Is it a root cause-“ish” approach or is it really root cause?
So, you have some symptoms or a “diagnosis” of sorts and you’ve decided you want to address the root causes instead of masking your symptoms with medications, but maybe you aren’t sure what that even means or how a provider goes about treating your root causes?
I hope this blog sheds a lot of light for you on what addressing the root cause actually means, the pitfalls I see in the functional medicine space, and how to find a practitioner that will be able to address your root causes.
Often when people decide they want to treat their health issues naturally, they seek guidance from a naturopath, functional medicine doctor, integrative health practitioner, health coach, MAPS doctor, biomedical practitioner, etc.
But what do all of these titles mean? Do they mean the same thing? Are they all going to treat your health issue in the same way?
The short answer is NO.
The title that best describes my methodology is “root cause medicine” or “root cause practitioner”. As we go you may start to understand why my methodology is different from the norm.
Though I know all of these practitioners mean well and all want to help you heal, there’s some peril’s in “functional” medicine that I’ve observed over the years:
An over reliance on lab tests
Outdated bloodwork markers
Not enough connecting the dots & putting together the 1,000 piece puzzle
One-size-fits-all protocols
Green pharmacy
A root cause practitioner should know which labs to run based on the symptoms you present and you won’t get too far requesting labs from someone that doesn’t know how to interpret the labs.
Let’s start with bloodwork:
So many skip over bloodwork and opt for fancy functional labs because the majority of practitioners aren’t adequately trained in interpreting bloodwork from a functional perspective and most use outdated labs and standard lab reference ranges, thus, important information isn’t gleaned from bloodwork with the average practitioner. I’ve been there and done that - I used to wonder in college why physicians even ran bloodwork because 1) they rarely ever went over it with you 2) they usually would say “everything looks fine” when you really don’t feel fine 3) I never gleaned any answers ever from any physician running my bloodwork
Clients/patients are usually surprised by how much information they glean when I run bloodwork on them and interpret it from my root cause medicine lens.
What’s the standard lab reference range?
Most labs determine whether or not a marker is “high”, “normal” or “low” based on the standard lab reference range, which is based on the sickest of the sick population - by the time your ranges are in the standard lab reference range, there’s likely a bigger issue at play than if you looked at it from an optimal range lens, you have a much better likelihood of catching things early and preventing bigger issues from developing. Those values have broadened over the years because people in general have gotten more and more unhealthy. Optimal ranges are where you likely feel your best, and thus are the ranges I use when interpreting blood work ranges.
OUTDATED blood markers:
The average practitioner, even functional medicine doctors, often only run basic bloodwork markers that are very outdated and often don’t shed a lot of light on root causes.
Let’s talk lipids: most run a standard lipid panel (cholesterol, triglycerides, LDL, VLDL, LDH) to get a beat on your overall metabolic health and CV risk (it can also shed some light on many other possible issues - possibility of infection/heavy metal/mold exposure, for example). The issue with a standard lipid panel is it only measures the overall passengers on a highway for an indication of how much traffic there is, whereas a NMR Lipoprofile measures the actual vehicles on the highway.
Let’s talk blood sugar: Most practitioners only run glucose and hemoglobin A1C.
I generally run hemoglobin A1c, glucose, glycomark, LDH, insulin, c-peptide and the NMR lipoprofile with insulin resistance markers to get a complete picture of someone’s blood sugar regulation.
Let’s talk Iron: Most practitioners only run a few bloodwork markers and rely heavily on one marker in particular… ferritin. When actually ferritin is not the most accurate marker for your iron status - it’s a better marker of inflammation than iron status.
To determine the real root causes to your anemia, you need to run hemoglobin, hematocrit, RDW, zinc, vitamin A (retinol), ceruloplasmin, transferrin, copper, MCV, MCHC, MCH, TIBC, UIBC, iron, iron saturation, and ferritin.
Not enough connecting the dots:
Many clients I’ve had over the years are complex, very layered and require a deep knowledge of physiology and symptomology, but also being able to think critically, connect dots and put together that 1,000 piece puzzle. This is essential in discovering root causes and is precisely why I can only take on a limited number of clients.
Green pharmacy:
The practice of recommending a supplement in place of a pharmaceutical. For example, you often get urinary tract infections, so your natural health provider recommends garlic allicin pills (since it’s anti-microbial) in place of an antibiotic in hopes that it will naturally clear the infection and you won’t need antibiotics that will obliterate all of your healthy gut bugs, while never asking why you frequently get UTI’s. These are nice supports for an acute infection, but if it’s a common occurrence, then we need to start asking some questions. it excessive yeast overgrowth? A chronic bacterial infection your body hasn’t cleared? There’s many possibilities. What’s causing the frequent UTI’s and why is your body so susceptible? Ask those questions, know HOW to find those answers and figure out the solid answers to those questions, and you won’t continue to get UTI’s. That’s root cause medicine vs. green pharmacy.
An over reliance on lab tests:
No rift on functional labs, I am a lab-based practice and use them frequently in my practice, but one problem I see in functional medicine is an over reliance on them and not utilizing critical thinking, blood work, and symptomology enough. I have had more clients/patients than I can count that have sent me $1500 worth of functional lab test results that previous providers have requested and they left that provider without a full understanding of the lab results or any clear direction on how to address the results of the labs.
Root cause Medicine example
Thyroid issues are so common, so let’s use thyroid issues as an example. How to get to the bottom of thyroid issues from a root cause medicine approach .
Most practitioners only run TSH and maybe if they’re feeling overzealous, T4. This is problematic because I cannot determine the root cause of your thyroid issues with these one (or two) markers alone. The reason conventional providers don’t run a full thyroid panel is because they 1) don’t know how to interpret them since they are not in the root cause business 2) there are no medications to correlate with the rest of the markers. The only treatment a typical provider offers for thyroid issues….is thyroid medication. A conventional provider is trained that TSH is all you need to determine if you have an overactive or underachieve thyroid and this is far from the truth. TSH doesn’t even measure the thyroid. It is measuring the pituitary response.
The hypothalamus sends sends thyroid releasing hormone (TRH) to the pituitary gland. The pituitary releases TSH (thyroid stimulating hormone) down to the thyroid gland. TSH is measuring pituitary output, not measuring thyroid output. If TSH is low, it’s a pituitary issue. It’s a brain problem. Hypothalamus isn’t telling it to produce enough.
Thyroid medications are aiming at giving you thyroid hormone, when that may not even be the problem. Further, the thyroid often RESPONDS to other issues in the body.
IT’s not just about the gland, it’s about thyroid physiology.
Let’s look at what a full thyroid panel actually is, because it’s not just TSH.
A full thyroid panel includes these markers:
TSH
Total T3 and Total T4
Free T3 and Free T4
Reverse T3
T3 Uptake
TPO and Thyroglobulin antibodies
TSI antibodies
Yes, I need all of these markers ran and then some to be able to identify your root causes. There’s also several root causes to thyroid issues:
Let’s look at her thyroid panel before and after:
From looking at her thyroid markers, her T4 is in the optimal range, but her T3 (active thyroid hormone) is low. This process happens in the liver, I want to see how her liver is functioning and her liver enzymes (AST and ALT) happen to be elevated.
But that’s not all - She has symptoms of hypothyroid: feeling cold all of a sudden, hair loss, depression, and really dry skin (you don’t have to have all of these symptoms). Anytime you have low T3, you are likely going to be experiencing hypothyroid symptoms. These symptoms are your body screaming that there’s an imbalance and once you start to feel symptoms, you likely have been experiencing health imbalances for quite some time.
Also part of her root cause picture - she has dysregulated blood sugar and high cortisol and chronic stress - blood sugar dysregulation can impact the thyroid because it causes inflammation - inflammation can suppress TSH. Cortisol impacts activity of the deiodinase enzyme (enzyme that converts T4 into T3), so we can put together that she’s struggling to make enough active thyroid hormone because of her sluggish liver, high cortisol and chronic stress that is disrupting her HPA axis, and blood sugar dysregulation.
We addressed these root causes in a matter of 4-5 months and this is her AFTER profile:
This is what root cause medicine is. It’s being a detective and asking WHY until you arrive at the root causes. It’s getting to the deepest layer, to the ROOT, if you will.
I often get asked from followers on instagram “what labs or bloodwork markers should I request from my healthcare provider?”
Well, a root cause practitioner should know which labs to run based on the symptoms you present and you won’t get too far requesting labs from someone that doesn’t know how to interpret the labs.
If you are tired of using google and trial-and-error to heal your health issues and want to partner up with a practitioner that will be in your corner and act as your private health detective, you can apply for 1:1 support from me. We can also schedule a free coffee chat, too.
