With his newest book, The Disease Delusion, functional medicine pioneer, Jeff Bland, PhD, endeavors to help practitioners and patients alike fundamentally change how we view illness, health, and healing.
This deeply researched, yet thoroughly readable book challenges one of our most deeply held beliefs: the notion that chronic diseases are fixed and distinct “entities” to be treated with fixed therapeutic protocols.
Rather, Bland posits that what we call “diseases” are stable though dysfunctional patterns of imbalance in seven core physiologic processes. Genetics may predispose people to certain of these imbalances, but few illnesses are truly “genetic” in the deterministic sense.
Practitioners, Bland contends, should direct effort toward restoring physiological balance and correcting mismatches between a patient’s genetics and his or her environment and behavior.
The Disease Delusion brings together the major principles first laid out in the Institute for Functional Medicine's Textbook of Functional Medicine, but offers them in a more up-to-date format for a wider audience. The book echoes ancient principles underlying healing systems like Ayurveda and Chinese medicine, but is equally grounded in Bland’s thorough understanding of physiology, biochemistry and molecular biology.
I caught up with Dr. Bland at the Institute for Functional Medicine’s 2014 International Conference in San Francisco to discuss The Disease Delusion, and his vision of the future of healthcare.
NG: “The Disease Delusion” is a provocative title, what would you say to people who might misunderstand and say, “I’ve just been diagnosed with cancer. Are you saying I am making it up?”
JB: The title seems contradictory because we know there are diseases, and so one would logically ask, why would I call a book The Disease Delusion when it’s not a delusion when you have a disease?
The delusion is that most of us carry the view that these diseases came hard-wired into our genes, so, we get our breast cancer from our mother, our prostate cancer from our father, we get our diabetes from our parents and so forth, and that these are genetically related, inevitable conditions that we didn’t have much control over.
Over the last 25 years with the deciphering of the human genome, we didn’t find that genes coded for specific diseases; they coded for specific functions that would respond in that individual to their own environment, their own lifestyle, diet, exercise, stress, environmental exposures. When those individual responses come together to create a dysfunction in physiology, we later call it a disease. So it’s not that they are hard-wired and inevitable, it’s that they are unique to our own strengths and weaknesses.
Now does that mean people should be blamed for their disease? No! What that means that is that they should recognize that within their genes are powerful opportunities for great health! Everybody has in their genetic structure, health. And everybody has in their genetic structure the capability of disease. Some people have greater numbers of health attributes than others. However, all of us have the white light of good health if we turn on what I call our bliss genes and we turn off our tragedy genes.
Now how to we do that? By designing a specific lifestyle, environment, diet, exercise program that is matched to our genetic strengths and not playing into our genetic susceptibilities. It’s not a one-size fits all. The program for even your brother or sister might be slightly different than the one for you to optimize your genetic expression of the white light of good health.
So the concept of “disease delusion” is about the delusion as to the origin. It is a very empowering concept, because now it gives people the knowledge from these scientific discoveries that they can, with the implementation of an appropriate program, turn around what appears to be inevitability of disease, into the inevitability of good health. That’s the message of the book.
NG: Why did you choose to release this particular book now?
JB: Good question. I think there are two reasons. Number one is that when we authored the Textbook of Functional in its first edition, it was written in 2001-3 and published in 2005, and then revised and republished in 2009. Over this period there has been the most remarkable revolution in understanding of the origin of chronic disease in the history of human science. We are living through an epic period in which the doubling time of information is every three years. So there is so much that has happened to give explanations for the origins of heart disease, diabetes, certain forms of cancer, dementia, arthritis, digestive disorders that we didn’t know when the Textbook was written. Medicine
Empowering people to have access to that information was one of the first reasons for writing the book. The second is that over the last 10 years since the Textbook has been written, the ability to test many of these concepts through research and clinical trials has been accomplished. Our own group has published probably more than 60 papers that relate to whether this model we propose really holds up, whether it’s true.
This is just a part of the broader body of literature. There’s exploding literature on clinical validation of these concepts. So I wanted to bring that weight of extraordinary new information to readers who are having to make decisions as they are growing older about how to manage their health. The options are far greater today than they were 10 years ago to create a health program particular to their needs.
NG: The book encapsulates so many colossal changes in our thinking. When comparing it to the conventional reductionistic perspective, it seems like it represents nothing less than a revolution.
It is a revolution of similar magnitude to what we saw when it was recognized that infection could cause disease, which was a little over 100 years ago. That completely transformed our view of health and disease. At the turn of the last century people were thinking there were humors, hot and cold, warm and moist - these things were causing illness – they didn’t really know the origin of infectious diseases, and we had 1 out of every 3 children die postpartum, and 1 out of 6 women who had children ended up with some form of sepsis as a consequence of infection.
Once those particular discoveries were made, it increased life expectancy by almost 20 years, by just applying these concepts of “bugs cause disease, let’s keep hygiene and sanitation.” And then antibiotics, and then immunization.
We are undergoing the same kind of transformative discovery today, not about infectious disease, but around these chronic complex diseases. I believe we will have another huge bump in life expectancy as we implement these concepts. We’ll reduce the burden of unnecessary disease. Our health span will improve.
This will be a distributive healthcare system versus a top down system based on specialty medicine. It is going to become a variety of collaborators that have certain expertise in exercise, stress management, diet, botanicals, various types of physical medicine. All of these disciplines will work together collaboratively to develop a personalized system that delivers to the person what they’re going to have to do to manage their health.
NG: It seems like many so-called “CAM” practitioners are still caught up to varying degrees in protocols for specific disease states. Even though they are much better at treating the “person” rather than just the disease, the conceptual shift still needs to penetrate further into awareness.
JB: I think that’s beautifully insightful. What happens in “CAM” –and by the way I’m not being critical, I’m just making an observation having been in CAM for thirty plus years-- is it’s a kind of “green medicine.” Its concept is: “Well, drugs are toxic so let’s use a plant or a nutrient that’s less toxic.” But we’re going to use the same strategy, we are still going to look at the disease, and we’re going to treat the cause of the disease with a safer intervention, versus saying, “What, really, is a disease?”
A disease is a product of a mismatch been that person’s genes and their environment, so let’s look at the cause and not the effect. The disease and what we call it is not important. What’s important is how the person got the dysfunction that produces the disability that they are later going to call the disease. So let’s focus upstream at the cause. When we do that, then we are obligated to say, what’s the genetic strength and weakness of the person? What are they doing in their daily life, and what are they exposed to? These become the therapeutic tools, so it’s not just treating a symptom with a green medicine.
NG: Moving to features of systems biology, and features of complex adaptive systems, there is the concept of “hormesis”--how small things can make big changes to an entire system. You mention this in the book. Is this similar to chaos theory?
JB: I would say yes and no. Chaos theory is a little related to a tipping point with a small perturbation of the system that then creates a disruption of the system. But that small thing can also cause an aggregation in, or harmonic entrainment of the system too, right where it is the organizing factor. So rather than always being a disorganizing factor it (a small change) can also be an organizing factor. So hormesis can either be a positive or a negative on the stability of the system. When we think of BPA (the toxin, bisphenol A), it could have a negative hormetic effect, because it can cause disruption to the system. But ginger could have a positive hermetic effect causing the system to stabilize itself.
NG: In complex adaptive systems, “tipping points” can be very relevant. I notice with my CFS patients that they can be taking numerous multifactorial approaches over many months, and the analogy is like those old balancing scales: each treatment may take off one weight from one side of the scales, but the scales wont go back into balance until the very last weight is removed.
JB: This is what Dr Sidney Baker calls his “tacks” rule: if you’re sitting on two tacks and you take one out, do you get a 50% reduction in your pain? Of the course the answer is, no. You have to take both tacks out before you feel the difference. This is one of the fundamental principles of functional medicine and we’ve talking about this for 25 years.
NG: I think many patients give up too soon on treatments because they haven’t understood this – and it is vital for practitioners to understand if they want to retain patients.
JB: What people need to understand is that when a system is perturbed, it will then move to a new state of function that is stable. It is a stable disturbed system, meaning the person has symptoms. The body is over here saying, “OK, I’m stable, I’m going to be like this for years, and you’re going to know about it right?” Then as you restore the function of that system by changing the variables, you get to the hundredth monkey, that one that triggers a new state function and now it jumps almost like a quantum effect to its original resting healthy state. But you had to actually change the system to such an extent that a system that was, say, homeostatic to diabetes becomes homeostatic to normoglycemia.
NG: Changing subjects a bit, let’s talk about nutrigenomics and the revolution in genetic testing. The company 23andMe continues to impact the public because of the low-cost of its tests. Although the FDA has banned 23andMe from offering health risk analysis reports, consumers can still order their raw genome data, and now other websites are offering analyses.
JB: Yes, absolutely. You know, the government can’t legislate against this. There will be no government in the world that can legislate against this revolution that’s happening with genetic typing, and its relationship with health and disease. Trying to prevent people getting access to their genetic data is like trying to legislate against the internet.
NG: So what do you think about the health risk analysis issue? Do you think health analysis should only be given through qualified practitioners?
JB: Well, I think there are two parts to that. Number one is that the focus today on genetic testing is always to be looking for the bad news, the “What’s my disease risk?” I would turn this entire thing around, I would say that’s not the real information – it’s what’s your health opportunity? So, say this is not about relative risk and the gloom and doom model of, “I have a 40% risk of this, and 25% risk of this” and living in fear that you are going to get one of these diseases like the Monte Carlo effect of pulling the big handle of the slot machine.
Rather, say “Look at these unique characteristics I have that if I can activate these, these are my health characteristics, they will allow me to ward off infection, they will allow me to repair a wound, they will allow me to have good mental function, these are my strengths.” Everyone has genetic strengths, just as everyone has genetic susceptibilities, so why are we always focusing on the disease? I think this is where the real opportunity lies: to bring out the characteristics that give me natural defense and give me the proper repair.
NG: So, we are not the victims of our genes.
JB: That’s the key. Yes, we can alter the way our genes are read. As I said in my book, our “Book of Life” is encoded in 23 chapters: half of these chapters are written by our biological mother, the other half by our biological father. The stories within each chapter are called our genes, the thousands of stories, not all being read simultaneously. If they were, we’d be a mess, because in every cell in our body is the story for every other cell type at every other age of our life, so we can’t be reading all that Book in every cell all the time, or we’re just going to be a mess.
So that means only selected portions of our Book of Life are being read. And what portion do we want to read? Do we want to read the Greek tragedy stories or do we want to read the bliss love stories? That’s our opportunity individually to figure out: How are we going to design our lives to access the information in the really good stories?
NG: Based on research by myself and some colleagues comparing test results from 23andMe and other labs, as well as cross-comparisons between different companies all interpreting data from 23andMe, there are discrepancies. There is a lack of agreement around standards and parameters used to report SNPs (Single Nucleotide Polymorphisms). There are differences in assessment of relevance, importance, and so forth. What would you say about how to resolve these issues?
JB: This is a new science, it’s new information, and like all new things, it’s in flux. So don’t over-read. It’s just a point on the curve, it’s not the answer-all. What is your answer-all is your (genetic) code. If your code is read correctly, in other words the analysis was done correctly, that will stick with you for the rest of your life, you only need that analyzed one time. The interpretation of the code, however, is going to change remarkably as the science improves. It’s a very robust iterative system and you’ll see new discoveries all the time in the coming years.
NG: At the moment, in the wrong hands, mistakes can be made with the interpretation such as inadvertently treating the SNP rather than the person. So training for healthcare professionals working with the genome data seems important.
JB: Yes, I think with any new technology it should be sifted through by the people who understand the technology and can sift out some of the wild cards. Over time, as people get more comfortable and the group intelligent increases, then the reliance on professionals declines, but I think for the next say 10 years, healthcare professionals are going to be critically important as the conduits to the person to help them not over-react or not to get overly concerned and so forth.
You have to have professionals who are going to provide the service to people in need of a new type of collaborative relationship. And you have to have consumers who are asking for a different set of services. But they have to know the questions to ask. If you don’t know the questions to ask, you’re never going to ask for those services so there will be no reason to provide them.
NG: Any final comment or message for Holistic Primary Care readers?
JB: Up to this point I believe there has been extraordinary commitment, energy and tireless work on the part of holistically-minded practitioners to provide service to their clients and patients, without having a unifying concept as to how their particular efforts are going to fit into the big picture of transformation. I think this big picture of opportunity for transformation is emerging so that their efforts will be multiplied in value. It wont be one patient at a time, it’ll be a multiplicative value as we get the concept that each one of these skills is part of a broader whole of creating this transformation in healthcare based upon this model. So it’s not just a grab bag or smorgasbord of different techniques; acupuncture one day, aromatherapy the next. It’s an integrated construct of how we transform thinking about health and disease.
Holistic Primary Care would like to thank our friends at CAM Magazine, the UK’s leading publication for holistic practitioners, for allowing us to use this interview material which was originally published as a cover story in their July 2014 edition.
Niki Gratrix is an internationally renowned, award-winning nutritional therapist and coach who originally co-founded one of the largest complementary and alternative health clinics in the UK. Niki was Director of Nutrition where she formulated the nutrition protocol, trained 5 other therapists and completed over 7,000 consultations. Niki trained at the Institute for Optimum Nutrition in the UK and served as the Vice Chair of the British Association for Applied Nutrition and Nutritional Therapy in 2012-2013. She speaks internationally, writes in a range of health magazines. Niki also has a certificate in NLP (Performance Partnership) and originally got her degree in Economics and International Politics from the University of Warwick, UK. Reach Niki via her website: www.NikiGratrix.com