5 Root Causes of All Disease

5 Root Causes of All Disease

You’ve been asked what disease you have, you may have been asked when it started, how it happened, or where in your body it resides, but have you ever been asked WHY you have your disease? In Functional Medicine, we are less concerned with the what’s, where’s, and when’s of your disease; we want to know WHY. Why do you have your disease, why did it start when it started, and why does it manifest in the specific way that it does for you.

“Bad Genes”

If you brought this question to your everyday Doctor, you’d probably hear that your “Bad Genes” are to blame. That you have this disease because you lost the Genetic lottery, and thus you are powerless to change it. But 21st century science has now taught us that our Genes are only responsible for 30% of our individual disease, and that 70% of the equation is caused by something else. Something you can change. Something called Inflammation.

Turn off your “Bad Genes”

Inflammation has now been proven to turn on and off “Bad Genes”, and the idea that we can change our diseases by turning off “Bad Genes” has spawned an entire science called Epigenetics.
Epigenetics has found certain factors in our lifestyle that when targeted and reversed, can eliminate disease by decreasing the inflammation that turns on the “Bad Genes”. If you have ever been told that you are doomed to suffer with a disease forever, simply because you were born with certain “Bad Genes” I have news for you. Very good news. The real truth is that by decreasing your overall levels of inflammation, you can turn off your “Bad Genes” and heal yourself.

Keeping this fact in the back of our minds, and after nearly 20 years of asking WHY a patient has a certain disease, Functional Medicine has determined 5 Root Causes for Inflammation in the body, things that can be addressed and improved in patient’s lives, reducing inflammation, and thus triggering the healing that lives within your body.

1.     Stress. Stress is the number one culprit for inflammation in our body. If there is only one thing you do to decrease inflammation and turn off your “Bad Genes”, it should be to work to decrease stress. Stress both directly and indirectly causes inflammation in the body. It does so directly through the hormones that are released by the body in response to stressors (the “Fight-or-Flight” Hormones Cortisol and Epinephrine) which lead to impaired glucose metabolism, narrowed arteries, elevated blood pressure, and decreased ability to digest food, among many other things. Indirectly, stress causes alterations in the Gut Microbiome, depletes your nutrients, increases your gut permeability, and decreases your ability to detoxify.

Stress can be either:

• Emotional: Work stress, prior traumas/abuse, traffic, taxes, death/illness of a loved one, loss of job, financial difficulties, beginning/ending a marriage, moving.
• Physical: Motor Vehicle Crashes, Surgery, Exercise(Overtraining >30 minutes at a time)

2.     Bugs: 70% of the immune system resides in the Gut. Good Gut bacteria improve our immune system to fight off pathogens. Good gut bacteria make 7 of the 8 B vitamins that we need for healthy energy levels(say good bye 5 hour energy shot!). Good gut bacteria help break down 50% of the toxins that we take in every day. Good gut bacteria help build up and protect our gut lining. Its impossible to overstate the positive effects of having healthy gut bacteria.

What causes altered Gut Bacteria?

• Stress, Antibiotics (even just once! And the earlier the antibiotic the more damaged the gut bacteria), Oral Contraceptive Pills, NSAIDS(Ibuprofen…), Antacid Use(PPI’s, H2 Blocker’s), Lack of fiber/veggies, Too much Sugar, Alcohol use

3.     Nutrient Insufficiencies: Not having enough vitamins, minerals, amino acids (protein), or Omega 3 Fatty Acids all decrease the body’s ability to naturally function without inflammation. It can also lead to altered Gut flora, decreased ability to manage stress, or decreased ability to handle and eliminate toxins.

4.     Food Sensitivities/Leaky Gut: Very different than true food allergies (think: throat closing up), food sensitivities are the result of disruption of the mucosal barrier (by any of the above causes) which leads to leakage of large(not fully digested) food particles through the lining of the intestines. When the gut’s immune tissues come in contact with these large food particles, they think they are invaders, and the immune system becomes revved up. This only leads to more inflammation, more disruption of the barrier, and more Inflammation throughout the body.

5.     Toxins: This is a tricky category that we usually reserve until we have made sure that we have addressed all of the other Root Causes above. We do this because we know that 50% of the toxins that we take in through our food are processed and taken care of by our Gut Bacteria. Toxins can be any number of foreign substances that our body has trouble eliminating, and thus accumulate and wreak havoc on our normal body processes. These can include: Heavy Metals, Mold (mycotoxins), chemical pesticides/fertilizers, Glyphosate (Roundup), or other chemical exposures in the past.

So think hard about the above 5 root causes of disease as they may pertain to your specific level of health. If you wake up every night at 3AM with thoughts racing, you likely have a stress/cortisol issue. If you suffer from recurrent urinary tract or respiratory/sinus infections, you likely have an issue with your immune system, which may originate with your gut flora. If you suffer from recurrent diarrhea or constipation, you likely have an issue with both bowel flora as well as food sensitivities and leaky gut. And if you have “tried everything” and still fail to fit into the image of perfect health that you have for yourself, you may be suffering from a toxin burden that can only be eliminated once properly identified. True healing is available to each and every person, and it is certainly available to you. If you would like to learn more about how the above root causes of disease may pertain to you specifically, contact Dr. Schatz below.

My Brush with Burnout

Last July, I burned out. I was moving from the first (also deemed Intern) year to the second year of my 3 year residency. The role of the intern, and thus the year long internship, is typically heralded as the most stressful of all the years of residency. Most of the clerical burden falls to the intern. Partly through a hierarchical power structure, and partly because that’s always how it’s been done, the Intern is responsible for writing all of the notes on patients whether they are coming, going, or have been there for weeks. The never ending grind of this clerical task is, of course, extremely educational, but at times can be tedious to the point of mind-numbing monotony, and is always stressful. Once finishing your Intern year though, a fresh new batch of interns is available to take on that task and you progress to the rank of Senior Resident. This was supposed to be an opportunity for less time to be spent with your nose in a computer, and more time face to face with patients; less time spent typing, scrolling, editing and more time spent actually making decisions; less time being an Intern, more time being a Doctor. So suffice it to say that when I made the transition from Intern to Senior on July 1st 2016, it was with welcome arms. After 6 brutal back-to-back inpatient months leading into this, the first block of my second year, I was already on the edge.  Looking back, I had endured that last Intern Block simply through sheer will alone, certain that the magic of being a senior would alleviate all my troubles. Boy was I wrong. Imagine doing all of the work of an Intern, with one less level of oversight, all the while still expected to perform all of those tasks of a senior. I was already physically, mentally, emotionally, and spiritually exhausted, and after only getting through the last Intern block with the hope of a lighter payload come July first, the realization that I was now required to pull double duty was just too much to bear. I burned out. I gave up. I remember vividly sitting in our terribly “cozy” 10x10ft rounding room at about 8pm, on my first of a string of 6 night shifts.  The fluorescent lights of nearly unbearable intensity filling the room with disorienting luminescence, as I sit languidly staring into my computer in sheer panic. Questions of such existential matters began flying out of my head, “Why am I here?” “What am I doing with my life?” “Why am I doing this?” Each one pulverizing my spirits more and more as I sank lower and lower into my chair in hallowed despair.  Eerily, I began hearing the words “I don’t know what to do,” repeated over and over. Softly at first, then louder. And louder. Somewhere between the decibel level of crowded-room conversation and airplane tarmac, I realized that it was me who was talking. “Strange,” I thought, “Because I know exactly what to do.” I wanted to RUN. To GET OUT NOW. I wanted to break out of those deathly 4 walls and into the hundred-plus degree Tucson July air and go absolutely anywhere, anywhere but here. I began to seriously consider my options. “So there is an attending, and she is more than capable of handling these patients, so more than likely no one would die. But...what if something really did happen?” As I seriously pondered the possible implications of literally walking out on my Job, the phone rang. Caller ID: 694-5868. Every resident in the entire hospital has this number burned into their memory. Famous for calling right before, (or right after) signout, this was the number for Patient Placement, the central office who distributes admissions. My heart sank. I was getting an admission. I ruefully answered, noted the ED bed number and hung up before a litany of self-pitying remarks came flowing from my mouth on the unsuspecting and undeserving Operator. I began looking up the patient, getting a sense of what I was getting myself into.  Mr. Woolworth, 84yoM, Hypertensive Emergency, NSTEMI. I quickly opened a note template, populated all the objective data, and whipped up quite the comprehensive assessment and plan, pleased that I could do so in such a short time, without ever laying eyes on the patient. “Get in, get out, lets make this a quick, straight-forward admission,” I willed to myself in my head while descending the 2 flights of stairs to the ED.

Arriving into ED bay 31, I met Mr. Woolworth. He was tall, sitting up in a low gurney his eyes were exactly on the level of my 5 foot 10 inch frame, while his feet emerged from under his hospital sheets, dangling out over the edge of the bed frame. He was a slender but strong and wiry African American Gentleman, who appeared to be not a day over 65. His huge white Afro rose in stark contrast to his Dark Chocolate complexion, with even darker freckles dotting his cheeks. He looked at me with a smirk that revealed his jovial spirit and matched his southern drawl.  "Hello Mr. Woolworth, My name is Dr. Schatz, and I'm going to be taking care of you upstairs." My outstretched hand became engulfed in a firm yet gentle embrace with a wide palm that I could tell from its coarse texture, was no stranger to hard work. My H&P questioning was met with all sorts of witty aphorisms that characterized his joie de vivre, sayings such as “I’m alive ain’t I?” or “The good lord brought me this far, why should I stop now?” I couldn’t help but be endeared by this man, partly by his handsome exterior, partly by his youthful exuberance, lighthearted demeanor, and genuine zest for life.

It was somewhere between asking him if I could listen to him, holding up my stethoscope(“What, chu ain’t been listenin to anything I said so far?”) and re-cycling his blood pressure cuff (210/170, “But I’m tellin’ ya’ll, I feel fine”) that I realized I no longer had that feeling of panic. I was still in his ED room 45 minutes later, chatting with him about whether or not the cafeteria would be able to provide vegetarian meals(“Doc, I don’t eat nothin’ with a face”),  when my phone rang again. 694-5868. Silencing the phone, I notified Mr. Woolworth that I had to go, promising to see him again on the 4th floor. As you might expect, he offered me a gracious and genuine "Thank you" from the bottom of his heart for taking care of him. I smiled, and accepted.

As I stepped out, answered the call, and accepted the admission, a smile slowly spread across my face.

Thank you, Mr. Woolworth. From the bottom of my heart.