What can functional medicine offer in addition to a traditional approach to cardiovascular disease? First, it’s important to note that the best approach is a team-based approach in disease diagnosis and treatment. Adding functional medicine or a root cause analysis to traditional medicine in disease management and treatment is synergistic. Simply stated, when functional medicine works in collaboration with traditional medicine, patients experience a greater outcome!
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Patient: Glen, age 65
Provider: Mark Holthouse | MD, FMI Medical Director
“I truly believe that functional medicine saved my life. The heart labs ordered by Dr. Holthouse revealed that I was in jeopardy of having a potentially life-ending heart attack. Working with the FMI team, I learned about the importance of sleep, nutrition, diet and lifestyle choices that have helped me live a healthier life – one that will allow me to watch my grandchildren grow up!”
– Glen
Case Presentation
Glen presents a fascinating story and journey with heart disease, which in many ways mimics a roller coaster ride. There is a considerable history of heart disease in Glen’s family. He lost a brother to heart disease at age 63 and his father at age 52 after he suffered an acute myocardial infarction (AMI). He also lost two uncles to heart disease.
At age 65, Glen is a slim man who doesn’t fit the expectations of someone with heart disease. Other than labs showing high cholesterol, he has exhibited minimal heart disease symptoms. In 2012, Glen was prescribed a statin drug to manage high cholesterol and his other risk factors for heart disease, such as family history.
In 2019, Glen began seeing Dr. Holthouse at FMI. Because of his family history of heart disease, Glen met with a nutritionist to learn about healthier food choices, and a health coach to monitor his lifestyle choices that included exercise and stress reduction.
He also attended group classes, which included a renew program to determine what foods should be eliminated from his diet and replaced with healthy alternatives. He also attended a webinar on Intermittent Fasting that outlined the benefits of safe and deliberate fasting. As a result of these provider meetings, insights and classes, Glen lost 27 pounds in four months and became enlightened about good lifestyle choices, including the value of restful sleep.
In November of 2019, Glen contacted his cardiologist to report night sweats and nightly snoring that interrupted his sleep. An echocardiogram ultrasound revealed an enlarged heart muscle, which indicated sleep apnea, which can be related to heart disease.
The tests also revealed that Glen stopped breathing 30 times per hour during sleep. He was treated by a sleep specialist, who suggested a CPAP machine for nightly use, which soon reduced his breathing cessations from 30 per hour to just one per hour over the course of a few months.
In February 2020, Glen met with Dr. Holthouse to review his overall health status and labs. His labs from previous years showed that HDL and trigylcerides were within normal guidelines. But his November 2019 Cleveland Heart Lab profile revealed an inflammation marker (Myeloperoxidase) at 939, nearly double the number (540) associated with high risk of heart disease. Other inflammation markers also showed high risk of heart disease.
Dr. Holthouse immediately followed-up with Glen’s cardiologist, who ordered an electrocardiogram (ECG) stress test. The ECG results documented an abnormal recovery time. Glen then had a heart scan, which showed blockages in one of the main coronary arteries.
He underwent a coronary angiography in early April and two stents were placed in his main artery, where blockages were 85 percent. Despite normal cholesterol (result of long-term use of statin drug), low blood pressure, and a thin and fit physique, Glen suffered a heart attack while in recovery from stent placement in April. Fortunately, he survived.
Glen met with Dr. Holthouse for a follow-up on new cardiac labs. The results were quite amazing, with inflammation markers and associated heart disease risk falling in the optimal range.
Looking Upstream
Glen’s treatment plan in 2020 and beyond will focus on looking “upstream”, rather than studying one type of problem, which is a common approach in traditional medicine. A system that is out of balance moves downstream toward disease.
With functional medicine, efforts start with the disease, and look “upstream” to uncover the imbalance or dysfunction, find out how and why it occurred, and work together with the patient to resolve it.
Glen will participate in a comprehensive, upstream, root-cause approach that is not directly linked to the heart. For instance, Dr. Holthouse will be looking at periodontal disease, gingivitis and other sources of inflammation. “We now know that bacteria in and around gums is associated with systemic inflammation and heart attacks.”
Using the functional medicine approach, Dr. Holthouse will evaluate Glen’s gut, his symptoms and food sensitivities, as well as any stress that might be affecting the good bacteria in his gut that keep the immune system in check. Mindfulness, relationships, and spirituality will be part of the functional approach as well.
“We will talk about exercise and determine if Glen is doing the right kind of exercise as opposed to exercise that impacts oxidative stress. We will look at sleep and how it impacts stress, gut health, blood pressure, cortisol, blood sugar and weight. Glen will meet with our nutritionist to ensure he continues with a healthy and appropriate diet. And he will spend time discussing any challenges he may be experiencing with our health coach.”
“As a traditional family practitioner in the past, I wasn’t looking for sources of disease. But today, in functional medicine, we look for the sources that are driving inflammation. For instance, what caused the inflammation leading to the need for stents in Glen’s artery, when he had relatively little heart disease risk, other than a genetic predisposition for heart disease? While he’s made good choices to reduce his risk of heart disease, we plan to go beyond good lifestyle choices and determine the drivers of Glen’s inflammation as we continue his functional journey to optimal health.”
