Why We Get Sick—and How To Get Well
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Why We Get Sick—and How To Get Well

by Chris Kresser

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If you have one of the many chronic health problems that people suffer from today—such as IBS, fibromyalgia, chronic fatigue, and autoimmune disease—you will likely be given a drug to manage your symptoms and not much else. The key to successfully treating these conditions, however, is addressing their underlying cause. This is the promise of functional and evolutionary medicine.

We’re in the midst of the most serious epidemic of chronic disease humans have ever faced. Half of US adults have one or more chronic health conditions, and 25 percent have two or more. (1) 7 of the top 10 causes of death in 2010 were chronic diseases, and two of them—heart disease and cancer—together accounted for almost half of all deaths. (2)    

While some of these problems (like heart disease) are fairly well-understood by conventional medicine, others are more mysterious. Conditions like Irritable Bowel Syndrome (IBS), chronic fatigue, diverticulosis, fibromyalgia, and autoimmune disease together affect hundreds of millions of people around the world, but in most cases, patients are told that the causes of their condition are unknown and simply prescribed drugs to manage the symptoms.

But is it really true that we don’t know what causes chronic illness? Certainly, there are particulars related to each specific illness that we don’t yet understand. But I would argue that we do, in fact, have a solid grasp on the most important factors that contribute to virtually all chronic disease. This means that it is within our power now to prevent, and even reverse, many of these conditions.

The Functional Medicine Systems Model

As many of you know, I will be launching a Functional Medicine training program for clinicians later this year. (You can learn more about it here, and stay tuned for another announcement in the next few weeks!) In preparing for that program, I’ve created a “unified theory” of what causes disease that I call the Functional Medicine Systems Model. I’d like to share that with you here, and use it as a springboard for our discussion.

exposome + genome copy

As the diagram illustrates, the interaction between an individual’s genome, epigenome, and exposome is at the core of what determines our health.

The genome is our complete set of DNA, containing all of the information needed to build and maintain the human organism.

The epigenome consists of chemicals that modify the genome in a way that tells it what to do, where to do it, and when to do it. These modifications do not change the underlying genes, but they can be passed on to future generations.

The exposome represents the sum total of all non-genetic exposures an individual experiences from the moment of their conception through the end of their life. It includes the food we eat, the water we drink, the air we breathe, the chemicals we’re exposed to, the social connections we have, and the environment we live in.

Did you know that 8 underlying causes are at the root of most chronic disease?

To use an analogy, the genome is like a piano; the epigenome is like the sheet music, and the exposome is what determines how the music is written and performed. The quality of the piano will certainly affect the sound that it produces. But the finest piano in the world will still sound terrible if the sheet music and performance are terrible. Likewise, a virtuoso pianist performing a Mozart piece will not be at her best playing a poor-quality piano.

In the same way, genetics do play an important role in human health and disease. However, we now know that the exposome (and its influence on the epigenome) is far more significant in most cases. In fact, it is responsible for more than 90 percent of human disease. That is why the exposome is at the core of the Functional Medicine Systems Model, and should always be the first thing addressed regardless of the patient’s complaint.

The modern diet, lifestyle, and environment affect the expression of our genes and lead to pathology, which in turn cause disease and symptoms in the patient.

But what are those pathologies?

The 8 Core Pathologies That Underlie All Chronic Disease

I believe that virtually all diseases and symptoms that we experience are caused by one or more of the following 8 core pathologies:

  1. Gut dysfunction. Includes small intestine bacterial overgrowth (SIBO), infections (e.g. parasites, pathogenic bacteria, viruses), low stomach acid, bile, and enzyme production, intestinal permeability, and food intolerances.
  2. Nutrient imbalance. Includes deficiency of nutrients like B12, iron, folate, magnesium, zinc, EPA/DHA and fat-soluble vitamins (most common), and excess of nutrients like iron (less common).
  3. HPA axis dysregulation. Includes regulating the communication between the hypothalamus, pituitary, and adrenal glands, and balancing the production of hormones associated with those glands (e.g. DHEA, cortisol)
  4. Toxic burden. Includes exposure to chemicals (e.g. BPA, phthalates, etc.), heavy metals (e.g. mercury, arsenic), biotoxins (e.g. mold/mycotoxins, inflamm), or impaired detoxification capacity due to nutrient deficiency, GI issues, or other causes.
  5. Chronic infections. Includes “stealth” infections by tick-borne organisms (e.g. Borrelia, Babesia, Bartonella, Erlichia), intracellular bacteria (e.g. Mycoplamsa, Chlamydophila), viruses (e.g. HHV-6, HPV), and dental bacteria.
  6. Hormone imbalance. Includes hormones associated metabolism (e.g. insulin, leptin), thyroid, and gonads (e.g. estrogen, progesterone, testosterone).
  7. Immune dysregulation. Includes autoimmunity, underactive immune function, and chronic, systemic inflammation. 
  8. Cellular dysfunction. Impaired methylation, energy production, and mitochondrial function, and oxidative damage.

These pathologies (and the exposome-genome-epigenome interactions that lead to them) are at the root of everything from obesity, to Hashimoto’s thyroiditis, to asthma, to autism spectrum disorders, to depression. The understanding that the same 8 core pathologies underlie most modern, chronic diseases has profound implications for how we should address these conditions.

In conventional medicine, the focus is often on diseases and the symptoms; it works “from the outside in”. For example, let’s say that you go to the doctor for your annual exam and your blood tests reveal that you have “high cholesterol”. The most likely outcome in this situation is that you’ll be prescribed a statin, and in some cases be told to exercise more and eat better. There is rarely any serious investigation into what caused the high cholesterol in the first place.

In Functional Medicine, however, we work “from the inside out”. We pay less attention to the symptoms and more attention to the pathology that produces those symptoms. High cholesterol is a symptom, not a pathology. The pathologies that can lead to high cholesterol include poor thyroid function, intestinal permeability, disrupted gut microbiome, chronic viral or bacterial infections, insulin and leptin resistance, and nutrient imbalances—to name a few. If I find high cholesterol in a patient, we will examine all of these potential pathologies, and of course, we will also look at how the individual’s genetics, diet, lifestyle, and other factors related to the exposome may be contributing to them. Once we have addressed all of the core pathologies, the cholesterol levels typically normalize on their own.

Whether the patient’s main complaint is infertility, fatigue, sinusitis, or skin problems, I will focus on these 8 core pathologies because I know (from both clinical experience and research) that they are the most likely underlying causes of their condition. In my practice, most of my patients are dealing with not just one of these pathologies, but several.

As you can see, this is a fundamentally different approach than what is typically done in the conventional setting. The downside is that it requires a lot more testing and investigation up front, which can be costly and time-consuming. The upside—which obliterates any of the downside considerations—is that it becomes possible to not only prevent but even reverse many chronic disease conditions without the need for taking medication for the rest of your life.

Unfortunately, the Functional Medicine approach is not yet embraced within the conventional healthcare model. But I believe that is changing. The prestigious Cleveland Clinic just launched a Center for Functional Medicine, directed by Functional Medicine pioneer Dr. Mark Hyman. This is a big step toward mainstream acceptance of Functional Medicine, and the research the center is engaged in will almost certainly lead to even broader recognition.

I think health insurance companies will also see the benefits of Functional Medicine. They’ll recognize that spending a little more money up front to properly diagnose and treat the root of the problem will lead to enormous savings down the line.

These changes aren’t going to happen overnight, and we still have a lot of work to do. But the tide really is starting to turn!

If you’re a healthcare practitioner and you’re interested in training in this approach, learn more about the ADAPT Practitioner Training Program.

If you’re struggling with a chronic health problem and are interested in learning more about how this approach can help you, click here to learn more about how my team and I work with patients and set up an initial consultation.

Now I’d like to hear from you. Have you been able to resolve chronic health problems by addressing any of the core pathologies I listed above? Have you found success with a Functional Medicine and ancestral nutrition/lifestyle approach? How did that compare to what conventional medicine offered for your condition? Let us know in the comments section.


Join the conversation

  1. First, I did not read all the comments above (sorry; not enough time). Instead, I searched for “intolerance” on the page but found nothing relevant on the 3 instances that came up.

    I want to share our family experience with food intolerance. This developed in the males (father first, son at similar age later) as adult-onset. The symptoms (the same for both) were getting worse, serious and disabling. The first time, an intelligent doctor said “No, it is not cancer or a parasite or whatever, it looks like something you are eating.” The patient, being an experimental scientist, conducted 2 years of experimentation, with the result of excluding all grains, big or small, from his diet. Examples of excluded: wheat, corn, rice, peas, beans, black pepper, grain spices, coffee, chocolate, all “vegetable” oils (except olive virgin first press), annato, food additives such as emulsifiers etc, … Bingo: end of problem. That was almost 30 years ago. Since then, provided we shop carefully and cook at home with safe ingredients, the patient is healthy.

    Clearly, we rarely (if ever) “go out” as a family to eat. We also have built quite a repertoire of how to shop and cook at home (but nobody “outside” seems to care much; I mentioned this by email to an acquaintance in the Nutrition program at the local U and got not even a response). When invited to something that includes food, our men typically take along their food (cannot expect others to understand such restrictions; some have tried, and included things that hurt, not knowing enough to ask). I have known people with celiac, this helped (these would be fine on our “diet”). Basically, we cook much like our rural grandparents did, using what we have and what works (root, bark, leaf; meat, eggs, dairy; we de-seed tomatoes, etc).

    • You are describing my life. It’s a challenge to do social things as almost everything social involves food.
      I also had to do my own research and experiment s as Doctors had no idea and recommended things that made me much worse.
      Life is getting easier thanks to the paleo movement. Not that I follow any “diet” as such but for going out Paleo would be the closest thing I could eat if I’m caught out.
      The social isolation is hard, and being treated as if this is my lifestyle choice harder.
      Thanks for sharing your experience. It helps to know I’m not alone.

  2. Actually, I’m this article highlights the causes and indeed but very little is said about How to Get Well.

    The Jury is out on Mr Kresser for 4 reasons.

    Firstly, his articles on the acid/alkaline myth are mythical, basically summarising that urine acid levels only reflect the acidity of the urine and aren’t indicative of levels in the body. The whole article tries to debunk acidity in the body, which is an acidic stance in itself. Whilst alkalinity may not be the answer to everything, of course over acidity can create a toxic load. Also, why eating bacon and beef can be good for you if it’s super grass-finished and killed humanly, no one size fits all, especially different people with different problems and at different levels of health. Someone with impaired glutathione conjugation, and missing genes for Methylation, with heavy metal burden, and yeast overgrowth, may find any additional acidic input from food extremely damaging to tissues. Of course it matter, it’s ignorance to claim acidity is not extremely important in some cases.

    Secondly, his interviews are on occasion extremely negative, I’ve heard him talk on R. Arthritis, and what he would do in that circumstance, basically giving very little hope tojjjuu those who have it. It’s in a par with Karazzians “when we see x, y, and z together, we get very very nervous” comments, frightening to most who are already anxious about their health. Hyman never reveals a chink of darkness regarding the possibility of reversibility nor lack of hope and nor should any seriously positive, healthy, health professional.

    Thirdly, I’m not convinced Kresser has addressed his own mitochondrial challenges. He comes across very low energy, monotone and down beat and one wonders, if his methods are not working for him……………??

    Lastly, this article is just a list of causes, which in fact conventional pharmaceutical medicine doesn’t really disagree with albeit they don’t have the resources nor sanctions to test for all of these things….that’s coming with Theranos. However, the article makes the claim that it communicate how people can get well…..where?? All I learned is an elongated list of testing I might have to do…..and the second bit…..getting well?

    Not convinced about Kresser’s abilities nor underlying PMA at all.

    People believe because they do a bit of good, that damage has to be overlooked if it is minimal. This is not the case. One has to take a very good look at the overall all net product of ones efforts, and assess, honestly and deeply whether the net, net, net toll on the universe is indeed positive or not. Sometimes, doing nothing is a more compassionate stall, this applies to many who just don’t care to look and intuit.

  3. Hi Chris,

    I listen to your podcast and read your articles and am so grateful for all of the information and help I receive. I have a question that I can’t seem to get an answer to. I’m hoping you can help! How much mercury in the blood is dangerous? I am having neurological problems (likely peripheral neuropathy) and diagnosed Erythromelalgia (rare). My neurologist ran a slew of blood tests including mercury, which was 11. The “normal” range is 0-10. My PCP referred to my result as “sub clinical”. Tell me please, would you be concerned with a mercury level of 10? The only advice I received from the neurologist was to avoid fish that are high on the food chain like swordfish, halibut, grouper, etc. I love fish and eat fish 3-4 times a week and have been avoiding the big fish but would very much appreciate your advice. Thank you.

    • check out the Quicksilver tests from Colorado. Lots of docs and dentists order them now, you can also ask them who. It uses blood hair and urine to give a much better heavy metals testing. I had my first one in 2010 and second in 2015 (I know Chris uses this test now with his patients).

  4. Wow! First of all my deepest empathy to all of you who are suffering in one form or another and koodo’s to all of you for being open minded enough to look beyond traditional medicine. I do believe that functional medicine is the way to go and strongly believe it can work if you make the commitment to what ever life style changes are required. I also hope the traditional medical community will take off their blinders to see a different side of health care.
    I suffer from silent reflux. A condition that has severely affected my breathing. It just crept up on me one day. I have gone from being a 10km runner to not running at all and sometimes even struggle to catch my breath going up stairs. The traditional medical community went straight to Nexium (I don’t take it). I have started seeing a local naturopath who strongly believes in functional healing and I sure I will be running again in no time. Keep the faith, things can change.

  5. I am new to this site in hope to find an possible answer and some much need help or advice to a very troubling issue.
    I started to see a nutritional it’s and a functional doctor if how of finding why I had severe depression and anxiety.
    They did the DNA methylation test and Started to work on leaky gut, celiac, and SIBO.
    How ever, after starting treatment for this we then found out I had parasites and had to do 5 month cleanse which at this point I had to stop since it became to have on my body. I had already lost a lot of weight ( down 40lbs in one yr.- 96lbs anorexic).
    But since doing the cleanse my mental state had continued to deteriorate with more depression, anxiety, confusion, brain fog, dizziness, poor concentration, and cause me much fear.
    I can’t seem to get a answer to why from either dr.
    Was wondering if I may be still having detox from supplements and toxins running wild.
    Need to find a good functional dr near Pa.
    Any one every have or experience this. Any advise from Chris or others reading my post. VERY SCARED AND DESPERATE FOR HELP!!!

    • In my opinion, it’s very likely that a mineral imbalance could be one of, if not the central cause of your issues. You may consider getting an HTMA (hair tissue mineral analysis) done to assess your current mineral status, find any obvious deficiencies, and at the same time determine if there are any supplements or substances that could actually worsen your condition. I’ve found it to be an extremely cost effective and efficient way to either determine crucial information about the health of my patients, and to also rule out any obvious imbalances in mineral ratios. Hope that helps

    • Sheila,

      Sorry you’re going through all that. Did your doctor address heavy metals? What kind of diet were you on?

      Functionalmedicine dot org has a feature to search for doctors.

      Hope this helps.

    • I have it like that Sheila. I have loose much weight now and it is just the skin and bone of me. I have SIBO. And here in Norway they can not help me. I am so sick no. The metabolism is totally wrong. I had no immune system. I not tolerated food or nothing else. I have muc much toxiner in my body. I have parasites and i CSN not swollowing,breathing. I can not be out. I have so
      Much pain in my stomach,in my body,balcpain,neck,snd muc in my head and brainfog. I think i will die soon. I am desperate. Dear Chris. I wish i live there so i could get help. Can you help me? PleSe.

  6. Chris, your initial question was regarding resolving one or more of the core pathologies listed above. Here is an interesting contrast for you.

    I have two sons, in their early 20’s each with Crohn’s disease. Last summer the younger son was also diagnosed with Celiac Disease. As a result, we changed his diet to autoimmune paleo then paleo. He still takes his Crohn’s medication but we are weaning it. He also takes supplements and has really watched his food intake to heal his leaky gut. remove toxins etc and he has improved immensely! Conversely, the older of the two, not compliant with his western meds, has had a significant downturn in his health. For the past few months he has been dealing with pain, high powered drugs and hospital stays. The result is he will be having surgery next week to remove a fistula and terminal ileum, reattaching the small and large intestine. I feel certain if I could have convinced him earlier this year about the benefits of taking control of his health he would not be in this situation. I have two young men, same disease, two differing views on health and lifestyle.

    The younger one is living at home so managing his diet is easier. We did spend quite a bit of money on his testing and supplements. My older one thought that since insurance didn’t cover the cost it was not worth the effort.

    Very saddened for my older son, who by the way, is a cancer survivor. He had Hodgkins Lymphoma at 17. Both sons…two immune diseases each….diet, environment, toxins, lifestyle…I’m convinced.

  7. I just had skin lichen planus all over my torso, front and back, for about 6 months. About a month into it, I went to my general practitioner just to see what he’s say, even though I figured he would probably prescribe a long course of oral prednisone steroids, which he did. I told him that I was going to try it my way, with something called the Autoimmune Protocol or the Elimination Diet. I also tried to manage stress, exercise, get enough sleep, and get some sunlight every day if possible, not to mention trying to be nice and care about people and life in general. It took about 3 or 4 more months, but now the lichen planus is completely gone. I’ve read that it can last years if untreated. Mine lasted about 6 months total. No prednisone needed. Love your website! I think you are helping so many people! Thanks!

  8. Hi Chris, We met at the WAPF conference a year and a half ago. We chatted; I urged you to learn German New Medicine. You said others had been urging you to learn GNM, too. I’m going to say it again: PLEASE learn German New Medicine! While this is a great article, it’s off by one component and it’s a HUGE component. Please learn GNM and you’ll understand chronic symptoms 100%.

    • The connection between the psyche and disease is indeed very real. After my father died, I was plagued for 3 years by chronic shingles. Well after the first flareup it was just a small itchy patch that grew or shrank depending on stress levels. I knew it had to be related to my father (apart from his being abusive). I finally figured out that like him, I wasn’t staying grounded in myself, my true values, etc. I often became what people thought I was or I became like them. The realization didn’t help on its own. I had to learn to live with intention (I forgave a long time ago and also acknowledged the good ways in which we were similar).

      Listening to the youtube guru Matt Kahn is what ultimately did it. After listening to his talk on intention for the third time and finding in myself a slight strengthening of conviction, the shingles started fading away. This isn’t to say I haven’t worked hard on my health in other ways and I have cut out foods that cause inflammation in my body (of which there are many). But being true to my highest self was the final piece of the puzzle.

    • Hi Andi Locke Mears,

      How would German New Medicine help if you have Vitamin D or some mineral deficiency?
      How it can explain 100% success of Chromium and Vanadium for diabetes for 2 -4 weeks?
      How it explains that babies get ill and animals get ill too?

      • This answer is for Pet who responded to my previous post urging Chris to learn German New Medicine. I appreciate your questions, Pet! There are easy answers to all your questions from a GNM perspective. I’m not sure if you know the Five Bio Laws, however, my answers wouldn’t make any sense without that knowledge. Feel free to contact me privately if you’d like to continue this discussion. Thank you!

        • Hi Andi,

          I just begin to read about Five Bio Laws – i here is what i see:
          Undernourishment, injuries, and poisoning can result in organ dysfunction(s) but cannot cause diseases such as cancer
          Well this explains everything – i can agree with the above – i am in very bad physical condition and doctors can not find what is wrong with me for years because organs are not damaged – just not functioning well. So if i understand correctly – if someone have slow thyroid – this is not disease according to GNM.

      • A vitamin or mineral deficiency would be considered malnourishment – and would require supplementation. Keep in mind some alterations is vitamin and mineral levels are side-effects of biological conflict as well. If an individual has success eliminating diabetes by taking chromium and vanadium – then it is clear a “track” to the biological program that was turned off. Biological conflicts may occur in utero. Animals are subject to biological conflicts as well. In fact out figurative human conflicts originated in the literal ones found in the animal kingdom.

  9. As an associated idea I have read and believe there to be good and evidence, that a useful first approach to a variety of chronic illness would be the treatment for candidiasis – a condition that is probably affecting a majority given our lifestyle and environment exposure and especially to medication such as antibiotics Candidiasis would seem to be part of the third layer?

    Also, I live in England and have been searching for practitioners here and abroad, especially those offering residential courses of treatment, who will take you through a course of treatment.

    I would appreciate hearing from those who have any knowledge and experience of treating candidiasis.

  10. I’m 63, been told my thyroid is dead. I’ve been gluten and dairy, sugar free (as much as possible)about 2 yrs. I’m trying to find medical support in the Chicago area. Can you offer any suggestion? Thanks for all you do.

    • Dr. Emily Lindner is a Chicago functional medicine practitioner who was very helpful with my chronic fatigue and joint pain issues.

  11. I have IBS and diverticulosis which was made worse after chemotherapy which nearly killed me because I had an adverse reaction. It is 6 years since then and I am taking tamoxifen.

    I have strong family history of allergies(sensitivities) to all dfifferent medicines mostly antibiotics( for ex. penicillan).

    I am an active sport minded woman of 67. In the last few months I have managed to get off meds for the IBS after believe it or not matzoh. It changed the system and I only take omepredex for gerd. And I feel best when eating meat. Most foods, vegetables, legumes, high fiber would make me suffer. However since about 4 months I have been able to bring these things back into my diet.

    Here is the question. I never got sick before this(cancer) and everytime I have an infection it takes much longer for me to recuperate. This is intolerable for me. I have had pneumonia this past month and it is going on 6 weeks and still am not myself. No tennis zumba or pilates.

    Just so you know I have nueropathy in my legs/feet which is also part of family history…but may have been exacerbated by the chemo. No one knows. I am never pain free but never let it totally stop me from doing what I love.

    I am not in the states now but will be in August. What suggestions do you have?.I am tired of being tired. Life is too short.

  12. I found this very interesting and hopeful for the future of medicine. Common sense says that the pharmaceutical companies would not be happy for Functional Medicine to take off in this country. They would prefer to keep going with status quo. Healthier people need less medications; people with proper nutrients and detoxification need less medications.

    I would be curious to hear from you re: any impact Moringa could have on these conditions. The NIH (www.researchmoringa.com) seems to believe it can be very helpful.

  13. Hi Chris–I am eighty four years old and have a severe curvature of the spine that I have had to live with my entire
    life. I am now unable to stand up straight and in constant pain.
    I have been taking Ibuprofin for years to help ease the pain but
    this doesn’t help very much. I realize that nothing can be done
    with my back so dealing with the pain is about all that I can do.
    Other than my back, I am in good health overall. I am 5’11” and
    weigh 165 lbs, never have smoked, do not drink, never had
    high blood pressure, diabetes, heart problems etc. I walk every day a mile or so, get 6 or so hours sleep, eat healthy as is possible with the foods that we have these days etc.
    Since my having to deal with pain and take Ibuprofin now I
    would rather take something that would help with the pain
    and not have to use the drug. Any help or suggestion that
    you might offer would be greatly appreciated. My walking is
    made a bit tough not being able to stand up straight and being bent over a bit. I want to thank you in advance for your
    advice or help of any kind.

    • Hi John,

      I’m sorry about your back, chronic pain is tough. I have back trouble due to injury. I had pretty good results from taking white willow bark, or curcumin. Chiropractic and acupuncture helped as well.

      Hope you find relief.

  14. Hi chris i live in toronto and would love ro find a dr like you for my husband who suffers from ibs, diverticulitis etc etc..the list goes on and on! Any canadian directory info would be most helpful. Thanks!

  15. Hi Chris. You are the main blog I follow.
    I’m 74, never felt better and of course, it wasn’t always that way. I was over “Antibioticed” at an early age, and on, my dad being a doctor, and Penicillin the recent “wonder Drug”.
    At middle age, Eczema, Fatigue, foggy thinking, very underweight except swelling legs and ankles, also a dry cough. 7 or 8 local Chico, CA doctors included 2 Dermatologists, 2 internists, an Alergist, a few Family doctors….You name it. No One Ever Addressed my Gut.
    Finally Diagnosed by a Farm Lady I happened to run into: “lady, you’ve got the worst case of Candida I have ever seen. When my animals have too many Antibiotics, it ruins their Gut. and that’s what you’ve got….a Ruined Gut”
    Gave me a start to research. Finally met up with Butte Valley Weston A Price group and in 3 mos on a modified GAPs diet, my skin cleared, energy returned….been going strong every since and that was 7 years ago.
    During my worst period, I kept eliminating foods from my diet until I was down to Brown Rice and Apples….and thank God for Blue Green Algae supplement, I think that is what kept me alive. no fun.

  16. conditions like heart disease are well understood. conditions like IBS, fibromyalgia, chronic fatigue, and autoimmune disease, are less understood. These diseases affect hundreds of millions across the globe.

    the unknown!!! We need to prevent and reverse these diagnoses of exclusion.

    exposome + genome and epigenome.
    exposome- the sum total of all environmental exposure from conception to death, including air, water, food, relationships, and our living spaces
    Genome- complete set of DNA containing all the information needed to build and maintain us!
    epigenome- chemicals that modify the genome in a way that tells it what to do, where to do it, and when to do it. These modifications do not change the underlying genes, but they can be passed on to future generations.

    genetics play a role in human disease, but the exposome is far more important, and should be addressed first and foremost

    Thesis: The modern diet, lifestyle, and environment affect the expression of our genes and lead to pathology, which in turn cause disease and symptoms in the patient.

    The 8 core pathologies:
    1. gut dysfunction, including SIBO

    2. Nutrient imbalance, including B vitamins and fat-soluble vitamins. That’s why I’m going to be getting my vitamin K from Life Extension sent to me right quick!

    3. Hypothalamus-Pituitary-Adrenal axis. Mine use to be buggered. Using these principles, I feel more energetic than I have EVER felt before. Not exaggerating.

    4. Toxic Burden. I’m currently doing oral chelation therapy to reduce my lead and mercury levels. DMSA is the only chelating agent (I think) that removes lead from the brain!! Check out this link for more.

    5. Chronic infections, I wonder if H. Pylori is included in this?

    6. Hormone imbalance, staying active and limiting carbohydrate intake is how I deal with this. Also, adequate protein intake 🙂

    7. Immune dysregulation, Vitamin C? managing stress? Managing sleep? managing diet? Managing exercise?

    8. Impaired methylation. I have a gene mutation in my MTHFR gene. So I take B vitamins on a daily basis and extra B12 and folate (methyltetrahydrolate) every other day.

    I love how Chris says that these 8 pathologies are at the root of EVERYTHING, including complicated social and medical diseases like obesity and depression. Imagine a cure for depression that doesn’t involve drugs!

    “The upside—which obliterates any of the downside considerations (which means high cost of time and money)—is that it becomes possible to not only prevent, but even reverse many chronic disease conditions without the need for taking medication for the rest of your life.”

    This has certainly been true in my case. I have been working with a functional medicine practitioner for months now. For the first 6 months of my treatment, I was presenting with hypothyroidism, which according to old school thinking, is a problem that requires nonstop medication for your entire life! Yet, after 6 months of focusing on my health, changing my sleep, exercise, and eating habits, my thyroid levels normalized and they’ve been great ever since. Chris’ book on thyroid disorders and Hashimoto’s was invaluable in helping me become informed and communicate effectively with my doctor.

  17. Interested in finding a reputable functional medical doctor/physician in Sydney Aus. And recommendations? Cheers !

  18. Chris, you are a bright, steady light in a very scary, dark sea of health information available. Traditional medicine information overall is very negative and generally hopeless, often resorting to dangerous drugs, surgery or your told the problem is due to old age. Alternative medicine is full of endless conflicting opinions of the best diet or of endless amounts of supplements to take that don’t help. Personally my functional medicine doctor gets frustrated when I try to explain that my body can’t handle so many supplements, or when I want to find the cause of my health problems. Chris, thank you for being my main source for finding information that I feel I can trust. You always make sense to me! You are a great public servant, because for most of us, we do not have access to “true” functional medicine that treats us as individuals.

  19. Chris thank you for your invaluable continuous contribution to my life. I have been following you for a long time now and I have seen various health benefits by practicing your advice. I have been on a low carb diet, gluten free, high in quality fats (from meat, grass-fed butter, coconut oil, etc), protein from meat, fish and dairy products, among which keffir and plenty of live yogurt. Also I take probiotics plus digestive enzymes to support my gut, and brazil nuts for detoxification, plus 4000 IU of vitamin D per day because I have hashimoto’s and lichen planus (hoping to raise my blood levels to between 60-90 per Dr Amy Myers suggestion for people with autoimmune problems). Any other suggestions for my two autoimmune conditions will be truly appreciated. Thanks Chris! Keep up the good work

  20. There has been a lot of talk about gut dysbiosis and leaky gut etc. recently but nothing said about diverticulitis. I would very much appreciate some information about how to improve this condition.

    • Hi Jan, I have Diverticulosis and about two years ago I had 6 months of continual colds or flu and was going to the emergency once a month for antibiotics. My daughter, who was on the Paleo Diet urged me to try it. So I tried only cutting out grains and legumes and I notice a hugh different in how my gut felt by that same afternoon, then I tried the complete diet and I haven’t had any problems since. I hardly ever get sick anymore either.
      Hope this helps, it really helped me.

  21. Thanks Chris for this well explained article. I found out a year ago that my multiple pathologies were related to each other (HT, infertility, hormonal issues, skin issues, gut issues).

    I want to be on the road to recovery and find a good Functional Medicine doctor that understands everything you just said. What is the best resource/directory to find one? I live in Seattle, one of the best cities in the nation for medical treatment, yet I have no clue how to sift through all of the crap doctors.

    • I too am in need of a functional medical doctor in the Seattle, Edmonds or Kitsap county in Washington state.

  22. Re: functional medicine practitioners — there are several comments here about how some have not been as helpful as hoped for. This is a real issue, and I know it first hand. There are many good ones, but also many others who call themselves FPs but who really only layer a few tests or protocols on top of conventional medicine, and some of whom don’t even evaluate lab results by apply FM optimal lab ranges. It can be very costly and frustrating. When the great divide between science and medicine finally comes together, hopefully that will change. Thanks to people like Chris, there is hope that it will, eventually.

    • I’m afraid that’s what I’ve encountered thus far. I read all of these articles and apply the concepts to my own life as best I can, but how do I know what applies to me without first consulting a competent practitioner? I currently live in Alabama. I have searched for a doctor that I can have confidence in, but have yet to find one. I don’t suppose you have any recommendations do you? Thanks for your comment

      • Philip, how frustrating it is. You may need to travel for a first visit, and then many of the docs can do Skype visits after that. I don’t live in your part of the US. The only ones I know of in the south are in Texas, Nashville. Amy Myers MD is in Austin and Dr. Josh Axe is in Nashville. I don’t know if either are taking new patients, but you might try contacting their offices to find out and to see if they know of someone good who’s closer to you. Also, you might see if someone who works for Sarah Ballantyne PhD (aka The Paleo Mom) knows of someone close to you. She’s in Atlanta I believe.

        • Susan, thank you very much. I will look into all of those. Nashville and Atlanta are both approximately 4 hours from me so either would work. Thanks again

          • Philip, I do online consultations for people like yourself across the world. I offer functional lab testing and any nutrients you may need. I design protocols based of the results of the lab tests. Feel free to reach out if you need help.

          • Philip, I live in Montgomery AL and have an autoimmune disease that I’ve been trying to treat with alternative methods. I have thought of getting in touch with Sarah Ballentyne since I find all of her information very informative.

            Currently, I am doing GutThrive with Christa Orecchio (sp?) who is in California. It is done over the web and seems to be a good program.

          • Hi Phillip. I’m in Birmingham and see a functional medicine practitioner here who takes insurance (!). Please email me at mpmandsgw at gmail dot com if you’d like her info. Best, Mo

  23. I am a certified health coach who has been self studying for almost 15 years (everything from anatomy to disease-conventional and functional approaches). When I work with clients I focus on five foundations of health: Whole food, Sleep, stress reduction, safe movement and fun….but the one I have added in the last couple of months is the most important in my opinion. That’s instinct. I think the biggest piece people are missing is instinct. People rely way to heavily on what practitioners tell them to do….recommendations and suggestions are important, having a guide is crucial. But, it boils down to what works for you? What feels right? What doesn’t work? I have seen more proteins, supplements and meal plans on my clients intake form (people buy these things because they are told it will help) then even if they get digestive upset/rashes, headaches etc they continue to use them “because my doctor told me to”. I teach my clients how to listen to their own body, and I even tell them if what I tell you doesn’t resonate with you at your deepest gut level? Don’t do it. We are putting way too much responsibility on other to get us well. I certainly hope I can participate in your training Chris….I have many years of experience in working with the toughest cases but having your credentials behind my name would be even better.

    • I think you’re right about instinct. We’ve lost the ability to listen to our own bodies, and a host of addictions from legal drugs like caffeine to “foods” like refined sugar makes it even more difficult. I work in the supplement industry and I can’t tell you how often people continue to take supplements that aren’t helping them at all.

  24. Hi Chris
    You saved me in a round about way. Your practice was closed last September, so I googled functional MD. I found someone in Santa Cruz who hss helped get to ” root “. Demylinating poly neuropathy caused by 2 cell mutations mthfr & c- something. Paleo of course, methylguard, vit.,D, vsl3, on thyroid med, bp, & celexa still. Horrific rash slowly dissipating. Now must detox high high lead starting Monday. I have a lot of the 8 & yrs spent last 6 mo. EFT
    Healing past traumas. I am slowly getting better. Wortied about the lead detox. Thanks fir allllll your help!!

    • Hi Kristen, I live in Santa Cruz and am looking for a good FM doctor, would you mind sharing who it was you liked in SC?


  25. Wish I knew why some insurances will only pay for doctors to give you pills for the rest of your life. Instead of covering someone that will fix your health problems for life !! Never made sense – Never will ..

    • Maybe the insurance companies along with the western medicine model in general don’t want to get people well; they want us to stay sick so we will continue to give them business. Time for a new paradigm in the world of medicine in this country.

    • Hi Diana,
      I like what u commented.. Why not people take care of their health and boost up immune system. Prevention is better than cure..

    • I believe it is done for their convenience and or gain. Some may really believe it to help, and some just don’t care in my opinion. It is up to the individual or their care giver to determine the validity of the practicing physician. I have a permanent brain injury which may have derived from taking the prescribed medications. I have since drastically altered my diet and stopped taking most of 12 pills a day! Big Parma has big bucks but I do not support it any longer. I can walk, talk and drive again. I am 52 years of age

    • believe it or not as part of the PPACA/Obamacare there are several provisions to drive large insurers toward population disease management – aka accountable care organizations. Rather than reimbursements paid by treatment reimbursements are distributed by population outcomes.

      Health insurers do not make money when you file claims. They want doctors to move toward preventative treatments.

  26. Chris, I really like the concentric circle diagram. It’s intuitive in that many symptoms are often seen or felt at the surface or point of discomfort, but that it often takes some peeling of the onion skin to get to the core/root cause.

    Your list of 8 pathologies provides a structured approach to help me better understand and wrap my mind around all of the moving (and some broken) parts.

    The fact that stress, anxiety, any negativity contributing to the problem is depicted as residing in the center is consistent with how we often suppress it inside, deep down in our guts.

  27. My problems are hormonal and I can’t find a blood pannel that groups what I need cost effectively for bi weekly draws. I have a nonunion fracture as well. 36 is not too old.

  28. Gut bacteria are so important I almost died for lack of them.
    I had Ulcerative colitis for 16 years I did what the Dr. told me took drugs etc wound up on steroids that left me pre-diabetic. Then I was given a round of antibiotics that was followed shortly after by a massive flare up. I was literally bleeding to death. I was offered more drugs including methotrixate and I just thought enough. I spent months researching and trying the alternatives many diets which lead me to the specific carbohydrate diet, that got me well enough to really start looking for answers.
    In the end I resorted to doing a fecal microbiota transplant using my husband as a donor. I did 4 transplants over 5 days and then like a miracle I got better.
    I have since discovered that a solution made from well rotted compost filtered through kitchen paper and simply drunk is a really good way of restoring your gut bacteria, and its free! No Colitis symptoms since!

    • Wow, I would be very careful about drinking compost liquid. There could be all kinds of nasty things in that, like clostridium botulinum, which is found in all soils, etc.

  29. “All the Kings horses and all the Kings men, couldn’t put Humpty Dumpty together again”.

    Chris, your list sums up exactly what has happened to me over the last 30 years, and also the piece by piece solutions that are finally putting me back together again.

    For me building good health is like building a house. If the foundations are not solid, all the other stuff you plaster over it is irrelevant and will eventually crumble. When you restore a house you always start at the foundations.

    Your site is my ‘go to’ reference as it is meticulously researched and balanced. You speak truth, and you always speak it carefully. I am so glad you are going to train other practitioners because it is badly needed. Natural practitioners also suffer from the knee jerk, piecemeal approach of mainstream practitioners. In fact their practice model mimics it. I’ve never had one of them tell me they will start from the foundations and work upwards. Practitioners need to explain the process of recovery at the outset, that it’s a partnership, that it will take trial and error – and time. It’s up to the patient if they sign up for the journey.

    The functionanks for the summary.

  30. Since my teens allergies gradually increased to the point of destroying my quality of life. Basically had post-nasal drip like a fire hose most of the time. Additionally, I suffered from ever worsening cold-air exercise induced asthma – which was getting pretty scarey. GP and allergy specialists were useless.

    One day I happened to take some magnesium for some muscle cramps – and noticed that my asthma pretty much disappeared. I couldn’t believe all the time and money wasted on a problem so easily solved. Later I tried Paleo and my allergies pretty much vanished too. Probably dairy was the culprit. Life changing.

  31. Hi. Good article. I am nervous BC I suffer from 7 of the 8. The good news is I have a functional doctor. The bad news is she doesn’t differentiate much. For my MTHFR she said just take methyl B12,probiotics and NAC but I feel even worse. I keep weight gaining despite a clean aip diet. I wish she would dig further but I don’t feel she knows more. I feel too overbearing when I ask questions about my labs and digestive issues but I am in pain for so long….Rifaximin and vsl#3 made me worse too that she suggested.

    • You’ve been given the standard approaches, but most practitioners don’t yet understand the more sensitive patient who will react badly to many of the standard approaches and amounts of various supplements given. Further, most practitioners won’t understand the deeper fundamentals of her case and what makes her more sensitive, then what to do instead that will be effective and safe.

      Don’t feel like you’re being overbearing or otherwise inappropriate when you request more interpretation of your tests. Here’s where the practitioner has to know their patient, to know how much detail and time to give test interpretation in the consultation. Many patients don’t care to learn about their tests and just want a simple bottom line and treatment approach, others want some info but are easily overwhelmed and don’t take good notes, and still others are very smart and want to learn as much as possible. It’s a spectrum. The practitioner may want to schedule another visit if more time is required. If you’re seriously interested in learning more about your functional testing and not just buying tests because the practitioner wants the results for their own consideration of your case, mention that upfront when you’re checking out a new practitioner. Say what you’re looking for, and see if that’s a good fit for both of you. There is also a lot of introductory test interpretation info available online, which allows you to do homework so you’re better prepared to ask relevant questions next time you talk with your practitioner.

      It’s normal to be passive and to learn many things the hard way when you’re first transitioning into a naturopathic and/or FM approach to healthcare. With experience, you become a more savvy, pro-active patient. Don’t be afraid to ask questions and engage in dialogue — you can learn a lot about how the practitioner thinks and how they want to practice. Check fit, communicate, check fit, communicate.

  32. What would you recommend for symptoms of fatigue, panic, depression and ibs? A friend of mine is suffering a lot. She was getting some help from ssri but still she is not well.
    Any good advices?

    • I am not a health or medical practitioner but have been taking back care of my health since following mainstream health guidelines lead to a heart attack and a life saving stent 6 years ago. Chris Kresser has been a huge help along the way among others.
      Here is some advice from an unqualified person unfamiliar with details of your friend’s condition:
      1) Ween yourself off the ssri’s immediately; they play merry hell with all your bodily and psychological functions—especially your gut—as I’m sure you’ve noticed. If this idea freaks you out, gradually substitute St.John’s Wort but get off that drug road! I could—from personal experience—say that ssri’s are evil but that’s not very dignified and just my personal opinion so I won’t mention it here.
      2) a.Eliminate all grains from your diet. b. eliminate all sugar from your diet even greatly limiting fruit. c. try eliminating virtually all starches. Find out about acellular carbohydrates and resistance starch and think for yourself. Become a disciplined experimenter while acknowledging your reactions if that’s fun.
      3) Prepare your own food using fresh ingredients—NO processed food. Use organic produce when possible. Always cook high roughage food like Kale and broccoli. Raw lettuce is fine. Eat grass fed (grass finished) happy animals and their products (eggs, butter) and ESPECIALLY their fat! Start taking fish oil or Krill oil today! Google LCHF.
      4) Walk (NOT jog) at least twenty continuous minutes a day at least 6 days a week, hopefully with at least a block of uphill. Don’t make a production out of this, just head out and then think about it while you walk. This is the greatest help for #5.
      5) Become a sleep connoisseur. At least 8-9 hours a night in a DARK cool room. No computer (or smart phone) or TV an hour before “lights out” (read by crummy old fashioned light to get drowsy, no full spectrum!). I still take (the amazing) valerian at bedtime but look forward to eliminating that and it doesn’t work well for some people.
      These non-invasive steps cost nothing extra and will get your friend well on the way to wellness while seeking an effective health professional.

  33. I too have been wanting to see a functional med. nutritionist /dietitian , and pretty much covers the same things you talked about here . I’m under contract with my reg. GP were she has to give me a reference , before my insurance will approve it. At leas the nutrition part would be covered, I’m willing to pay for what testing needs to be done.
    My GP is really dragging her feet and keeps almost running out the door when I mention it. She calls them money grabbers and quackery and it’s not real medical doctor advice .. I have brought it up twice so far and she always tells me lets talk it over on your next visit – I will have more time . It’s getting Old , I don’t think she ever will do it. She doesn’t want me cured or get healthier ,cause I won’t need her any more !!

    • Diana,

      Keep in mind that a dietitian/nutritionist referred by a conventional doctor is most likely a *Registered* Dietitian (RD) or *Registered* Dietitian Nutritionist (RDN) who’s training program, while rigorous, is funded in part by pharmaceutical companies, large processed food corporations, soda corporation, dairy industry, etc., so they offer a mix of healthy and unhealthy (pharma and food industry supporting) advice.

      *Certified* Nutritionists (CN) programs take no such funding and offer a Functional approach. A good CN will have graduated from an NANP accredited school (National Association of Nutrition Professionals). Often CN’s get their degree/certification through distance programs (online) due to the relatively small number of NANP accredited schools.

      That said, there are RD’s who have learned to reject the industry funded protocol, but if they practice in a truly Functional way they will not be allowed to work in hospitals or conventional practices.

      • The reply to this comment is true. That RD’s don’t necessarily practice functional medicine/nutrition. But the last paragraph is also true-that some do! I am one such nutritionist and there are many others too. Just make sure the RD you pick is “functional and integrative”. Insurance will cover an RD 😉 http://www.diannerishikof.com if you are interested

      • While it’s true that functional medicine RD’s don’t typically practice in a traditional allopathic setting such as a hospital, their training consists of a 4 year bachelor of science degree plus a one year or longer internship program whereby they learn the concepts of clinical (hospital based) or community based nutrition. Except for a week long stint at the dairy council which I protested, there was absolutely no big pharma or corporations influencing my education and training. Also, the number of integrative/functional medicine RD’s is vastly on the rise which is good because they have the science and medical background of 5+ years to build on.

    • Diana,

      I think Susan is correct and that you’d be sent to a registered dietician who is likely to use the same general philosophy as the doctor who sends you. So I recommend that you head out on your own prepared to pay out of your pocket and deal with the awkward situation of having at least two competing schools of medicine and health.
      There is nothing short of a revolution happening in health science and medical practice and it’s the doctors who will bear the brunt of the conflict as discoveries by their patients are imposed upon them. Let’s hope we don’t just wind up trading one set of ignorance and prejudice for another.


  34. Great article, thanks. While I completely agree that all of these are causes of illness, in my experience, I have come to believe that it goes even deeper, and that the REAL root causes are emotional, mental, and spiritual. I suddenly started having lots of health issues that I’d never had before, right after I had an emotional trauma about 10 years ago. No matter what I did (I’m all natural and organic – no allopathy or processed foods, chemicals, etc), nothing got better until I finally realized this and started doing lots of emotional, mental, and spiritual work. If you dive into the world of EFT (Emotional Freedom Technique), you’ll find this to be true over and over again – allergies, illnesses (some “incurable”), CFS, fibromyalgia, and much more, resolving after addressing the non physical issues. 🙂

    • Based on the comments, I can see that I wasn’t as clear about this as I hoped.

      The causes of disease and symptoms are in the core of the circle: exposome + genetics/epigenetics. Exposome includes both internal factors (like psychology, emotions, etc.) as well as external factors (air pollution, chemicals, etc.). These influences then manifest as specific pathologies or mechanisms.

      Put another way, the pathologies are the physiological expression of the causes—diet, lifestyle, environment, attitude/emotions/spiritual factors.

      • And all of these factors can simply be broken down into what negatively or positively affects you, be it food, chemicals, emotions, thoughts… It is up to each individual to determine those parameters. I, for example, like spiders (positive), many people see them as an eight-legged critter that needs to get out of their house (neutral) and many fear them beyond reason (negative). Each of these perceptions is going to induce a certain degree of stress, first in the mind then physically. The same can be said of food. I don’t have any problems eating gluten (positive), for many others this constitutes a devastating health problem (positive). In trying to diagnose a problem, first start with simplicity and work towards the complex.

  35. Hi Chris,

    I’m happy and so relieved to know that you are finally letting people know what is at the root of some devastating conditions! I personally know what it’s like to suffer from severe CFS for several years only to find out later that it was really the result of extreme gut dyspiosis that developed when I wasn’t aware that shouldn’t have taken a lot of antibiotics at the same time I was trying to get over a bad case of strep throat when I was in Mexico. CFS caused my immunity to plummet and I didn’t now what was wrong with me for too long. I’m happy to say that I recovered when I followed a restricted diet and took high doses of probiotics. The world needs to know what causes CFS so it can be prevented in the future. The CFS wore down my adrenals too, so I now am slowly recovering from hypoadrenalism, which is a huge challenge as well. Thanks, Chris!

  36. Hi Chris,

    I was diagnosed with MS in 2003 after being what I considered quite healthy (no overt health issues) for most of my life. In retrospect, there were subtle signs of dysfunction. I changed my diet in 2006 (GF, CF, low sugar, soy free) and am working towards a Paleo diet (following Wahl’s Protocol. Despite dietary changes and supplementation, my MS symptoms seemed to worsen, so last year I undertook extensive biochemical testing (UTM, UEE, HMT, CSA, UAA, MAP, hormones, biopterin) along with DNA testing. What I discovered was that I have all 8 pathologies you identified! As a result I am methodically addressing them, but realize that this may be a long process (6-7 years) before I can be healed. I experience a lot of Herxheimer reactions to new supplements, so it hasn’t been easy. But because I do know how “messed” up I am, I can be patient.

  37. Hi Chris, I had in total 5 years intensive antibiotics due to Lyme Disease. Last autumn after I ate, I had severe joint pains/burning skin/cognitive defects. Recently I read one of your articles on oxalates. I joined the Try Low Oxalates FB group. I now realise I had a diet high in oxalates, thinking it was healthy. My doctor gave me drips of vitamin C and vit D so I was probably producing them endogenously. Last week due to Yersinia, I landed in hospital. Now I have burning, crawling sensation on my skin, sometimes burning muscles, bones even and as if my brain is full of glue. No one here as ever heard of oxalates, but worse they are not willing to learn. They sent the pain specialist who’s given me Lyrica. I will see the neurologist too. They reject my feeling that the problem is my gut flora and a build up of oxalates in the body. How I get out of this hell (sorry, but it is currently)? I’m in northern Germany.

    • Kathryn,

      Sorry to hear you’re going through this! You may already know since you joined the yahoo group, but antioxidants are really important. I’d try NAC or CoQ10 for starters, if you look up antioxidants at the yahoo group you can see what everybody else has used.

      Have you tried Epsom salt baths? Sometimes it can help.

      I’d be careful with the Lyrica, a lot of members had worsening problems after taking it.

      I hope you start to feel better soon!

      • That’s kind you write, Dee.
        N-Acetyl-Cysteine gave me unbearable brain fog/brain pressure. I was told it contains sulphur so maybe I have an intolerance. I’ve just started Acetyl-L-Carnitine. I take Ubiquinol which is CoQ10. I take Epsom Salt baths up to 3 times a day to cope with the pain. But this is no life. I want my life back.
        The hospital only offered Lyrica and vit B. Vit B I’ve been taking since last year.
        I still think damaged gut flora is the problem but a range of probiotics, including VSL3, has not helped. So tired of this.

        • Dear Kathryn,

          So sorry! The only thing I can think of is maybe trying some oral magnesium as well (just avoid the glycinate form as it can convert to oxalate), and maybe checking the forms of B vitamins that you’re taking, i.e., methylcobalamin instead of cyanocobalamin, folate instead of folic acid etc. It sounds like something (or things) is affecting your nerves and I had some benefit from magnesium and B vitamins in the past when I was having nerve issues. Also, I think if you are taking too much B6 or the P5P form, it can cause the oxalate to start leaving your body too quickly, which might exacerbate symptoms or cause new ones.

          I realize you have a lot going on that can be causing the burning and crawling sensations, but I would recommend asking about reflex sympathetic dystrophy, just in case. Early treatment makes a big difference. I was lucky I only went for months, not years, without a diagnosis, but if it is caught early on, some people go into remission.

          I wish you the best and will remember you in my prayers.

          • You’re very knowledgeable, Dee. And with a heart. Thank you. You’re right about the vitamin B6/P5P. I think I was taking too much and reducing oxalate intake too quickly, which caused too much dumping. I’m thinking the burning pain in my skin/bones/muscles and brain feeling clogged up could be oxalic acid / oxalate crystals. It seems the most likely explanation given my medical history / dietary history / blood results. It’s just no doctor has the time to look in detail at these factors and no one here has heard of oxalates not relating to kidney stones. Worse or bizarre, I find, is that no one is willing to learn. I can mention RSD but my overwhelming experience so far is that doctors here aren’t so good at listening to patients. I just wish I could get my brain clear then I think I would be able to cope much better. I have magnesium hydrogen citrate and Tri-magnesium dicitrate. Am hoping they are ok. I need to get on a controlled low ox diet, which eventually I should be able to do with a low ox health coach I’m in skype contact with. Any more ideas to clear my brain, do let me know! Thank you for your prayers. They are very much appreciated.

            • Hi Kathryn,

              I’ve never heard of problems with the forms of magnesium that you have, hope they work for you. I have read that magnesium l-threonate is good for the brain. I think there are a couple of studies available at pubmed.

              I’m wondering if you’ve been checked for heavy metals? I believe Susan Owens wrote a little bit about oxalate chelating heavy metals, and there was a doctor who needed to slow down her patients chelation therapy, because that in combination with the low oxalate diet was making the heavy metals come out too quickly. I seem to remember hearing years ago that mercury toxicity can cause burning pain. And it has a very strong effect on the brain.

              Have you already tried starting with really small amounts of probiotics? Some people say starting small and working up worked well for them.

              I started reducing the oxalate in my diet too quickly, too. I had uncomfortable symptoms for several months, but I got off easy compared to lots of people. I’m just glad that it didn’t seem to make my kidney stones worse. I hope your Skype coach can help. It is really hard to figure out or even remember what to do when you’re really ill.

              I have a hard time understanding how doctors can be so closed-minded. It leads to frustration and suffering for patients, and I really don’t understand how they can be so uninterested in new information that is coming from studies all the time. I find scientific studies fascinating, and in regard to health, you would think more doctors would be eager to have new ways to help their patients.

              If you at any point suspect RSD, I really recommend looking up one of the RSD groups. I think RSD dot org was the first one I found. RSDfoundation dot org has a German version of the site, if that helps. Some practical things for RSD: refrain from icing the area (very bad for RSD!) and try to start massaging the areas with the worst burning pain if you can, it can help to start retraining your nerves/brain so it doesn’t expect horrible pain from even the lightest touch. I really hope it isn’t RSD, and part of me hates to even bring it up, but I try to warn anyone with the symptoms so they don’t have to go through what I did, or worse.

              Don’t lose hope! These really horrible health problems can improve, even when it doesn’t feel like they ever will. There was a period of time when I really didn’t know how I was going to get through the excruciating pain of RSD, but I have had so much improvement.

              • Dear Dee,
                Early in the year, I had chelation 8x for heavy metals and a challenge test (which nearly killed me as it drained me of minerals) showed negative for heavy metals, as did a hair analysis test. My doctor was convinced originally that it was heavy metals. It helped slightly but I now think it was chelating oxalates.
                I’ve been in contact with Susan Owens.

                I used probitiocs since August of last year: first low levels, then finally VSL3. I think I used too much in the end and it caused oxalate dumping. Nothing worked however ultimately. I’ve just started at low levels again.

                Just having someone who acknowledges that the condition exists helps. No one here, medical or otherwise, has heard of it. The ‘problem’ is I don’t have kidney stones but there is published research from Susan Owens that oxalates don’t form kidney stones in 100% of cases. Doctors here believe absolutely that they do.

                That’s so very true that it’s “really hard to figure out or even remember what to do when you’re really ill”. I struggle very very desperately with cognitive functions, but look normal. I make huge effort to communicate then people say but “you’re communicating fine’. No! My brain feels like a stone and I can’t think fully by a long long way!!!!

                I identify TOTALLY (don’t usually use capitals) with your paragraph on how doctors can be so closed-minded when it causes such great suffering for patients. If they haven’t learned it in their studies they can’t do anything. But science is always developing. I though being a doctor was all about getting people healthy.

                No one would ever look into a diagnosis of RSD. I struggled like crazy to get a diagnosis of Lyme/neuroborreliosis 8 years ago, even though the symptoms were raging. I was almost in a coma until a doctor recognised it and could read the blood results properly. He then treated it with long-term antibiotics. I find it incredible to find myself in the same situation again.
                I have all preconditions for secondary hyperoxaluria, one positive 24h urine test, symptoms but no doctor is interested as it means reading up a lot and then in English (I’m in northern Germany).

                It’s interesting that RSD talks of previous injury. Often I wonder if the Lyme damaged my nerve endings so that when I get another condition the nerves hurt in the same way. The brain pressure is horrendous and like Lyme.

                Thanks so much! With self-medication (how come I’m forced to do this) and no support from a doctor I’m finding it extremely hard-going.
                Best wishes, Kathryn

  38. Hi Chris,
    I am beyond thrilled that you will be making an announcement soon about the course! I am wondering if you have had a chance yet to decide if you have to be a licensed practitioner to take the course? I am a Certified Nutrition Consultant and Educator. Beyond that, I have a tremendous amount of other complimentary health education in the last 16 years, but no license.

    Thank you so much!!

  39. thanks SO much for highlighting functional medicine!

    dr. melissa ponce esguerra and i have been working closely with each other since october of 2014. she helped me address my hashimoto’s diease, infertility, and she helped me discover my hormone imbalance and adrenal fatigue through an extended female hormone panel (umm, why didn’t we start there in the first place?!). sometimes i wonder how our journey would have changed had we thought of taking this step but what’s done is done, right?

    i am in the best health of my life. my TSH levels are in normal range again, my thyroid-antibodies have decreased dramatically, i’m sleeping better, my energy levels sustain me throughout my day, and my cycles are 28 days on. the. dot. my cycles were very unpredictable and ranged from 30-37 days, and i owe it all to dr. melissa. she was/is my guide, and i am forever indebted to her for proving to me that i was capable of self-healing. i am a testament to the power of taking your health into your own hands, and seeking the support and guidance of those that share similar values and philosophies. even better, all of this was done by means of major lifestyle changes, natural supplements, herbs, and essential oils.


    • Hi Marian,

      Kidney stones are terrible I’m sorry you’re dealing with them on top of everything else. I highly recommend the Trying Low Oxalates yahoo group run by Susan Costen Owens. It gives you access to the most up to date and comprehensive oxalate food list I have been able to find. There is tons of info available there and the members are really helpful with questions. I passed at least 3 stones after starting to reduce the amount of oxalate in my diet, and the CT scan I had done showed my kidneys stone-free. The lowoxalate dot info website has info and simplified food lists you can look at. If you decide to try it, don’t reduce the amount too quickly, as that can cause some really unpleasant symptoms. They usually recommend you estimate what your previous intake was, and then reduce by 5-10 % per week.

      For the UTIs – you might try 50 ml of cranberry juice 2 times a day, along with 500 mg of L-methionine 3 times a day. There was a study done that showed that treatment could be just as effective as antibiotics. I have heard d-mannose recommended as a treatment as well, although I believe that one is specifically targeted towards e coli.

      Hope you are in a better health situation soon.

  41. Regarding insurance, the problem is that functional medicine is a long-term approach, and insurance companies have no financial incentive to cover it. Insurance companies favor quick fixes and putting off costs that may happen later because people and companies change insurance plans so often that an insurance company that covers a large up-front cost for functional medicine isn’t likely to see the benefit in reduced premiums for those patient down the road; there’s a good chance those people they invested in will be on another insurance plan by then. Add to that the short-term (quarter-by-quarter and stock price driven) incentives for insurance companies and the obstacles to getting traditional insurance coverage of functional medicine are huge. So even with the Cleveland clinic raising the profile of functional medicine, there’s a fundamental business change that needs to happen before insurance companies have the financial incentive to cover functional medical care.

    The mygreeninsurance mentioned above looks like a positive step, specifically because it focuses on non-traditional health care. Even if there were other insurance plans focusing on non-traditional health care, these insurance providers will most likely make their investment back if people switch from one of these plans to the other. So it’s possible the answer to the insurance issue is the establishment of new insurance companies and plans focusing on functional and non-establishment medicine, rather than a hope or push for traditional insurance companies to cover plans which are better for the patients but potentially worse for their bottom line.

  42. Hi Chris,
    Thank you for all of your amazing and thought-provoking articles.
    I have read your work for the past couple of years and have decided to pursue a career in Naturopathic Medicine and will start school this Fall!

    I am eager to start helping people the way you do. You are such an inspiration to me and I thank you for all of your hard work!

  43. I’m so grateful that my work has been helpful to those of you commenting on this thread, and I really appreciate your feedback. This is why I do what I do, and hearing about your experiences makes it all worthwhile!

  44. Hi Chris,
    Thank you so much for all you do. I have your book and read your newsletters, which have helped me seek out a ND. I am currently being treated for the top three of your eight as well as hormone imbalance. I was just diagnosed with SIBO and have just started treatment. I went to different MD’s and kept getting more and more medications, now with the help of a ND and Integrative doctor I have gotten off 4 meds already !
    Thank you so much for being the inspiration for me to invest in my health by getting to the root cause!

  45. Thanks for all of your informative articles! Can you point me at any resources for fluctuating hearing loss? I lost my hearing for a few years in one ear then it came back for a few years. It is gone again for the last 4-5 years. The hearing loss pattern is similar to Meniere’s but I don’t have other symptoms. The specialist at MGH Eye & Ear diagnosed me with fluctuating hearing loss and said it could eventually result in Meniere’s. I have searched the web but can’t find out much about this. Do you know of any resources? Otherwise I am healthy and following an 80/20 primal eating pattern. I did try the 30 day plan in The Paleo Cure but that didn’t change anything (I did cheat on red wine, though 😉

  46. You could say there are only TWO types of medicine:-
    1. Functional medicine.
    2. Dysfunctional medicine

    • Clever phasing and a month ago I would have agreed wholeheartedly. Now I would rephrase it as Functional Practitioner vs Dysfunctional Practitioner. I went to a functional doctor and got useful test results and some potentially useful treatment. But I also got conflicting recommendations with no help in resolving the demands of multiple health issues. Worse, I was accused of lying about what I eat and it was implied that I was so inactive that even a little housework would be good for me. Meantime, I told my new regular doctor about the test results and she keyed in on them, suspected sleep issues and I am now being treated for sleep apnea. Clearly, one of the doctors practiced functional medicine and one had the true functional mindset.

  47. I can not use your method as I do not know what to do 🙁
    I have a skin rash for 10 yrs. now, I’m always tired, I have arthritis (which the surgeon said I need both knees replaced), I’ve been diagnosed with depression, fibremiology, I have difficulty going to sleep, my right foot hurts and burns so much I can’t walk sometimes and I have difficulty actually getting out of be ie I’m awake for several hours before I can actually get moving and last but not least I’m often very light headed. NOW……can you help me on a road of recovery?

    • Hi
      While my and my wifes symptoms are nowhere as poorly as yours we both changed up to LCHF. We have lost weight lots of it, improved our lipids, reduced pain to more manageable levels, chucked statins, and I have stopped blood press meds all with improved lipids. So my suggestion is to research LCHF or Paleo, get yourself going, and monitor progress. You should see an improvement. Then experiment makes it better still. Bearing in mind Chris’ points above. You will find as I did, that with research lots of it, understanding, experiment, that you realise what Chris means. That is for non-medical trained people go practical to find out what it means and what is happening to you.

    • Susan I can sympathize with you…I went through many years with chronic issues. You have to start with food, stress relief, sleep and safe movement. Chris offers a 14andfour program that would be beneficial to a beginner in this method of approach to getting well. I recommend you explore that resource in the links at the top of his website.

    • Hi Susan,

      Sorry to hear you’re going through so much. I know it can be difficult to figure out to do when you are dealing with multiple health problems.

      In regard to the light-headedness, have you been looked into adrenal or cardiac problems? If it was me, I would want to rule out cardiac, as that’s usually more serious. Looking up adrenal insufficiency or fatigue (term differs depending on who’s doing the talking) should give you lots of info on that, it is one of the common causes of feeling light-headed (you might notice it a lot when you’re changing positions from lying or sitting down, bending over, etc.). Chris has several articles dealing with it, and Dr. Alan Christianson is another good source of info. The difficulty going to sleep and needed a long time to get going in the morning sound a lot like adrenal issues, too.

      I would also check into hypothyroidism and Hashimoto’s disease; if your adrenal glands are having a problem, very often the thyroid will be as well. Being tired all the time is common with hypothyroid/Hashimoto’s.

      Several of your health issues might be helped by a low oxalate diet. I highly recommend the Trying Low Oxalates yahoo group run by Susan Costen Owens. The lowoxalate dot info website also has lots of information regarding the subject. Many of the members at the yahoo group have had improvement in their fibromyalgia.

      I don’t know if it would help in your specific knee situation, but my friend had very good results from a gel injection (she said it was derived from rooster combs). She had pain relief for about a year before she needed another injection.

      Lastly, the burning pain in your foot, although obviously many things could be causing it, I would suggest that you check into Reflex Sympathetic Dystrophy, if only to rule it out. Burning pain is the biggest symptom of this condition. A lot of doctors are not familiar with it and early treatment can make a huge difference. I certainly hope that isn’t what it turns out to be, but if it does, don’t be discouraged. Just finding out what is causing the problem is a relief, and the condition can improve a great deal after you start doing the right things. And in some cases stop doing the wrong things! Icing the area is extremely bad for RSD, it interferes with myelin regrowth around the nerves and makes everything worse.

      I wish you the best, and hope you are able to find healing.

    • Hi Susan,

      Have you been tested for Lyme Disease? To me this sounds like a textbook case, and pain and burning in the feet is commonly associated with a Bartonella co-infection.

      The conventional lab testing for Lyme and co-infections is extremely unreliable, so I would recommend testing through IGeneX labs. Hope this helps!

      Feel better,

    • Susan, I had a lot of these symptoms though for not such a long time as you and most of them got better with a Gluten Free diet, the rest have been bettered by LCHF diet and drinking Kefir, (home-cultured not the comercial kind). Some people are even better completely grain-free and /or dairy free,
      I hope they may work for you.

    • Forgot to say that have Hashimotos thyroiditis, diagnosed 2009) but the medication didn’t relieve my exhaustion symptoms, muscle pains and spasms, arthritis pains in my hands and feet, and I got so that I couldn’t turn over in bed without hanging onto the mattress, I was permanently fatigued,slept badly, had permanent itchy yeast rashes and eventually Derm. Herpetiformis before going gluten free. Now almost everything is resolved and am fitter than I have been for years plus the debilitating migraines that I had suffered since puberty have completely disappeared, all thanks to diet.

    • hi Susan De
      It has been about 18 months since you wrote the above comment. I would be interested in your success.
      Did you try LCHF?

  48. I have suffered from psoriasis for over 30 years. Not comfortable with the idea of a lifetime of treating only the symptoms, I began researching what might be at the root cause of this disease and stumbled upon the possible connection between gut permeability, diet and psoriasis. I have spent the last two years healing my leaky gut and improving my diet. I’ve added digestive enzymes, a good probiotic, eliminated night shades and processed junk, and started making my own bone broths and fermented foods. My skin is almost clear now. (I know I need to give up gluten if I’m going to heal completely, but I’m an avid baker so this has been hard for me.) At first my dermatologist was rolling her eyes at me… but at this last visit, she asked if it would be ok if she gave my phone number to her patients who asked about diet and healing psoriasis. I have opened her eyes to the functional medical world. I listen to your podcasts religiously and share them with as many people as I can. You have changed my life. I wish my medical insurance would cover a full-blown functional medical workup, but maybe someday soon!

    • Hi Jackie!
      Glad to hear you’re doing much better! But as I was reading your post, I cringed when you said you were still eating gluten!
      You’ve come a long way and by eating gluten you are stopping
      yourself from fully healing. You said you’re trying to repair your leaky gut but gluten is one of the number one contributors to gut permeability! You will not fully heal unless you get off the gluten. You’ll just have to learn to start baking gluten free! There are great recipes out there! Also glad to hear that your dermatologist is finally on board. Good luck with everything!

      • Jackie, you are amazing!! Because of your psoriasis you have entered a world that will change the quality of your life forever. You’re making lemonade :)!! And now you are sharing that experience with others so that they can take action and heal their autoimmune diseases, whatever they may be. I find it EXTREMELY UNFORTUNATE that Lizzie responded with the ONE thing you still have left to work on instead of focusing on the ONE HUNDRED things you have already done to heal, that is so negative, so just let it go. I believe this path is a journey and we take the steps we are ready to take. When you are ready for the next step you will take it. Keep smiling and doing what you are doing … I could read your excitement through your words!

    • You’ve taken some major steps, and seeing results. Psoriasis is an auto immune condition. Eliminating gluten just may make all the difference in crossing the finish line. You mentioned being an avid baker, perhaps you could exchange that culinary craft for another, such as a fermentation artist. All the best!

    • Jackie or Chris – regarding psoriasis. Your story is very encouraging. I have been dealing / managing psoriasis now for 10 years. Over the past 3 years is when it really started to affect me – primarily on my hands and then led to joint flare-ups. I have been following the Autoimmune Paleo diet but I occasionally use a biological to help while I am figuring this out. The skin on my hands is the toughest to resolve. Since you’ve had psoriasis for so long, have you ever used the biological? Curious to see if you did and how long it took for you to fully be off of them.

      Thanks so much!

      • I brought him a quart of raw unprocessed milk a day and his skin was almost clear in 5 days. Is it available in your area?

        • Thanks Mike. Yes, I do have access to raw milk but that did not seem to help. This is certainly a tricky one for sure.

          All the best,

          • I’m not selling milk. I’m sure any healthy diet would probably work. Just curious. Are we both talking about the same thing? You are referring to raw unpasteurized milk either strait from the farm or a small health-food store, right? Not just organic milk from Whole Foods. Did you drink at least a quart a day? Two quarts a day is not hard.

            Here’s a little copy paste: “The Raw Milk Cure: The therapy is simple. The patients are put at rest in bed and are given at half hour intervals small quantities of milk, totaling from five to ten quarts of milk a day. Most patients are started on three or four quarts of milk a day and this is usually increased by a pint a day.”

            I used to drop a half gallon bottle in my back pack. We had two cup holders and two 8 oz cups on the dash of our service truck. We’d have a glass between jobs and finish it by the end of the day. I noticed that if you drank the milk before you got hungry it could prevent the purchase of a soft drink. Which is why weight gain was not a problem.

    • Am interested in your comments in regards to psoriasis diet.
      I have tried many diets and removed many things and generally take all necessary supplements you mentioned, however I have noticed my psoriasis flares up very irregularly and I cant after 15+ years find the trigger.
      Any advice your willing to share would be really appreciated.
      Many thanks

    • Thanks for sharing your inspiring story. In my practice, I’ve found that skin conditions are (almost) always related to gut pathology. There are often other factors as well, but focusing on the gut tends to make the biggest impact.

    • Go gluten-free and become a different kind of baker. There’s a large and growing market for it, and it’s an art! You’d be helping your own cause and others’ too!

    • I think you and Chris have hit the nail on the head. I knew a guy with psoriasis. I brought him a quart of raw unprocessed milk a day and his skin was almost clear in 5 days. If you are an avid baker you should start with organic wheat and sugar. They have half as much glyphosate. Try and go gluten free. Pamela’s pancake mix is a good start. It’s getting easier to go sugar free with the new stevia products. Then there’s raw honey or sweet fruits and vegetables. Organic of course. I’ve had some luck with heirloom grains. Heirloom grits are fabulous. There are many I haven’t tried yet. We really should make an effort before they are all too contaminated by GMOs. I have heard there are no seeds that can be guaranteed 100% GMO free.

      • I believe the main problem with gain is the (herbicide/descale agent/antibiotic) glyphosate rather than the gluten.

  49. Hi Chris

    I have ME/CFS ( the sort with disproportionate and delayed fatigue rather than Chronic fatigue of ‘just tired/wired’). I have used your Paleo diet book here in the UK to reduce some of the symptons, but we are not there yet

    I have a an experienced nutritionist and we have done genetics to find out I have a sulphur CBS mutation so high sulphur foods ( i.e. kales, crucifers, eggs, whey etc) common Paleo food!, were actually flaring my symptoms

    I hope this can be covered in your future work and really show that one size does not fit all. Although suffering with ME/CFS for over a year now I am fascinated in how food can cure and hoping I will regain my health

    I have asked to be considered for your training as would like to teach more people in the UK about the benefits


    • Hi Kirsty
      I am also in the UK, can I ask how you did the test to find you has a sulphur CBS mutation? I haven’t been able to eat those foods for the last 16 years and so find it hard to nourish myself back to health with a very leaky gut…Can i ask you if you have found a functional doctor in the UK?
      Chris, thank you so much for all your information, you have really helped me over the years and many of my friends’ with the knowledge you share. I am so grateful…and I still need a functional doc here in UK:) If my brain was working and not ill I would do the training you are about to offer…

      • There is at least one in Suffolk, use google, at Stowmarket, his website shows a range of testing packages.

    • Chris , That’s the same things I’ve had problems with, plus spinach ,nightshades and coconut products . Well to name a few with all my allergies on top. So going strictly lchf makes things very hard. It’s been 7 months , but I found other low carb choices . Can’t come up with too many different dishes. For me I rather go without and have the benefits of feeling healthier ,

  50. Hi Chris

    This is a perfect opportunity to thank you for all you publish (and most for free) that enable people like me to take control of our health, and in particular steer others in the right direction.

    My daughter (here in UK, so NHS – ‘free’ in theory…) aged 23 diagnosed with RA, PCOS, also given antidepressants and tested as pre-diabetic last year and miscarried at 18 weeks last autumn (a missed miscarriage in fact – so emotionally very tough). By this point she was 5 stone over the weight she left home 5 years before.

    Her GP wanted her to take a fat-absorption inhibitor drug and go on no fat diet before she would even check her hormone levels again when she visited Spring this year.

    Since last November (when I sent her your latest book) she has taken her health into her own hands and with my help (my expertise is entirely gained through your information and others in the field) We’ve got her down 3 stone and counting, her cycle has re-established, unwanted hair growth has disappeared, she can fast at will, she no longer has RA (been signed off by the clinic). She weaned herself off the anti-depressants within weeks of starting you eating protocol.

    We added probiotics, HIIT, lots of walking and I sent her a bundle of all the likely deficient vitamins given her symptoms and previous diet. It took a couple of months of healing and feeling better before the weight started going, in fact 6 months, which fits with her having ‘abused’ her body for 6 years. She never took the fat-busting prescription BTW and she still can’t get them to test her hormones again, but she knows she is improving all the while.

    So thank you so much.


    • Kelda, I second your first paragraph many times over! Chris, my heartfelt thanks — you have an incredible ability to take emerging and evolving info about health issues and brilliantly organize and explain to the layperson so that it is easier to apply for real results. It’s a roadmap that’s not always easy to do, but the results follow if one is persistent.

      Kelda, your description of your daughter’s health issues shows that you don’t have to perfectly understand what is wrong in order to apply principles of good health — and get real results! Congratulations to both of you for having the courage to follow Chris’ roadmap, thereby finding a healthier way than the traditional medicine treatments.

      I bet some of her doctors were irritated / angry that she didn’t follow their directions, and I bet virtually none are curious about what she is actually doing to successfully heal her health issues.

      • They haven’t even asked her what’s she’s done! It amazes me, if I were a doctor and saw such improvement I’d want to know how so I could help my other patients.

  51. Dear Chris
    Your articles on digestive disorders have been immensely helpful to me and have enabled me to deal very effectively with esophagus and hiatus hernia issues. I don’t think you mention in your articles physique-related issues such as flabby stomach muscles, weak diaphragm, poor posture, stooped/rounded back and the muscular movement of the ribs when breathing. I have worked on all of these issues with pilates, yoga, breathing exercises, vibration, massage and drinking much more water….. and surprisingly (to me) the arrhythmia I had been experiencing cleared up!
    Thank you.

  52. Dear Chris
    Had I followed my doctor’s advice I would have been taking statins, beta-blockers, warfarin and proton pump inhibitors daily from as early as 1991, not to mention other medication to deal with the side-effects from these drugs. However I was fortunate enough to find your website! Thank you.
    If you do not already know about it, you might be interested in an initiative called the Choosing Wisely Programme which started in the US and has now been taken up in the UK by the Academy of Medical Royal Colleges.called the Choosing Wisely Programme. Its purpose is to limit inappropriate interventions by the medical profession. A steering group has been established in the UK at [email protected]
    Kind regards

  53. I wish to say a heart-felt thank to you Chris. I was diagnosed with severe Rheumatoid Arthritis (RA) 3 years ago and conventional treatments did not work (except for prednisone) in fact, they made me more sick. My mother also had RA and passed away at an early age of atherosclerosis, which may have been the result of the high doses of prednisone she was prescribed – hence me not wanting to take it. So, I took to the internet to research and I extremely happy to say I found you! I have followed everything you recommended I do having an autoimmune disease. I follow a Paleo lifestyle (well 80/20) and lost 33kgs (73 pounds) and also take the supplements you recommend. The icing on the cake was approaching my specialist and asking to be prescribed Low-Dose Naltrexone (LDN) which she luckily was open to and even enthusiastic for me to try. Hand-on-heart I am now completely pain free, actually I feel disease free and twenty years younger! I am truly grateful and cannot thank you enough for giving me back my quality of life – please, keep up the great work!

  54. Hi Chris,

    Do you know good healthcare providers who can find the root cause in the Netherlands?

    I suffer from POTS (postural ortostatic tachycardia syndrome), CFS (depends who you ask) and bloated bellies.

    Paleo helped me a lot but adding safe starches makes me fatigue and eating LC pales is hard in a professionally life.

    Thanks for your advice and suggestions.

  55. Hi there,
    I was diagnosed at the age of 16 with familial hypercholesterolaemia and told there was no other option but to go on a Statin. I remained defiant and refused to go along with this initial advice, instead learning more about the role of fatty acids and lifestyle changes to alter my cholesterol levels instead.
    At the time of the diagnosis I was quite sedentary, consumed a vegetarian diet; albeit very high in simple carbohydrates and a fairly low amount of fats.
    Post diagnosis I began regular exercise, started eating a higher protein, lower carbohydrate vegetarian diet and increased my fats through both diet and supplements. I used butter, coconut oil and olive oil with all my meals and even added extra if i was still hungry. I started taking supplementary fish oil in the highest recommended dose 3 times a day.
    The doctors were very cautious of my new regime but within the year my new cholesterol level was within the normal range and my HDL:LDL ratio had improved dramatically, and continues to this day (age 27yrs).
    After reading this article I just want to highlight the importance of persistence, research and what can seem like slow progress…….when, it can in fact change even your genetic predisposed trajectory without a prescription ever even being filled!
    This new medical model definitely deserves to be implemented before often unnecessarily lifelong treatments are initiated.

  56. hi Chris, great article.

    I have been treating blastocystis parasite infection for over 3 years, prior to that conventional doctors and natural practioners purely treated IBS symptoms or bloating, food intolerance and fluid etc. I am in my 50’s and suffered bad stomach / GI issues since a child. Finally an integrative doctor was over cautious and did many tests to uncover parasites and h.pylori.

    I have been cleared of everything finally after multiple antibiotic treatments over 3 years including the colonic infusion of strong antibiotics which did the trick.

    My question is, what if you can tick off 4 of the above pathology “causes” would you still focus on eliminating the parasite (if carrying a sub type aligned to chronic illness) or focus on other pathology issues first. As you know the medical world is divided on whether blasto is in fact pathogenic and many people believe it is purely opportunistic and enters the body when you are immune compromised. Personally, removing blasto with antibiotics was the only thing that settled down my symptoms and supported me with all other pathology issues and healing my gut (and finally absorption and hormonal issues). Natural or diet change did not work only as a symptom reducer temporarily.

    My second question is, what is your experience with parasites, and blasto in particular, which is known as a very resistant parasite to clear. What approach do you take if a chronically ill patient presents with long tenure of symptoms and failed “treatments”.

    Thanks 🙂

    • Someday I’ll write a blog post or series on Blasto. It’s such a fascinating question, but the short version is Blasto can be both nonpathogenic, and incredibly pathogenic, depending on a variety of factors including host-pathogen interaction and the particular subtype (or even variations within subtypes) of the organism. I recently read a study suggesting that over 80% of healthy people have Blasto, so it certainly can’t be possible that Blasto is always a pathogen. Yet there are also many other studies that confirm it can be pathogenic, and we see that in our practice. (Blasto was, in fact, one of the parasites that made me sick and I definitely improved when I got rid of it.)

      This uncertainty really complicates the picture when Blasto is found on a stool test.

      • Thanks so much Chris for responding. A blog on blasto would definitely be of interest to so many people across the globe as there are still too many grey areas in how one should approach blasto. This is mainly due to the variances you speak of in how it effects people so differently, and a great divide in the medical community on best treatments due to limited or outdated research or limited experience with blasto in particular . Look forward to seeing research develop with blasto, understanding more about the sub types, variances within sub types, blasto a role in the body (if it has one) and best treatments to eliminate or live with blasto. Thanks again for responding.

  57. Chris, do you have experience with treating OCD? What do you find the most common root cause is? Gut dysfunction (I’ve got that), hpa axis dysregulation, low neurotransmitters?

        • Sorry, comment got cut off:
          Thanks for the reply, Chris.
          1. Which one would you recommend focusing on first (I have to address my gut first due to constipation)?
          2. Would you recommend taking 5 htp or tryptophan for rebalancing serotonin (also maybe to help with constipation)?


  58. Chris,
    I’m curious if you would add “9. Negative Emotions” to your list of causes. You often mention stress as a contributing/underlying factor in many conditions, and in my personal experience, I’ve found it to be the the sole cause of certain health conditions I’ve suffered.
    I’m forever grateful to Dr. John Sarno’s books and his concept of TMS for curing my sciatica and IBS. In my case, the underlying cause of these physical issues was entirely emotional. I had strong negative emotions that I was repressing, and once I acknowledged these feelings, actually allowed myself to feel them, and worked through the underlying issues, the physical pain/symptoms dissipated. When my sciatica starts to return, it’s a signal to me that I’m not tending to my emotional needs and something in my life needs to be addressed. Sarno and other doctors contend that there are many medical conditions caused by TMS (such as musculoskeletal issues, chronic pain, fibromyalgia, CFS, digestive issues, etc.) and those who are Type A, conscientious, perfectionistic types are most susceptible.

    • Negative emotions, psychological and even spiritual issues would be included in the “exposome + epigenetics + genetics” area. These are core things like diet, lifestyle, and other internal and external influences that interact with the genome/epigenome and give rise to the 8 pathologies. You can also think of the pathologies as mechanisms. They are the physical manifestations/consequences of imbalances in diet, lifestyle, emotions, etc.

  59. I (and probably lots of other folks) would be grateful for some specific advice for those of us who have genetic cholesterol problems.

    The transcripts of your conversations with Chris Masterjohn seem to indicate that those with familial hypercholesterolemia might actually benefit from taking statins, but that isn’t something I’m currently willing to do.

    • Chris,

      Sorry to seem like a nag, but I see that you just posted some responses.

      I have been getting conflicting advice regarding my cholesterol issue, even from the functional medicine doctor that I am seeing.

      I really respect the your opinion and the work you do, so if you have time for even a very brief response of any sort, I’d be so grateful.

      Thank you.

      • Yes, some of the data suggest statins may be beneficial in people with FH. But there are likely other options that, when added together, may have a similar impact in reducing heart attack risk. It’s far too much to cover in a comment, or even a series of blog posts (though I have reviewed the basics in my “diet-heart myth” eBook, which is free). The High Cholesterol Action Plan digital course I created goes into a lot of depth on this.

        • Chris,

          Thank you so much for taking the time to respond. I did read the diet-heart myth e-book. I’m going to look for the course you mentioned.


  60. I think Amy’s question is the biggest challenge most of us face. Unable to work because of these health issues, so unable to get to the root of the problem because we have no money to fund the tests/labs/dr appts./supplements/special diet. It has created a vicious cycle of debt for me. Which has brought on more stress in an already stressful situation. Nobody has ever addressed this issue in the3years I’ve been around this community. Its like it’s no big deal…only $500 for an mthfr test. I wanna scream…PEOPLE!! I’VE BEEN OUT OF WORK FOR 2 YEARS!! Lol. I don’t expect charity, but there has to be another/better way.

    • Five hundred dollars for an MTHFR test is some of the worst of FM or integrative med, when you can get your genome direct-to-consumer with some 750,000 SNPs for $99 from 23andme.com, which includes the key SNPs on the MTHFR gene. Then you can opt run your genome thru independent specialized programs for nominal prices for more info if you want.

      Most FM testing is like other shopping challenges — you have to learn the best places to get things, and what time of year to get them on sale in some cases. The people selling an item for high dollar aren’t going to educate you on that.

  61. I am a practitioner. I think it is so important to find the “root” cause for sure BUT it can be very expensive for patients. What happens if a patient needs help and cant afford functional medicine to find the “root”….? Sure they can eat paleo and do what they can but if the root is an infection they need help finding that and treating that….Supplements and tests for functional medicine are very expensive. Any thoughts on this. thanks

    • I wish I had a good answer for that, but I don’t. The tests and supplements are definitely expensive, and unfortunately not often covered by insurance. We need to continue to work toward broader acceptance of functional medicine in the reimbursement model—and initiatives like the Cleveland Clinic Center for Functional Medicine are a step in that direction.

      • I also struggle with this. Living in New Zealand, it is extremely difficult to find functional medicine practitioners. The tests are even more expensive here because they often have to be shipped to Australia or the USA for analysis.

        I know that functional practitioners are in high demand and not necessarily subsidized by the health care/insurance system in any way, but I still don’t understand why $750-$950 is a reasonable fee to ask for a consult. Unfortunately, functional practitioners themselves are also often prohibitively expensive, in addition to the expenses of running all the tests themselves.

        I hear a lot of practitioners banging on about changing the system, while limiting their own patients to ‘haves’ because the ‘have nots’ will never even get a look in!

        • Hi Sarah,
          I have been consulting with a naturopath via Skype (he’s more than 600km from my home) with excellent results – I had an organic acids test done in Victoria (just posted the urine sample to them in kit supplied) which revealed some amazing info about my health, which I have been able to act on with equally amazing outcomes
          If you search http://www.planetnaturopath.com/ you will find his website

      • Hey Chris,
        While searching for an insurance plan to help with the testing costs I found mygreensurance. It’s a coop that supports 100% for functional medicine. It’s the first of it’s kind and I was very excited to find it. It’s cheaper than a conventional PPO for a family. I think this would be the answer you guys are looking for as well to help support the cost of these tests. A few features of the plan: Allows you to really choose any doctor / alternative practitioner anywhere in the world, monthly premium is 200/m for a normally healthy single person, is open to anyone in the us living in any state. The yearly “deductible”/ donation for a single person is 500$. This works out a whole lot cheaper for me than conventional health plan.

    • I’m not sure yet. I would like to be able to offer that, but it’s somewhat difficult to get set up. If not the first year, hopefully the second and thereafter.

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