Upstream Medicine – addressing the root cause

“Name it, blame it, and tame it” is the conventional approach employed by modern medicine.

In simple terms, this pursuit seeks classification. Through a rapid interview of symptoms, the physician starts the identification process that leads to objective data collection, such as labs and imaging. Perhaps a physical exam is carried out, but this isn’t emphasized like it used to be. Ultimately, this conventional approach is fixated on the diagnosis.

Once a disease has been named, we have the answer, right? 

That diagnosis is blamed for the symptoms, and the prescription that follows lessens the severity of those symptoms, thereby “treating” the disease. We could call this downstream medicine…examining the stream only so far as to figure out the point of nearest turbulent flow.  

In Functional Medicine, we take a different approach. Rather than being satisfied with the identification of the disease itself, that’s only the starting point. We seek to identify the root cause of the disease by identifying triggers, antecedents, and mediators that led to its development in the first place. We survey the river drainage up to the headwaters—hence, it’s referred to as upstream medicine. 

Let’s use Inflammatory Bowel Disease as an example. 

The traditional allopathic approach is to diagnose the condition based on a history of frequent bloody stools and colonoscopy findings consistent with inflammation. A biopsy confirms the diagnosis. Great! Now, we can select an appropriate medication to alter the molecular pathway responsible for the inflammatory cascade, which leads to improved symptom control. 

While treating the symptoms can greatly improve a patient’s quality of life, what are the consequences of blocking that molecular pathway and ignoring the upstream physiology? 

Aren’t there risks of doing so? Absolutely. One common adverse outcome is a weakened immune system. We know this to be true when thinking about drugs such as Remicade or Humira, which suppress the immune system and leave patients vulnerable to infection. 

The Functional Medicine approach is to identify what caused the problem in the first place. 

For example, diet-triggered inflammation, metabolic stress, toxin exposure, and even mental and emotional stress can all trigger downstream pathways that lead to inflammation. Just categorizing a disease, writing a script, and moving on to the next patient misses the mark.

Of course, this systematic approach I’m suggesting is time-intensive and expensive. Clinicians have to get into the stream and start kicking over stones to investigate all possible disease triggers.

It requires a thoughtful problem-solver who is trained in root-cause medicine. It also requires the patient and clinician to have a trusting relationship and can unpack any underlying mental or emotional factors impeding optimal health. And for the patient, it requires wanting to make lifestyle changes — sometimes big habitual changes. It’s a team effort, and unlike traditional medicine, where compliance is perhaps as simple as taking a pill on schedule, upstream medicine is educational. Liken it to your fishing guide studying you and then teaching you your secret style of fishing rather than just being there to tie another fly to your tippet.

When done correctly, the Functional Medicine approach can truly heal in a way that pharma can never compete with. After all, if you remove the disease, there is nothing left to treat. 

The Empowered Patient. 

Dr. Kate Erickson 

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