Integrative, Environmental, and Holistic Doctors Offer a Different Approach to Disease
by Dr. Susan Tanner, MD
In reading the articles written on this website, you may have wondered about some of us who write them and thought to ask the question, “How are you—an environmentally-trained doctor—different than a ‘regular’ doctor?” I have been asked that question quite a bit in my medical career, and this article will attempt to explain the practice differences and how and why many of us chose to take a less conventional path. This information will be especially helpful to those of you who are dealing with things like mold or chronic Lyme and have become frustrated with “traditional” medical doctors who do not acknowledge or actively treat such diseases.
First, the ability to use the title ”Doctor” when it pertains to the medical field may vary from state to state. For example, in the state of Georgia, it is only medical doctors (MD), Doctors of Osteopathy (DO), Chiropractors (DC), and Dentists (DDS) who are able to use this moniker with the exception being the Ph.D., or Doctor of Philosophy, which may pertain to psychology or any other number of fields related to medicine. The significance of the title is that each of these doctors is required to fulfill a program of post-college study, usually 4 years or more, and pass certain licensure exams which are both on Federal and State levels. In Georgia, as in many other states, the ability to prescribe medications is currently limited to medical doctors, osteopaths, and dentists.
That then leads us to the discussion of the differences between a traditional or conventional doctor and a physician who is integrative, environmental, functional, or holistic. While these approaches are similar and have much crossover, there are some slight contrasts in each philosophy. To help illustrate how a change in thinking can shift toward a more integrative or environmentally-focused approach, I will share my personal story.
My Shift Toward a More Environmental Approach
Most of us started in a traditional medicine role. I did, and I practiced that way as a family practitioner/internist for 15 years. The reason for my search outside the box came as I found myself with an increasing number of patients with chronic illnesses that did not fit the diagnostic codes provided. More of my patients were presenting with chronic fatigue syndrome which later became called fibromyalgia. I kept thinking that there must be more to it than that—fibromyalgia/chronic fatigue was often labeled a psychiatric illness, but most of these patients were not depressed. As a matter of fact, if depression was a factor, it usually was because they were no longer able to live and function normally.
The other major impact on my medical career came with the increasing numbers of children I was seeing who were diagnosed with autism. At the time, what I knew about autism could have been summed up in two sentences. However, these growing numbers of patients without clear diagnostic testing available or even criteria for what causes the disease led me to investigate further. Very serendipitously, I was introduced to the American Academy of Environmental Medicine (AAEM). My first meeting hosted by the organization was a huge eye-opener! There were over 300 doctors in attendance who felt and were experiencing a shift in the kinds of patients and diseases they were seeing the same as I. Now I was with a large group of my professional peers who also felt that there was more to these chronic health problems than giving out prescriptions for antidepressants. I jumped in and tried to learn all I could. Then, with the mentorship of several incredible teachers, I began the journey that became my practice today.
As an aside here, I will take a moment to thank Dr. Allan Lieberman, of Charleston, SC, for his mentorship. A pediatrician in his prior practice, he began the Center of Occupational and Environmental Medicine, in which he still practices today, in his mid-80s. His teaching is unsurpassed, and he has been awarded an honor by the State of South Carolina for outstanding contributions to medical care. Through this organization and through the courses and teaching there, I began the crossover of traditional and environmental medicine.
Traditional medicine itself has evolved away from how it all began as well. Medicine was always thought of as an art, not just a science. There is such individuality among patients that, even though there are standards of care and protocols to follow, they do not always fit every patient or every situation. It is not just an A+B=C situation. Unfortunately, as insurance companies and pharmaceutical companies became more and more involved in the practice of medicine in addition to directing the research, it felt to me as if traditional medicine did not allow for that patient’s individuality to factor into their treatment, that art of the practice of medicine. This is not to say that I will not always respect the education and training that I received in medical school and beyond. I respect the foundation and knowledge I gained immensely! I also admire the practitioners who have hung in there in the face of these challenging and changing times. But for me, I knew I needed to find a different path.
Environmental medicine really refers to the entire environment—the air that you breathe, the food you eat, the illnesses and medications that you have taken, the genetics you are born with. There were several concepts that I learned within that organization that still ring true to me:
- Genetics loads the gun, and the environment pulls the trigger. For example, you may be genetically predisposed to not being able to effectively detox mold toxins, but you will not be made sick by mold until you live in a moldy environment. This is also why multiple family members will live in the same moldy home, but only one or two become very sick.
- When the body load is exceeded, which may be genetically determined, then disease will occur. This body load may be illness, pollution, toxicity, stress, or a combination. For example, you may enjoy good health for most of your life, but move to a different city where your job is very stressful and you live in a moldy apartment and suddenly, your health takes a major nosedive.
- The body has a remarkable ability to adapt and switch. That is to say that what sets off an illness or reaction at one point may change to something else, or it may impact the body with entirely different symptoms. For example, I have had patients with mold-related illness who had relatively mild sinusitis then developed headaches, which later became vertigo and paresthesias with exposure to mold. Symptomatically they seemed like different illnesses but it was all mold.
- Disease improves, and symptoms lessen or disappear when the body load is lessened. For example, many chronic Lyme patients find that their Lyme symptoms almost disappear when they address environmental burdens, like mold.
As you know if you have been reading my articles, most of what I write about has to do with following some version of those 4 concepts and working with them to regain health. It is more of a whole-body approach and cause-focused approach that makes sense of disease and why it is occurring, rather than just focusing on a patient’s symptoms. Of course, I always want to help my patients with symptoms too, but to bring about lasting health, one must look a the body load and therefore the environment to truly move the needle.
Functional and Integrative Medicine
Are functional and integrative doctors different than environmental medicine doctors? Not so much. Some of these doctors come more from the perspective of a unique biochemistry in the body. There are training organizations and memberships such as IFM (Institute of Functional Medicine) and ICIM (International College of Integrative Medicine) who, like the Academy of Environmental Medicine, attempt to get to the “why” of the illness or disorder and not just the “what” or the diagnostic label. Having a membership, myself in ICIM, I have found fascinating speakers and teachers on every topic from cancer, to mental illness, to Lyme disease.
The testing that is done within these groups of practitioners may vary somewhat from the traditional route as well. While similar blood tests may be done, the interpretation of the results may be a bit different. Blood test “normals” or “baselines” are based on an average of the populations. (See Dr. Dennis’s article about the pituitary and growth hormone testing for an example.) Thus, what is called normal may not be exactly that. There are also tests that are done that are considered “functional” tests, like the organic acids test. These are looking at actual biological or biochemical processes in the body more so than at levels circulating in the blood. Both have value when it comes to treating a patient. Often the body fluids that may be examined in these functional tests could be urine, stool, saliva, or hair as these may carry valuable information impossible to get from standard blood tests. An example of this would be urine mycotoxin testing to help diagnose mold toxicity.
The opinion of what good health looks like, both physically and on blood results, may also differ a bit between traditional and integrative physicians. Again, looking at the individual rather than a study is likely the reason for this. For instance, I have seen patients declared “healthy” because their cholesterol levels were within the normal range, yet their overall health and well-being was not good at all. I am sure that Dr. Dennis can tell you of his fungal sinusitis patients who were told that they were well, did not have allergies, and were given yet another antibiotic. Yet further testing and evaluation told otherwise!
When we use the term “holistic”, it means that health is being considered on a physical, mental, and spiritual level. Holistic medicine is the art and science of healing that addresses the whole person – body, mind, and spirit. Holistic medicine integrates conventional and alternative therapies to prevent and treat disease, and most importantly, to promote optimal health or total wellness. The real difference is that lifestyle and spiritual elements of the patient’s health are really put into focus. All energy forces in a patient’s life are thought to be part of the healing, and patient education and participation in the healing process are key for success with a holistic approach. Homeopathy is also often used in holistic medicine as “like cures like” while honoring the body’s ability to heal itself when given the right signals.
I believe that traditional and integrative physicians can be holistic and can approach each patient as a unique case with unique needs and energy forces at play. It takes time, caring, and empathy. Most of all it takes following the Hippocratic Oath: “First do no harm”. I am incredibly grateful for the training I received traditionally as well as environmentally/functionally. There have been wonderful and brilliant teachers in all areas, and being able to meld the two has been richly rewarding.
For more information about these organizations and to find doctors who are members, you can investigate the following websites: