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March 31, 2023

"The wise physician treats disease before it occurs."

- Ancient Chinese Proverb

In 1953, James Watson and Francis Crick laid the foundation for contemporary study in cell and molecular biology with the discovery of the double-helical structure of deoxyribonucleic acid (DNA). By 1962, this earned them the Nobel Prize in Medicine. This was a monumental discovery , rapidly advancing our study of genetics, protein synthesis, and cell biology. I remember celebrating the 50th anniversary of their discovery while I was an undergraduate at Oregon State University, in 2003. Linus Pauling, a former Oregon State University alum, was hugely influential in the discovery of the DNA double helix by working out bond angles and molecular distances. Pauling's work helped solidify Watson and Crick’s theory. This discovery, 50 years old at the time, was an exciting period to start a career in medicine, understanding the potential of possibility when combining science with the technological revolution.

It was 2008 when I started my residency in orthopedic surgery in the suburbs of Detroit, Michigan. After completing my residency, I did a fellowship in orthopedic trauma in Newark, New Jersey. I was blessed with the opportunity to serve a vulnerable community through education and a unique skill. Through the years, I have developed deep, meaningful relationships with my patients; learned a lot about the human experience through the lens of others; and recognized that our system is not operating to its full capacity for our patients. Evidence suggests that only 12.2% of Americans are metabolically healthy based on 5 cardiometabolic parameters: waist circumference, triglycerides, fasting glucose, high-density lipoproteins (HDLs), and hemoglobin A1c. The pharmaceutical industry has reaped the rewards of this metabolic calamity. Because of this lucrative endeavor, one begins to wonder if the system is designed around the perpetuation of sickness, rather than the restoration of health. Certainly, this perspective has to be considered.

For decades, after the discovery of DNA, it had been postulated that the cell’s nucleus is responsible for interacting and driving cellular activity. In Bruce Lipton's book, “The Biology of Belief,” he hypothesizes that the cell membrane is actually the “control center” for cellular behavior and the nucleus provides the blueprint to restore essential proteins for cellular function. Evidence for this hypothesis can be elucidated by cellular differentiation during embryology. Tissue differentiation is vitally important during development, ensuring that bone tissue develops in the proper location and doesn’t become a kidney, liver, spleen, or any other tissue type, as this would lead to improper function for that specific tissue. The DNA within the nucleus of every cell has instructions to become an osteocyte (bone cell), but the surrounding cellular environment drives the epigenetic expression of cells to express genes that differentiate it into a bone cell in specific locations. Another example of cell membrane control is "senescence-associated secretory phenotype." Cells within the human body are bathed in a complex milieu of myriad signaling molecules, as well as endogenous and exogenous noxious chemicals. This environment strongly influences cellular activity in five directions: growth, programmed cell death, traumatic cell death, maintenance, or quiescence.

With the science and technology available, there is no reason for our population to be so unhealthy. Our medical system has siloed care, emphasizing medical specialists. This care delivery system ignores that the human body is greater than the sum of its parts. While on the surface, lipid metabolism seems to be completely unrelated and separate from metabolism and maintenance of bone tissue, there is actually a nuanced and critical connection . While specialty care is important for emergency health conditions, it is not the panacea for universal health care delivery, as witnessed by the burden of chronic disease. In 2021, healthcare expenditure in the United States topped $4.2 trillion, almost 20% of our GDP.

Functional medicine is an approach that individualizes care to optimize nutrition, sleep, and lifestyle with an emphasis on promoting health, rather than fighting off symptoms of disease. An analogy I often use to describe the contemporary medical approach is akin to asking my children to clean their room; shoving all of their mess under the bed will hide things, but the room still isn’t tidy. Most medications (not all) that are prescribed, treat symptoms, but not the underlying disease. Hiding symptoms from patients, and physicians, allows the pathological process to continue, but now without detection. In my opinion, our threshold for detecting abnormal physiological conditions should be more sensitive and we should be more aggressive with nutritional and lifestyle modifications earlier in the process. There are two dichotomous paths to longevity: (1) aggressive treatment of disease upon manifestation, which will compromise health span, or (2) optimizing health span throughout your life to avoid disease as long as possible. The latter approach will enrich the human experience and allow for prolonged functional ability.

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