Episode 20 – Functional Vs Progressive medicine.

Feel Better Live more Blue Zones episode.


Since stating my podcasts I have been listening to quite a few different podcasts in the “Alternative Health” category on I-tunes to “scope out the competition”. I’m joking. Clearly, I see these as yet more helpful resources for people to benefit from, rather than competition – I do, honest.

I have become a bit obsessive checking my stats and ratings to a degree that was becoming unhealthy and unhelpful. I have had to manage my mind about it. This unhelpful habit is similar in nature to many forms of addiction, which often boil down to an unhelpful coping strategy in dealing with life, and I’m going to talk more about this later in this episode.

Anyway, in listening to the other resources aimed at health and wellbeing it occurs to me that the terms floating about are somewhat confusing, and I thought it might be helpful to have a think about what I mean by some of these terms; western, holistic, progressive, functional and alternative medicine.

We have talked quite a bit about western medicine previously on this podcast. It is, after all, supposedly my area of expertise. It is what I have been trained to do, and what the NHS is paying me to deliver day to day. I think most people know what to expect from western medicine, it is what they get from their GP, A+E and hospitals. It is perhaps less clear with the other terms.

For me progressive medicine is about understanding what we don’t know. It’s about accepting that the human body and mind, as a single unit, that human beings, (and dogs and horses and elephants for that matter) are incredibly complex. Far more complex than we can fully understand. And understanding that because of this, the human body is normally far better at taking care of itself and healing itself than doctors are. Nature is more powerful than human ingenuity. (Think of Jeff Goldblum in Jurassic Park – “Nature will find a way”). Because of this we need to think very carefully before we start “tinkering” with it, as there is a reasonable chance we will make things worse rather than better.

In general, western medicine is about “tinkering” with the human body. Trying to actively or “artificially” influence the internal workings of the body, in an attempt to make it run better. The problem with this is that anything we do has multiple unforeseen or unintended consequence. If we give antibiotics for a throat infection the aim is to kill bacteria that might be infecting the throat and making us feel unwell. But at the same time the antibiotics will also kill many other bacteria in the body, many of which may be helping us to be healthy. Our immune system may react against the antibiotic and cause a life-threatening allergic reaction, or the bugs in our body may become resistant to the antibiotic meaning that the next time we become unwell it is harder to treat. It is likely that we would have got better anyway without the antibiotic, because mostly our bodies are extremely proficient at fighting infections.

This is a well-known, tired example, and every GP spends considerable time and energy trying to convince patients that antibiotics might not always be a great idea. I have found that across all fields of medicine often less is more. The best thing you can do for many symptoms and illnesses is nothing at all. Artfully doing nothing is a key skill of all the best doctors. There is a famous quote from the French philosopher Voltaire which goes; “‘The art of medicine consists of amusing the patient while nature cures the disease.” Whilst Aldous Huxley said; “Medical science is making such remarkable progress that soon none of us will be well.”

Now in many ways Functional medicine is the opposite of this philosophy. Fundamentally it has the same basic philosophy as western medicine, namely that through the power of human knowledge and ingenuity we can out-do nature in the bid to make ourselves healthy and happy. By tinkering with the system and employing “life hacks” we can trump nature. Functional medicine merely uses slightly different hacks than western medicine. Instead of focusing on pharmaceuticals and surgery it looks at nutrition, diet, exercise and sleep. By “artificially” interfering with these it aims to elevate us beyond our nasty, brutish and short natural state.

This may seem confusing. I am always going on about how good health lies in our lifestyles. “Hang on a minute”, you may cry, “surely these things are all about lifestyle. What’s the difference?”

The difference is that I don’t pretend that I know what the best food to eat is, or whether you should exercise in the morning or the evening, or whether probiotics or prebiotics are better for your hormonal health. And honestly, I suspect that sometimes nobody else does either. Using restricted diets, dietary supplements, or strict exercise routines are essentially “tinkering” with the body in the same way as taking a medication or undergoing a surgical procedure. We don’t really know which regimen is most beneficial, or what the unintended consequences are. This is also likely to be different from one person to the next. A system that agrees with one person may not suit somebody else. We are not all identical.

What’s more I think this philosophy or ethos has the potential to be harmful in the same way as western medicine can. It is possible to become addicted to “healthy” things so that they become harmful. We can be addicted to the gym to the extent that it means we are neglecting other parts of our lives. We can become obsessive and compulsive about or food choices or eating rituals to a point where it becomes harmful and reduces our overall enjoyment of life. We may be using supplements that have unknown, unforeseen harmful consequences, that may actually upset the balance in our bodies rather than restoring it. Everyone is loving the gut microbiome at the moment. It is certainly interesting and fun to pontificate over, but there is undoubtedly an element of the illusion of explanatory depth. How much do we really understand about the gut brain axis? Could it be possible that massively loading our guts with bacteria isn’t as good for us as we first thought?

This is why these things are sometimes described as “fads”, They are fads because what we decide is good or bad, harmful or helpful changes from month to month or year to year, essentially because we had limited understanding of the far-reaching implications of the intervention in the first place. What was good for your heart last year will cause cancer and kill you the next. When it comes to health, less is more, and functional medicine is often more and not less.

A good illustration of this is the concept of blue Zones. Blue zones are areas in the world where people are found to live significantly longer than in other places. The idea is to reverse engineer this, to see what these people are doing to result in their exceptional longevity. It’s fascinating and if you are interested, I would recommend listening to the FBLM episode about it – as always, I will post the link. I’m not going to go into detail here, but what they are not doing is following strict health rituals, with carb loading days, and carb free days, probiotics, food supplements or dopamine detoxes.

Now I want to restore a bit of balance to this episode – you know me – I’m all about balance. I am not saying that functional medicine is a terrible thing, or that all functional medical practitioners are charlatans that have no idea what they are talking about. Just like with western medicine, cleaver, capable people have done a lot of hard work, and learnt a lot of things about the human body and mind, and when things are not running smoothly often, they can guide us to get us back on track. We know, for example, that having a sedentary lifestyle, or having a diet that consists exclusively of fats, are not good for your health. Getting advice from a nutritionist, personal trainer, physiotherapist or alternative health specialist may have huge benefits on our health. I came across a great example of this last weekend when I visited the Scott Polar museum in Cambridge. Despite growing up in Cambridge I had never been before. It’s a great little museum, and if you haven’t been it’s well worth a visit.

In 1845 Sir John Franklin led an expedition to search for a North west passage between the Pacific and Atlantic. His ships and crew were never seen again. It is thought that the fate of the expedition may have been the result of a Scurvy. Scurvy is caused by a deficiency of vitamin C. It used to be a major issue amongst sailors who had a restricted diet. By John Franklins time it was already known that Scurvy could be prevented by drinking lemon or lime juice, following a remarkable experiment by Dr James Lind in 1747, although it wasn’t fully understood why. It is suggested that Franklins team may have boiled their supply of lemon juice in order to preserve it for what was planned to be a voyage lasting several years. They didn’t know that the process of boiling almost completely inactivates vitamin C. Had they been able to consult a modern dietician many lives may have been saved.

It’s not that functional medicine knows nothing about what we need to be healthy, it’s just that it does not know everything. Just like with western medicine, we need to be cautious that we do not overestimate its ability, to expect it to be able to cure all our problems, to the detriment of balance in our lives.

If you are seeing a functional medical specialist and you are feeling better in yourself, I am all for it. Anything that makes us feel well is worthwhile in my book. In some ways it doesn’t matter too much which program you are following. I think a large part of the benefit is just having something to follow. Having a sense of purpose and achievement. Feeling that you are proactively taking control of your own health has its own benefits. We just need to be careful that we don’t start following a program that might be inadvertently causing us harm, or that we don’t become militantly obsessive about it so that we lose perspective and balance.

I think a good way of picturing the difference between Functional medicine and Progressive medicine is to picture the training montage from Rocky 4. Drago is Functional, but Rocky is Progressive.

So, you might think that all this leaves us with a bit of a problem. It sounds like I am essentially professing ignorance. Well I am. I have absolutely no idea how much of your diet should be carb based, if you should exercise in the morning or the evening, or which type of pro-biotic you should take, and at what time of day. And part of me thinks that probably no one else does either. I read a 1-star review on the bottom half of the internet that said; “If your doctor tells you they have all the answers, run a mile”. Even 1-star reviewers sometimes have an important point to make, even though they may have also lost some balance and perspective.

That’s all very well, but if lifestyle is the key to health, and nobody knows which is the right lifestyle, are we not more or less up the creek? I like to tell my patients that our bodies tell us what they need. I commonly encounter this after people have been ill with gastroenteritis. They say “what should I eat doctor”. And I say, with great care and compassion, “Your body will tell you what it wants”. And I think this is true. After we have had diarrhoea and vomiting, we don’t normally feel like a curry and a pint, but if we did, probably a curry and a pint wouldn’t be all that bad for us. I think this is true in day to day life too. If we had a curry and a pint for breakfast lunch and dinner for a week, we would probably start to feel pretty unwell. Probably we wouldn’t really feel like having another curry or pint for a little while.

If you ask your doctor this question, and they say “brown rice, shredded lettuce and water” you should ask them to show you the evidence that this dietary regimen improves recovery following gastroenteritis. Ultimately, I am not too worried about it, because I suspect that it makes very little difference. Human beings are, in general, remarkably robust. We have evolved as omnivores, and we can do pretty well on whatever is going. In the blue zones people eat whatever happens to grow or live where they live, and the diets across the various blue zones are quite different from each other.  

It is mostly about balance. It doesn’t matter what you do, so long as you don’t do too much of it. Pretty much everything can be both good and bad for you depending on how much you do it. Kale might be considered a healthy food, but if you only ate Kale you would not be very healthy. Even things that are considered bad for you probably aren’t bad, so long as you don’t have too much. A Big Mac is not in itself unhealthy. It’s not poisonous. Ok it has a lot of fat and sugar, but we need fat and sugar to survive. When I was a teenager, I loved Big Macs. Now much less so, but I think my body was telling me what I needed. As a highly active teenager I needed a lot of fat and sugar to meet my energy requirements. I still occasionally enjoy a Big Mac after a tough mountain bike ride, and I don’t think this is especially unhealthy. Even things like smoking are not necessarily unhealthy in themselves. I consider sharing a cigarette with a friend or enjoying a cigar at a wedding one of the finer things in life. If this is not done in excess, I think it is very likely that the benefits in terms of friendship, recreation and pleasure outweigh the harmful effects on the lungs. If it is done the right amount smoking could be considered a healthy pastime. The problem with smoking is that it is fairly poisonous, so the optimum amount might be something like 1-2 cigarettes a year.

For me progressive medicine means thinking about our health holistically. Seeing the body and mind as a single unit and maintaining balance throughout all aspects of our lives. It is also about understanding the complex connection between all these different factors, how what we eat effects how we sleep, how we sleep effects how our bodies function, what we think affects how we feel, how we feel impacts on what we do. This interconnection between the physical and the mental, the spiritual and the divine is so complex we will not always be able to game it, or out smart it. We need to listen to our bodies, pay close attention to what feels right, learn from each other, be open minded, and prepared to experiment and explore. Ultimately to be well we need to live well.

A common objection to this concept of “listening to our bodies” is that it will lead to excess. When we become addicted to things and start using them to numb our pain, are we not listening to our bodies? If we are drinking too much, smoking too much, eating too much or using Netflix or social media excessively is it not our natural appetites and hunger that drives this? The same can be said of avoiding healthy activities. When I stay inside rather than go out for a run because it is warm and comfortable inside and cold, wet and dark outside, is this not my body telling me to hunker down? The idea is that we need to deny our natural instincts and inclinations to prevent excessive, compulsive or unhealthy behaviours.

But I don’t think this is quite right. It is not our natural instincts or appetites that cause this harmful excess but our rational (or irrational) thoughts. It is the sentences in our brain. When we become addicted to things this comes from our thoughts about them.

I want to clarify that I am not talking about drug and alcohol dependence, so hold fire on your 1-star reviews on chemical addiction. I don’t think we get a chemical dependence on Netflix, or checking our podcast stats, which are the kind of addictive behaviours I am referring to. Although these thought patterns may also apply to some extent in other forms of addiction, even if there is also an additional chemical dependence. Most things in life are multi-factorial.

Anyway, the reason I can develop a habit of excessively checking podcast stats, to the point of it becoming harmful to me, is a product of the thinking part of my brain, rather than the doing part of my brain. (If you are not sure what I’m talking about, you should go back and listen to episode 10. I think it’s the best one, but for some unknown reason is the least popular – I will know if you do – I always check!). This is the opposite of listening to your body. It is the same thought error that functional medicine commits when compared to progressive medicine. We think that our human intellect can outsmart nature. Let’s take appetite as an example. Our bodies are actually quite good at regulating how much we eat. We have feed-back mechanisms that cause us to feel hungry when we need more energy, and full when we have enough. But the thinking part of our brain thinks it knows better. It thinks, “hang on a minute, eating that steak felt AMAZING. My body is telling me I am full, but surely if eating the steak felt that good, imagine how good I will feel after the sticky toffee pudding!”

We think we know best and we don’t listen to our bodies. If we are mindful and honest, we will know that when we have been in all day watching Netflix on a wet windy weekend, we can start to feel restless and a bit unwell, maybe we get a slight headache or feel a bit muzzy. Our bodies are telling us to get out and move about a bit. But we think we know better. We think, “getting wet and cold is very unpleasant, maybe I will just stay here”. If instead I listen to my body and go out running in the cold and wet, I am repeatedly surprised when it feels amazing.

A good example of this for me is Xbox. I find Xbox very addictive. Its fun, but it is easy to keep on playing long after the fun has ended. My eyes are crispy, I have lost all co-ordination, I am shouting uncontrollably at the screen as I’m relentlessly mocked by 12-year olds, I am tired, angry and thoroughly miserable. And yet I think, “I will just get one more kill”. My body is screaming at me to go outside, and my brain says “Yes, but Xbox is so much fun!” This is the basis of many excessive behaviours, and represents a fundamental thought error, that if some is good, more must be better.

OK, that’s enough for today, I’m feeling tired, the sun is shining, and I want to go outside. Just before I go, I do want to make a quick disambiguation. If you google progressive medicine, you will hopefully find me. But you may also find something quite different. The definition of progressive medicine I am giving here is in many ways my own. I have highjacked the term, but I don’t feel guilty because my interpretation is far better. The other type of progressive medicine you will find, especially in the US, is companies that are offering what I would term “pseudo-western medicine”.

They are offering expensive therapies such as IV mineral infusions, cold laser therapies or Ozone joint injections. These practitioners use similar language to me; holistic health, wellness, balance and spirituality. However, in many ways some of these alternative therapies are the exact opposite of my philosophy. Injecting a joint with Ozone is not about restoring balance to our lives and giving our bodies the environment they need to heal themselves. It is an attempt to game the system, to outsmart nature. It is in essence identical to western medicine. Having an Ozone joint injection is no different in principle to having a cortisone injection. Now I am not saying that I am fundamentally against this, or that it is impossible that Ozone injections can be of benefit, but what I would say is that it is likely the Jury is out. The reason I call these therapies pseudo-western medicine is that they try to game the system using the same biochemical model as traditional western medicine, but are not supported by the same body of evidence. If they were, they would become western medical treatments. This does not necessarily mean that they don’t work, but it does mean that we don’t really know if they work or not, and more over we don’t know what potential negative or harmful side effects they may have. In addition, like western medicine they may prevent us from taking responsibility for our own health and seeking more practical solutions to our problems.

The other reason I am sceptical of these treatments is that people are making a lot of money from them. This is why I am so proud to work in the NHS, and why we should all be fighting to keep it. Where medicine is driven by profit it is in the interests of the medical system for patients to be ill, the sicker the patient is, the more they will spend, and health will not be the primary goal. In the NHS everyone benefits from people being well. The primary driving force is health, and only treatments that are cost effective, evidence based and proven to be of benefit are offered. If a treatment is not available on the NHS it probably means that it is not that great. If it truly worked it would save the NHS money to provide it, because ill people are expensive.

The final disambiguation is between functional medicine and functional symptoms and illness. These are completely different, and it is important not to confuse them. I will be talking at length about functional symptoms and functional illness in the future. It is an area of medicine that is widely misunderstood by patients, doctors and society at large. This misunderstanding is extremely detrimental to our health and causes a massive burden of illness in modern society.

Your Homework this week is to think about listening to your body. Be mindful and try to recognise when your brain thinks it knows better. See if you can catch yourself ignoring helpful message; to stop scrolling on your phone, or to get outside for a walk, or stop putting off calling your mother. Think about listening to your body and maintaining balance and equilibrium across all aspects of your life.