Functional medicine is complex because the diseases that it’s applied to are also complex. There’s no “one pill for one symptom” model to manage chronic gut health, hypothyroid, autoimmune, or many other conditions. Instead, multiple systems in the body typically play a role in symptoms and require a broad application of diet and lifestyle, which are often key factors in the development of these conditions.
This approach eschews the idea of a “life-changing” product that will fix everything, because no such product exists, despite the most compelling claims of pharmaceutical advertisements. Rather, treating the root causes of many chronic conditions requires a life change, work, and self-education on behalf of the patient.
A nonpharmaceutical diet and lifestyle approach isn’t covered by insurance, unfortunately, even if it’s evidence-based.
Many people aren’t willing to travel down the path of functional medicine until the pain of the problem outweighs the pain of the solution. The good news is that once the path is chosen, the results are often profound and lasting, and people finally feel that they’re in the driver’s seat of their health.
Although I go over these basics in all of my courses, in this article, I cover what I call “Functional Fundamentals”—basics that you must implement regardless of your symptoms or conditions.
These fundamentals are so unglamorous that they’re easily overlooked. People who become well-versed in managing chronic health conditions can become exceptionally well-educated. I’ve learned much from my patients over the years and see that they can sometimes get lost in the weeds of the latest study or supplement. Even among my most educated and empowered patients, I often see these simple foundations go ignored.
1. Eat Enough Protein
One of the biggest mistakes that I see people make is not eating enough protein. It’s common for patients with food sensitivities and autoimmunity on limited diets to under-consume protein.How Much Protein Is Enough?
Your ideal intake should be 0.36 grams to one gram of protein per pound of body weight. Typically, it’s suggested to use “ideal” body weight if you’re overweight, but it may be appropriate for you to go higher than that, particularly if you’ve been under-eating protein.There are roughly seven grams of protein per ounce of meat.
- 4.6 ounces of salmon—about 28 grams.
- five ounces of strip sirloin steak—about 35 grams.
- four ounces of cooked, skinless chicken breast—about 28 grams.
Sources of Protein
Protein from meat is more bioavailable and complete than protein from plants. Meat proteins are also more complete in terms of amino acids. Vegans and vegetarians need to consume more protein and pay attention to amino acid profiles, including leucine.I generally don’t recommend plant proteins because they’re immune reactive for many people with autoimmunity and leaky gut. Eggs and dairy are also commonly immune reactive. As with most diet-related issues, protein tolerance depends on the individual.
I don’t recommend protein powders that contain whey, milk, soy, egg whites, or peas because they’re immune-reactive ingredients for many people with chronic health issues. Protein powders made from beef, collagen, or chicken may be more suitable. Again, this depends on the individual.
While periodic fasting can help to reduce inflammation in some people, I don’t recommend it for those who’ve long been protein-deficient until they rebuild their protein sufficiency and general resilience.
2. Get Essential Fatty Acid Diversity
Essential fatty acid (EFA) balance is one of the most overlooked areas in managing autoimmunity, chronic health conditions, and repairing leaky gut. EFAs are converted to prostaglandins, which profoundly affect immune modulation. Industrialized vegetable oils and trans fatty acids promote the synthesis of pro-inflammatory prostaglandins and should be avoided.Fish Oil Is Best if You Have High Blood Sugar and Insulin Resistance
It’s important to mention that insulin resistance plays a role in which omega-3 fatty acid sources are best for you, as many Americans are insulin resistant. You likely have insulin resistance if your fasting blood sugar is more than 100 or your HbA1c is 5.6 or higher. In these cases, fish is the best source, as insulin resistance can hinder the body’s ability to convert alpha-linolenic acid (ALA), a type of omega-3 fatty acid found in plant sources such as flaxseed, chia, walnut, and hemp seed into a more usable form.This extreme imbalance between omega-6 and omega-3 creates a highly inflammatory environment that plays a role in many chronic conditions, including heart disease, diabetes, autoimmune disease, leaky gut, and brain degeneration.
How Much Fish Oil Should You Take?
Because most people don’t consume enough EFAs, I recommend supplementing with a high-quality fish oil. However, people who take fish oil commonly don’t take enough.EPA and DHA Serve Different Functions
Most fish oil supplements have a 1:1 ratio of DHA to EPA. Both are important, but each has different functions in the body.EPA has more of an anti-inflammatory focus, while DHA has the greatest effect on brain health. If your goal is mainly to dampen inflammation, then regular fish oil or fish oil with concentrated EPA is appropriate.
Omega-6 and Omega-9 Fatty Acids
Omega-6 and omega-9 fatty acids are necessary for good immune health—although caution should be taken as overconsumption of omega-6 fatty acids is pro-inflammatory.Arachidonic Acid
Arachidonic acid (AA) is commonly vilified as pro-inflammatory, but we need it for healthy immune function. AA’s reputation for being pro-inflammatory comes from the overconsumption of omega-6 fatty acids in the general population.Sources of arachidonic acid include fatty meats, shellfish, butter, and ghee. Many people with an intolerance to the dairy protein casein may nevertheless tolerate butter and ghee.
3. Resolve Blood Sugar Imbalances
High and low blood sugar spikes can lead to systemic inflammation, immune flares, hormonal imbalances, and compromised brain function. Supporting balanced blood sugar is critical for recovery from any inflammatory condition.Blood Sugar That Drops Too Low Triggers Inflammation
The biggest sign of a blood sugar imbalance is the change in energy throughout the day. Your energy level should remain fairly stable. One of the most common mistakes that I’ve seen patients make is allowing their blood sugar to drop repeatedly.Feeling “back to normal” or energized after meals means that you’re letting your blood sugar drop too low. This can cause a loss of function, low energy, and irritability (becoming “hangry”).
Eat or snack frequently enough to avoid these drops in blood sugar levels. The best snacks and meals are centered around protein, fat, and fiber. Avoid sweets, fruits, and excessive carbohydrates, as these can cause blood sugar highs and lows.
When High Blood Sugar and Insulin Resistance Trigger Inflammation
If your blood sugar climbs too high because you ate too much, you ate too many carbohydrates, or insulin resistance prevents enough glucose from getting into your cells, you may get very tired after your meals.To avoid energy crashes after meals, reduce the amount of carbohydrates and portion size until you no longer feel tired after eating. Daily physical exercise is another great way to help reverse high blood sugar and insulin resistance.
4. Remember to Hydrate
Many studies have shown that dehydration can activate the inflammatory response and impact healthy immune function.- Fatigue.
- Dark urine and low urine output.
- Constipation.
- Dry skin, decreased skin elasticity, cracked lips.
- Headaches.
- Light-headedness and dizziness.
- Heart palpitations.
- Low blood pressure.
- Poor concentration—altered mood and mental state.
5. Eat a Variety of Vegetables and Fermented Foods Daily
Each microbiotic species in our gut has various enzymes that support different physiological functions, such as converting hormones into active forms, activating nutrients, metabolizing toxins, and producing energy.The more diverse your microbiome, the more physiological resiliency you may develop and the better your shot at recovery.
Eating a variety of vegetables is very easy. Visit your local farmer’s market or make the produce section of your grocery store your main shopping priority. Vegetables are easy to prepare and can be lightly steamed or boiled, sautéed, roasted, and added to soups and stews.
Fermented Foods Support a Healthy Gut Microbiome
Foods that are fermented contain bioactive peptides and short sequences of amino acids that can have antioxidant, anti-inflammatory, antimicrobial, and immune-modulating properties.They also contain microbial metabolites that can help digest proteins and produce short-chain fatty acids, vitamins, antioxidants, and antimicrobial substances. They support gut bacteria that have been shown to improve immune health.
When to Not Follow the Advice on Fermented Foods and Ample Fiber
People with small intestinal bacterial overgrowth (SIBO) or histamine intolerance likely need to avoid fermented foods until they improve those conditions. Too much fiber may also be an issue for those with SIBO or other gut disorders.A common response to fermented foods if you have SIBO is to bloat. Bloating can force open the ileocecal valve between the small and large intestines, allowing bacteria from the large intestine to translocate to the largely sterile environment of the small intestine, causing or worsening SIBO or other gut problems. Therefore, I don’t recommend deliberately causing bloating, even if fermented foods are generally considered healthy. A big clue that you have SIBO is that any food—not just fermented foods—that contains fibers or sugars causes immediate bloating.
People with histamine intolerance react to foods that are fermented, aged, cured, left out too long, or overripe.
6. Remember the Basics When Managing Complex Conditions
It’s easy to get lost in searches for the most obscure supplements, technical genetic alterations, or dietary rabbit holes, but some of the most profound practices to manage your autoimmune or chronic health condition are also the simplest and most overlooked.- Eat sufficient protein: about 1 gram per pound of body weight.
- Ensure a diversity of essential fatty acids in proper ratios.
- Keep your blood sugar, and hence your energy, stable throughout the day.
- Sip three to four liters of water throughout the day, and add electrolytes if necessary.
- Eat a variety of vegetables and fermented foods.
Once you’ve mastered these and the other “functional fundamentals,” you can move into more specialized strategies. The goal is to personalize a health care plan based on your unique needs, triggers, and goals.