A Functional Medicine Case Report

A Functional Medicine Case Report

Over at Respectful Insolence is an article entitled What "functional medicine" really is.

Read it first. The come back. I'll wait.

You back? One take home quote from Orac was

They can always find ways to justify any form of treatment, be it science-based or quackery, simply by invoking the "biochemical individuality" of the human being whom they are treating.

I came across Refractory Depression, Fatigue, Irritable Bowel Syndrome, and Chronic Pain: A Functional Medicine Case Report.

Man.

Do they justify any form of treatment in this case report.

I'm an Infectious Disease doc by trade and two things are worth noting in the report from an ID perspective.

The first is they found Candida glabrata in the stool. Normal flora. They called it Yeast overgrowth. No such thing. It was treated for a month with fluconazole 100 mg a day, a dose that is more on the homeopathic end. In the real world, where we treat real diseases, the dose would be closer to 400 to 800 mg a day.

I remain of the opinion that diagnosing and treating Candida overgrowth is 100% sensitive and specific that the provider has no understanding of infectious diseases.

Also the diagnosis of dysbiosis was made to due to

No growth for beneficial bacteria (Lactobacillus, E coli) 4+ growth (Citrobacter braakii and youngae)

and treats the patient with

Probiotics (multiple: Lactobacillus and Bifidobacteria species plus Saccharamyces boulardii) daily

E. coli, a minor constituent of the gi tract, is hardly "beneficial" and beneficial in what way? What can be said about the GI microbiome is that the "beneficial" microbes are likely the ones that can't be grown in the lab.

The Sesame Street level conceptual understanding of dividing bacteria into 'good' and 'bad' should not be in the medical literature

Saccharamyces boulardii, unlike C. glabrata, is not normal gi flora, but a tropical strain of yeast, isolated from lychee and mangosteen fruit.  Oh. And we spell it Saccharomyces. Regular readers know there is real issues if I find a spelling problem

And the Lactobaccili and Bifidobacteria in probiotics are not the same as indiginous organisms of the same name. All Lactobacilli and Bifidobacterium are the same.

Lactobacillus and bifidobacterial cultures are increasingly used as probiotics in pharmaceuticals and in foods. The selection of strains is performed often for technological rather than for microecological reasons.

So they give unneeded antifungals for normal flora and try and treat a 'dysbiosis' by giving nonindiginous bacterial and fungal organisms. Of course. It so makes sense to me.

And I bet they gave the Saccharomyces at the same time as the fluconazole, although they did not say in the paper.

The paper concludes by saying

the comprehensive approach outlined here integrated the clinical expertise found in organ-system-based disciplines with the perspective of functional medicine's systems-biology approach.

Combined with what appears to be a profound lack of understanding of infectious diseases.

I can't speak for the other labs ordered and the supplements the patient took; it is outside my knowledge base. I suspect it is a target rich environment for those who are knowledgeable in the area.

But the microbiologic component can only elicit a simultaneous head shake and eye roll. It reads more like the approach of an ND rather than an MD.

Points of Interest 12/07/2016
Points of Interest 12/06/2016