The Winding Road to Functional Medicine: Life after Plum Spring

Aug 17, 2010 | Functional Medicine

The following interview with Dr. Sharp and Kathleen Williams was published in the August 2010 issue of Health & Healing in the Triangle.

For many, the way practitioners view the function of the human body is a critical health issue. To explore the meaning and purpose of the emerging paradigm called “functional medicine,” we visited with Dr. Michael Sharp at his practice in Chapel Hill.

Health&Healing: Dr. Sharp, share with us the nature of your practice.

Dr. Sharp: I practice functional medicine with my wife Kathleen Williams, integrative health coach, in a structure I built on our home property. We welcome patients and clients to this quiet place to engage in a process of discovering the roots of their illness and the path to their health.

H&H: Your resume describes an unusual career path: Harvard Medical School, UNC Pediatrics residency, UNC School of Medicine faculty, Plum Spring Clinic, now this. Can you trace a thread through these?

Dr. Sharp: I’ve always been drawn to the relationship between a person’s life and their illness. My father, who was a physician, taught me that medicine is a combination of science and humanism, that these are inextricably woven. My medical school training was all about the science, and I was surprised at a gut level about the absence of exploration of the human connection. My residency in pediatrics was painfully eye-opening in this regard. I watched patients and their families struggle emotionally, spiritually, physically, and financially to cope with serious illnesses. Yet I was at a loss for tools to acknowledge, let alone begin to address effectively, the role that these aspects of life played in the course of each individual’s illness. Looking back, I realize that much of my career has been spent exploring and attempting to “fix” this disconnect.

During the ’80s and ’90s on the UNC faculty, when I wasn’t seeing patients I was involved in program and curriculum development focused on putting medical students and pediatric residents in the community to be exposed to family perspectives and help them learn about child development from the family and other professionals involved in the care of children. Parallel to that was the establishment of a network of peer-to-peer support groups of parents of children with chronic illness helping other families experiencing the same illness. We were able to track research showing improvement of all manner of outcomes resulting from peer support.

In those days, I was part of a wave of societal interest in more holistic, community-based medical education, which addressed what I saw as the great deficit in medicine: the inability of physicians to factor the nature of patients’ lives into their illnesses and how their illnesses relate to their lives. Then towards the end of the ’90s, there was a huge swing back and the high-tech science agenda was reasserted, purging many of these efforts to humanize medicine. I felt increasingly like a square peg, and took a sabbatical year to study acupuncture.

H&H: You sometimes talk about your study of Chinese medicine as a turning point.

Dr. Sharp: The game-changer for me was the fact that Chinese medicine is holistic—everything in a patient’s life is related, everything is connected. It incorporated the issues I tried to bring to light for students and residents through my work at UNC. Moreover, Chinese medicine opened me to a new way of seeing the world. At first it was hard because it violated so many core principles of the science I’d been taught.

In western medicine, if you can’t measure it, it doesn’t exist—yet half of Chinese Medicine is “yang,” which is immeasurable. I remember giving a lecture on acupuncture and a scientist in the room asked, “It’s interesting, but is it real?” Of course, we try to measure all sorts of things in medicine that are subjective—like patient satisfaction—but this imperative to quantify is so controlling of our mindset that it sometimes prevents us from seeing what is truly there.

Chinese medicine also started to have a powerful influence on the way I was with patients. Instead of my interaction with patients being controlled by the requirement to categorize symptoms and make a differential diagnosis, I started to listen and try to understand. What a difference that can make. It opens all sorts of doors that are otherwise closed.

H&H: Can you give us an example?

Dr. Sharp: Just recently I saw a patient with a knee problem that she’d been suffering for a year. She’d seen an orthopedist and a physical therapist and no one seemed to understand what was going on. In talking with her it came out that she was raised by a very demanding mother. I don’t know that that aspect of her life would be included in the usual series of questions one would ask about the cause of knee pain, but it turned out to be extremely relevant to how she was responding to her knee and her rehab program.

There are patterns in our lives that are related to the illnesses we have that Chinese medicine understands and western medicine does not, because western medicine cannot account for the intimate relationships between personality, behaviors, emotions, and illnesses. Just being in a space where all of a person is relevant allows the most important information and aspects of an illness to come forth.

H&H: You now call yourself a “functional medicine physician.”

Dr. Sharp: Chinese medicine wasn’t really my language. But when I encountered functional medicine a couple of years later, I recognized my language immediately—human biochemistry, harnessed to the kind of holistic or systems view I found so useful in Chinese medicine. This gave me the scientific framework for the consideration of interconnections—the “everything is connected” of western science. Mind you, this is the same biochemistry of very thoroughly worked-out metabolic pathways that I studied in my first year of medical school, and is still part of the first-year curriculum. Yet even as they are expected to learn it, medical students today are told they’ll never use it.

As I first encountered it, functional medicine seemed to reflect the yin and yang of human biochemistry—the concept of the Chinese energies applied to human biochemistry so that instead of using medications to influence the yin and yang of human biochemistry you use nutrients and botanicals and maybe some talk, massage, or manipulation.

H&H: If the point is to positively influence the yin and yang of human biochemistry to make it function better, why the preference for nutrients and botanicals over medications?

Dr. Sharp: The general answer is that pharmaceuticals are targeted at resolving symptoms by blocking natural processes. In functional medicine the idea is to use nutrients and botanicals to nurture under-functioning processes, restoring good working order to the overall system and resolving symptoms that way.

A good example is the use of selective serotonin reuptake inhibitors (SSRIs) in depression, which is an illness marked by a deficiency of the neurotransmitter serotonin. This class of drugs blocks the reuptake of serotonin, thereby increasing the amount of it in the active neuronal space. Ultimately though, SSRIs deplete serotonin levels over time, because the reuptake they block is actually the recycling mechanism that allows the body to reuse the serotonin. In contrast, 5HTP—a nutrient—can actually help increase serotonin levels by providing more of the material the body needs to make serotonin.

Anti-hypertension drugs are another example. If elevated blood pressure is seen as the problem rather than a symptom of a complex metabolic disturbance, bringing it down without considering everything it points to is like responding to the “check engine” light in your car by cutting the wire to the light. This is not to say that I never prescribe anti-hypertensive medication; rather, it illustrates a classic western medicine response—treating hypertension as if it’s the disease rather than addressing the functional disturbances that underlie high blood pressure. Sometimes people need medications, but in my experience medication is much more likely to be helpful in the context of a holistic approach.

H&H: What do you mean by the term ‘functional’ in this context?

Dr. Sharp: It’s a way of viewing health as a state of positive functioning of the physiological systems that make up our metabolism rather than the absence of disease. In conventional western medicine, you go to the doctor who tries to make a diagnosis that provides a label we call a “disease.” That label is then treated with medications and/or surgery. But if you have a symptom and haven’t yet developed a disease according to specific criteria, the doctor doesn’t know how to treat you. In functional medicine, the patient’s symptoms provide clues to underlying physiological disturbance or dysfunction. The patient might not have a disease—yet—but the symptoms can be important messages about physiological processes headed in that direction. So instead of trying to put the symptoms together under a label, functional medicine looks for signs of disturbances in the patient’s physiology and focuses on repairing those.

Sometimes it takes a while to figure out which disturbances are in need of repair. That’s where the human connection comes in, where everything that gets put on the table is relevant, and where the patient’s instincts are crucial to the discernment. I’ve found that a person’s feelings about his or her illness are as important as symptoms or empirical lab values.

H&H: We hear a lot about healthy lifestyle. Where does that fit into the picture?

Dr. Sharp: Once the patient, with their unique physiology and sensibilities, is at the respected center of the therapeutic process, the treatment space naturally opens up to work with lifestyle behaviors as they factor in. And current research is showing beyond a doubt the strong correlation of lifestyle choices and disease risks. So it was a very logical step for us to expand the concept of nurturing function with botanicals and supplements to nurturing overall health with positive lifestyle choices. We began incorporating education about low-glycemic load eating, positive stress response, the importance of exercise, all of which can be decisive in reversing the systems dysfunction which ultimately results in disease and death. Lifestyle medicine has been a powerful addition to our kit of tools to help patients, as is integrative health coaching.

H&H: Tell us about the health coaching piece.

Dr. Sharp: I work in the space of exploration, discovery, and education with a patient, as we establish a framework for understanding and addressing health problems. Kathleen’s integrative health coaching process with patients supports them as they develop plans for lifestyle choices that will move them to health. Take weight loss, for example: each patient comes in with a unique set of metabolic disturbances and personal issues preventing them from reaching their desired weight. I work to identify those issues and recommend an individualized treatment plan. Kathleen then works with them to plan for lifestyle or habit modifications that reflect what we’ve discovered, and empower the patient to achieve his or her wellness goals.

H&H: We all know it’s hard to make lifestyle changes—is there something in the coaching process that specifically addresses these hurdles?

Kathleen Williams: With the tools of active listening and open-ended inquiry, I help the patients identify where they most want to go with their health. If it’s weight loss, we explore the bigger vision served by that goal. We hold this space of the patient’s optimal health vision, because sometimes as patients we forget the connection between our health and our heart’s desire. We then develop a plan for structured, supported progress toward that vision.

Health coaching confirms the patient at the heart of his or her health journey. Our patients can work with Michael to understand and address the physiological disturbances underlying their illness symptoms, and with me to open a path to their vision of optimal health through choice of behaviors and habits. It’s inspiring to me that our little practice, the two of us here in our Medicine House, can engage with patients in such an encompassing process.

H&H: It appears that the “Plum Spring” has resurfaced, and it runs through the new practice.

Dr. Sharp: As you say that, I realize it’s very healing to my heart. I’ve found a practice of medicine that feels right. Feels like I’ve come home.