giving a supplement/herb for every symptom, but supplements are expensive. I tell all my patients that we may start on many “therapeutic” supplements at first (6+ months), but the goal is to wean down to those that are needed for “maintenance” (after 80-90% improvement in symptoms).
- Health education. This is where the art of medicine comes into play. The most difficult part of educating patients is to teach them about how/why nutrition and lifestyle affect the body. For example, I see so many people who had a food intolerance test (IgG-based) “years” ago, and are still eating based on that test. IgG tests will change every 3-6 months depending on what foods are avoided/added, and these are intended to accompany a protocol to heal a “leaky gut”. They are not intended to be a permanent diet change/fit. If you use a food intolerance test, advise patients of the aforementioned, and that you can change the results if you address the cause. Then retest in 6-12 months.
In summary, patients (and clinicians) can get caught up in the urgency to test and treat for everything. But we have to remember that the STRESS that accompanies these fears will affect health outcomes. Be up front and honest with patients, and talk to people about the “80/20” or “90/10” rule (and be gentle in circumstances that require 100% avoidance of certain triggers). No one will or should be perfect, whether they are a patient or a clinician.
Anything I missed?
Wishing everyone great health, happiness, and a life at ease!