I am a disciple of the human condition.

Mar 16, 2022

There are so many terms used to explain individuality in healthcare today. Yet it can be confusing to know what any signifier in front of the word “medicine” actually means. If a provider is not a medical doctor, can we trust them? Is what they’re doing comparative hocus pocus?

Conversely, when we visit our doctor for what we believe is care particular to our individual needs, why might we unknowingly receive something vastly different? We can make the words match our experience, but in fact, we’re speaking two different languages. We each nod our heads and smile, thinking we’ve gotten our salient points across. But we leave with divergent ideas about the conversation, and maybe even the next steps.

Relationships take time. And individualized care takes both time and inquiry.

To be clear, I’m not here to bash medicine or M.D.s. Instead, I’m here to look at the needs of a growing population of patients — people with chronic health challenges that have taken root in their body. Conditions that manifest in signs and symptoms from fatigue to pain to allergies to anxiety to unexplained weight gain and more. With careful consideration and 15 years of clinical experience, I’m advocating for a new model of care. It’s one where we don’t expect everything from one provider and recognize that we (the patient in each of us) are one of the key partners in our health care journey.

This new model of care embraces the “yes, and.” It supports not only the patient, but the doctor too. Your physician may see you once or twice a year, but who sees you in between those visits? (Hint: It’s you.)

Let’s take a moment to consider some of my favorite areas of the evolving medical field and what we, as patients, can learn from each of them:

Precision Medicine

Precision Medicine directs us away from the therapeutic solution that works for the average. It diverges from (equally important) notions of “population health,” identifying that one grouping of cells in the body may behave a certain way based on the particular body they live in, as well as their molecular or genetic make-up. And it validates that you are unique, and recognizes that more targeted medicine can lead to better health outcomes.

For now, Precision Medicine is most commonly used in cancer treatments where it’s been determined that considering the “personality” of the cells is crucial to effective care. That’s a somewhat cute and conceptual way of saying that the make-up of the cancer cells in two breast cancer patients may be vastly different, even if the patients are the same age, the same weight, and have tumor growth in the same relative location. Instead of prescribing therapies for “breast cancer,” we consider interventions based on how to best target the weakness of the cancerous cell type and the terrain that allowed those cells to proliferate.

For more insights on Precision Medicine, tune into episode #23 of the 15-Minute Matrix podcast: Mapping Precision Medicine with Dr. Grace Terrell

Key Takeaways from Precision Medicine:

You are unique
What worked for someone with your same sign, symptom or diagnosis may not work (or work in the same way) for you
Pay attention to all you can learn about yourself (more to come on self-health tracking soon!)

“It is more important to know what patient has the disease than to know what disease the patient has.”
– Sir William Osler ( 1849-1919 ), Physician, diagnostician and patient-centered clinician

Functional Medicine

This leads me to one of my favorite subjects. While my area of practice is Functional Nutrition, for now let’s explore the medical side of the Functional equation.

Functional Medicine reminds us to consider the entirety of the person seeking care — their history, habits, histamine, happiness, hormones and more. Based on this confluence of factors, it assumes that no two humans are truly identical. The concept of bio-individuality, shorthand for biochemical individuality, was popularized over two decades ago by Roger J. Williams’ book, ‘Biochemical Individuality’.

While the discovery that we each have unique fingerprints dates back to the 17th century, Williams’ research illustrated that the shape and size of our organs — from our liver to our stomach to our heart — vary. Your immune system operates differently than mine (even if we both have Hashimoto’s, as I do). A father and son may experience the same traumatic event but have very distinct emotional and chronic responses. Genotype aside, even one twin may have altered enzymatic function from her identical sister because of their organ proportion, function, and a lifetime of divergent eating patterns or environmental exposures. (And by “divergent” I mean dissimilar to each other, not “bad,” abnormal, or deviant.)

As a result of the distinctions in the human body — those we inherit and those we develop or acquire — it’s challenging to prescribe one dose of a medicine or a nutrient and know, with certainty, that it will work as intended. (I’ll save all rants about how dosages are determined and for what body type for another time.) Even this concept of bio-individual nutrient dosing has a name. It’s called Orthomolecular Medicine.

Key Takeaways from Functional Medicine:

Embrace systems-biology and an understanding of how the body functions
Look for root causes, asking why, not what
Cultivate a therapeutic relationship between patient and provider

Orthomolecular Medicine

“Ortho” means “normal,” and “orthomolecular” was a term coined by Linus Pauling back in the 1960’s. It describes a method that uses nutrients and “normal” constituents of the body in targeted amounts as treatment and therapy. This means that nutrients — likely specific ones and in specific doses— are introduced to fine-tune biological function and preserve health.

Orthomolecular Medicine was one of the precursors to the Functional approach. It states that the basis for health is good nutrition, and that “good nutrition” is different for every person because each of us has distinct nutrient requirements.

Let’s consider an example that helps us to better understand the orthomolecular approach:

A study might conclude that eggs are good for brain health and development because of their high concentration of the nutrient choline. Yet, consider someone who’s taken several rounds of antibiotics in their childhood (like many of us did), and developed an immediate or delayed immune response to eggs as a result. For them, eating eggs may actually harm brain health, contributing to both neurological and systemic inflammation. Therefore, despite information that the egg provides key nutrients for health, it may not be ‘healthy’ for all.

Those of us who cannot tolerate eggs will consume less choline on a regular basis than people who have a daily omelet or hard-boiled for breakfast. This means that those who steer clear of eggs for their own bioindividual reasons will have a greater need to address their choline intake and possible deficiencies in this key nutrient. They may need to look elsewhere for this important nourishment.

A more simple analogy may be to consider our modern-day mineral intake given the depletion in our soil (at least here in the mainland US). These deficiencies will vary from person to person based on their geographical location, food choices, physiological function and more. In this way, each of us has specific and individualized needs for particular minerals.

“It’s not (just) about the food, but instead about where food meets physiology. I like to call this “symbiosis.”
- Andrea Nakayama

Key Takeaways from Orthomolecular Medicine:

Individual needs matter when it comes to nutrition
“Good nutrition” differs for each of us because we all have different needs for different nutrients
We may have unknown subclinical deficiencies in nutrients that are critical for metabolic and body function

N-of-1 and Functional Nutrition

If we continue on our trajectory of embracing the individual and fast forward to 2022, we’ve now quickly adopted the concept of N-of-1, a term used for at least a decade to describe the single subject clinical trial. I now hear people (including myself) using it to say “here is what’s worked for me.” (Subtext: I cannot promise it will also work for you. Sub-subtext: You are different from me for reasons that would take me a lot of time to uncover and explore.)

And yet, while I am a huge believer in individualization and would never backburner the singularity that is you, I also like to embrace our similarities. It’s a sweet dance between the body systems and your body systems. As a Functional Nutritionist and a disciple of the human condition, this is a dance I happily enjoy.

Key Takeaways from N-of-1 and Functional Nutrition:

Everything is connected (gut/brain; detoxification/hormones; etc.)
We are all unique (I see you!)
All things matter (that means sleep matters, lunch matters, breath matters, and more)

If you have a story of when you wished you had experienced more individualized care and/or if this understanding of some of the lineage of individualized medicine was helpful, I want to hear it! You can leave a comment below or write your story and send it to scribe@andreanakayama.com.

Self Health with Andrea Nakayama

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