This posting is a continuation of the first part of the Interview regarding Dr Gant’s practice philosophy.
The first part is here: dr-gants-practice-philosophy-1
Q: Why does the medical community seem disinterested in such an in-depth risk factor analysis, and how can obviously dedicated, compassionate healthcare practitioners not want to determine these fundamental risk factors which cause their patient’s to suffer and die?
A: Even a better way to ask this question is, exactly which risk factor that is causing one’s patient to be sick would a practitioner not want to know about? The answer for me is none; I want to do a thorough risk factor analysis and determine as many causal risk factors as possible, and I typically order 300-500 distinct laboratory tests on each patient in a deep search for the underlying answers. I am not content to label any patient with a prescientific diagnoses which merely describes the appearance of a condition, illness, syndrome, disease or disorder. I must know the risk factors causing other risk factor or causing the symptoms. For instance, I may diagnose a patient as having bipolar disorder, but I also know that an in-depth risk factor analysis will reveal one or more of the 40 to 50 causalities of bipolar disorder.
Q: What happens when a risk factor is found on diagnostic testing which has not been correlated through any competent scientific studies to be related to your patient’s symptoms or superficial diagnostic label?
A: The famous saying that “the absence of evidence is not necessarily evidence of absence” comes into play here. In other words, just because a certain nutritional, toxicological, metabolic, hormonal or genetic abnormality revealed through diagnostic testing has not been correlated in scientific studies to a patient’s symptoms or to their older, pre-scientific, diagnostic designations, that does not necessarily mean that science will not march on and find that such abnormalities possess a causative link.
Q: So you assume that any abnormality might have such a correlation and be a causative risk factor of your patient’s problems?
A: Should I wait for the science to someday reveal that correlation which would then somehow justify the assumption that a certain risk factor should be addressed? No, because my patients are suffering today, and if an in-depth risk factor analysis reveals certain nutritional, toxicological, metabolic, hormonal or genetic abnormalities, I must assume that it is relevant regardless of the scientific evidence at hand as to its importance.
Q: So what separates conventional doctors from functional medicine practitioners is simply that they have more of a scientific curiosity about determining the underlying, root, science-based, or I suppose you’d call it, “someday-to-be-proven-science based, risk factors.”
A: That’s right. Functional medicine practitioners tend to diagnose from a causative, science-based perspective, the 2nd definition of the term diagnosis, rather than from a descriptive perspective which is the older, pre-scientific meaning of the term diagnosis. Functional medicine practitioners therefore can come closer to a targeted “cure” of problems instead of simply palliatively managing the symptoms with medication and other stop-gap treatments. This is what is so exciting about functional medicine. It promises to completely revamp the way healthcare practitioners diagnose and treat chronic medical and psychiatric disorders.
Q: Let’s move on to genomics. I thought that our genes are hardwired and can’t be changed.
A: That’s correct, our genes can’t be changed, but their expression can be. Any change in status, an added stressor, a shift in nutrition, an infection or the sudden appearance of a toxin causes all of the cells in our body to adapt, by going into their DNA library and pulling out new copies of DNA to make new proteins to adapt to the change. Some of the old DNA and RNA that was being used to make protein and enzymes may get put away. So any change, especially chronic sustainable changes, causes our cells to change its genetic expression.
Q: Does this mean that all healthcare practitioners, regardless of what they do or whether they are aware of it or not, is to change genetic expression?
A: And we are fond of using the term, optimize genetic expression, because we all have a certain genetic code which can have its expression spruced up. Everyone has hundreds to thousands of genetic quirks called polymorphisms, which makes us all so delightfully unique. We can test for many of the polymorphisms, especially the ones which can interfere with optimal genetic expression.
Q: So what quirky genes or polymorphisms do you test for.
A: First of all, they have to be important ones. Why test for a gene which doesn’t potentially do bad things. Secondly we test for polymorphisms which are common – why test for a rare quirky gene. And finally, we test for polymorphisms which we can change the expression of – why test for a polymorphisms which you can’t do anything about anyway.
Q: So you test for genetic quirks which are common, important and modifiable, and then what?
A: We can recommend focused lifestyle changes, nutritional supplements and detoxification which controlled studies have suggested can modify the expression of these genes to then improve and potentially optimize genetic expression.