Proactive Medicine
At The Key Clinic, we start with intelligent health decoding - using biochemical markers to analyse effects of lifestyle - stress, sleep, nutrition, exercise, genetics on one’s wellbeing.
Unlike the very compartmentalised approach of traditional medicine, we then look for patterns, analysing the functioning of the body as a whole, rather than its component parts in isolation.
This allows us to identify and target the root causes of health problems rather than simply suppressing symptoms where they arise.
We create fully personalised transformation plans based on an individual’s genetic, biochemical, and lifestyle factors. This includes nutrition, exercise, nutrient therapy and relaxation techniques, among other things.
This approach not only helps to support good health, it actually helps people to feel at their best.
We like to think it is a more intelligent approach to healthcare and one that we hope will ultimately save medical providers a fortune in reduced referrals and prescriptions.
At The Key Clinic, we want to give people the keys to thrive, so that the next 10 years look better than the last 10.
Proactive Medicine Research
The proactive, individualised approach we use at The Key Clinic is based on Functional Medicine principles. Below are two studies which indicate that this proactive approach can be more effective at improving patient reported, health reported quality of life and wellbeing than the conventional reactive medical model:
Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes, October 25, 2019
Visit link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753520
Michelle Beidelschies, PhD1; Marilyn Alejandro-Rodriguez, BSAS1; Xinge Ji, MS2; et al; Brittany Lapin, PhD2; Patrick Hanaway, MD3; Michael B. Rothberg, MD, MPH4
Question: Is the functional medicine model of care associated with patient-reported health-related quality of life?
Findings: In this cohort study of 7252 eligible patients (functional medicine center: 1595; family health center: 5657), functional medicine patients exhibited significantly larger improvements in Patient-Reported Outcome Measurement Information System Global Physical Health at 6 months than propensity-matched patients at a family health center (398 matched pairs). Improvements in Patient-Reported Outcome Measurement Information Sy stem Global Physical Health appeared to be sustained at 12 months.
Conclusions and Relevance: In this study, the functional medicine model of care demonstrated beneficial and sustainable associations with patient-reported HRQoL. This care model as delivered through individual appointments was recently associated with improved patient-reported health-related quality of life (HRQoL) compared with a care delivered in a primary care setting.
There is also evidence that functional medicine based support for those with chronic health conditions can improve outcomes when there is some shared collaboration. This was the principal behind BeBright’s ‘Bonding Through Better Health’ initiative.
BMJ: Cleveland Study of Functional Medicine
Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: A retrospective cohort study
Abstract
Objective To compare outcomes and costs associated with functional medicine-based care delivered in a shared medical appointment (SMA) to those delivered through individual appointments.
Design A retrospective cohort study was performed to assess outcomes and cost to deliver care to patients in SMAs and compared with Propensity Score (PS)-matched patients in individual appointments.
Setting A single-centre study performed at Cleveland Clinic Center for Functional Medicine.
The sample included 2455 patients (226 SMAs and 2229 individual appointments) aged ≥18 years who participated in in-person SMAs or individual appointments between 1 March 2017 and 31 December 2019. Patients had a baseline Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score and follow-up score at 3 months. Patients were PS-matched 1:1 with 213 per group based on age, sex, race, marital status, income, weight, body mass index, blood pressure (BP), PROMIS score and functional medicine diagnostic category.
Primary and secondary outcome measures The primary outcome was change in PROMIS GPH at 3 months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics, and cost.
Results Among 213 PS-matched pairs, patients in SMAs exhibited greater improvements at 3 months in PROMIS GPH T-scores (mean difference 1.18 (95% CI 0.14 to 2.22), p=0.03) and PROMIS GMH T-scores (mean difference 1.78 (95% CI 0.66 to 2.89), p=0.002) than patients in individual appointments. SMA patients also experienced greater weight loss (kg) than patients in individual appointments (mean difference −1.4 (95% CI −2.15 to −0.64), p<0.001). Both groups experienced a 5.5 mm Hg improvement in systolic BP. SMAs were also less costly to deliver than individual appointments.
Conclusion: SMAs deliver functional medicine-based care that improves outcomes more than care delivered in individual appointments and is less costly to deliver.
Evidence of the effect of digestion and diet on behaviour
The Autism Research Foundation published the results of a recent questionnaire asking 25,000 parents of children with Autism, which interventions they found most helpful. 65% said taking gluten and dairy out of the diet. This resulted in a reduction in hyperactivity, meltdowns and obsessive behaviours.
Neuroactive Peptides From Common Foods Contribute to Psychiatric Disorders
PowerPoint Presentation
Intestinal Digestive Resistance Of Immunodominant Gliadin Peptides
Scientific Journal
Intestinal Digestive Resistance Of Immunodominant Gliadin Peptides
Scientific Journal
Urinary Peptide Levels In Women With Eating Disorders. A Pilot Study.
Scientific Journal
A naturally occurring opioid peptide from cow's milk, beta-casomorphine-7, is a direct histamine releaser in man.
Scientific Journal
Beyond The Gut: The Relationship Between Gluten, Psychosis, And Schizophrenia
Paper
Dietary influences on behavioural problems in children.
Paper
Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study.
Scientific Journal
Recommended Viewing:
Adjunct Therapies for Depression: More Options
Prior to the COVID-19 pandemic, mental health disorders were considered one of the leading causes of health-related burden worldwide. Research from the World Health Organization estimates that during the first year of the pandemic, the prevalence of two common mental health disorders, anxiety and depression, increased 25% across global populations.1 Depression is most acutely seen in females and young adults (aged 18-34);2 however, the prevalence among children and adolescents has significantly increased in recent years.3
Depression is a multifactorial condition that may have several different antecedents and triggers unique to each individual, and as such, a singular focus on antidepressant medication therapy may not be the optimal approach. In fact, a major study published in 2018 found that only about a third of patients diagnosed with depression actually start treatment.4 Non-adherence to antidepressants is also common.5 A 2017 study found that 68% of the females surveyed did not follow their prescribed antidepressant therapy.5 Forgetfulness was the main reason for missing doses. Another study showed that antidepressant non-adherence is common among veterans, with ineffectiveness and avoidance of side effects frequently reported as reasons.6
For those who adhere to antidepressant therapies, treatment of the acute phase of major depressive disorder (MDD) leads to a greater number of adverse events in patients 65 and over, according to a 2019 systematic review.7 Antidepressants included in the study were selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), bupropion, mirtazapine, trazodone, vilazodone, and vortioxetine. Specifically, the reports found that SSRIs and SNRIs led to a greater number of study withdrawals due to adverse events, and duloxetine increased the risk of falls.7
Many factors can impact the efficacy of given treatment, but with lower rates of patient engagement to medication therapy, it may not be as effective as standalone treatment. When the cycle of depression continues for your patients and they still do not find relief, the clinical encounter can seem as hopeless as the patient feels. How can you get to the root cause for an individual patient, and what adjunct therapeutic interventions might improve outcomes?
The Path Forward: Complementary Therapies
The functional medicine model emphasizes a multi-pronged approach to health and wellness, engaging patients in a therapeutic partnership that recognizes that the current conventional paradigm does not optimally address the needs of patients with depressive symptoms. In the following video, IFM educator Patrick Hanaway, MD, IFMCP, talks about how a clinician might unravel the root cause of depression by looking at several factors, including levels of vitamin D and other vitamins, amino acids, and minerals—as well as the gut microbiome.
Clearly, variable reports on the efficacy of antidepressants,8,9 combined with the high prevalence of depression,10-11 have left many clinicians challenged about how to help patients. According to one report, 42% of doctors had a hard time differentiating between unhappiness and clinical depression.12 What’s more, clinicians differ greatly in how they diagnose depression—from using checklists to using “gut sense.”13 Perhaps due to lack of time or the inherent difficulties of diagnosis, some clinicians are not inquiring much or at all about depression.14 But there is a wealth of medical research on the topic, and studies continue to point to the effectiveness of non-pharmacological therapies for depression.
For patients who have tried several different antidepressants to no avail, other therapeutic interventions such as diet may yield better results. Although epidemiological studies do not establish causality, some have suggested an association between diet and mental health.15 A 2019 study found that long-term adherence to a healthy diet may offer protection against recurrent depressive symptoms.16 Analyses were conducted on a sample of 4,949 men and women, and diet scores were calculated using data collected from food frequency questionnaires repeated over 11 years of exposure. Higher scores on the Alternative Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension, and transformed Mediterranean diet were associated with a lower risk of recurrent depressive symptoms.16
Evidence suggests that dietary or supplemented intake of other nutrients, such as those listed below, can be protective against depression or reduce depressive symptoms:
Vitamin K17
Fatty acids18-20
Zinc (postpartum depression)21
Magnesium22,23
Exercise and movement are also not to be overlooked. Research suggests that physical activity alone can help improve mild to moderate depression symptoms.24-26 A 2015 cross-sectional national data study found that higher physical activity levels were associated with fewer self-reported days of poor mental health.27 Another large cohort study found that regular leisure-time exercise is associated with reduced incidence of future depression; it was predicted that 12% of future cases of depression could have been prevented if all participants had engaged in at least one hour of physical activity each week.28 Accumulating evidence also suggests that tai chi and yoga can significantly regulate emotion and relieve the symptoms of depressive disorders.29,30
Depression is a common and complex mood disorder that can severely affect a patient’s quality of life and even their family dynamic. The source can be biological, psychological, and/or social, and in the functional medicine model, it is incumbent upon the clinician to unravel the root cause of depression in order to address it effectively. Functional medicine tools like the timeline, as well as other resources, can help the patient cope, manage, and navigate a path to recovery.
Read more about the functional medicine approach to addressing depression and improving health outcomes in the following IFM-authored articles:
LIFESTYLE ALTERNATIVES TO ANTIDEPRESSANTS
DEPRESSED MOOD & EXHAUSTION MAY CONTRIBUTE TO CARDIOMETABOLIC RISK
MICRONUTRIENTS, PHYTONUTRIENTS, AND MENTAL HEALTH
References
World Health Organization. COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. World Health Organization News. Published March 2, 2022. Accessed June 22, 2022. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
Daly M, Sutin AR, Robinson E. Depression reported by US adults in 2017-2018 and March and April 2020. J Affect Disord. 2021;278:131-135. doi:10.1016/j.jad.2020.09.065
Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis. JAMA Pediatr. 2021;175(11):1142-1150. doi:10.1001/jamapediatrics.2021.2482
Waitzfelder B, Stewart C, Coleman KJ, et al. Treatment initiation for new episodes of depression in primary care settings. J Gen Intern Med. 2018;33(8):1283-1291. doi:10.1007/s11606-017-4297-2
Shrestha Manandhar J, Shrestha R, Basnet N, et al. Study of adherence pattern of antidepressants in patients with depression. Kathmandu Univ Med J. 2017;15(57):3-9.
Zivin K. Antidepressant non-adherence is common among veterans, with ineffectiveness and side effects as commonly reported reasons. Evid Based Ment Health. 2011;14(4):91. doi:10.1136/ebmh.2011.100177
Sobieraj DM, Martinez BK, Hernandez AV, et al. Adverse effects of pharmacologic treatments of major depression in older adults. J Am Geriatr Soc. 2019;67(8):1571-1581. doi:10.1111/jgs.15966
Barbui C, Cipriani A, Patel V, Ayuso-Mateos JL, van Ommeren M. Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. Br J Psychiatry. 2011;198(1):11-16, sup 1. doi:10.1192/bjp.bp.109.076448
Jakobsen JC, Katakam KK, Schou A, et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and trial sequential analysis [published correction appears in BMC Psychiatry. 2017;17(1):162]. BMC Psychiatry. 2017;17(1):58. doi:10.1186/s12888-016-1173-2
Lara Muñoz Mdel C, Jacobs EA, Escamilla MA, Mendenhall E. Depression among diabetic women in urban centers in Mexico and the United States of America: a comparative study. Rev Panam Salud Publica. 2014;36(4):225-231.
Inglis AJ, Hippman CL, Carrion PB, Honer WG, Austin JC. Mania and depression in the perinatal period among women with a history of major depressive disorders. Arch Womens Ment Health. 2014;17(2):137-143. doi:10.1007/s00737-013-0408-1
Botega NJ, Silveira GM. General practitioners’ attitudes towards depression: a study in primary care setting in Brazil. Int J Soc Psychiatry. 1996;42(3):230-237. doi:10.1177/002076409604200307
Thomas-MacLean R, Stoppard J, Miedema BB, Tatemichi S. Diagnosing depression: there is no blood test. Can Fam Physician. 2005;51(8):1102-1103.
Keeley RD, West DR, Tutt B, Nutting PA. A qualitative comparison of primary care clinicians’ and their patients’ perspectives on achieving depression care: implications for improving outcomes. BMC Fam Pract. 2014;15:13. doi:10.1186/1471-2296-15-13
Nakamura M, Miura A, Nagahata T, Shibata Y, Okada E, Ojima T. Low zinc, copper, and manganese intake is associated with depression and anxiety symptoms in the Japanese working population: findings from the Eating Habit and Well-Being study. Nutrients. 2019;11(4):E847. doi:10.3390/nu11040847
Recchia D, Baghdadli A, Lassale C, et al. Associations between long-term adherence to healthy diet and recurrent depressive symptoms in Whitehall II Study. Eur J Nutr. 2020;59(3):1031-1041. doi:10.1007/s00394-019-01964-z
Bolzetta F, Veronese N, Stubbs B, et al. The relationship between dietary vitamin K and depressive symptoms in late adulthood: a cross-sectional analysis from a large cohort study. Nutrients. 2019;11(4):E787. doi:10.3390/nu11040787
Sublette ME, Ellis SP, Geant AL, Mann JJ. Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry. 2011;72(12):1577-1584. doi:10.4088/JCP.10m06634
Mozaffari-Khosravi H, Yassini-Ardakani M, Karamati M, Shariati-Bafghi SE. Eicosapentaenoic acid versus docosahexaenoic acid in mild-to-moderate depression: a randomized, double-blind, placebo-controlled trial. Eur Neuropsychopharmacol. 2013;23(7):636-644. doi:10.1016/j.euroneuro.2012.08.003
Carney RM, Steinmeyer BC, Freedland KE, Rubin EH, Rich MW, Harris WS. Baseline blood levels of omega-3 and depression remission: a secondary analysis of data from a placebo-controlled trial of omega-3 supplements. J Clin Psychiatry. 2016;77(2):e138-e143. doi:10.4088/JCP.14m09660
Roomruangwong C, Kanchanatawan B, Sirivichayakul S, Mahieu B, Nowak G, Maes M. Lower serum zinc and higher CRP strongly predict prenatal depression and physio-somatic symptoms, which all together predict postnatal depressive symptoms. Mol Neurobiol. 2017;54(2):1500-1512. doi:10.1007/s12035-016-9741-5
Derom ML, Sayón-Orea C, Martínez-Ortega JM, Martínez-González MA. Magnesium and depression: a systematic review. Nutr Neurosci. 2013;16(5):191-206. doi:10.1179/1476830512Y.0000000044
Yary T, Aazami S, Soleimannejad K. Dietary intake of magnesium may modulate depression. Biol Trace Elem Res. 2013;151(3):324-329. doi:10.1007/s12011-012-9568-5
Hallgren M, Kraepelien M, Öjehagen A, et al. Physical exercise and internet-based cognitive-behavioural therapy in the treatment of depression: randomised controlled trial. Br J Psychiatry. 2015;207(3):227-234. doi:10.1192/bjp.bp.114.160101
McCurdy AP, Boulé NG, Sivak A, Davenport MH. Effects of exercise on mild-to-moderate depressive symptoms in the postpartum period: a meta-analysis. Obstet Gynecol. 2017;129(6):1087-1097. doi:10.1097/AOG.0000000000002053
Josefsson T, Lindwall M, Archer T. Physical exercise intervention in depressive disorders: meta-analysis and systematic review. Scand J Med Sci Sports. 2014;24(2):259-272. doi:10.1111/sms.12050
Fluetsch N, Levy C, Tallon L. The relationship of physical activity to mental health: a 2015 behavioral risk factor surveillance system data analysis. J Affect Disord. 2019;253:96-101. doi:10.1016/j.jad.2019.04.086
Harvey SB, Øverland S, Hatch SL, Wessely S, Mykletun A, Hotopf M. Exercise and the prevention of depression: results of the HUNT Cohort Study. Am J Psychiatry. 2018;175(1):28-36. doi:10.1176/appi.ajp.2017.16111223
Kong J, Wilson G, Park J, Pereira K, Walpole C, Yeung A. Treating depression with tai chi: state of the art and future perspectives. Front Psychiatry. 2019;10:237. doi:10.3389/fpsyt.2019.00237
Capon H, O’Shea M, Evans S, McIver S. Yoga complements cognitive behavior therapy as an adjunct treatment for anxiety and depression: qualitative findings from a mixed-methods study. Psychol Psychother. 2021;94(4):1015-1035. doi:10.1111/papt.12343