I am in the back row of a prayer breakfast at your local church. The atmosphere is kind and jovial. Those who serve are happy to do so. The commitment to love and follow Jesus is evident. The leader is caring and competent as he or she invites attention to review recent prayer requests and invite new ones. As the hopes and prayers of the faithful are reviewed I hear it… a jarring sound that should not be heard. Someone is snickering; not a light hearted giggle of fellowship, but a secretive, derisive, ugly snicker. I turn with a critical raise of the eyebrow, ready for chastisement, but to my surprise, who do I see? It is the infamous Uncle Screwtape with a devious, gleeful grin on his face. Looking haughtily at me and with complete disregard for my eyebrow, he cannot contain himself,
“Just look at this! By far, the most common prayer request that comes to church leaders is regarding an individual’s lack of health, the second is related to fracturing of relationships, and the third concerns a perceived problem with finances. Those represent the vast majority of the communal prayer effort of the American Christian church community. And just look! They are so unaware, and they just joyfully eat and pray over the very kind of food that helps to rob them of their wellness. They sacrificed time and sleep to come early but fail to see how they are stuck following the habit of not living according to the designed rhythm of sleep and sabbath. This leads to even more stress in their interpersonal relationships. And they spend their prayer effort on the very consequences of the food over which they pray?! This is one of my most brilliant tactics. I can’t wait to tell Wormwood!”
While Screwtape and his nephew are infamous fictional characters in my not-so-famous story, the reason for his glee is true and the consequences are evident. You and I have been in these gatherings many times. I have tasted the sweet fellowship of praying with brothers in arms.
There is a fundamental goodness to this, and we are commanded to pray for all of these things. But, as a physician, and as a regular Christian American human, church go-er, husband, father, and consumer, I am frustrated living in this ironic (maybe even irrational) state! We all rightly lament the pain of our people, but we misguidedly and blindly keep doing that which is fueling the pain. We give thanks for our (costly) medicine and pray for guidance for the hands of our doctors as we unawarely keep our own hands in the very fires for which we need the prescription and prescriber. We rightly seek God in prayer for our wellbeing so we can seek and pursue his kingdom but we behave in a way that unravels the very fabric of that wellbeing.
As theologically mature Christians we understand that one’s worldview matters as one invests in following Jesus and his vision for the Kingdom of God in every area of our lives. One’s first principles form the foundation of what eventually becomes routine thinking and behavior. Therefore, since the majority of our Christian communities in America can relate to the reality that chronic physical symptoms, chronic financial symptoms, and chronic symptoms in our relationships are primary drivers of our prayers for help, it is evident that we are operating from insensible first principles. Biblical Functional Medicine is a “medical worldview” or a set of first principles that will help our overly symptomatic people think and live in a way that cultivates their sense of wellbeing.
TRADITIONAL MEDICAL PRACTICE
I am so grateful for our healthcare system, yet I have some serious concerns about major aspects of that system. Our healthcare is very expensive and I am deeply grateful for insurance and health sharing companies. I want to be very careful not to disparage our healthcare system and especially the individual workers within that system. There is much for which to be grateful! In fact, American healthcare performs quite well when it comes to acute trauma and acute infection. Anyone reading this, regardless of their strongly held convictions on this topic, will be very glad for a prompt response and effective care when they are in a motor vehicle accident or suddenly have a 103 degree fever at home.
However, when one’s goal is wellbeing and wholeness; if one has a sense of a loss of peace or contentment or joy. Or, if one has a sense of fatigue, or lack of energy, or chronic pain, or lack of motivation (and this likely includes every human on the planet at some point in their lives) then the application of current healthcare strategies will likely not be able to help. I can hear the “what-about” questions already popping up in your mind,
“What about a case of clinical depression? What about a person with hypothyroid? What if there is sleep apnea?”
Or any other “what-about”, of which there are, well, as many as there are individuals on the planet. Of course, my answer to any “what-about” is, “Yes, maybe that is related to the cause of this perceived symptom.”
And therein lies our complex and sticky problem. The traditional medical approach is founded on the first principle of ascertaining the diagnosis as soon as possible. Again, if there is acute trauma and/or infection, and if that is apparent on physical exam or diagnostic testing, then the traditional model will often achieve its goal of returning the patient to their former state of health. But, if the patient has a long (or short) list of subtle (or not so subtle) concerns like low “energy” or “my GI system is irritated”, to use very common examples, then the current system will provide a very expensive investigation that will often return the “diagnosis” of “there is nothing wrong with you” or a symptom based diagnosis like “irritable bowel syndrome” (the exact words the patient uses for the symptom).These are not technically wrong conclusions, but they certainly tend to leave the ones feeling the symptoms with confusion and frustration. This happens so often I am sure that most people reading this will immediately have someone in mind if not themselves.
The stickiness of the complexity deepens when we consider those who may actually be told that an abnormal biomarker has been found. In America, if you are over 40 years of age and are not in extreme poverty then I expect you already have been found to have one or more of the following measurable biomarkers: overweight, “slightly” high cholesterol, “slightly” high blood glucose (or “prediabetes”; 60% of adults and most of them do not know it), and/or “slightly” high blood pressure. Well, none of those markers, if not severely abnormal, have anything directly to do with what people care the most about: a sense of wellbeing and capacity that they can do what they need or want to do!
Yet, the patient still walks out the door with a prescription for a medicine that may very well help control a wayward biomarker, but almost never does that prescription help with what matters most. Again, I can hear the “what-abouts”! “What about the one with severe clinical depression?” Yes! I agree! The acuity is now so high that there is a higher likelihood that a medication will help, and it should be tried straight away.
The irony is that the health-care system will tend to be more successful as the patient develops a higher degree of un-health. And, the point of my essay, there are so many who are not severe enough in whatever symptom they have, they do not have a clear biomarker, they do not want to “try a medicine”, but they are left with no other clear option. At the end of the day, especially with the masses in low acuity “primary care”, there is a sense of feeling, maybe not clearly “dysfunctional”, but not feeling as well as one would like. What, then, can we do in addition to our prayers to help those with slight dysfunctions (which includes just about all of us) to feel more “functional”?
BIBLICAL FUNCTIONAL MEDICINE (BFM)
As I lay out the first principles of a paradigm shift in how to pursue and preserve human wellbeing, allow me to begin with a brief description of each word. By “Biblical” I mean to say that I am approaching this subject as one who accords authority to the Scriptures as we consider the body-mind-spirit as it relates to all other areas of life. I do not mean to imply “orthodox” or “true” or “correct” with regard to specific medical care philosophies or therapies. I am confident there are many when it comes to the infinitely complex human condition. The Bible provides us with a frame of perspective for how God created us, how he cares for us, and how we can participate in living well according to his example and even direct instruction. Please see 1Tim 6:19, Rom 12:1-2, Prov 3:5-8, and 1Cor 6:19-20 for a quick reference to some support for a biblically influenced medical world view.
By “Functional” I am not indicating that there can ever be someone who is “perfect” or a pie-in-the-sky kind of “health” all the time. Conversely, it does not mean that one must be satisfied with any current state of “function” that allows one to merely meet the standard of care or to “just be ok”. In fact, it is the patient’s privilege to define their desired level of function, hopefully in prayerful communion with God, as they go about their day following Jesus as the best example of “function”.
Lastly, “Medicine” is not used in reference to the profession or the university degree, but is used in a broader sense, referring to anything in one’s life that promotes true wellbeing as alluded to by God (Prov 3:8; a very “medical” verse!). Notably, these terms are very deep and full of meaning, especially when applied to each other. I will necessarily remain at a very general level, focusing on the foundation of a BFM approach as opposed to exploring its application to any one diagnosis or condition.
The field of Functional Medicine (FM) is no longer considered new, and there are several organizations that offer education and accreditation. I have been most influenced by the Institute for Functional Medicine (www.ifm.org), but my thoughts regarding BFM and the application in clinical practice are my own along with any errors they may contain. My introduction to the field came through the lens of being one of those patients who was “always symptomatic, but not really sick”. In fact, it was my physician-father (indeed, a subspecialist MD in the exact area of my maladies) who first taught me to question the traditional medicine status quo. Dad was not only my medical mentor, but he gifted me with a love and respect for deep study of the Bible. I entered medical school on an Air Force scholarship to learn traditional medical philosophy, and I understood I would necessarily be a “regular” Family Medicine physician for my active duty years. Well, those 9 years were wonderful, from North Carolina, to Japan, to Germany my wife, Marcie, and I loved every minute.
We transitioned out of the USAF to Colorado where I started a “regular” primary care practice, but also began learning and applying FM principles in earnest. Those years had a theme of …dissonance. I may not have recognized it at the time but it is not possible to operate a private physician business where one is to get remuneration from a third party payer system IF the doctor and the patient are using a value system (or a patient centered definition of “function”) that is different from the payer. This area of medical economy is extremely complex and not meant to be a part of this essay, but, in the end I was compelled to completely change the business structure and do my best to work directly for the patient and their unique goals (over time this idea has grown and is now called Direct Primary Care (DPC)).
Adding to the dissonance was the call to contemplate the “function” and “wellbeing” of our mind-body-spirit through a biblical lens vs the traditional medical lens. Whereas there is much excellent material written by Christian physicians about the medical profession, and there is plenty exploring the theology of the body and its relation to the mind and behavior, I found very little written about a biblical approach to Functional Medicine. So, continually rearranging my affairs around Jesus and his hope for my part in the Kingdom of God in our little Colorado town, I began to pursue the application of Functional Medicine through the lens of a biblical worldview as it pertains to the profession and business of medicine.
The Four Cornerstones of Biblical Functional Medicine
There are four areas of life that humans must participate in or there cannot be wellbeing (and even death will be hastened). God has designed it this way, and it is good. Identifying these areas allows us to engage the problem of “dysfunction” and the hope for better “function” in a special kind of malleable algorithm. Of course there must be an algorithmic system of thinking (otherwise there is chaos), but, also of course, there must be malleability to the unique needs and goals of the patient (otherwise individuals are perceived and treated as just a diagnosis code). You can see how the traditional medical system is strong on algorithm and weak on malleability.
It helps to picture the algorithm as four cornerstones that support a building. A building (human life) must be founded on these cornerstones, and if that foundation is weak or cracked there will be a consequence in that building. All persons, by definition, have some cracking in their foundations. This is the condition of a fallen world, but those cracks can “be being” mitigated. This is the reality of Emanuel, God with us, and his present Kingdom. There can be an infinite variety and uniqueness to each building, and there can be some variation in the way the foundation is built, but all buildings must have a foundation, and an improving foundation increases the likelihood of wellbeing in that building.
INPUT
The first cornerstone is Input. What is going into the body-mind-spirit that it needs? What is going in that it does not like or needs to get rid of? Most people will immediately think of nutrition or food. But keep in mind the other forms of input the body has such as hearing, or seeing, or even breathing. Every breath is an input that provides needed oxygen, but also contains what the body does not like: pollution, dust, viruses, etc. Every breath I take is at 8,600 feet up in the Rocky Mountains so there is less oxygen and my body must account for this added physiologic stress. Your skin is also semipermeable, so there is another form of input. Your colon lining is in contact with trillions of bacteria (the gut microbiome) that is NOT a part of your body, and it absorbs necessary bacterial byproducts such as biotin.
Perhaps most often overlooked is both your “outer ear” (messages, others’ voices, information you take in by hearing) and your “inner ear” (what you “hear” from your inner voice). Imagine being told wrong directions which may lead to a car wreck, but also consider the person told wrong or cruel things about themselves by an uncaring parent. That kind of input tends to reverberate for decades inside one’s mind, persisting as bad information, resulting in a continual kind of car-wreck-like trauma in one’s mind-spirit. And then there is the input through the eyes with its consequences. A beautiful mountain sunrise may help provide a sense of peace and contentment. But pornography is a kind of visual consumption that is known to impact the neurological hard-wiring of the brain to the point of erectile dysfunction in some men in their young 20’s. Yes, Input is crucial to consider when one is evaluating a cornerstone to the building of wellbeing.
In American healthcare, not only is there not enough time to consider all the complex forms of Input, but most consideration is aimed at finding a specific culprit. There is an assumption that the main cause of any diagnosis can be linked to a single trigger such as a virus, or bacteria, or even a bad burrito. When it comes to the complex topic of nutrition, therefore, we tend to vilify single foods or food groups, eliminate those, and call the whole diet “healthy”.
Nutrition in America is a good example of complexity and tension in our four cornerstones. It goes without saying that there are some “foods” that are most often detrimental to health and some that are generally considered “healthy”, but what exactly is a “healthy diet”? The answer is, “it depends”! Our healthcare system is so top heavy with emphasis on diagnosis and treatment and finding a simple solution to XYZ problem that we have 50 years of nutrition “science” and “policy” that has resulted in confusion and frustration. The better way forward is not to only do more research on individual nutritional molecules of nutritional biochemistry but to first focus on the individual and their unique symptoms, history, and goals as they pertain to the other cornerstones and the foundation as a whole.
OUTPUT
In human physiology, if there is input, then there must be Output. This is true of all living systems: nutrients, energy, information (etc) come in, and something must come out. Most people will have thought of this in the context of exercise or movement. At least, in the context of trying to be “healthy”, people will often say the word “exercise” right after the word “diet”. However, this cornerstone is so much more complex than just “burning calories”.
My first consideration is built on the first principles that energy expenditures require elimination of byproducts. So, consider what happens after one breathes in…there is a breath out. Between the in and out there is a textbook worth of pulmonary physiology – billions of molecules involved in energy transfer and waste elimination, which we all mostly take for granted! Consider the near infinite complexity between the input of fluid and food and the elimination of waste in urine and feces. All of that helps to produce a muscle contraction or a brain thought, and people are somehow led to believe this can be supported for 85 years by breakfasting on a bowl of Fruit Loops?! Output of course also contains physical movement and exercise, but perhaps even more critical is the deep question of what the overall output of your life is to be. What is your mental output? How do you put yourself out there in the world? What is the product of your life?
Naturally, we would not ever expect our primary care doctor to ask any such question. Yet, the entire purpose of putting nutrients or information into our body-mind-spirit is to then do something with it and produce…thought, feeling, mood, movement, etc. A doctor oriented to “healthy lifestyle” or “prevention” may lean into this area but the focus will likely only be on physical movement or exercise. Just as with “diet” there are myriad kinds of exercises and many books touting one or the other, and the majority of average Americans are a bit confused on the whole topic and basically just… don’t move much at all. “Which exercise is the best one for me?” is a common question. Again, the answer will be, “it depends”. Most often I will simply begin with suggesting, “the one you will do”!
RECOVERY
Humans that are functioning well demand Input and Output, and these are necessarily followed by Recovery. This cornerstone represents what I call “the Re-words”: re-store, re-cuperate, re-create, re-member, re-new, re-cover, etc. This complex biochemistry does not just happen with some random hours in a bed, or certainly not “vegging out” at the end of the day in front of the TV! That may represent a kind of relief, but it does not fuel true restoration.
Sleep that is rhythmic and restorative is a main component of this cornerstone. If a healthcare system is built on identifying clear diagnoses and measurable biomarkers then this cornerstone of wellbeing is left ignored because its very nature is not clear nor does it have clear biomarkers. Also, if sleep is not helping to achieve restoration then the consequences are so myriad that people rarely think to investigate what is happening with their sleep mechanics. Ineffective sleep can be related to just about any symptom or any sense of lack of wellbeing. Therefore any systemic approach to enhancing human function and wellbeing must include a deep awareness of the physiology of human sleep. In our practice the priority of sleep is paramount so we ask patients about it and we are quick to spend resources to investigate the few sleep biomarkers.
While sleep is a weighty component of Recovery, most fail to consider a second area that has equal gravitas. Remarkably, Christians are just as likely to be unaware of the physiologic demand for sabbath as the rest of the world. In fact, they tend to be raised in a family mindset that highly values education and work and responsibility, so true sabbath tends to quietly slip out of awareness. The first principle of sabbath, demonstrated to us in Genesis does not only mean sitting for a few hours in a pew once a week and then distracting one’s mind from the weight of the world with football on TV. Those moments are not bad or wrong in themselves, but they do NOT equal what true sabbath is.
We are designed to be able to thrive over our 90 or so years of life if there is not only adequate sleep, but there must also be regular, rhythmic time of ceasing all of our kinds of labor, and purposefully being WITH God, resting in his sufficiency alone. This could take many forms such as silence, prayer, or solitude, all of which may be done on a mountain bike, on a hike, or sitting on the office deck in the sunshine over lunch (or even football on TV with God!). I believe this is an invitation from God, not to go about our work and play with our head in the clouds, but he invites us to do all these things more and more WITH him.
We train to do this by regularly stopping the routine and realigning our thoughts, our very existence, on him. If we do not do this then, by definition, we are training and aligning our thoughts on a lifestyle that is NOT built on being with him. Anytime people train into a lifestyle (or anything) that does not have God weaved into its very fabric there will be developing a kind of pathology. We are meant to build healthy marriages, families, businesses, hobbies, etc. with him, and this is also clearly seen when we try to build functional physiology without him.
RELATIONSHIP
Finally, we come to the chief cornerstone – Relationship. Why would one care about any of this at all? What does it matter? Now we are at the first of first principles: who am I, and why am I here? This is the everyman question that all humans must answer to understand what a good life is. Your own personal relationship with all areas of input, output, and recovery will be guided by your answer to the questions, “What is a good life? What is truly LIFE? What is abundant life?”
God himself exists in an eternal self sufficiency that is built on a trinitarian relationship with himself. He invites us into a relationship with him, and the life we live – our work, our marriages, our families, our calling, our food, our exercise, our sleep, etc – is the working out of our relationship with God. He calls it good. Indeed, it is very good. But, on this side of the Fall, it is also hard and full of tension and the perception of pain – of not goodness.
As Christians we attempt to answer this question through a worldview that is built on right relationship with God. So how does this relationship influence our opinion on what is “healthy”? What actually is a relationship with one’s self (body-mind-spirit) that is “functional”? The answer to this question will be the prime influence on how one would initially perceive any symptoms or treat any pathologies (thus beginning “primary care”).
I do not believe that the conclusion is that God designed “wellbeing” to mean that there would be no pain, or no problems, or no ill health, or no anxiety, etc. In fact, a properly functioning nervous system is set up to give us a signal that the water is hot or the knife is sharp. That signal, or “pain”, is “good” in that context. So God’s idea of true life in 1Tim 6:19 (“…take hold of that which is truly life.”) is not a life with no symptoms. But, if there are less “symptoms” and more of a sense of “wellbeing” then we are more likely to be engaging in the kind of life that has more Function and less Dysfunction – a life that is leaning a bit more towards good.
CONCLUSION – HOW NOW SHALL WE LIVE?
Based on the history of Joshua and Caleb (Josh 14:10-11) and Psalm 90, I believe that our body-mind-spirit is designed for 80-90 years of full, active, working life. The scientific investigations into longevity also seems to be supporting this conclusion. But, if we just observe what is happening in the physiology of the average follower of Jesus, then our conclusion must be that most people are not full of vitality or capability or work at 80. In fact, a significant portion of us are showing signs or feeling symptoms of dysfunction at much earlier ages, and there is a general sense that only the lucky ones have any hope of doing what Caleb did. It should be our older, retired brothers and sisters that are going out on mission, but more often it is the young who are on mission serving the feeble who are often among our own elderly.
Now, am I expecting that all will reach 85 and be running off to the roughest mission field? Certainly not! And there are many confused and frustrated folks who have done all they know to do, and they are still burdened with symptoms. We must remember to approach the entire topic of body-mind-spirit wellbeing through a carefully thought out scriptural world view. Creation has fallen, and there will always be some degree of dysfunction in all humans at all times, and we will all die of some kind of pathology. Many have been confused by perceiving that following Jesus would result in a life with no signs of symptoms or pathology. However, any careful observation of physiology demonstrates some aspect of a lack of wellbeing within every person.
Others are in danger of leaning into a kind of hyper-orthodox position based on their own right rules for best lifestyle and inflicting wrong judgement on a person because of a particular kind of pathology (obviously missing the biochemical log in their own eye!). Just as there are none who are without sin, there are none who are without pathology! And in the end, after a life of walking with God in relationship as we eat, move, sleep, and sabbath, we mercifully get to die. On the other side of death there will be a full restoration and renewal. And yet, Jesus was still recognizable and he still had his scars, so there is some biblical evidence that what happens to our physical body has eternal significance.
Indeed, the weighty question of how to eat, move, sleep, and even think is a source of many books, lectures, and podcasts. Recognizing that we all live in bodies and circumstances that are near infinitely unique, and that there are just as many similarities that unite us as humans, I must conclude that there is no perfect “primary care” system. And at the same time, noting the evidence that there too is a large burden of symptoms indicating lack of desired function in our bodies and lives, I must conclude there is a problem with our current average lifestyle and healthcare system.
I am convinced that a shift in paradigm toward a Functional Medicine model from a biblical worldview will increase the likelihood of living a good and abundant life. That is our best hope of frustrating the wily Screwtape in this corner of the spiritual war in which we are all fighting. I must re-emphasize this will NOT mean a symptom or hardship free life. There will always be symptoms and even dysfunction. But if our prayers had a consequential shift in emphasis from being primarily related to our lack of health toward praying for what God is calling us to do with him with our more functional body-mind-spirit, then how much more abundant life would we be living?!
Ultimately, the main responsibility for each individual’s wellbeing lies (mainly) with the individual or (mainly) with the larger culture and healthcare system. I believe that God has given us freedom and responsibility to captain our own metabolism. Of course, we are also to teach and coach others how to live with wisdom the kind of life that is a good one. Our healthcare culture has shifted to a foundational philosophy that “health” is a primary responsibility of the government or the collective culture (a healthcare system which then also defines what they think health actually is). In part, it is. But, “primary care” is primarily the responsibility (or care) of the individual and the family. A Biblical Functional Medicine approach invites those with ears to hear to step back into the role of captaining their own metabolism, physiology, and body-mind-spirit toward the well-lived life to which God is calling them.
Dr. Randy James is an MD at True Life Medicine inWoodland Park, Colorado.
I am in the back row of a prayer breakfast at your local church. The atmosphere is kind and jovial. Those who serve are happy to do so. The commitment to love and follow Jesus is evident. The leader is caring and competent as he or she invites attention to review recent prayer requests and invite new ones. As the hopes and prayers of the faithful are reviewed I hear it... a jarring sound that should not be heard. Someone is snickering; not a light hearted giggle of fellowship, but a secretive, derisive, ugly snicker. I turn with a critical raise of the eyebrow, ready for chastisement, but to my surprise, who do I see? It is the infamous Uncle Screwtape with a devious, gleeful grin on his face. Looking haughtily at me and with complete disregard for my eyebrow, he cannot contain himself,
“Just look at this! By far, the most common prayer request that comes to church leaders is regarding an individual’s lack of health, the second is related to fracturing of relationships, and the third concerns a perceived problem with finances. Those represent the vast majority of the communal prayer effort of the American Christian church community. And just look! They are so unaware, and they just joyfully eat and pray over the very kind of food that helps to rob them of their wellness. They sacrificed time and sleep to come early but fail to see how they are stuck following the habit of not living according to the designed rhythm of sleep and sabbath. This leads to even more stress in their interpersonal relationships. And they spend their prayer effort on the very consequences of the food over which they pray?! This is one of my most brilliant tactics. I can’t wait to tell Wormwood!”
While Screwtape and his nephew are infamous fictional characters in my not-so-famous story, the reason for his glee is true and the consequences are evident. You and I have been in these gatherings many times. I have tasted the sweet fellowship of praying with brothers in arms.
There is a fundamental goodness to this, and we are commanded to pray for all of these things. But, as a physician, and as a regular Christian American human, church go-er, husband, father, and consumer, I am frustrated living in this ironic (maybe even irrational) state! We all rightly lament the pain of our people, but we misguidedly and blindly keep doing that which is fueling the pain. We give thanks for our (costly) medicine and pray for guidance for the hands of our doctors as we unawarely keep our own hands in the very fires for which we need the prescription and prescriber. We rightly seek God in prayer for our wellbeing so we can seek and pursue his kingdom but we behave in a way that unravels the very fabric of that wellbeing.
As theologically mature Christians we understand that one’s worldview matters as one invests in following Jesus and his vision for the Kingdom of God in every area of our lives. One’s first principles form the foundation of what eventually becomes routine thinking and behavior. Therefore, since the majority of our Christian communities in America can relate to the reality that chronic physical symptoms, chronic financial symptoms, and chronic symptoms in our relationships are primary drivers of our prayers for help, it is evident that we are operating from insensible first principles. Biblical Functional Medicine is a “medical worldview” or a set of first principles that will help our overly symptomatic people think and live in a way that cultivates their sense of wellbeing.
TRADITIONAL MEDICAL PRACTICE
I am so grateful for our healthcare system, yet I have some serious concerns about major aspects of that system. Our healthcare is very expensive and I am deeply grateful for insurance and health sharing companies. I want to be very careful not to disparage our healthcare system and especially the individual workers within that system. There is much for which to be grateful! In fact, American healthcare performs quite well when it comes to acute trauma and acute infection. Anyone reading this, regardless of their strongly held convictions on this topic, will be very glad for a prompt response and effective care when they are in a motor vehicle accident or suddenly have a 103 degree fever at home.
However, when one’s goal is wellbeing and wholeness; if one has a sense of a loss of peace or contentment or joy. Or, if one has a sense of fatigue, or lack of energy, or chronic pain, or lack of motivation (and this likely includes every human on the planet at some point in their lives) then the application of current healthcare strategies will likely not be able to help. I can hear the “what-about” questions already popping up in your mind,
“What about a case of clinical depression? What about a person with hypothyroid? What if there is sleep apnea?”
Or any other “what-about”, of which there are, well, as many as there are individuals on the planet. Of course, my answer to any “what-about” is, “Yes, maybe that is related to the cause of this perceived symptom.”
And therein lies our complex and sticky problem. The traditional medical approach is founded on the first principle of ascertaining the diagnosis as soon as possible. Again, if there is acute trauma and/or infection, and if that is apparent on physical exam or diagnostic testing, then the traditional model will often achieve its goal of returning the patient to their former state of health. But, if the patient has a long (or short) list of subtle (or not so subtle) concerns like low “energy” or “my GI system is irritated”, to use very common examples, then the current system will provide a very expensive investigation that will often return the “diagnosis” of “there is nothing wrong with you” or a symptom based diagnosis like “irritable bowel syndrome” (the exact words the patient uses for the symptom).These are not technically wrong conclusions, but they certainly tend to leave the ones feeling the symptoms with confusion and frustration. This happens so often I am sure that most people reading this will immediately have someone in mind if not themselves.
The stickiness of the complexity deepens when we consider those who may actually be told that an abnormal biomarker has been found. In America, if you are over 40 years of age and are not in extreme poverty then I expect you already have been found to have one or more of the following measurable biomarkers: overweight, “slightly” high cholesterol, “slightly” high blood glucose (or “prediabetes”; 60% of adults and most of them do not know it), and/or “slightly” high blood pressure. Well, none of those markers, if not severely abnormal, have anything directly to do with what people care the most about: a sense of wellbeing and capacity that they can do what they need or want to do!
Yet, the patient still walks out the door with a prescription for a medicine that may very well help control a wayward biomarker, but almost never does that prescription help with what matters most. Again, I can hear the “what-abouts”! “What about the one with severe clinical depression?” Yes! I agree! The acuity is now so high that there is a higher likelihood that a medication will help, and it should be tried straight away.
The irony is that the health-care system will tend to be more successful as the patient develops a higher degree of un-health. And, the point of my essay, there are so many who are not severe enough in whatever symptom they have, they do not have a clear biomarker, they do not want to “try a medicine”, but they are left with no other clear option. At the end of the day, especially with the masses in low acuity “primary care”, there is a sense of feeling, maybe not clearly “dysfunctional”, but not feeling as well as one would like. What, then, can we do in addition to our prayers to help those with slight dysfunctions (which includes just about all of us) to feel more “functional”?
BIBLICAL FUNCTIONAL MEDICINE (BFM)
As I lay out the first principles of a paradigm shift in how to pursue and preserve human wellbeing, allow me to begin with a brief description of each word. By “Biblical” I mean to say that I am approaching this subject as one who accords authority to the Scriptures as we consider the body-mind-spirit as it relates to all other areas of life. I do not mean to imply “orthodox” or “true” or “correct” with regard to specific medical care philosophies or therapies. I am confident there are many when it comes to the infinitely complex human condition. The Bible provides us with a frame of perspective for how God created us, how he cares for us, and how we can participate in living well according to his example and even direct instruction. Please see 1Tim 6:19, Rom 12:1-2, Prov 3:5-8, and 1Cor 6:19-20 for a quick reference to some support for a biblically influenced medical world view.
By “Functional” I am not indicating that there can ever be someone who is “perfect” or a pie-in-the-sky kind of “health” all the time. Conversely, it does not mean that one must be satisfied with any current state of “function” that allows one to merely meet the standard of care or to “just be ok”. In fact, it is the patient’s privilege to define their desired level of function, hopefully in prayerful communion with God, as they go about their day following Jesus as the best example of “function”.
Lastly, “Medicine” is not used in reference to the profession or the university degree, but is used in a broader sense, referring to anything in one’s life that promotes true wellbeing as alluded to by God (Prov 3:8; a very “medical” verse!). Notably, these terms are very deep and full of meaning, especially when applied to each other. I will necessarily remain at a very general level, focusing on the foundation of a BFM approach as opposed to exploring its application to any one diagnosis or condition.
The field of Functional Medicine (FM) is no longer considered new, and there are several organizations that offer education and accreditation. I have been most influenced by the Institute for Functional Medicine (www.ifm.org), but my thoughts regarding BFM and the application in clinical practice are my own along with any errors they may contain. My introduction to the field came through the lens of being one of those patients who was “always symptomatic, but not really sick”. In fact, it was my physician-father (indeed, a subspecialist MD in the exact area of my maladies) who first taught me to question the traditional medicine status quo. Dad was not only my medical mentor, but he gifted me with a love and respect for deep study of the Bible. I entered medical school on an Air Force scholarship to learn traditional medical philosophy, and I understood I would necessarily be a “regular” Family Medicine physician for my active duty years. Well, those 9 years were wonderful, from North Carolina, to Japan, to Germany my wife, Marcie, and I loved every minute.
We transitioned out of the USAF to Colorado where I started a “regular” primary care practice, but also began learning and applying FM principles in earnest. Those years had a theme of ...dissonance. I may not have recognized it at the time but it is not possible to operate a private physician business where one is to get remuneration from a third party payer system IF the doctor and the patient are using a value system (or a patient centered definition of “function”) that is different from the payer. This area of medical economy is extremely complex and not meant to be a part of this essay, but, in the end I was compelled to completely change the business structure and do my best to work directly for the patient and their unique goals (over time this idea has grown and is now called Direct Primary Care (DPC)).
Adding to the dissonance was the call to contemplate the “function” and “wellbeing” of our mind-body-spirit through a biblical lens vs the traditional medical lens. Whereas there is much excellent material written by Christian physicians about the medical profession, and there is plenty exploring the theology of the body and its relation to the mind and behavior, I found very little written about a biblical approach to Functional Medicine. So, continually rearranging my affairs around Jesus and his hope for my part in the Kingdom of God in our little Colorado town, I began to pursue the application of Functional Medicine through the lens of a biblical worldview as it pertains to the profession and business of medicine.
The Four Cornerstones of Biblical Functional Medicine
There are four areas of life that humans must participate in or there cannot be wellbeing (and even death will be hastened). God has designed it this way, and it is good. Identifying these areas allows us to engage the problem of “dysfunction” and the hope for better “function” in a special kind of malleable algorithm. Of course there must be an algorithmic system of thinking (otherwise there is chaos), but, also of course, there must be malleability to the unique needs and goals of the patient (otherwise individuals are perceived and treated as just a diagnosis code). You can see how the traditional medical system is strong on algorithm and weak on malleability.
It helps to picture the algorithm as four cornerstones that support a building. A building (human life) must be founded on these cornerstones, and if that foundation is weak or cracked there will be a consequence in that building. All persons, by definition, have some cracking in their foundations. This is the condition of a fallen world, but those cracks can “be being” mitigated. This is the reality of Emanuel, God with us, and his present Kingdom. There can be an infinite variety and uniqueness to each building, and there can be some variation in the way the foundation is built, but all buildings must have a foundation, and an improving foundation increases the likelihood of wellbeing in that building.
INPUT
The first cornerstone is Input. What is going into the body-mind-spirit that it needs? What is going in that it does not like or needs to get rid of? Most people will immediately think of nutrition or food. But keep in mind the other forms of input the body has such as hearing, or seeing, or even breathing. Every breath is an input that provides needed oxygen, but also contains what the body does not like: pollution, dust, viruses, etc. Every breath I take is at 8,600 feet up in the Rocky Mountains so there is less oxygen and my body must account for this added physiologic stress. Your skin is also semipermeable, so there is another form of input. Your colon lining is in contact with trillions of bacteria (the gut microbiome) that is NOT a part of your body, and it absorbs necessary bacterial byproducts such as biotin.
Perhaps most often overlooked is both your “outer ear” (messages, others’ voices, information you take in by hearing) and your “inner ear” (what you “hear” from your inner voice). Imagine being told wrong directions which may lead to a car wreck, but also consider the person told wrong or cruel things about themselves by an uncaring parent. That kind of input tends to reverberate for decades inside one’s mind, persisting as bad information, resulting in a continual kind of car-wreck-like trauma in one’s mind-spirit. And then there is the input through the eyes with its consequences. A beautiful mountain sunrise may help provide a sense of peace and contentment. But pornography is a kind of visual consumption that is known to impact the neurological hard-wiring of the brain to the point of erectile dysfunction in some men in their young 20’s. Yes, Input is crucial to consider when one is evaluating a cornerstone to the building of wellbeing.
In American healthcare, not only is there not enough time to consider all the complex forms of Input, but most consideration is aimed at finding a specific culprit. There is an assumption that the main cause of any diagnosis can be linked to a single trigger such as a virus, or bacteria, or even a bad burrito. When it comes to the complex topic of nutrition, therefore, we tend to vilify single foods or food groups, eliminate those, and call the whole diet “healthy”.
Nutrition in America is a good example of complexity and tension in our four cornerstones. It goes without saying that there are some “foods” that are most often detrimental to health and some that are generally considered “healthy”, but what exactly is a “healthy diet”? The answer is, “it depends''! Our healthcare system is so top heavy with emphasis on diagnosis and treatment and finding a simple solution to XYZ problem that we have 50 years of nutrition “science” and “policy” that has resulted in confusion and frustration. The better way forward is not to only do more research on individual nutritional molecules of nutritional biochemistry but to first focus on the individual and their unique symptoms, history, and goals as they pertain to the other cornerstones and the foundation as a whole.
OUTPUT
In human physiology, if there is input, then there must be Output. This is true of all living systems: nutrients, energy, information (etc) come in, and something must come out. Most people will have thought of this in the context of exercise or movement. At least, in the context of trying to be “healthy”, people will often say the word “exercise” right after the word “diet”. However, this cornerstone is so much more complex than just “burning calories''.
My first consideration is built on the first principles that energy expenditures require elimination of byproducts. So, consider what happens after one breathes in...there is a breath out. Between the in and out there is a textbook worth of pulmonary physiology - billions of molecules involved in energy transfer and waste elimination, which we all mostly take for granted! Consider the near infinite complexity between the input of fluid and food and the elimination of waste in urine and feces. All of that helps to produce a muscle contraction or a brain thought, and people are somehow led to believe this can be supported for 85 years by breakfasting on a bowl of Fruit Loops?! Output of course also contains physical movement and exercise, but perhaps even more critical is the deep question of what the overall output of your life is to be. What is your mental output? How do you put yourself out there in the world? What is the product of your life?
Naturally, we would not ever expect our primary care doctor to ask any such question. Yet, the entire purpose of putting nutrients or information into our body-mind-spirit is to then do something with it and produce...thought, feeling, mood, movement, etc. A doctor oriented to “healthy lifestyle” or “prevention” may lean into this area but the focus will likely only be on physical movement or exercise. Just as with “diet” there are myriad kinds of exercises and many books touting one or the other, and the majority of average Americans are a bit confused on the whole topic and basically just... don't move much at all. “Which exercise is the best one for me?” is a common question. Again, the answer will be, “it depends”. Most often I will simply begin with suggesting, “the one you will do”!
RECOVERY
Humans that are functioning well demand Input and Output, and these are necessarily followed by Recovery. This cornerstone represents what I call “the Re-words”: re-store, re-cuperate, re-create, re-member, re-new, re-cover, etc. This complex biochemistry does not just happen with some random hours in a bed, or certainly not “vegging out” at the end of the day in front of the TV! That may represent a kind of relief, but it does not fuel true restoration.
Sleep that is rhythmic and restorative is a main component of this cornerstone. If a healthcare system is built on identifying clear diagnoses and measurable biomarkers then this cornerstone of wellbeing is left ignored because its very nature is not clear nor does it have clear biomarkers. Also, if sleep is not helping to achieve restoration then the consequences are so myriad that people rarely think to investigate what is happening with their sleep mechanics. Ineffective sleep can be related to just about any symptom or any sense of lack of wellbeing. Therefore any systemic approach to enhancing human function and wellbeing must include a deep awareness of the physiology of human sleep. In our practice the priority of sleep is paramount so we ask patients about it and we are quick to spend resources to investigate the few sleep biomarkers.
While sleep is a weighty component of Recovery, most fail to consider a second area that has equal gravitas. Remarkably, Christians are just as likely to be unaware of the physiologic demand for sabbath as the rest of the world. In fact, they tend to be raised in a family mindset that highly values education and work and responsibility, so true sabbath tends to quietly slip out of awareness. The first principle of sabbath, demonstrated to us in Genesis does not only mean sitting for a few hours in a pew once a week and then distracting one’s mind from the weight of the world with football on TV. Those moments are not bad or wrong in themselves, but they do NOT equal what true sabbath is.
We are designed to be able to thrive over our 90 or so years of life if there is not only adequate sleep, but there must also be regular, rhythmic time of ceasing all of our kinds of labor, and purposefully being WITH God, resting in his sufficiency alone. This could take many forms such as silence, prayer, or solitude, all of which may be done on a mountain bike, on a hike, or sitting on the office deck in the sunshine over lunch (or even football on TV with God!). I believe this is an invitation from God, not to go about our work and play with our head in the clouds, but he invites us to do all these things more and more WITH him.
We train to do this by regularly stopping the routine and realigning our thoughts, our very existence, on him. If we do not do this then, by definition, we are training and aligning our thoughts on a lifestyle that is NOT built on being with him. Anytime people train into a lifestyle (or anything) that does not have God weaved into its very fabric there will be developing a kind of pathology. We are meant to build healthy marriages, families, businesses, hobbies, etc. with him, and this is also clearly seen when we try to build functional physiology without him.
RELATIONSHIP
Finally, we come to the chief cornerstone - Relationship. Why would one care about any of this at all? What does it matter? Now we are at the first of first principles: who am I, and why am I here? This is the everyman question that all humans must answer to understand what a good life is. Your own personal relationship with all areas of input, output, and recovery will be guided by your answer to the questions, “What is a good life? What is truly LIFE? What is abundant life?”
God himself exists in an eternal self sufficiency that is built on a trinitarian relationship with himself. He invites us into a relationship with him, and the life we live - our work, our marriages, our families, our calling, our food, our exercise, our sleep, etc - is the working out of our relationship with God. He calls it good. Indeed, it is very good. But, on this side of the Fall, it is also hard and full of tension and the perception of pain - of not goodness.
As Christians we attempt to answer this question through a worldview that is built on right relationship with God. So how does this relationship influence our opinion on what is “healthy”? What actually is a relationship with one’s self (body-mind-spirit) that is “functional”? The answer to this question will be the prime influence on how one would initially perceive any symptoms or treat any pathologies (thus beginning “primary care”).
I do not believe that the conclusion is that God designed “wellbeing” to mean that there would be no pain, or no problems, or no ill health, or no anxiety, etc. In fact, a properly functioning nervous system is set up to give us a signal that the water is hot or the knife is sharp. That signal, or “pain”, is “good” in that context. So God’s idea of true life in 1Tim 6:19 (“...take hold of that which is truly life.”) is not a life with no symptoms. But, if there are less “symptoms” and more of a sense of “wellbeing” then we are more likely to be engaging in the kind of life that has more Function and less Dysfunction - a life that is leaning a bit more towards good.
CONCLUSION - HOW NOW SHALL WE LIVE?
Based on the history of Joshua and Caleb (Josh 14:10-11) and Psalm 90, I believe that our body-mind-spirit is designed for 80-90 years of full, active, working life. The scientific investigations into longevity also seems to be supporting this conclusion. But, if we just observe what is happening in the physiology of the average follower of Jesus, then our conclusion must be that most people are not full of vitality or capability or work at 80. In fact, a significant portion of us are showing signs or feeling symptoms of dysfunction at much earlier ages, and there is a general sense that only the lucky ones have any hope of doing what Caleb did. It should be our older, retired brothers and sisters that are going out on mission, but more often it is the young who are on mission serving the feeble who are often among our own elderly.
Now, am I expecting that all will reach 85 and be running off to the roughest mission field? Certainly not! And there are many confused and frustrated folks who have done all they know to do, and they are still burdened with symptoms. We must remember to approach the entire topic of body-mind-spirit wellbeing through a carefully thought out scriptural world view. Creation has fallen, and there will always be some degree of dysfunction in all humans at all times, and we will all die of some kind of pathology. Many have been confused by perceiving that following Jesus would result in a life with no signs of symptoms or pathology. However, any careful observation of physiology demonstrates some aspect of a lack of wellbeing within every person.
Others are in danger of leaning into a kind of hyper-orthodox position based on their own right rules for best lifestyle and inflicting wrong judgement on a person because of a particular kind of pathology (obviously missing the biochemical log in their own eye!). Just as there are none who are without sin, there are none who are without pathology! And in the end, after a life of walking with God in relationship as we eat, move, sleep, and sabbath, we mercifully get to die. On the other side of death there will be a full restoration and renewal. And yet, Jesus was still recognizable and he still had his scars, so there is some biblical evidence that what happens to our physical body has eternal significance.
Indeed, the weighty question of how to eat, move, sleep, and even think is a source of many books, lectures, and podcasts. Recognizing that we all live in bodies and circumstances that are near infinitely unique, and that there are just as many similarities that unite us as humans, I must conclude that there is no perfect “primary care” system. And at the same time, noting the evidence that there too is a large burden of symptoms indicating lack of desired function in our bodies and lives, I must conclude there is a problem with our current average lifestyle and healthcare system.
I am convinced that a shift in paradigm toward a Functional Medicine model from a biblical worldview will increase the likelihood of living a good and abundant life. That is our best hope of frustrating the wily Screwtape in this corner of the spiritual war in which we are all fighting. I must re-emphasize this will NOT mean a symptom or hardship free life. There will always be symptoms and even dysfunction. But if our prayers had a consequential shift in emphasis from being primarily related to our lack of health toward praying for what God is calling us to do with him with our more functional body-mind-spirit, then how much more abundant life would we be living?!
Ultimately, the main responsibility for each individual’s wellbeing lies (mainly) with the individual or (mainly) with the larger culture and healthcare system. I believe that God has given us freedom and responsibility to captain our own metabolism. Of course, we are also to teach and coach others how to live with wisdom the kind of life that is a good one. Our healthcare culture has shifted to a foundational philosophy that “health” is a primary responsibility of the government or the collective culture (a healthcare system which then also defines what they think health actually is). In part, it is. But, “primary care” is primarily the responsibility (or care) of the individual and the family. A Biblical Functional Medicine approach invites those with ears to hear to step back into the role of captaining their own metabolism, physiology, and body-mind-spirit toward the well-lived life to which God is calling them.
Dr. Randy James is an MD at True Life Medicine inWoodland Park, Colorado.
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