Past, Present, and Future of “Biological Aging” with Dr. Fitzgerald
It’s not often we get to mark the change of a decade. But what an opportune moment to take stock of what’s been going on over the last 10 years, and perhaps even more importantly what we’re heading towards.
One of the things I appreciate most about my work is that it takes place in this amazing community of brilliant Functional Medicine minds. Collectively, we can do so much more to move Functional Medicine forward than we can alone. So when I started to ponder what should be in this article, it was obvious to me that we needed more than just my opinion. Amazingly, as always, we received many responses to my email ask! And I’m really happy to share them with you here, with my thoughts at the bottom too). Each of us have put into words (sometimes in short-note form – please forgive our busy-ness!) our answers to the following questions:
- What do you think have been the most major breakthroughs of the last decade?
- Where do you think we are headed in the next decade? What changse or trends will we see?
It was very interesting to me, as I compiled these responses, to actually see how in alignment we are. We are most-all lit up about the omics revolution, particularly around the microbiome. Dr. Sandberg-Lewis also raised the ecology connection, which I very much appreciate. It’s also interesting to have a contribution from an evolutionary biologist, who’s thinking about aging as a driver of chronic disease, Josh Mitteldorf PhD. He’s the biostatistitian we’ve been working with in our epigenetics study (Methylation Diet & Lifestyle) and he has given me a new lense through which to look at our data.
Humbly, I now turn you over to my colleagues, who each have kindly given us insight into what they are thinking about. I ask that you consider adding your own thoughts too, in the comments below. We are all in this together!
DrKF
Jeffrey Bland, PhD, FACN, FACB
A biochemist by training, Dr. Bland earned dual degrees in biology and chemistry from the University of California, Irvine, and completed his PhD in organic chemistry at the University of Oregon. He is a Fellow of both the American College of Nutrition where he is a Certified Nutrition Specialist and the Association for Clinical Biochemistry. Widely considered a ‘father’ of Functional Medicine, Dr. Bland was one of the founders of the IFM.
What do you think are the most major breakthroughs of the last decade?
The important role of microbiome in influencing physiological function and genetic expression.
Where do you think we are headed in the next decade? What changes or trends will we see?
Smart device informatics systems that will capture real time physiological and physical function data and provide systems level feedback for personalizing health.
Steven Sandberg-Lewis, ND
Dr. Steven Sandberg-Lewis has been a practicing naturopathic physician since his graduation from National University of Natural Medicine (NUNM) in 1978. He has been a professor at NUNM since 1985, teaching a variety of courses but primarily focusing on gastroenterology and GI physical medicine. His gastroenterology specialty student rotations are a unique clinical training at NUNM. In addition to supervising clinical rotations he also maintains a practice at Hive Mind Medicine, in Portland, Oregon.
What do you think are the most major breakthroughs of the last decade?
- The explosion of research on the microbiome (formerly microbiota) – oral, gastric, enteric and colonic. So much research on a topic that has been known since Metchnikoff, but ignored by most of healthcare until now.
- Working out the initial details of overgrowth of commensal flora and novel approaches to restoring balance.
Where do you think we are headed in the next decade? What changes or trends will we see?
Researching and dealing with the effects of climate change, pesticides, genetic engineering and mounting stress on all earthly life forms.
Todd LePine, MD
Dr. LePine is a Dartmouth Medical School graduate, is Board Certified in both Internal Medicine and Functional Medicine. Utilizing a variety of scientifically based Integrative Medical approaches, Dr. LePine helps transform one’s health for more energy and vitality by restoring the natural balance in both the Mind and Body.
What do you think are the most major breakthroughs of the last decade?
I think some of the big breakthroughs in medicine in the last decade are the new regenerative tools including stem cells, exosomes and peptides. These treatments offer real hope to heal and regenerate tissue/organs in ways that were impossible before. Also the rise of n=1 medicine is BIG with apps, personal devices such as continuous glucose monitoring, Oura ring, etc allow people to be engaged in their health and helps provide feedback to change behaviors which is often so difficult to do.
Where do you think we are headed in the next decade? What changes or trends will we see?
The major breakthroughs of the last decade include the exponential computing power combined with massive information on the human gene……if we combine this with CRISPR and AI and we won’t recognize medicine in the next decade. The future is going to be exciting so fasten your seatbelts!!
My work is never done…….
Sara Gottfried, M.D
Dr. Sara Gottfried has elegantly distilled her years of clinical experience and thousands of patient interactions into a user-friendly body of knowledge for physician and layperson alike. She’s truly a functional/systems medicine pioneer, combining the best of scientific data with the art (and heart) of medicine.
What do you think are the most major breakthroughs of the last decade?
Continuous glucose monitor. The technology has completely revolutionized our approach to personalized medicine on a platform level, and real-time behavior on an individual level.
Where do you think we are headed in the next decade? What changes or trends will we see?
Care will become more omics informed and integrated, with a far greater understanding and evidence for a Precision and Personalized Medicine approach.
Josh Mitteldorf, PhD
What do you think are the most major breakthroughs of the last decade?
Medicine has long ago reached a stage where the diseases of old age predominate. But cancer, CVD, and Alzheimer’s disease have been researched and treated as separate diseases, partially because of the specialized training that separates cardiologists from oncologists from neurologists. In the last decade, this has begun to shift. Researchers have had so much success delaying and sometimes reversing aging in lab animals that age reversal in humans has become plausible possibility. If this is achieved, it will have enormous epidemiological impact, because the risk of cancer, CVD and AD all rise exponentially with age. Shaving even a few years off a person’s functional age lowers risk dramatically.
Where do you think we are headed in the next decade? What changes or trends will we see?
In the next decade, researchers will acknowledge that aging is not an inevitable deterioration of the body. It is driven by an epigenetic program, the same epigenetic program that makes children grow and causes adolescents to develop sexually, but the program is extended into a phase of self-destruction. Inflammation is ramped up because of pro-inflammatory genes are turned on. Antioxidant protection is ramped down because glutathione, ubiquinone, SOD, and other protective molecules are held back. Autophagy is scaled back. Apoptosis is dialed up so high that healthy nerve and muscle cells are bowing out.
As we learn to reprogram our epigenetics, the benefits for disease prevention will be beyond anything medicine has known since sanitation, vaccines, and antibiotics were introduced in the last century.
Cass Nelson-Dooley, MS
Cass Nelson-Dooley, MS, studied medicinal plants in the rain forests of Panama, in 2003 as a Fulbright Scholar, and then launched a career in science and natural medicine. She researched the pharmacology of medicinal plants at the University of Georgia and AptoTec, Inc, and then joined the innovators at Metametrix Clinical Laboratory and Genova Diagnostics. She enjoys teaching, presenting, writing, and researching how to address the underlying causes of disease, not just the symptoms.
What do you think are the most major breakthroughs of the last decade?
Maybe PCR or qPCR in routine clinical testing. I know MMx released GIfx in 2007, but I think it’s an important technology that is gaining use and momentum for routine clinical testing in the last decade.
James Maskell
James Maskell is a serial healthcare founder, innovating at the intersection of functional medicine and community. His projects include the Functional Forum : the world’s largest functional medicine conference, Evolution of Medicine : content and communities dedicated to transforming chronic disease care and Knew Health : an affordable alternative to health insurance for health conscious Amercians.
What do you think are the most major breakthroughs of the last decade?
Functional Medicine clinics in every city in the country. And the JAMA Article and Cleveland Clinic project that have firmly established the benefits of a Functional Medicine approach.
Where do you think we are headed in the next decade? What changes or trends will we see?
We will see the mainstream adoption of functional medicine inside health systems, and the growth of group delivered care as new standard of care.
Robert Luby, MD
Prior to joining IFM as their Executive Director of Medical Education, Dr. Robert Luby spent 26 years as a board certified family physician providing primary care in Latino community health centers, successfully applying the Functional Medicine model in these under-resourced settings.
Where do you think we are headed in the next decade? What changes or trends will we see?
1) There will be increasing recognition of disease “endotypes” (or “subtypes” or “clusters”)
- Evaluative tests of biomarkers and other markers will be developed to identify endotypes.
- Therapeutic interventions will increasing be deployed with more precision according to endotypes.
2) Real world data and real world evidence will be increasingly recognized as valid.
3) Individuals without medical/training licensure (or with limited training) will practice as mavericks and/or outside the scope of their licensure, especially as diagnostic and therapeutic intervention “products” become more available to the public.
Datis Kharrazian, DC PhD
Datis Kharrazian, PhD, DHSc, DC, MS, MMSc, FACN, is a clinical research scientist, academic professor, and a functional medicine health care provider. He specializes in developing evidence-based models to treat autoimmune, neurological, and unidentified chronic diseases using non-pharmaceutical applications such as diet, nutrition, and lifestyle medicine.
What do you think are the most major breakthroughs of the last decade?
One of the most important breakthroughs in the last decade has been the role of the microbiome in human health. The vast communication system that exists between gut bacteria metabolites and signaling agents that have a powerful impact on the brain, the immune system, the cardiovascular system, etc.
We have learned that the gut microbiome is all about bacteria diversity rather than the simple model of good bacteria versus bad bacteria. We know the gut microbiome is directly impacted by diet, exercise, hormones, medications, and environmental chemicals. We also know that the gut microbiome can change within a few days with these factors. The discoveries of the microbiome will help us understand how our genes combined with diet, lifestyle, and environmental factors impact chronic disease. We know the answer to improved health will not be as simple as a fad diet or a fad supplement. It will involve a complicated relationship between multiple factors that work together to impact our health.
Where do you think we are headed in the next decade? What changes or trends will we see?
I think in the next decade, we will see a greater emphasis on microbiome testing and research on how the microbiome impacts human health. Despite the evidence, the future healthcare model will be slow to implement these findings into conventional models, and healthcare will continue to ignore the complex set of variables involved with chronic disease. The rates of chronic disease will continue to rise, and the public will continue to seek out experts in functional medicine to help them implement diet, nutritional, and lifestyle interventions.
David Brady, DC, ND
Dr. David M. Brady, is a leading naturopathic medical doctor at Whole Body Medicine in Fairfield, Connecticut. He is the VP of Health Sciences and the director of the Human Nutrition Institute at the University of Bridgeport and the chief medical officer of Designs for Health, Inc., and Diagnostic Solutions Laboratory, LLC.
What do you think are the most major breakthroughs of the last decade?
The “omics” revolution and the ability to now acquire big-data from populations and through sophisticated analysis begin to apply lessons learned at the level of the individual, using AI and machine learning platforms, opens up endless opportunities to develop truly transformational precision and personalized medicine approaches that perfectly align with the functional medicine paradigm.
Where do you think we are headed in the next decade? What changes or trends will we see?
As we work to develop better analytical methods and acquire a deeper understanding of the genome, microbiome, metabolome, proteome, and other “omes”, and how they intersect with the individual’s health status (or lack of it), the way clinicians practice will radically and fundamentally change. For instance, the days of receiving your lab reports on a static print out or PDF are coming to a close. We are now delivering patient data to clinicians within sophisticated medical informatics portals that allows for data mash-ups and mining through AI and machine learning, integrated with clinical contextualization by the practitioner at the point of clinical care, to arrive at treatment interventions that will move the dial on health and wellness for the individual in ways we can’t even imagine today.
Dr. Kara Fitzgerald
Dr. Fitzgerald is a Functional Medicine clinician, educator and researcher, on faculty with the Institute for Functional Medicine. She has authored numerous books, book chapters, and other publications. Prior to clinical practice, Dr. Fitzgerald completed a post-doc under the supervision of Dr. Richard Lord at Metametrix Clinical Laboratory (now Genova).
What do you think are the most major breakthroughs of the last decade?
We are in a tremendously exciting time in medicine and science. I am grateful and in awe that we are participants in this revolution. The last decade: Those of us in functional medicine spent a lot of time smelling the sweet aroma of the omics revolution, knowing it would soon be our feast, but full access to the omics tools flooding the research environment was still forthcoming. And for many of us, myself included, I had to tape my mouth and sit on my hands to stay still. I simply couldn’t WAIT to have access to all I was reading about.
The past decade also saw us embracing systems thinking. We in FxMed were vindicated time and time again as the microbiome, dysbiosis, intestinal permeability and systems concepts became mainstream ideas in science, and while largely not acted on in the greater medical model, they certainly became recognized concepts.
We saw massive growth in FxMed. And extraordinary strides (e.g. the JAMA Network Cleveland Clinic publication) in mainstream medicine. Even our Clinic Immersion program saw increased interest from the greater medical community: more and more docs are craving the possibility of FxMed. We want to be there for them- it’s a fundamental piece of our mission.
Where do you think we are headed in the next decade? What changes or trends will we see?
Helen Messier, MD PhD and team are working on FxMed AI- this is an essential component for meaningful incorporation of omics data in clinical practice. Indeed, until we have some of these tools at the ready, analyzing hundreds of thousands of data points isn’t feasible….. fortunately for us, we still have smaller panels that are highly useful in clinic practice. The first generation of AI was really disappointing. Numbers people without biology or clinical training looking for patterns that are often non-relevant. But Helen, who straddles both worlds- FxMed clinical and bioinformatics- is best positioned to lead a team to create a game changing tool for us to use. I’m all in and optimistic regarding Helen and her team. Stay Tuned. At my clinic, are about to publish-and hopefully continue researching-the influence of diet and lifestyle on the epigenome. I would like to participate in making clinically relevant epigenetic testing available to practitioners.
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