Looking beyond the symptoms
Integrative medicine movement started in the 1990s and is aimed at treating the person, not just the disease
Integrative medicine began as a formal movement in the 1990s as public awareness of alternative therapies grew and a study revealed that one in three people in the US had used one.
The movement’s aim is to treat the whole person, rather than a symptom or disease. So, for example, at the Advanced Integrated Medical Centre in Houghton, Johannesburg, there are, apart from the specialist doctors, a nutritionist, chiropractor, colonic hydro therapist, yoga classes and lifestyle management workshops.
At the Integrative Medical Centre in Bryanston, there is also a sexual health specialist, physiotherapist, integrative nutritionist, stem-cell innovator and a compounding pharmacy where custom-designed remedies are dispensed.
Specialist physician and integrative medicine practitioner Dr Craige Golding founded the Advanced Integrated Medical Centre with Dr Mahomed Bux in 2014, after having an epiphany that most conventional pharmaceuticals did not tackle the causes of illness, but merely treated the symptoms.
Golding, at that time a specialist in internal medicine, went on a quest to find ways to treat his patients in a more holistic, multidimensional way. He went to the US 17 times, he says, after coming across the A4M, the American Academy of Anti-Aging Medicine. It offers two board-certified courses in anti-ageing medicine and Golding emerged with a US board certification in anti-ageing and regenerative medicine and as a fellow in anti-ageing and functional medicine.
“There are many studies on naturlal medicines and an enormous amount published in peer-reviewed journals.”
Golding is one of only a handful of South African practitioners specialising in integrative and functional medicine.
Dr Dhesan Moodley consults at the Integrative Medical Centre and also has a practice in Atlanta, US. After completing his MbChB at the University of Natal and an MBA and master’s in sports science at the University of Cape Town, he went to the University of South Florida to complete a master’s degree in Metabolic Nutritional Medicine.
Integrative medicine takes on board therapies such as Chinese medicine, homeopathy and naturopathy. All the treatments must have quality evidence to support them.
Golding says that as a practitioner in conventional medicine, he felt frustrated having a limited arsenal with which to treat patients. "Pharmaceuticals are useful for acute care but they do not help reverse chronic conditions such as osteoarthritis, diabetes, cancer, dementia and heart disease."
He and Moodley believe people can do a lot to prevent these diseases and they can be treated successfully without drugs, which often have unpleasant or even debilitating side-effects.
For example, statins used for high cholesterol may cause headaches, insomnia and memory loss. But a red yeast rice supplement has no adverse side-effects. People who take insulin need to administer it carefully to avoid hypoglycaemia or insulin resistance; and research indicates that women who use synthetic hormone replacement therapy run a higher risk of developing breast cancer.
A symptom such as insomnia may be caused by a hormonal imbalance, so taking a sleeping tablet will not deal with the underlying cause and may worsen it.
Integrative specialists work differently from GPs. They spend more time on consultations and getting a full medical history. Depending on the symptoms described and what they can assess from a physical examination, they will send patients for full blood tests. These range from insulin and sugar levels to thyroid, cholesterol, hormone levels and vitamin D. The doctor will prescribe pharmaceuticals, supplements, nutraceuticals, botanicals or bioidentical hormones to treat deficiencies.
Golding works with pharmacist Brent Murphy, who says: "There is so much more to supplementation than merely multivitamins and minerals. The science of nutrition has marched on and with it has come the discovery of many micronutrients. These include herbal extracts, phytochemicals, amino acids, essential fatty acids, digestive enzymes, probiotics and prebiotics."
Murphy says it is important to get the recommended dietary allowance (RDA) of vitamins daily to prevent deficiency diseases and in some cases, more than the RDA.
"For example, 1,000mg of vitamin C daily, which is 16 times greater than the RDA, has antioxidant effects that seem to protect the immune system, helps control cholesterol levels and slows down skin ageing. It is virtually impossible to achieve these higher doses from diet alone. Amino acids are also an essential part of the brain’s neurotransmitters responsible for mood, memory and even love."
While modern diets generally contain too much of the essential fatty acid omega 6, most people get too little omega 3, says Murphy. "Omega 3 essential fatty acids are essential for the normal growth of all the cells in the body, especially the brain and are necessary for heart health. Fish and krill omega 3s are superior to plant sources [flaxseed] since the type of omega 3 they contain is in a ready-to-use form."
Probiotics are useful for replenishing healthy bacteria in the gut destroyed by stress, excessive alcohol, low-fibre and high-fat diets, smoking and antibiotic use, Murphy says. They are effective in preventing irritable bowel syndrome.
“Pharmaceuticals are useful for acute care but do not help reverse [some] chronic conditions.”
Golding says that there is science behind age management medicine. "There are many studies on natural medicines and an enormous amount published in peer-reviewed journals," he says.
Many of the remedies the integrative specialists prescribe are not available at ordinary pharmacies. The Integrative Medical Centre has a compounding pharmacy with a state-of-the-art laboratory — a R50m investment, says Dr Dhivia Naidoo, who is also completing her fellowship in metabolic and nutritional medicine at the University of South Florida.
Compounding combines a time-honoured practice with the latest medical knowledge and technology, allowing the preparation of customised medication for each patient.
Integrative medicine is about maintaining optimal health rather than simply treating a disease, says Golding.
"We don’t only want to see you when you’re unwell, we’d prefer to see you when you’re well to keep you well."
Since the ground-breaking work done on the human genome, personalised, or precision medicine is replacing "one-size-fits-all" conventional medical treatment, says Discovery Health CEO Jonathan Broomberg. "This refers to the way in which everyone with a disease, such as diabetes, is treated in a similar way, even though their disease and the appropriate treatment might be quite different," he says.
"There have been limits to our understanding of disease, and of normal function, in each person. It turns out that your kind of diabetes, your response to medicine, your risk for cancer and heart disease, and many other health issues, may differ based on your genes, which until recently, we have been unable to analyse.
"Since 2001, the possibility of looking deeper and seeing the biological basis of what makes each person unique — your DNA, or our genome — has come much closer. This has led to the concept of ‘precision medicine’, which holds the promise that newly available knowledge of the genome, and other related molecular aspects of the body, will enable diagnosis and treatment to be more accurate, more successful and perhaps even less expensive, over time."
Broomberg adds that the first full sequence of a human genome — all of a person’s DNA — was published in 2001, at a cost of billions of dollars. "Since then, the cost of doing this analysis has plummeted, making it potentially available for mainstream medical practice. A whole genome can be analysed for as little as $2,000," he says.
But DNA does not tell the whole story — several other related tests have been developed that can reveal more about the actual effect of the DNA on health.
DNA sequencing can provide information about an individual’s risk of disease in the future, says Broomberg.
"This applies to thousands of rare diseases that are caused by small changes in a single gene. Having one of these changes in your DNA might not affect you, but could affect your children."
People’s genomes also hold information about how their bodies respond to certain medications, that can be used to make better choices of medication or to adjust their dosage.
Finally, Broomberg says, it is now understood that cancer is a genetic disease. "Every tumour has genetic abnormalities that drive its uncontrolled growth. Analysing the DNA of a tumour in some instances can be used to choose treatment and this is a very active area of research and evolving clinical practice."
Among the conditions that can successfully be treated with personalised medicine are familial hypercholesterolemia, which causes high levels of cholesterol and leads to heart disease; cystic fibrosis, Long QT syndrome, a heart condition causing sudden death; malignant hyperthermia, that can cause deadly reactions to common anaesthetic drugs; thoracic aortic aneurysms that can rupture and cause death and, left ventricular hypertrophy – heart enlargement leading to heart failure or rhythm disturbances and sudden death.
Cancer treatments are available for lung adenocarcinoma and breast cancer — using targeted chemotherapy — and melanoma.
Broomberg says Discovery Health has well-established procedures to evaluate these treatments. "New treatments and tests that use genomics and related technologies will be evaluated on the same basis as other treatments. If precision medicine interventions are effective, safe and reasonably affordable they will be covered."