What is it all about?

Put quite simply you are what you eat! Despite the amazing choice of food available in todays society, most people choose their food for reasons of taste, cost, convenience and psychological gratification. All those reasons are OK as long as we do not forget the real reason why we eat: to nourish the cells of the body with essential ingredients from the diet. While humans can survive on many differing and bad diets for years, we can only thrive on a narrowly defined set of nutrition principles.

In addition to poor choices in food, the western diet of today is often over-processed, grown in poor conditions and stored for long periods. By the time it reaches our tables it has lost many nutrients and is coated in chemicals.

We are all bio chemically individual with particular lifestyle demands. Our nutrition needs have to be tailored absolutely to suit us.

Nutritional Deficiencies.

Deficiencies can begin to occur from birth or even before from deficient mothers. As we grow and develop the body requires more nutrients as building blocks and cofactors of enzymes. If they are absent or in short supply the body simply cannot function normally. Over time these deficiencies can lead to chronic illnesses and diseases.

Functional Medicine www.functionalmedicine.org

As a practitioner I rely upon nutrition in my clinical practise and often get asked if there are laboratory tests to check for certain nutrient status, or are there randomised controlled clinical trails to prove effective nutritional intervention, and I would have to say not many. As a clinician I have been taught the practises of clinical nutrition following the functional medicine approach. In the dictionary sense, the word “function” is derived from the Greek term ergon, which means “the kind of action or activity proper to a person; the purpose for which something is designed or exists.” This definition tells us the concept of function must be viewed in the same category as the concepts of “purpose” and “design”. It tells us we cannot understand the function of a person without also understanding the purpose for which that person is designed.
Clinically this definition tells us that every naturally occurring nutrient, every naturally occurring food, and every naturally evolved dietary pattern has a purpose and design. The functional approach assumes that every food, in its co-evolution with the organisms surrounding it, contains a vast majority of molecules that are necessary, purposeful and “designed” to support life. Even the simplest food contains literally thousands of identifiable molecules such as vitamins and minerals. These were discovered in the early and mid twentieth centaury because clinicians started noticing the negative effects of vitamin deficiency: lack of vitamin C with scurvy, lack of niacin with pellagra and lack of thiamine with beriberi.
The negative effects of foods continued to be discovered such as reduction of dietary fat for intestinal malabsorption and decreased sugar intake for dysglycaemia. While the problem-avoidance intervention might be critical in nutritional management of a health condition, it does not address functionality, or the re-establishment of a positive balance in which underlying metabolic patterns are actively supported. Understanding why the body has a problem with fat absorption or blood sugar imbalances and using other nutritional interventions rather than just elimination applies the functional approach to a positive “balance restoring” philosophy in which whole-body function is emphasized versus the negative “problem-avoiding” approach that is taught as standard.
The focus of functional medicine is to link the underlying metabolic patterns and nutrient interactions rather than isolate nutrient deficiency. Conventional approaches placed nutrients into one of two categories essential (the body cannot synthesize so must be obtained through diet) and nonessential (the body can synthesize and therefore need not be obtained through diet). A functional perspective argues that nutrients cannot be placed accurately in either category and that they are all “conditionally” essential for a variety of reasons:
* A human may have a constitutive genetic “defect” which prevents ordinary synthesis of the nutrient.
* The body may have an induced genetic defect in which the promoter region for a nutrient-synthesising enzyme has been inhibited by a toxic substance, resulting in a lower production of the nutrient.
* The body might have an atypically high need for the nutrient and therefore, although the body synthesises the nutrient in an amount considered adequate for a typical human body, the nutrient needs will not be met.
In any of the above cases a “nonessential” nutrient would need to be supplied exogenously through diet or supplementation. The reasons for these differences are due to our biochemical individuality and our everyday involuntary processes are unique to us. The “one size fits all” philosophy using bell shaped distribution curves, parametric statistics and food pyramids may no longer apply, so the Recommended Dietary Allowances (RDA) based on these “safety nets” no longer apply.
Another principle in Functional medicine is homeostasis defined as “the relatively stable physical and chemical composition of the internal environment of the body which results from the actions of compensating regulatory systems.” Homeostatic systems are defined as control systems consisting of a collection of interconnected components that function to keep a physical or chemical parameter of the internal environment relatively constant. Understanding the homeodynamic events is the key to understanding the different systems and their interactions at the individual biochemical level. When we think of the term “dysfunction,” we should think not only about the loss of processes universally operating in human beings, but also the loss of the processes that are unique to a single individual in which the dysfunction occurs. For example the resorption of bone calcium is perceived to be a calcium deficiency and calcium carbonate supplements are prescribed however calcium deficiency is not isolated but a problem with both balances between nutritional and non nutritional parameters. We can’t achieve bone remineralisation with calcium carbonate supplements alone, other nutrients such as magnesium, manganese, zinc, copper, boron and phosphorus are equally important in the bone matrix and the formation of hydroxyapatite. We also need to engage in physical activity for bones to mineralise.
Understanding nutrient interactions is important, nutrients do not travel alone through the body, and they are accompanied by other nutrients and non nutrients factors that play an important part. An objective with nutritional therapy is to ensure these companionships take place. Certain forms of minerals in an inorganic delivery form require hydrochloric acid in the stomach for proper absorption, some must attach to organic acids or amino acids for absorption, flavanoids enhance vitamin C absorption, and zinc antagonises copper absorption. So the therapy needs to recognise natural balances and antagonisms.
A balance of microflora in the intestines has a major impact on the path that nutrients take, imbalances of these may lead to the nutrients being consumed by the growing bacteria and therefore unavailable for human cells. Conversely, deficiency of certain bacteria in the gut can alter nutrient paths for example a specific fibre in the diet is required to nourish bacteria and they ferment this fibre producing short chain fatty acids such as butyrate used by the endothelial cells of the intestine to maintain intestinal health and integrity necessary for proper absorption.
Important areas of nutritional intervention are cofactor and substrate therapy. All enzymes have active protein sites which are required to bind substrate molecules that undergo the transformation, in addition they have binding sites for non-substrate molecules that influence their metabolic activity i.e. on/off buttons. Most of these on/off buttons are referred to as cofactors and these are vitamins and 1/3rd require minerals e.g. glutathione peroxidase require selenium and superoxide dismutase requires zinc, copper and manganese. The relationship between enzymes and nutrient
cofactors has given nutritionists a practical way to measure, on an individual biochemical basis, degrees of nutrient deficiency and the therapeutic amounts needed to remedy deficiency.
In summary:
Functional Medicine
* Functional medicine is science-based health care that demands a systematic, patient-centred approach to understanding the underlying web of physiological factors and effects that influence health and the progression of disease.
* It incorporates the functional principles that exist in many conventional and alternative practices but focuses as a special core competence, on the principles of molecular medicine and modern nutritional biochemistry with an emphasis on clinical application.
Functional Medicine is Based on the Following Principles
1. Biochemical individuality---determined by your genes rather than data compiled from a bell shaped curve that determines "normals" in medicine.
2. The definition of health is positive vitality--Health is not the absence of disease. It is bliss and well being in mind and body and it extends to every aspect of life. 3. Functional Health is complex. It is determined by a balance within a system of emotional cognitive and physical processes rather than in one organ system. 4. A dynamic interaction between genes and environment establish a balanced body system
Differences between conventional and functional medicine
* Conventional acts when a diagnosis can be made and when signs and symptoms are severe enough to demand clinical intervention.
* Functional does intervene when a diagnosis is made but also evaluates functionality much earlier to restore balance to the dysfunctional system by strengthening the fundamental physiological processes that underlie them and adjusting the environmental inputs that nurture or impair them
Human Genome Project
Our health and disease patterns after infancy are not ‘hard wired’ deterministically by our genes, but rather a consequence of the interaction of genetic uniqueness with environmental factors. This is truly a change in thinking about the origin of disease that requires a similarly bold change in how we treat disease.
Dr Jeff Bland (2004)

Single nucleotide polymorphisms (SNPs)
* Single nucleotide polymorphisms (SNPs) a small genetic change, or variation, that can occur within a person's DNA sequence. Although many SNPs do not produce physical changes in people, scientists believe that other SNPs may predispose people to disease and even influence their response to drug regimens.
* Estimated that 3 million will be identified, 1.8 million have been found
* They affect the phenotype as they encode a protein, enzyme leading to a minor change such as an amino acid change, but that change alters activity i.e. tweaks the metabolic pathway function.
* e.g. toxins may not be processed and excreted efficiently or their need for a nutrient cofactor may be higher because of lowered ability to bind a specific nutrient, resulting in lower rate of reaction and maintaining activity e.g. folate in methylation
Pharmacogenomics
* Now supporting that one size does not fit all, now biochemical individuality.
* Realisation that variability in drug metabolism is due to polymorphisms in genes for drug metabolizing enzymes.
* Genetic tests can now determine whether mutations are present before drugs are administered.
Nutrigenomics
The science of nutrigenomics is the study of how naturally occurring chemicals in foods alter molecular expression of genetic information in each individual.
Nutrition has shifted:
Epidemiology and physiology à Molecular biology and genetics
For example:
* Blood lipid and lipoprotein responses to dietary changes – A diet that is low in fat high in complex carbohydrates may in one individual with a genotype lower total blood lipids but in another different genotype increase specific members of the lipid and lipoprotein families.
* Same with higher protein low carbohydrate diets also show reduction in blood lipids and in others elevation.
* No longer one diet fits all.
Optimal outcomes via:
* Clinical practice
* The patients story – triggers, mediators and antecedents (FH)
* Evidence based medicine à the integration of best research evidence with clinical expertise and patient values
* E.g. CFS dysfunction is the end stage of a multifactorial process which needs a greater understanding of the factors that predispose individuals to develop the illness.
Nutrigenomics
e.g. MTHFR SNP produces a variant enzyme that requires high doses of folate to facilitate co-enzyme binding to MTHFR enzyme activity. Using appropriate nutritional intervention serum homocysteine levels can be equilibrated.
This is a very common genetic mutation with approximately 44% of the population being heterozygous and 12% being homozygous for the mutation. MTHFR is crucial in the biochemical pathway that converts the amino acid homocysteine into methionine. In order for this pathway to properly function, vitamins B12, B6 and folic acid are required as co-factors.

* Genes for heart disease and cancer may never be translated into actual disease expression unless individuals plunge these less resistant genes into an environment that triggers his/her unique constitution e.g. smoking, high fat diet, high stress, obesity, low B vitamins, low levels of vitamin D.
* Nutritional support is tailored to the individual to favour beneficial phenotypic expression or to suppress processes that lead later to pathology e.g. Mediterranean Diet
Homeostasis – a dynamic balance
* Human life is dependant upon an intricate balance of minerals, vitamins, water, organic molecules and high energy bonds.
* Cells have their own unique intracellular environment bathed in a unique extracellular fluid.
* There needs to be a state of equilibrium in the body with respect to various functions and the chemical composition of the fluids and the tissues. Illness results from failures in these regulatory processes.
Factors affecting homeostasis
* Xenobiotics ( detoxification)
* Oxidative stress and energy production
* Biochemical mediators (hormones and neurotransmitters)
* Cognitive and emotional mediators (mind, spirit)
* Social/cultural (community, beliefs)
* Environmental inputs (diet, nutrition, exercise, trauma)
* Immune and inflammatory balance
* Gastrointestinal status
* structural
Vitamins and minerals
* DRI’s set up as min amount to prevent diseases e.g. scurvy, pellagra, rickets. However these are not variable amounts needed for polymorphic populations for optimal health.
* Nutrients restore normal function by optimizing normal biological functions mostly through their actions as coenzymes in biochemical reactions. (whereas pharmaceutical agents alter pathology)
* A single nutrient may catalyze hundreds of biochemical reactions. Suboptimal levels may lead to cellular and molecular dysfunction that is not recognised as a deficiency disease.
* The notion that higher doses may be needed for optimal functioning of the total organism is not widely taught, despite new evidence that suboptimal nutrient status may contribute to ‘long latency’ deficiency diseases that are epidemic such as CVD, cancer, osteoporosis, neurodegenerative disease and immune dysfunction.
The future
* We need to cultivate different tools of assessment and research that allow us to better answer questions about nutrition and nutraceutical therapies.
* We need to increase the observational research.
* Pre-agriculture diet was: High in protein, calcium, folic acid, vitamin D, low glycaemic intake and an alkaline ash residue. Nutritional physiology is adapted from many diets not based solely on current recommendations.
* We now know that osteoporosis needs 4 x more vitamin D than rickets
* Neural tube defects require 4 x more folate than anaemia.
* We need to develop and train all on clear nutritional guidelines and consensus using emerging evidence of importance.