Finding opportunity in COVID-19 and beyond
The novel coronavirus (COVID-19) provides an opportunity for integrative and functional medicine, said Jeffrey Bland, PhD, FACN, FACB, during the virtual 2020 Institute for Functional Medicine Annual International Conference.
When considering resilience in healthcare, patient practices, in communities, and in the globe at large, Bland said there may be a theme that ties this all together, and the question integrative and functional practitioners should consider is where we might go from here.
Bland said the acquired immunodeficiency syndrome (AIDS) in the early 1980s changed his understanding of the nature of infectious disease and pandemics. A 2012 paper published in the New England Journal of Medicine defines infectious diseases as, “usually acute and unambiguous in their nature. The onset of an infectious disease unlike the onset of other types of disease, in an otherwise healthy host can be abrupt an unmistakable.”
Infectious diseases contrasted to chronic disease because it had a single origin, an infectious pathogen, and if the pathogen is controlled the disease is controlled and there are no other variables.
“I believe when we look at COVID-19, we’re going to see that that’s not totally true,” Bland said. “The virus didn’t produce the disease. The virus had to do with the interaction with the host, and the reaction goes back to their resilience.”
Resilience, Bland said, goes back to function—physical, metabolic, cognitive, and behavioral. Therefore, we’re not only looking for a therapeutic aid, but for a socio-biological relationship between virus and human resilience, he said.
“This poses a slightly different way of looking at the functional medicine model in light of this virus,” said Bland. All disease is a result of disordered function. We must focus on restoring disordered functions to order.”
The functional medicine epistemology illustrates how an individual’s genes and environment gives rise to a particular phenotype, or how a person looks, acts, and feels. According to Bland, genes plus an individual’s environment, lifestyle, and diet garner a specific phenotype, with three of four factors being modifiable.
Underlying causes of disease include toxins, allergens, microbes, nutrition, and stress. Gene expression includes genomics, proteomics, metabolomics, and epigenetics. Functional medicine targets assimilation, defense and repair, energy, biotransformation, communication, transport, structure, and psycho-spiritual. Practitioners should look at how the virus interacts with the host and how they can influence these systems to created health versus disease, Bland said.
A 2016 study published in the New England Journal of Medicine showed how genes and lifestyle are correlated. The study found that over 50 percent of outcomes related to cardiovascular disease were determined by modifiable factors in the subjects’ lifestyles. Therefore, reducing phenotype or appearance of cardiovascular disease has an important link to modifiable functional factors.
Only certain genes are expressed during certain times and under certain conditions, Bland said. They are responding to changes in lifestyle and environment, including chemicals, diet, and stress, which all influence how genes express themselves in to a phenotype.
“The good thing is the marks are put on, but can be taken off,” Bland said. “There is a dynamic relationship between the individual and their environment.”
This links back to COVID-19, Bland said, because the immune system can be modulated through the functional medicine model.
“We in functional medicine have the keys to this approach,” he said. “When treating these pandemics, what we’re talking about is how we can pre-regulate immune resilience, the innate and adaptive immune system balance, to produce a proper outcome.”
Research already points to lifestyle, nutrition, and the environment as tools that are an important part of the resilience story. These provide core opportunities for integrative and functional medicine practitioners as the healthcare landscape continues to change. Bland focused on five principles for the integrative and functional medicine opportunity:
- Redefining pandemics: focus on the cause, not the effect
- Redefining public health: move from population‐based epidemiological data to precision public health
- Redefining prevention: immunosenescence, social determinants of disease, resilience, and metabolic flexibilty
- Redefining reimbursement for medical services: telemedicine, health coaching, group medical visits
- New awareness of planetary health
“We’re witnessing prevention being redefined,” said Bland. “There is a place for disease risk function, but it doesn’t tell us about the individual’s function based on their interaction with genes and lifestyle. We need to move away from disease risk to functional concepts and understand resilience. Resilience is the way we quantify prevention in the individual which is related to their function. These are powerful changes that will occur.”
Editor’s note: Click here to explore our 2020 Institute for Functional Medicine Annual International Conference live coverage.