Top Down Medicine- It all starts with the brain

Top Down Medicine- It All Starts With the Brain

by James E. McMinn, M.D.

I’d like to share with you a profound paradigm shift in my own thinking about the fundamental underpinnings of wellness and disease. To put it into an oversimplified nutshell, it is the realization that most of what happens to us medically begins in the brain. Many years ago in my studies of Traditional Chinese Medicine, I learned a phrase that goes like this, “the body is a puppet of the mind.” At the time I remember being quite intrigued by this concept. However, understanding the true significance of this ancient Chinese wisdom has taken many years of study and some maturity. The combination of this concept constantly rolling around in my head, along with a steady stream of patients who visit me in my integrative medical practice for physical illness most certainly related to stress, anxiety, depression, neurotransmitter imbalance, immune deficiencies, and hormone dysfunction, has helped me realize that most illnesses are caused by or related to fundamental imbalances in the brain.

Let me illustrate with a case study of Mrs. Doe. Although the name is changed to protect the innocent and to keep me out of HIPPA trouble, the case is real. She is a 50ish year old woman who honored me with visit to my office. She had suffered for many years with profound depression with some associated anxiety. She was also under tremendous stress. She was having trouble sleeping at night. She was also terribly fatigued, and had numerous other physical ailments. All of this was taking a toll on her life, her health, and her relationships. She had been on the usual circuit of anti-depressants: Prozac, Zoloft, etc., as well as anti-anxiety meds and sleeping pills. She had also experienced the typical associated side effects such as brain fog, diminished libido. She also complained that although they helped her depressions, she felt like she was “in a zone.” While on the meds she wasn’t as sad, but she was never really happy either. It was as if her life had gone from a color movie to a black and white movie. She felt emotionally disengaged on the meds, with no real feelings or joy. In addition she had some degree of anxiety, along with the usual litany of associated physical complaints such as migraine headaches, irritable bowel, rashes, low libido, and fatigue. She didn’t feel like the traditional approach was working for her, and she was hoping to find other alternatives.

I began our session by taking a thorough history. The art of medicine begins with the art of listening. I’ll never forget the wisdom that an old medical school professor shared with me when he said “listen to the patient, they’ll tell you what’s wrong with them.” Then we proceeded with an en examination, and finally some lab work. The premise of my approach is that many of her physical ailments were related to her psycho- social-mental-emotional- spiritual condition. Also, as we peel back the layers of the onion, we find that the psycho-social-mental- emotional- spiritual condition is related to hormone and neurotransmitter dysfunction. Then if we peel back to the next layer we find that the status of the neurotransmitters are related to factors like stress, nutrition, sleep, and toxins.

In keeping with a functional medicine approach, we evaluated these underlying parameters with an evidence based approach. As with most patients, it’s usually not just one big cause of such problems, but instead it’s a multitude of small imbalances which contribute tot he overall clinical picture. We then proceeded with a comprehensive evidence-based therapeutic regimen to bring this patient back into a healthy balance.

When I saw her in the waiting room for her follow-up visit, I could hardly recognize her. Unlike during the previous visit, her eyes were sparkling, and I could feel her positive energy. She was looking and feeling fantastic. Her depression was gone. Her fog had lifted. Her fatigue had abated, and once again she had energy back in her life.

The main point of this story is not just that her depression was better, but her physical complaints were improved also. I frequently see such physical problems as migraine headaches, irritable bowel, insomnia, rashes, and even obesity respond to a functional medicine approach.

A look at Guyton’s textbook of Physiology will tell you that neurotransmitters are directly related to: eyesight, mouth and gastric secretions, sweat glands, heart, blood vessels, lungs, liver, gall bladder, pancreas, bladder, kidney, penis, vagina, muscles, skin, blood coagulation, blood sugar regulation, basal metabolism, calorie utilization, adrenal glands, and mental activity. What’s more, we find that there are neuropeptide receptors in the tissues of the immune system. So the immune system is constantly eavesdropping on the mind. Perhaps that’s why we find people with a positive mental attitude are better able to fight off disease.

Integrative medicine is on the cutting edge of this functional mind/body approach to health and disease. No wonder some of the most prestigeous medical centers in the world like Harvard, Duke, Stanford, and Mayo Clinic have made major commitments to this approach by opening integrative medical centers. Also, many of the forward thinking medical schools now offer courses in integrative medicine.

In summary, we are not just a collection of independent organs. We are a whole being, connected by an overarching central nervous system and mediated through nerves, hormones, and neurotransmitters. As such, the true quest for wellness and the treatment of disease must take into consideration the mind-body-spirit connection.