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Alan S. Weiss, MD
Connections From the Bottom Up
Annapolis Integrative Medicine
. http://www.annapolisintegrativemedicine.com/

Connections From the Bottom Up

Medical school trains physicians to look for patterns that tell them what is going on with a patient, hopefully resulting in the physician coming up with a diagnosis that neatly explains the symptoms and provides a remedy for whatever it is that ails the patient.
Unfortunately often the thought process doctors use to understand what is going on is a “top-down” way of thinking.
What I mean by top-down is that often doctors will listen to the patients symptoms and think from a range of possible answers and diagnoses that explain the patients problems. And when the symptoms and history best fit a particular diagnosis, that becomes the answer, the diagnosis, and then the list of possible treatments and cures that go along with the diagnosis are utilized.
Often this works out well. However there are many patients who dont particularly fit any specific easy diagnosis. These are people with a range of symptoms including fatigue, body aches, bowel problems, and sleep issues who after a whole slew of testing and evaluation are told that there is really nothing wrong with them and maybe they should learn how to relax or need an antidepressant. These patients walk away thinking they are crazy, start treating themselves with herbs and supplements out of desperation, or get more determined to find someone who can help them figure out the problem.
I have come to the conclusion that while this type of patient does not
easily fit a diagnostic category, that is only because we are thinking about them in the wrong way. We are looking for a diagnosis to explain the issue rather than looking at what part or process of the body is not working correctly.
If we view the body from the perspective that if the body is given what it needs and cleansed of what it does not need it will generally work well, a whole different perspective on creating health can be utilized.
For example, a young patient of mine has been having chronic diarrhea, joint pains, fatigue and insomnia. It turns out that she grew up in Mexico where antibiotics are easily purchased by anyone at the corner store. Any time she sniffled as a child her mother put her on antibiotics. Over time this overuse of antibiotics, in my view, began to kill off the healthy bacteria in her colon that are critical to normal immune function. Over time with increasing stress, her bowel function got worse and she developed “leaky gut,” an increasingly recognized phenomenon where the bowels ability to only allow into the body what it should. This can result in chronic immune activation, fatigue, and adrenal gland fatigue.
With correction of her bowel problems and other “downstream” issues she has improved and should get completely better.
When we think of the patients symptoms and what causes them, a bottom-up approach, we have an access to treating patients who dont readily fit a simple diagnosis.

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