FM(I) Functional Medicine – The solution
Since 2001 the United States of America has been fighting relentlessly in the Global War on Terror. Our service members have been deployed into hostile, polluted environments with extreme climates for the past 14 years. As a result of this lengthy war, suicides, cancer and other “undiagnosed” or “hidden” injuries are plaguing the Department of Defense service members and their families. The causes of these “unexplained illnesses” are not “unexplained” or “hidden”. The causes of these illnesses are a result of being overexposed. These exposures include: Stress, sleep deprivation, blasts, pollutants (heavy metals/dust/smog/burn pits/industrial waste/chemical weapons), climate, Radio Frequencies (Jammers/Radar/Radios), processed and refined foods, prescription drugs and poor lifestyle choices. This past decade of war has contributed to hundreds of thousands of injuries and unprecedented exposure to stressors that have resulted in the worst epidemic of suicide, cancer and chronic illness in our country’s history.
The effects of these injuries and exposures are well known and documented in scientific literature. Doctors have a duty to learn about this information and connect the dots to better serve their patients. Cancer, suicide and chronic illnesses are all preventable and are all linked together. PTSD and TBI are both downstream effects of broken upstream mechanisms throughout the body. TBI and PTSD are not cut and dry, service members might have similar sets of symptoms but the pathophysiology of each individual service member will be slightly different. Providers need to stop looking at PTSD and TBI as a disease or disorder. PTSD and TBI are a dysfunction and to treat and fix them, you need to have an individual personalized treatment plan for each patient based on their bio individuality and their history of illnesses and injuries.
Service members will gladly go into harm’s way and will continue to serve if they know their leaders and providers are genuinely concerned for their wellbeing and possess the knowledge to identify health issues and assist them when they become ill. The military has set the example and lead the way with their trauma capabilities and our surgeons and medics are the best in the world.
With that being said, the injuries and conditions plaguing service members, veterans and family members are not life threatening wounds. Chronic, unexplained illnesses along with mental health issues are costing the DOD billions of dollars and more importantly the lives of service members are being lost. Not only are the service members affected, so are the family members and their unborn children. Spouses and children all bear the brunt of an emotionally and physically injured soldier. The third and fourth order effects of these problems not only cause distractions from work and effect job performance, they are also a financial burden on the Department of Defense and service members. How many military families have kids on behavioral medications? How many military members have had kids born prematurely? How many children have birth defects? How many military member’s kids have Autism? Is the military tracking these statistics? Does the military wonder why this is happening? Has anyone bothered to ask military members and family members these questions? Military members and family members know that there is a significant number of these problems but they cannot find any information regarding the causes of these health issues.
Deployment related exposures were not even considered by the military as possible causes of illness. Deployment related exposures can damage DNA, damage sperm and damage gut flora. All of these things can pass onto a child before, during and after pregnancy. Conditions such as premature birth, Autism, allergies, heart conditions and other developmental disorders are all linked to deployment exposures.
There is overwhelming research that not only supports this claim but has been conducted by the government. Until recently the military was not putting any effort into testing for deployment related exposures either because of blatant disregard for safety or because of ignorance. Either reason is unacceptable. Thanks to ground root efforts made by active duty and veteran groups there are programs like Task Force Dagger Foundation’s SOF Health Initiatives Program and the Veteran’s Affairs War Related Illness Injury Study Center (WRIISC). The WRIISC has an entire research program dedicated to Deployment Related Exposures. The vast majority of VA providers do not even know the WRIISC exists. The majority of veterans do not even know the WRIISC exists either. The military does not even have a program to effectively screen service members and treat them for deployment related exposures.
Environmental exposures are not just pollutants. Your environment is everything that you are surrounded by. Your environment directly effects your health, whether it be stress at work, stress at home (relationships), your water, your air quality, climate, sleep habits, diet, prescription drug use, alcohol consumption, tobacco use or exercise. To live a healthy life, you and your body both need to have balance. If you live your entire career in a stressed condition (gas pedal) your body will respond appropriately and it will break down. By being able to identify these exposures you can minimize the damage caused by them and can learn to counter the effects by offsetting them (brake pedal). Sleeping better, relaxing (mind/body/yoga/meditation), eating healthier, drinking less alcohol, quitting tobacco products, exercising correctly and giving the body a chance to clean and repair itself.
The environment is a critical piece of both warfare and medicine. Environmental exposures should be a key part of any patient’s healthcare history. How is any provider supposed to get 20 years’ worth of information in 15 minutes? Providers are also fighting an uphill battle do to restrictions and policies that they must adhere to and patients need to be aware of this to help mitigate and stress between the provider and patients.
The military needs to adapt and practice medicine in the same way it does tactics for war. You do not fight Unconventional Warfare with conventional tactics and medicine should be no different. Providers should have the ability to think outside the box to provide any means necessary to treat their patients. Providers need a platform to access a complete medical history/environmental profile to include: special qualifications (HALO/SCUBA), deployment history, duties, locations, timeframes, medications used, vaccines administered, injuries sustained, blast exposures and time working in shoot houses and breaching.
Lifestyle choices are critical parts to maintaining a healthy balanced life. You cannot always control your environment but you can control how react to it and how to protect yourself from it. The first step to treating any toxic exposure is to remove yourself from the source. If you cannot remove yourself from the source, you need to protect yourself the best you can. Part of healing and recovery is a healthy environment. You really are a product of your environment. If you want to recover and heal, you have to have an environment that promotes recovery and healing. That includes both lives at home (family) and at work. The family heals together as a unit, if one person is wounded, injured or ill, the entire family unit will feel the effects. This same concept applies on the battlefield.
Another issue with military medicine is the lack of communication and continuity between medical facilities, providers and specialists. Service members are often bounced from provider to provider because of turnovers with staffing and often find themselves going in circles and starting over from step one. A patient history profile will give any provider a big picture and treatment history of each patient so any provider can pick up where the last one left off. This patient history/resume can be viewed online by any provider in the military or civilian system allowing for better continuity of care and preventing oversight with any medications or treatments.
Besides heavy metals and other exposures, providers were not fully educated on the dangers of certain medications widely used during the war like the anti-malaria medication Mefloquine. Mefloquine was found to be neurotoxic and was known to cause temporary or sometimes permanent brain damage. Mefloquine is used in lab studies to induce lesions on the brains of rats. Mefloquine is a psychotropic drug and aviators and divers are prohibited from using because it causes, quoted directly from the FDA Black Box Warning, “neurologic side effects may persist or become permanent.” “The neurologic side effects can include dizziness, loss of balance, or ringing in the ears. The psychiatric side effects can include feeling anxious, mistrustful, depressed, or having hallucinations.” Mefloquine attacks the limbic system. This particular medication was mandatory in Afghanistan for the prevention of malaria and soldiers were forced to take it or would face disciplinary action. Some service members took this drug for 14 deployments.
This medication was more often than not administered with the original packaging and patients were not properly screened prior to being prescribed the drug. Mefloquine is just one medication that carried an FDA Black Box Warning Label for neurological damage. Fluoroquinolone Antibiotics have multiple FDA Black Box Warning Labels for neurological damage and connective tissue damage and were widely used during deployments. Soldiers were often prescribed these drugs along with some of the most dangerous drugs in the world.
The top 10 prescription drugs related to violence according to Time Magazine were prescriptions regularly used by the military during deployments. These drugs were prescribed with no medical proof of injury or illness, meaning there is no science to back up their diagnosis. Behavioral health providers prescribed these dangerous medications before ordering MRIs, testing hormones, nutrients or neurotransmitters. Psychiatrists and psychologists prescribed drugs like Seroquel, Zoloft, Effexor, Paxil, Adderall and Concerta all without any scientific proof or evidence of imbalances, meaning no MRIs to show brain damage, no neurocognitive testing, neuropsychiatric testing or lab results showing behavioral deficits, imbalances with neurotransmitters or hormones.
The dangers of these drugs are rarely conveyed to the end user and providers often used them off label or with little to no guidance. Soldiers were and still continue to be medicated with these dangerous drugs with very little supervision. A lot of these drugs carry warnings of depression, violence and suicide ideation. Soldiers are not properly warned of these drug’s possible adverse effects. Soldiers don’t report the adverse effects because they don’t know that the drugs they are using can cause those adverse effects. Prescription drugs alone can cause additional health issues and will most likely result in more prescription drugs being prescribed. Prescription drug use is just as dangerous if not more dangerous than any obvious exposure because nobody looks at it as a possible cause of illness or injury. The misuse, overuse and unnecessary use of prescription drugs has to stop.
Military life in general predisposes soldiers to hormone imbalances. Irregular sleep, stress, prescription drugs, poor nutrition and other exposures all decrease or inhibit sex hormone production. For men that will be testosterone and dihydrotestosterone, for women it will be estrogen and progesterone. Both sets of hormones directly affect behavior and health and both are critical for sexual and reproductive health. Combat alone will keep your hormone pathway focused on the production of glucorticoids (cortisol). Cortisol is critical for the preservation of life under stress. If you live in a constant state of stress you will be sure to shorten your life. Hormones control every aspect of your nervous system, neurogenesis in the brain, regulate heart rate, vasoconstriction, body temperature, cholesterol, digestion, sleep, memory and emotion. How come something so critical for health be overlooked as cause of illness? Hormones are also not checked prior to prescribing antidepressants or antipsychotics by behavioral health providers. If hormones control the nervous system, why are they not being tested regularly as a possible cause of mental illness such as anxiety? Anxiety is not a Xanax deficiency. Taking a pill to block or mask symptoms will never fix the problem, finding the root cause and fixing it will.
“Diseases” and “syndromes” do not just manifest out of thin air, they are a result of imbalance and dysfunction. The human stress response is known to suppress immune function, sexual function, detoxification, digestion, hormone production, muscle development, insulin sensitivity, normal sleep patterns and cognitive function. The military community lives in a constant state of stress and the effects of this toxic environment are devastating and costing lives and money.
Low testosterone levels and thyroid disorders with male service members are both common issues in military service and they are not being looked at as possible causes for behavioral health issues. Low testosterone and thyroid disorder symptoms alone make up a majority of TBI and PTSD symptoms because the hypothalamus, pituitary, adrenal axis (HPA) is often damaged by TBI, heavy metals, chronic stress and other environmental and occupational exposures. All of these exposures can cause HPA dysfunction and results in behavioral and physical changes in the body. Hormone imbalances can also predispose someone to PTSD by the mechanism of how memories are stored during different states of the stress response system and the storage of memories.
The soldier is the most important piece of equipment the military has. Experience cannot be manufactured or programmed. Every piece of equipment in the military has a manual, maintenance plan and service life except for the human operator. How do we not have a maintenance plan for the most crucial piece of equipment in the military’s arsenal? How do we not have a system for regular diagnostic testing? You would never fly a helicopter for 20 years with an annual checkup or an occasional oil change would you? So how can you expect a human operator to last 20 years running nonstop on low quality fuel, no down time and with damaged parts? If an aircraft or weapon started to malfunction would we just squirt some oil into it and send it out, or would you take the time to figure out the exact cause of malfunction, fix it and return it to duty or throw some fluids in and send it back out? Why would medicine be any different? The human operator is not much different from any piece of military equipment.
The soldier should have a maintenance plan, service life and service log just like any aircraft or weapon. The soldier should have a full overhaul after a certain amount of time in combat or training. If keeping a soldier healthy for 20 years is not attainable then cut the service life down. Why not count every month in combat or deployed as two towards retirement? Why is the military fixated on a 20 year retirement? Is a 15 year retirement unfair to the civilian population? Would a 15 year retirement not draw more qualified and desirable recruits? Is there a greater loss of experience after 15 years than at 20? How many operators over the 15 year mark are performing like they did earlier in their careers? Could soldiers opt to serve past 15 if they were healthy enough and motivated? Could 15 year retirees contribute more to the civilian sector longer? Would the military save more money in prescription drug costs for retirees if the retirees were healthier at the age of retirement? Would suicide and cancer be as prevalent with less exposure? Considering the greatest expense in the Defense Budget was prescription drugs for veterans and retirees, I would think someone would be trying to cut that prescription drug costs in half. A solution to make the force healthier, happier, stronger would definitely cut the use of prescription drugs down and save lives. The implementation of Functional Medicine can provide that solution
Diagnostic testing is cost effective and widely available to healthcare providers. Diagnostic testing can test bio markers for nutrition, metabolism, allergies, inflammation, gut flora, parasites, genetics, neurotransmitters, heavy metals and hormones. Diagnostic labs have the ability to pin point mechanism of dysfunction.
Functional Medicine uses diagnostic testing and can provide immediate results with minimal prescription drug interaction. Functional Medicine utilizes nutritional and lifestyle adjustments to optimize the body’s ability to repair and maintain balance. Functional Medicine eliminates the unnecessary use of potentially dangerous medications and fixes the underlying issues. Functional Medicine protects the patient, prevents long term drug costs and allows the patient to return to normal life. Leaders and healthcare providers have a duty to protect those under their care and leadership. Providers especially should adhere to their oath they swore to protect their patients. If this form of medicine is available to professional athletes why is it not available to the military? The military has millions of dollars invested into each Special Operator.
If the military wants to protect their investment they better have a solid maintenance plan that meets that requirement. Functional Medicine is that maintenance plan, it is the Field Manual (FM), the diagnostic computer, the tool to optimize health and performance.
If your soldiers are not bringing you their problems, it means they either don’t trust you or think you do not care about them. Either one is a failure in leadership. Also, if your soldiers are not bringing you their problems it does not mean there are no problems. Online training, DUI cards, mandatory briefings and every other indirect approach to combat bad behavior are reactive measures. These techniques are an attempt to treat symptoms of an overworked and over stressed military who are reacting normally to the amount of stress bestowed upon them. Until you know what is causing the poor behavior and apply the correct treatment, you will not correct the problem. Until leaders are able to identify underlying issues and take the correct approach to solving them, service members will continue to self-medicate and put their family, themselves, teammates and their careers at risk.
The stigma of being “broken” has to be eliminated. Suffering in silence might serve a purpose in combat or training but back at home it gets you isolated, physically ill, mentally ill and suicidal. A leader should be able to identify the difference between someone who is an all-around bad soldier or someone who could use some help or a little bit of mentoring. PTSD is not a disease, it is a normal response to extreme emotional trauma.
The exorbitant cost of prescription drugs and the astonishing numbers of suicides are both proof that the current system is not working. Why does the military continue to feed the prescription drug machine? Why are leaders and healthcare providers not concerned with a nearly 7 billion dollar annual prescription drug cost? Why are good soldiers being tossed on the curb without being treated properly? Why are good soldiers falling apart a few years prior to retirement? Military leaders and healthcare providers should be able to identify the difference between a “bad soldier” and one who is performing badly because he/she is physically, mentally or emotionally injured from war.
To reduce costs and save lives the Department Of Defense needs to find the underlying causes of illnesses and correct them with minimal prescription drug usage. PTSD, TBI and all of the above mentioned conditions are not isolated diseases, they are all linked together. To treat and fix these conditions you have to address all of them together. This can be accomplished by the introduction of Functional Medicine. Functional Medicine is a full systems, patient-centric approach to medicine. Every system in the body is connected and works together to achieve balance. Functional Medicine finds and cures the underlying causes of illness and eliminates the need for chronic care and a lifelong commitment to prescription drugs. That demand for chronic prescription drug use has cost the DOD over 5 billion dollars annually over the last few years. Functional Medicine combined with strong leadership will not only save money, it will save countless lives.
“There is no bond greater than the true brotherhood of the military. The brotherhood is not a patch, pin, beret, web page, poker run, club, book, movie or a speech. The Brotherhood is your actions both on and off of the battlefield to protect and look after each other. The Brotherhood doesn’t end when you make a mistake, or when you get ill, injured or wounded. The Brotherhood does not end when you ETS, PCS or retire. Leaders should be put into positions because they inspire others to become better leaders themselves and motivate them to get the job done. If you cannot see what has happened to our military members, you are part of the problem.”
So it is with my most sincere gratitude and appreciation that I humbly submit that the Depart of Defense begin to take a closer look at embracing a new paradigm for all of its war fighters and their families. It is with solid conviction and enforced by personal first hand experience that I know Functional Medicine provides a framework for this very shift in paradigm. It truly is the future of medicine that we have access to now. I simply takes an embracing of a mission who’s objective is to bring about the highest levels of wellbeing possible to all those who protect and defend our great nation. We must gracefully relinquish rules of engagement that as of today no longer match the terrain that it once did. It’s time to step toward a more powerful projection of care and embody a role of leadership. We owe it to all those before us and those who brought us here to bring forth a system of care that preserves the lives of those who stand ready for the call.
With Highest Regards,
Geoff Dardia – Mission, Purpose, Focus
Apr 23, 2016