Functional medicine approach to cardiovascular disease

Dr. Ferda Ayhan Yalcin

Even before the Covid-19 pandemic began, the medical community was in consensus regarding the epidemiological and clinical data that today’s main public health concern was the “Non-Communicable Chronic Diseases”. Now we are dealing with a big communicable disease problem, but still the former mentioned non-communicable chronic conditions, like obesity, diabetes, cardiovascular disease, cancer, chronic respiratory disease remain standing as the main predisposing factors to be infected with the virus or to have severe disease progress which means more morbidity and mortality. So, diseases are still the biggest burden for the individuals, families, public, health systems and for the chronic.

Despite the advances in early detection techniques in modern medicine, the therapeutic approach to chronic disease is not focused on prevention, is mostly not curative where its focus is to find an immediate pharmaceutical solution for a relief to defined symptom or cure for the acute disease. That is why these chronic conditions can not be treated correctly, there is no positive progress and the need for pharmaceuticals and side effects of these medications are on the rise accompanying further morbidities and lower quality of life of these patients. Most importantly the subclinical stages of disease development, the causality and ability and incentive to properly address disease-promoting lifestyles are mostly ignored (1). Most important of all, the root causes of these diseases and an in-depth analysis of causalities and their development stages remain ignored and underinvested.

It is now widely recognized that pathogenesis of diseases is often the result of interactions between genes and environmental factors. Functional investigates the sum of these environmental exposures from conception until the old age, known as exposome, covering the full spectrum of impacts of nutrition, toxic substances, physical and psychological stressors and their associated biological medicine responses (2).

Avicenna (973-1037) says: ‘The knowledge of anything, since all things have causes, is not acquired or complete unless it is known by causes. Therefore, in medicine we ought to know the causes of sickness and health.’

The functional medicine model of care provides an operating system that works to reverse illness, promote health, and optimize function by addressing underlying causes, symptoms, and functional imbalances in interconnected biological networks(3). These imbalances may impair principal biological functions which are classified regarding Functional Medicine as: assimilation, defense and repair, energy production, biotransformation, communication, transport, and structural integrity. These dysfunctions may be the result from gene environment interactions, including lifestyle, environmental toxins, and the microbiome. Functional medicine removes triggers for illness and provides inputs to restore and optimize health. Functional medicine also addresses social determinants, including the psychological, emotional, and spiritual aspects of health and disease(4). A foundation of functional medicine is the use of food as medicine to prevent, treat, and reverse chronic disease. The functional medicine model of care may have the ability to improve patient’s health-related quality of life (HRQoL), including physical function and well-being. (3)

Functional medicine practitioners are trained to think in terms of functions derived from biological and social systems and network biology. They skillfully utilize a dual perspective in analysis of their patients, namely both a telescopic and microscopic view. (5) Functional medicine practitioners use a highly innovative way of representing the patient’s signs, symptoms, and common pathways of disease. Organizing seven biological systems and clinical imbalances into the Functional Medicine Matrix Model creates an intellectual bridge between the basic science literature on physiologic mechanisms of disease and the relevance of clinical applications. Functional medicine postulates that, with scientific rigor, clinical wisdom, and innovative tools, we can identify many of the underlying drivers (both triggers and mediators) of chronic disease, allowing us to reverse these clinical imbalances, often before overt disease is even present.

These imbalances in assimilation, energy production and nutrition are activators of overall imbalance, manifesting itself as symptoms and multiple comorbidities. In this case, one expression of disease may arise from the interconnection of multiple clinical imbalances, whereas one clinical imbalance may be the root cause of multiple, seemingly different conditions. Functional medicine interprets health and disease as a continuum. An essential precept in functional medicine is that restoring balance—in every particular patient’s environmental inputs and in their body’s fundamental physiologic processes—is the key to restoring health.

Many clinical trials represented that the neuroendocrine and immune influences that act on the vascular endothelium, influence its function. As an analogy, “on endothelial cells acts a real neuro-endocrine-immune

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