A 71-year-old man had battled a persistent cough for 25 years. It had become more frequent and intense in the last three years, causing him to seek help from multiple specialists in pulmonology, gastroenterology, allergy and immunology.
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Standard treatments didn’t seem to help. Prednisolone wasn’t effective long-term. Neither were numerous other allergy and inflammation medications. That’s when the patient sought a functional medicine approach.
Nate Bergman, DO, MBA, of Cleveland Clinic’s Center for Functional Medicine, recommended a range of lifestyle interventions, including dietary changes and relatively low-risk detoxification methods.
Within six weeks, the patient’s cough had reduced dramatically — by 75 percent according to the patient. A year later, his cough had reduced by 85 percent. The patient also reported sustained weight loss, lower blood pressure and normalized HbA1c levels. He was able to reduce his blood pressure medication and stop using multiple other medications for diabetes and gout.
The patient’s cough symptoms and HbA1c levels remain significantly reduced despite discharge from functional medicine care and discontinuation of rigorous aspects of the intervention.
This functional medicine success story, recently published in BMJ Case Reports, is an isolated case, Dr. Bergman notes. But he believes the ripple it produces could become a wave of change, encouraging more physicians and patients to incorporate functional medicine approaches when treating chronic disease.
“We observed improvement in this individual,” says Dr. Bergman. “It could be enough to raise more questions, inspire new hypotheses and trigger larger prospective trials on the benefits of functional medicine.”
Digging down to the root cause
Dr. Bergman and other functional medicine practitioners already are believers that diet and other lifestyle factors offer additional treatments for chronic disease. They’re also believers in “root cause” medicine.
“When the patient presented at my clinic, I dug deep into his history to find clues to what may have caused his condition,” says Dr. Bergman.
In addition to being a former smoker, the patient had worked in aerospace manufacturing for 20 years, where he had been exposed to dimethylethylamine and triethylamine — chemicals proven to cause respiratory irritation and reduced pulmonary function.
“We reasoned that attempting to clear the potential remnants of these toxicants should be our goal, although it was decades after exposure,” says Dr. Bergman. “The interventions I recommended augmented his body’s ability to detoxify itself, primarily through the kidney, liver and lymphatic system. It is entirely possible that these interventions were not the reason our program was effective, but the results were remarkable and are hypothesis-generating.”
Using a multi-domain approach
An anti-inflammatory, low-glycemic food plan was the foundational treatment.
“Patients tell us all the time how certain foods — corn, dairy and gluten, for example — cause reactions in their body, such as swelling or sluggishness,” says Dr. Bergman. “When we remove those food triggers and lower the overall inflammatory burden, it improves the body’s ability to detoxify itself.”
Dr. Bergman also recommended that the patient sit in a dry sauna for 30 to 60 minutes per day (for thermal depuration), perform aerobic exercise as able, drink 3 to 4 liters of water per day, and take nutraceutical supplements. Nutraceuticals were intended to fill measurable gaps in nutrient levels associated with reduced inflammation and to support phases of liver detoxification.
“We combined various tactics — for which there are modest amounts of scientific evidence — into a multi-domain approach,” says Dr. Bergman. “A multi-domain approach is one signature of functional medicine.”
Multi-domain approaches are already established in other methods of treating acute and chronic diseases, he notes. Rather than prescribing one medication, physicians may layer medications and other treatments to multiply the impact on complex conditions like diabetes, heart disease, pulmonary disease, infectious disease, cancers and HIV.
What about scientific evidence?
“As a scientist, I cannot say that the outcome in this one patient can be generalized,” says Dr. Bergman. “But as a caregiver, I cannot ignore what he and other (but certainly not all) patients with chronic diseases are experiencing with functional medicine.”
There are bits of scientific evidence for the functional medicine approaches used in this case, although not the top-tier studies required of mainstream medicine. Nonetheless, incorporating low-risk interventions in a multidomain way appears to be worthwhile in some number of cases, says Dr. Bergman.
“Functional medicine works best when integrated within standard-of-care practices,” he says. “True, it is an ‘alternative’ approach at this time, but to imply there is no evidence for functional medicine is incorrect.”
This case study is one example, and perhaps the impetus of more to come.