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“Of several remedies, the physician should choose the least sensational.”
Not Every Practitioner Is Helpful
When it comes to reversing autoimmune disease, diet and lifestyle are the foundation, but when you hit a plateau it makes sense to seek help. The problem is that not all practitioners are created equal. So how do you find a good one? When you're about to make a large investment of your money and time in trying to heal, you want to find a guide who can truly help. In this article, I share my best advice for finding the right person to add to your healthcare team. Disclaimer: I am not a healthcare practitioner myself. I'm just a woman with autoimmune disease on a healing journey similar to your own. My advice comes from my personal experience, interviews with excellent practitioners, and also speaking with hundreds of people with autoimmune disease and seeing what has and hasn't worked for the community at large.
Signs of a Good Practitioner
- They recommend the paleo diet and lifestyle as the foundation. A good practitioner will be well-versed in paleo principles and have you try this for at least 1-3 months before trying anything else. It clears a lot of symptoms on its own and clarifies where troubleshooting needs to begin. Notice I said diet and lifestyle – they should advise you on areas beyond food as well, such as sleep and stress management. Both are common obstacles to healing. Here's a list of Paleo Functional Medicine Practitioner Directories.
- They specialize in autoimmune disease. One of the mistakes I've seen not-so-great practitioners make is treating everyone the same. People with autoimmune disease have different body responses than people without autoimmune disease, and the recommendations need to be personalized to our needs.
- They don't promise cure or remission. If a practitioner tells you they will cure your autoimmune disease, leave and don't come back. They're either outright lying to you or have a complete misunderstanding of how autoimmune disease works. Similarly, if a practitioner promises remission, they aren't being authentic either. Although it's our greatest hope, it's not something that can be promised. There is no practitioner who has achieved remission with 100% of their patients. It's a possibility – yes – and certainly worth trying for, but an honest practitioner doesn't prey on our vulnerability by pretending they can guarantee it. What a practitioner should be able to promise is that they will use their skills and knowledge to help you reverse your autoimmune symptoms and reclaim your quality of life. The goal is to help us live the best life possible with autoimmune disease, and that is a very worthwhile goal.
- They listen and see you as a partner in healing. They take a detailed patient history and want to know what you have and haven't tried, which interventions have succeeded and which have failed, and what your intuition is telling you about your health. You are seeking them out for their expertise, but the respect should go both ways.
- They help you prioritize. There are lots of potential areas of troubleshooting when it comes to autoimmune symptoms: gut health, adrenal health, hormone imbalances, nutritional deficiencies, genetic challenges, detoxification support, etc. A good practitioner will be able to tell where to start, by listening closely to your symptoms and patient history. Their approach should be targeted, rather than a shotgun “test everything” method. Often, when the most important problems are addressed, the others naturally resolve along with them.
- They make judicious recommendations when it comes to supplements. People with autoimmune disease usually have compromised digestion and detoxification abilities. Any pills – including natural ones – put a burden on our bodies. Sometimes the benefit makes it worthwhile, but the goal is to take the least amount of supplements for the shortest amount of time. A good practitioner will prioritize here as well. They will explain why they're needed, and they will re-evaluate regularly whether or not they are still needed. The supplements should also be allergen-free. Be sure to read the labels yourself – a lot of poor practitioners don't seem to know what's in their supplement lines. Resource: Where Supplements Fit on a Healing Diet.
- If you respond negatively to a treatment protocol, they change their recommendations accordingly. The goal is for you to get better, not worse. And while some treatments such as parasite cleanses can make you feel worse for a few days, that should be temporary, and ideally avoided altogether. The term “healing crisis” is overused in the functional medicine community. A good practitioner won't tell you to power through. They will reassess the situation. Resource: Is a Healing Crisis Really Healing?
Red Flags – Practitioners to Avoid
- They are either anti-paleo or don't have a true grasp of the protocol.
- They tell you that tests and supplements trump diet and lifestyle changes.
- They want you to spend thousands of dollars at your very first appointment.
- They prescribe a grocery sack full of supplements, and those supplements contain allergens and/or ingredients not allowed on the paleo autoimmune protocol.
- They prioritize the tests in the “waste of money” list below, rather than the tests that give you the most value.
- They recommend “detox cleanses” – something that often hurts more than helps people with autoimmune disease.
- They tell you that if you feel worse, it's a sign a treatment's working.
- They make grandiose promises.
- They leave you feeling frightened instead of empowered.
- They don't listen to you.
Tests That Give You the Most Value for Your Money
- Comprehensive Blood Test – The good news is that this test is often covered by insurance and you may already get this annually from your regular doctor. A functional medicine practitioner looks at this test through a different lens, gleaning a great deal of information about what's happening in your body.
- Comprehensive Stool Test – This is a 3-4 day test that screens for pathogens, yeast and parasites, but it also looks for beneficial bacteria, mucosal integrity and inflammatory markers as well. It provides a lot of information, and gut health is intimately linked with autoimmune health. The most respected labs are Doctor's Data and BioHealth.
- Urine Organic Acids Test – To educated eyes, this test provides a ton of information. You've heard of the MTHFR mutation? It's a genetic mutation that many people with autoimmune disease have that can interfere with our bodies' ability to detoxify. However, just because you have the mutation doesn't mean you have a problem. This test shows your actual methylation function – it's a much more helpful marker. And that's not the only one. This test reveals details of cellular metabolism bodywide, providing information on gut health, nutrient absorption, detoxification capacity, neurotransmitter breakdown and more. The most respected labs are Genova and Great Plains.
- SIBO Breath Test – Small Intestine Bacterial Overgrowth is a common problem among people with autoimmune disease. Markers for this will show up in the stool and urine tests listed above. This test specifically clarifies what type of SIBO, to best determine treatment recommendations. The most respected lab is Genova.
- Hormone Testing – There are three areas where hormones can go out of balance: adrenals, thyroid and sex hormones, and since they all interact, often if one is out of balance, they all are. Hormone imbalances directly impact autoimmune flares, so this is an important area. For adrenal and sex hormones, saliva testing was the standard and is still used by many practitioners. However, there is a new urine test called the DUTCH test that many practitioners are switching to. For thyroid health, you want a complete thyroid blood test that measures TSH, free T3 & T4, reverse T3, and thyroid antibodies (TPO and TgAB).
- Ordering the Tests – Most people order the tests through their practitioner. You can also order them through Directlabs.com.
- Note: I'm not saying that everyone needs all of these tests and certainly not all at once. Your practitioner should help you prioritize based on your symptoms, but if they recommend 1-3 of these tests, you will get a lot of information for your investment.
Tests That Are Largely a Waste of Money
- Food Intolerance Testing – Notorious for both false positive and false negatives, the science behind these simply isn't sound. An elimination diet like the paleo autoimmune protocol is the gold standard for determining food intolerances. If you don't feel better on the AIP, troubleshoot through the recommended tests above instead. Don't try to “diet harder”. Resource: Why Food Intolerance Testing Doesn't Work.
- Heavy Metal Testing – These are also notorious for false results. In fact, one lab was sued for having a misleading lab range that marked everyone as high in heavy metals, whether they were or not. In addition, the treatment protocol for heavy metals is chelation, and that is contraindicated for people with autoimmune disease. Dr. Datis Kharrazian has seen many autoimmune patients worsen, or even have new diseases triggered, by going through chelation protocols. A nutrient dense paleo diet is naturally chelating at a pace our bodies can handle. We can support this process through gentle measures that make us feel better rather than worse, such as Epsom salt baths. Resource: What You Need to Know About Chelation. Update 2018: There is now a new type of testing that is well respected and offers milder treatment (non-chelation). To learn more, listen to Podcast Episode 101: Heavy Metals.
- Leaky Gut Testing – If you have autoimmune disease, you have leaky gut. They go hand-in-hand, and a test isn't necessary. In addition, neither condition can be permanently cured, so again, a test isn't helpful. Don't be discouraged, though – both can be improved and managed through diet and lifestyle choices, along with the clearing of infections. Whatever you do to help heal your autoimmune symptoms will also help seal your leaky gut. Resource: Episode 32 of the Phoenix Helix podcast – Leaky Gut with Dr. Alessio Fasano.
- Chronic Lyme Disease Testing – I have a lot of friends who have been diagnosed with chronic lyme disease, and they might be surprised to see it on this list. Let me explain why. Early lyme disease can be successfully diagnosed and treated. This is when the condition is caught very shortly after a tick bite. However, tests for chronic lyme disease are prone to false positives, leading to misdiagnoses and overtreatment of a large portion of those tested. In addition, treatment is usually ineffective. In fact, many people feel worse instead of better after long-term antibiotic protocols, and I know a number of people who wish they hadn't gone through treatment. Lastly, there is controversy over whether chronic lyme disease even exists. Let me be clear: the symptoms associated with chronic lyme are definitely real; the question is whether lyme disease is the cause or if the true cause is unknown. Either way, this isn't a helpful diagnosis because it doesn't usually lead to improved symptoms.
- You May Be Feeling Angry If You've Had These Tests – I understand that! It is frustrating. Sometimes we even get attached to test results that we've invested time and money in, even when they haven't led to symptom improvement. My goal with this article is to help us all make the best choices we can going forward, and to highlight the tests and treatments that offer the greatest chance of symptom improvement.
Tests Not Mentioned
Above, I listed what I consider to be the best and the worst tests for your money. There are many tests I didn't mention. It's simply not possible to list every test that's offered. Some fall into a middle category – neither the best nor the worst. They might be helpful further down the line as you refine your troubleshooting, or they might not be necessary at all. Always start with the “best bang for your buck” recommendations above.
Patience Vs. Progress
Even with an excellent functional medicine practitioner, trial and error is part of the healing process. But a good practitioner checks in with you, listens to how you're responding and adjusts recommendations accordingly. And do remember this is a partnership. Be empowered in your relationship with any practitioner you choose: speak up, ask questions, express concerns, make requests. And be sure to listen to your practitioner as well. Once you've decided together on a course of action, commit to it. No one can “fix” you without your help.
Local Vs. Skype Consults
It is better to work with a good practitioner over Skype than a bad practitioner locally. Don't limit yourself to your geography. Good paleo functional medicine specialists are rare, and they can work very effectively with you from a distance, using today's technology.
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