Functional medicine is complex because the diseases that it’s applied to are also complex. There’s no “one pill for one symptom” model to manage chronic gut health, hypothyroid, autoimmune, or many other conditions. Instead, multiple systems in the body typically play a role in symptoms and require a broad application of diet and lifestyle, which are often key factors in the development of these conditions.
This approach eschews the idea of a “life-changing” product that will fix everything, because no such product exists, despite the most compelling claims of pharmaceutical advertisements. Rather, treating the root causes of many chronic conditions requires a life change, work, and self-education on behalf of the patient.
A nonpharmaceutical diet and lifestyle approach isn’t covered by insurance, unfortunately, even if it’s evidence-based.
Many people aren’t willing to travel down the path of functional medicine until the pain of the problem outweighs the pain of the solution. The good news is that once the path is chosen, the results are often profound and lasting, and people finally feel that they’re in the driver’s seat of their health.
Although I go over these basics in all of my courses, in this article, I cover what I call “Functional Fundamentals”—basics that you must implement regardless of your symptoms or conditions.
These fundamentals are so unglamorous that they’re easily overlooked. People who become well-versed in managing chronic health conditions can become exceptionally well-educated. I’ve learned much from my patients over the years and see that they can sometimes get lost in the weeds of the latest study or supplement. Even among my most educated and empowered patients, I often see these simple foundations go ignored.
I’m not saying that these basics will fix everything in everyone. However, they’re essential to solving the chronic health puzzle.
1. Eat Enough Protein
One of the biggest mistakes that I see people make is not eating enough protein. It’s common for patients with food sensitivities and autoimmunity on limited diets to under-consume protein.
Insufficient protein can make it impossible to rebuild intestinal cells to heal leaky gut or to recover tissue damaged by autoimmunity. Protein insufficiency is also linked to immune dysfunction, making it impossible to control autoimmunity over the long haul.
Adequate protein intake is essential to provide the building blocks to help rebuild a leaky gut and recover from autoimmune damage to tissues (joints, nerves, endocrine glands, and so forth).
In more than 25 years of working with patients who suffer from leaky gut and autoimmunity, I can’t begin to describe how futile efforts to recover were until they consumed adequate protein.
How Much Protein Is Enough?
Your ideal intake should be 0.36 grams to one gram of protein per pound of body weight. Typically, it’s suggested to use “ideal” body weight if you’re overweight, but it may be appropriate for you to go higher than that, particularly if you’ve been under-eating protein.
There are roughly seven grams of protein per ounce of meat.
Here are some examples of protein content:
- 4.6 ounces of salmon—about 28 grams.
- five ounces of strip sirloin steak—about 35 grams.
- four ounces of cooked, skinless chicken breast—about 28 grams.
Sources of Protein
Protein from meat is more bioavailable and complete than protein from plants. Meat proteins are also more complete in terms of amino acids. Vegans and vegetarians need to consume more protein and pay attention to amino acid profiles, including leucine.
I generally don’t recommend plant proteins because they’re immune reactive for many people with autoimmunity and leaky gut. Eggs and dairy are also commonly immune reactive. As with most diet-related issues, protein tolerance depends on the individual.
If you significantly undereat protein, increase consumption gradually. You may need the aid of hydrochloric (HCl) acid, digestive enzymes, and gallbladder support if you feel that protein is difficult to digest. You may also need to be screened for an H. pylori infection, which is a common cause of low HCl or indigestion, an issue that I describe in my gut health videos.
I don’t recommend protein powders that contain whey, milk, soy, egg whites, or peas because they’re immune-reactive ingredients for many people with chronic health issues. Protein powders made from beef, collagen, or chicken may be more suitable. Again, this depends on the individual.
While periodic fasting can help to reduce inflammation in some people, I don’t recommend it for those who’ve long been protein-deficient until they rebuild their protein sufficiency and general resilience.
Simply put, it’s physiologically impossible to recover and restore proper immune function if you don’t have the protein building blocks necessary for tissue and cell recovery and development.
2. Get Essential Fatty Acid Diversity
Essential fatty acid (EFA) balance is one of the most overlooked areas in managing autoimmunity, chronic health conditions, and repairing leaky gut. EFAs are converted to prostaglandins, which profoundly affect immune modulation. Industrialized vegetable oils and trans fatty acids promote the synthesis of pro-inflammatory prostaglandins and should be avoided.
It’s estimated that up to 80 percent of the U.S. population fails to get enough EFAs daily, which promotes chronic inflammation and immune dysregulation. EFAs are “essential” because the body can’t make them and they must come from the diet.
To promote the healing of tissues, reduce inflammation, and modulate autoimmunity, you must ingest a balance of omega-3, omega-6, omega-9, and arachidonic acid fats.
Fish Oil Is Best if You Have High Blood Sugar and Insulin Resistance
It’s important to mention that insulin resistance plays a role in which omega-3 fatty acid sources are best for you, as many Americans are insulin resistant. You likely have insulin resistance if your fasting blood sugar is more than 100 or your HbA1c is 5.6 or higher. In these cases, fish is the best source, as insulin resistance can hinder the body’s ability to convert alpha-linolenic acid (ALA), a type of omega-3 fatty acid found in plant sources such as flaxseed, chia, walnut, and hemp seed into a more usable form.
Eating a diet high in omega-6 fats may also hinder this conversion of ALA to omega-3s. Our hunter-gatherer ancestors ate about a 1-to-1 ratio of omega-6 fats to omega-3. Today, the average American eats a ratio of as high as 25 to 1—way too many omega-6 fats compared to omega-3 fats. This is largely because of sunflower, cottonseed, soybean, sesame, and canola oils in processed foods.
This extreme imbalance between omega-6 and omega-3 creates a highly inflammatory environment that plays a role in many chronic conditions, including heart disease, diabetes, autoimmune disease, leaky gut, and brain degeneration.
The best way to prevent or reverse this inflammatory environment is to increase your omega-3 fats and lower your consumption of omega-6 fats.
How Much Fish Oil Should You Take?
Because most people don’t consume enough EFAs, I recommend supplementing with a high-quality fish oil. However, people who take fish oil commonly don’t take enough.
A healthy intake of omega-3 is 3,500 milligrams (mg) for a person eating 2,000 calories per day. If you eat 3,000 calories, you should take at least 5,250 mg of omega-3 oils daily. The average EFA capsule is 1,000 mg. That means if you eat 2,000 calories, you should take about four per day; if you eat 3,000 calories per day, you should take five to six capsules of fish oil daily.
Algal oil supplements derived from algae are a good plant-based source of EPA and DHA (omega-3 fatty acids also found in cold-water, fatty fish). Of course, you can also eat fatty fish regularly, and raw nuts and seeds if you can tolerate them.
EPA and DHA Serve Different Functions
Most fish oil supplements have a 1:1 ratio of DHA to EPA. Both are important, but each has different functions in the body.
EPA has more of an anti-inflammatory focus, while DHA has the greatest effect on brain health. If your goal is mainly to dampen inflammation, then regular fish oil or fish oil with concentrated EPA is appropriate.
If your goal is to impact your brain health, then consider fish oil with a high concentration of DHA. Individuals with neurological imbalances derive more benefit when ratios of DHA to EPA are greater than 1:1. I like to use ratios greater than 10:1 or 20:1 of DHA to EPA.
Omega-6 and Omega-9 Fatty Acids
Omega-6 and omega-9 fatty acids are necessary for good immune health—although caution should be taken as overconsumption of omega-6 fatty acids is pro-inflammatory.
Cold-processed rapeseed oil (not to be confused with standard canola oil) and flaxseed oil are good sources of omega-6 fats. Omega-9 fatty acids are commonly found in olive and avocado oil.
Arachidonic Acid
Arachidonic acid (AA) is commonly vilified as pro-inflammatory, but we need it for healthy immune function. AA’s reputation for being pro-inflammatory comes from the overconsumption of omega-6 fatty acids in the general population.
Sources of arachidonic acid include fatty meats, shellfish, butter, and ghee. Many people with an intolerance to the dairy protein casein may nevertheless tolerate butter and ghee.
Including diverse sources of these healthy fatty acids in your diet is critical to modulating inflammation and autoimmunity.
3. Resolve Blood Sugar Imbalances
High and low blood sugar spikes can lead to systemic inflammation, immune flares, hormonal imbalances, and compromised brain function. Supporting balanced blood sugar is critical for recovery from any inflammatory condition.
Many people with chronic health conditions have blood sugar that’s too high, too low, or swings wildly between the two.
Blood Sugar That Drops Too Low Triggers Inflammation
The biggest sign of a blood sugar imbalance is the change in energy throughout the day. Your energy level should remain fairly stable. One of the most common mistakes that I’ve seen patients make is allowing their blood sugar to drop repeatedly.
Feeling “back to normal” or energized after meals means that you’re letting your blood sugar drop too low. This can cause a loss of function, low energy, and irritability (becoming “hangry”).
Each time that this happens, you undergo a physiological stress response that triggers an endocrine response and inflammation. This makes it extremely difficult to manage chronic health and autoimmune conditions.
Eat or snack frequently enough to avoid these drops in blood sugar levels. The best snacks and meals are centered around protein, fat, and fiber. Avoid sweets, fruits, and excessive carbohydrates, as these can cause blood sugar highs and lows.
I realize this flies in the face of advice to avoid snacking and to intermittently fast, but in low blood sugar situations, it’s more important to stabilize your blood sugar, energy levels, and neuroendocrine response.
When High Blood Sugar and Insulin Resistance Trigger Inflammation
If your blood sugar climbs too high because you ate too much, you ate too many carbohydrates, or insulin resistance prevents enough glucose from getting into your cells, you may get very tired after your meals.
Every time that you feel tired after eating, this activates an inflammatory pathway causing systemic inflammation, promoting leaky gut, and triggering an autoimmune response. This isn’t good for managing your health condition.
To avoid energy crashes after meals, reduce the amount of carbohydrates and portion size until you no longer feel tired after eating. Daily physical exercise is another great way to help reverse high blood sugar and insulin resistance.
Supplementing with 500 mg to 2,000 mg of berberine at meals can also effectively reduce insulin surges after eating.
4. Remember to Hydrate
Many studies have shown that dehydration can activate the inflammatory response and impact healthy immune function.
We frequently hear about the importance of hydration, yet many people still don’t drink enough water. Symptoms of dehydration include:
- Fatigue.
- Dark urine and low urine output.
- Constipation.
- Dry skin, decreased skin elasticity, cracked lips.
- Headaches.
- Light-headedness and dizziness.
- Heart palpitations.
- Low blood pressure.
- Poor concentration—altered mood and mental state.
Food cravings are often a disguise for thirst, so stay hydrated and add electrolytes to your water if necessary. People struggling with low cortisol and/or blood pressure may need to add electrolytes. Choose electrolytes that don’t contain sugar or artificial sweeteners. Many brands are unsweetened or contain stevia, which is fine for most people.
Aim for at least three to four liters of water per day, or about one ounce per pound of body weight—and more when you exercise, use a sauna, or are outdoors.
Measure your water intake for a while, and see whether you need to add more. Sip throughout the day instead of drinking large amounts at once.
5. Eat a Variety of Vegetables and Fermented Foods Daily
Each microbiotic species in our gut has various enzymes that support different physiological functions, such as converting hormones into active forms, activating nutrients, metabolizing toxins, and producing energy.
The more diverse your microbiome, the more physiological resiliency you may develop and the better your shot at recovery.
Eating a variety of vegetables is very easy. Visit your local farmer’s market or make the produce section of your grocery store your main shopping priority. Vegetables are easy to prepare and can be lightly steamed or boiled, sautéed, roasted, and added to soups and stews.
Some people with autoimmunity will need to avoid vegetables such as nightshades (such as tomatoes, eggplant, potatoes, and peppers) or those that contain lectins (such as beans, peanuts, lentils, tomatoes, potatoes, eggplant, fruits, and grains), as they can be very immune-reactive.
Fermented Foods Support a Healthy Gut Microbiome
Foods that are fermented contain bioactive peptides and short sequences of amino acids that can have antioxidant, anti-inflammatory, antimicrobial, and immune-modulating properties.
They also contain microbial metabolites that can help digest proteins and produce short-chain fatty acids, vitamins, antioxidants, and antimicrobial substances. They support gut bacteria that have been shown to improve immune health.
If you don’t normally eat fermented foods, introduce them gradually. Because they can rapidly change bacteria populations, you may experience changes in your bowel movements or experience bloating. Listen to your body when introducing them to find how much you can tolerate without bloating. The more imbalanced your gut microbiome, the more likely you will initially respond negatively to fermented foods. Individuals with healthy microbiome populations typically don’t react to a diet high in fermented foods.
When to Not Follow the Advice on Fermented Foods and Ample Fiber
People with small intestinal bacterial overgrowth (SIBO) or histamine intolerance likely need to avoid fermented foods until they improve those conditions. Too much fiber may also be an issue for those with SIBO or other gut disorders.
A common response to fermented foods if you have SIBO is to bloat. Bloating can force open the ileocecal valve between the small and large intestines, allowing bacteria from the large intestine to translocate to the largely sterile environment of the small intestine, causing or worsening SIBO or other gut problems. Therefore, I don’t recommend deliberately causing bloating, even if fermented foods are generally considered healthy. A big clue that you have SIBO is that any food—not just fermented foods—that contains fibers or sugars causes immediate bloating.
People with histamine intolerance react to foods that are fermented, aged, cured, left out too long, or overripe.
A small percentage of people have histamine intolerance because of a genetic lack of the enzymes DAO (diamine oxidase) and HNMT (Histamine N-methyltransferase). DAO primarily breaks down histamine in the gut, and HNMT degrades histamine primarily in the central nervous system. These people can experience various reactions to fermented foods, including skin rashes, headaches, mood disturbances, runny nose, irregular heartbeat, gut symptoms, flushing, dizziness, or gut symptoms.
If you don’t have these associated histamine symptoms when you eat fermented foods, you’ll unlikely have “histamine intolerance.” In recent years, histamine intolerance has grown very popular, which has resulted in many misdiagnoses of histamine intolerance. If you don’t have histamine intolerance, it’s helpful to make your diet as diverse as possible and include foods that histamine-intolerant people avoid, such as fermented foods, avocados, and various fruits, meats, and seafood.
6. Remember the Basics When Managing Complex Conditions
It’s easy to get lost in searches for the most obscure supplements, technical genetic alterations, or dietary rabbit holes, but some of the most profound practices to manage your autoimmune or chronic health condition are also the simplest and most overlooked.
I’ve worked with patients who were spectacular in their compliance with a healing diet and lifestyle, yet still missed these simple basics:
- Eat sufficient protein: about 1 gram per pound of body weight.
- Ensure a diversity of essential fatty acids in proper ratios.
- Keep your blood sugar, and hence your energy, stable throughout the day.
- Sip three to four liters of water throughout the day, and add electrolytes if necessary.
- Eat a variety of vegetables and fermented foods.
I include many other strategies in my videos, free guides, articles, and online courses, which you can find through drknews.com.
Once you’ve mastered these and the other “functional fundamentals,” you can move into more specialized strategies. The goal is to personalize a health care plan based on your unique needs, triggers, and goals.
