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I had a great opportunity to interview Kelly Brogan, M.D. about her medical practice and her views on some controversial issues. Dr. Brogan is a functional medicine practitioner. And I am very excited to publish this eye-opening material.
Please introduce yourself.
Hello inquiring minds! I am a holistic women’s health psychiatrist with a practice in New York City (Manhattan), and a mom of two little ladies. I write, teach, and treat patients from a perspective of healing the mind by healing the body and I bring a healthy level of concern to the discourse around safety of industrial, commercial, and pharmaceutical chemicals.
What limitations does conventional medicine (as opposed to functional medicine) have regarding exposure to toxins in the environment?
Conventional medicine adopts the standard of “innocent until proven guilty” when it comes to incriminating and eliminating environmental toxins. We have seen this play out over time with salient examples in the form of lead and cigarette smoking. Medicine is under the influence of powerful lobbies and corporate interests that necessarily sway medical regulators and policy makers in their perceptions of safety. Most doctors are thus convinced that the burden of proof lies with the sick patients and citizens to demonstrate that environmental toxins are at the root of their problems, or an important contributor. Conventional medicine has very little room for the complexity of chronic illnesses that are the result of environmental, pharmaceutical, and dietary exposures. These illnesses cannot be resolved by simply managing symptoms – you can turn off the smoke alarm, but the fire will keep raging. Appreciating how genes, their expression, and thus individual thresholds for toxic effects of environmental chemicals play out – this is not the strong suit of your average internist.
Conventional doctors feel uncomfortable making recommendations around anything but medication for fear that their recommendations are not based in real science. There seems to be a changing tide; however, and an increasing sense that we cannot wait for the fallout of some of these exposures because of how persistent many of these chemicals are in the environment. This year, the American College of Obstetrics released a bulletin in which they cautioned women about environmental exposures including plastics and flame retardants. This was an important step because the chemical lobby has been working hard to suppress these concerns, and the government has followed suit.
What can be done to solve these issues? Is the functional medicine the answer?
I believe that the answer to the current mismatch between the ills of the population and what medicine can provide will come from patients taking control of their health and limiting their contacts with the system. This can happen through dietary changes done in your own household, educating yourself about minimizing exposure to metals, endocrine disruptors, and food contaminants including genetically modified foods. For the system to evolve, doctors will have to become disenfranchised by a system that uses a one disease-one pill model that is exceedingly expensive, ineffective, and rife with side effects. They will seek a more enlightened path and there will be a tipping point at which these skills will then be taught in medical schools.
What is functional medicine?
Functional medicine refers to the strategic use of alternative medicine practices alongside of conventional medical approaches. A common example is acupuncture during in vitro fertilization treatment or adding an herb like Rhodiola to an antidepressant to improve brain fog. Using supplements in this way is sometimes referred to as “green pharmacy.” When I started my practice, I used functional medicine approaches. Then I learned more about the true power of looking at a person in their entirety – every gland and organ, and from spirit to friend network – and I began to heal and resolve symptoms rather than just “manage” them. This is functional medicine.
How did you become interested in functional medicine?
My post-residency fellowship training was in medical psychiatry, i.e., looking at how bodily problems like infection or liver disease can cause psychiatric symptoms, with a focus on reproductive psychiatry and the treatment of mood and anxiety disorders related to menses, pregnancy, and postpartum. Despite extensive training in helping women to navigate the risks and benefits of medication treatment during this vulnerable time period, many women chose to discontinue medication. This decision, coupled with the prospect of optimizing their health for an anticipated pregnancy pushed me to investigate what are some common drivers of psychiatric symptoms that start in the body, rather than the brain, such as thyroid and adrenal dysfunction, food intolerances and gut infections, and sugar imbalances.
I also began to research what evidence there was to support mood enhancing treatments that were also beneficial to the baby such as vitamin D, fatty acids, magnesium, and b vitamins. Now I focus on inflammatory models of depression and anxiety and look at environmental exposures first and supporting the immune system and minimizing inflammation second. I haven’t started a patient on an antidepressant in some time as a result of practicing functional medicine.
What are the strengths and weaknesses of functional medicine compared to conventional medicine?
The challenge in the functional medicine model lies in the engagement of a paradigm shift. For people to appreciate the subtle and covert processes that underlie chronic disease is difficult, and therefore, appreciating the impact of toxic exposures and inflammatory foods seems too virtual. I view lifestyle changes as a primary driver of clinical change, and I rely on evidence to back up my claims. I’m always pleasantly surprised to come across papers that support dietary modification or nutrients as treatment because doctors do not have the same financial support in the publication of these trials as they do clinical trials of medications, for example, but the articles do exist! Our threshold for considering risks around dietary supplements relative to pharmaceuticals belies a bias that we bring to our healthcare beliefs – medications are for serious problems, and herbs and vitamins are unregulated and dangerous options for minor problems. A recent paper proclaimed hospital-based treatments the third-leading cause of death in America, and, to-date, no one has ever died from a properly inspected nutriceutical.
Another challenge in practicing functional medicine is tempering expectations for results. When my patients meet me, they want to feel better yesterday. I want that for them too. To change the course of their body’s response to its environment takes time. True, comprehensive healing takes months and sometimes years. Sometimes change can come within a week, but functional medicine is a fundamentally different approach that looks at symptoms as sign posts leading to a common destination. That’s where the real, lasting change happens, and also where prevention comes from. It’s worth it.
Could you tell us more about your functional medicine practice? From a patient perspective, what are advantages and disadvantages of seeing an functional medicine provider over a conventional medical doctor?
The practice of functional medicine requires intensive doctor/patient collaboration and time. My new patient consult is 2 hours, and I spend about an hour after that formulating the case. For this reason, most doctors who do this work don’t participate directly with insurance plans. There is also an expectation of partnering between doctor and patient as part of the functional medicine model. I provide a comprehensive roadmap for recommendations, but the patient has to consider and implement these changes. I provide resources to support my claims, and provide research if requested, but the rest lies in their day-to-day decisions. I typically do upfront diagnostics to look for any evidence of nutrient deficiencies, inflammation, and hormonal imbalance and then make personalized dietary and supplement recommendations. I am trained to look within the reference ranges of lab values and to take as much data from the body as possible because we cannot wait for problems to further declare themselves. In the allopathic model, people are fine, fine, fine, fine, then sick. That’s not really how the body works. It struggles to correct problems for some time, and this is where we need to intervene.
I need all of my patients to detoxify their environments by filtering water, air, and purging their household cleaners and cosmetics. I need all of my patients to engage in some form of exercise and some form of meditation. This is how I get real results and secure more robust health for the future.
What kind of training does a medical doctor have to receive to become an functional medicine provider?
After my fellowship, I received certification through the American Board of Integrative and Holistic Medicine, which is one of the certifying bodies in functional medicine. That said, I am an obsessive learner and perpetual student. I read innumerable books and articles, attend conferences and seminars most weekends, and dialogue with colleagues. It’s really a passion project and not just a job. I also walk the walk and have applied these principals to my own life, to which I credit resolving postpartum thyroiditis/Hashimoto’s disease that I developed after my first pregnancy.
From the standpoint of functional medicine, what are the most important things people can do to achieve optimal wellness?
I believe it starts with clean food, water, and air. By clean food, I mean a diet stripped of processed foods and vegetable oils, sugar, pesticides, and GMOs. It needs to be nutrient dense, as much as possible, which is why I advocate for a plant-based Paleo diet. Exercise and meditation have the capacity to make changes in the body that we cannot possibly affect through medication or supplements. With this short list, in my opinion, 60-70% of chronic illnesses would never occur and can be resolved.
How do you typically treat patients in the frame of functional medicine, and how does that differ from conventional medicine?
I’ve developed deep concern for the excessive, and what I believe to be irresponsible, use of medications to manage chronic disease. We have lost touch with our body’s native ability to heal itself and to correct, through elaborate checks and balances, any disturbances. We’ve lost touch with this because we look to doctors when we should first be looking to our homes, our plates, and our minds to see how we can better facilitate that healing process. I believe that psychiatric medications, but also common medications prescribed for pain, acid reflux, and high cholesterol are wreaking havoc on the body’s ability to function optimally.
An example is this: I see a patient who comes in with debilitating, melancholic, depression, no energy, brain fog, and I even note some instability when they walk. They were put on an acid blocking medication 2 years ago for heartburn resulting from a diet high in sugar and fried foods. If they were seeing someone else, they might be started on an antidepressant after a 45-minute clinical contact. They can expect to take that antidepressant for the rest of their lives because few prescribers are experienced in medication discontinuation. I, however, might run a simple blood test to determine that they have a highly suboptimal B12 level and a secondary marker of B12 deficiency. This is induced by malabsorption of B12 in the setting of suppressed stomach acid (which results from the acid blocker they were prescribed by the other doctor). Treatment with B12 can resolve all of these symptoms.
There are cases in the literature of patients receiving electroshock and antipsychotic medications before someone bothered to check their B12 and treat them to remission with this vitamin. I work overtime to uncover what might be driving symptoms and driving inflammation. I don’t believe that the answer lies in a psychiatric medication, and I do believe that these medications can cause significant short and long-term side effects. Some have posited that, in addition to often containing synthetic preservatives, titanium, and gluten, medications such as Prozac contain fluoridated molecules which may impact the body as fluoride – a neuroendocrine toxin – does. That would be all worth considering if they actually worked more significantly than a placebo, which they have not been shown to do in meta-analysis of published and unpublished data!
Are you taking new patients? How can you be contacted?
I have a busy functional medicine practice, but am so far able to accommodate new patients. My website is www.kellybroganmd.com.
Thank you, so much, Dr. Brogan! This has been a very enlightening conversation!
Update: I am happy to share with you that Dr. Brogan has written a new book called A Mind of Your Own. A Mind of Your Own: The Truth about Depression and How Women Can Heal Their Bodies to Reclaim Their Lives by Kelly Brogan, M.D. is now available for pre-order, with the official release on 3/15/16.