Dr. Chen's General Approach to Medicine
Dr. Chen is a board-certified general internist with previous
experience both in academic and multi-specialty group practice
settings delivering primary care medicine. Her specific
interests in the areas of hormone balancing, metabolism,
nutrition, and preventive medicine developed out of trying to
help multiple family members with long-term health struggles,
including heart disease, asthma, life-threatening allergies,
autoimmune disease, breast and colon cancers, as well as severe
depression. She was also blessed with a very busy primary
care practice for many years and credits her patients with
teaching her to be a better listener through their persistent
engagement with Dr. Chen, and bringing in books and information
that they asked her to review and give feedback. Through
over 20 years of long-term interactions with patients, she has
learned the value of identifying presenting symptoms as clues
provided by the body that something is off-balance. She
sees her role as that of a "medical detective," looking for an
underlying, unifying pattern. This goes against an often
encountered approach of suppressing each symptom with a drug,
often marketed as an "anti-" drug, such as an anti-depressant
for depression/anxiety, anti-inflammatories for aches and pains,
anti-histamines for allergies, anti-acids for acid reflux,
etc. The symptoms will abate if the underlying imbalance
is corrected. Simply suppressing the symptoms with a drug
is doing away with the important clues needed to solve the
mystery.
Integrating all the clues is systems thinking, which dictates
that changing something in one part of the body can and does
affect other parts of the body and bodily processes, leading to
new symptoms in the process. Dr. Chen views the body as
consisting of many organs which are linked not only physically
by an amazing structural support of bones and connective tissue,
but also by an extraordinarily complicated web of invisible
communication channels which operate on multiple levels.
Therefore, simply adding "body parts" together typically falls
short of the whole person. Additional training in
functional medicine has helped Dr. Chen develop an integrative
approach, treating each patient as an individual with
potentially differing presentations and needs, in place of the
commonly employed "one-size-fits-all" approach. She values
the advances that both conventional medicine and technology have
brought us, also recognizing their limitations for preventing
disease. Dr. Chen feels that conventional and alternative
methods can often be complementary when integrated to treat the
whole patient. This is in-line with her systems thinking when
looking at individuals, which propels her to see the big
picture.
When getting acquainted with a patient's presenting symptoms
and concerns, there are numerous potential factors that Dr. Chen
tries to ascertain in her role as a "medical detective," which
are important in arriving at diagnoses and formulating
customized treatment plans. These often include, but are
not limited to:
1) Disruption in circadian rhythms, which include
temperature, hunger, metabolism, timing of meals and activities,
release of stress hormones, and most importantly, sleep as the
overarching regulator of circadian rhythms in the body.
The field of chronobiology is advancing rapidly with new
research implicating the significance of proper timing not only
in gene expression, but also bodily processes. For
example, a recent Salk Institute study published in the journal
Science on February 8, 2018, found that the activity of nearly
80% of genes follows a day/night rhythm in many tissue types and
brain regions across the entire primate body. The
researchers found that gene expression across many different
tissues was "rhythmic", i.e., expressed based on the time of
day, and that nearly 11,000 of the 25,000 genes in the primate
genome were expressed in all tissues, with 96.6% of those
expressed genes particularly rhythmic in at least one tissue
(http://science.sciencemag.org/content/early/2018/02/07/science.aao0318).
2) Imbalances in the gut microbiome, whether through
frequent use of antibiotics, chronic gut inflammation, dietary
indiscretions, chronic stress, and inappropriate timing of
meals, as the gut microbiome is also timed to the circadian
rhythm. Studies correlating the health and balance of the
gut microbiome have exploded over the past decade, and the more
we learn, the more our appreciation expands for its system-wide
effects, whether those might be metabolic regulation,
detoxification, communications with the brain, or the difference
between the production of anti-inflammatory immune signals vs a
source of systemic inflammation through the process of increased
intestinal permeability. For example, a recent animal
study indicated that the regular ingestion of fiber helps to
promote intestinal synthesis of certain types of short chain
fatty acids, which were subsequently found to be present in the
bone marrow, providing an anti-inflammatory effect by inhibiting
the inflammatory cells' ability to degrade bone. The
overall effect was an increase in bone mineral density
(https://www.nature.com/articles/s41467-017-02490-4).
3) Hormonal disruption and dysregulation, whether they be
sex hormones such as encountered by women in the transition
through menopause, or thyroid, insulin, cortisol, etc. For
example, the assessment of symptoms in women typically has some
relationship to the time of the menstrual cycle, so the
interpretation of testing should also be timed to that context.
4) Neural factors, such as mood disorders that might
affect brain/gut communication, and different roles of central
vs peripheral vs autonomic vs enteric nervous systems and how
they might be affecting or be affected by the patient's current
medical status. For example, someone who is "extremely
sensitive" to environmental stimuli, whether they be chemicals,
sound, EMF, temperature, etc, may have underlying limbic system
dysfunction, which is the most primitive part of the brain
concerned with protection and survival. Such limbic system
dysfunction leads to prolonged over-activation of the body's
defense systems, resulting in systemic inflammation. In
these situations, the patient is much more likely to improve if
the underlying limbic system dysfunction is properly addressed,
rather than launching on a slew of nonspecific anti-inflammatory
agents, whether they be drugs or natural supplements.
5) Immune factors, the dysregulation of which leads to
chronic inflammation pathology that is proving to be the
pathology that leads to many of our modern day human diseases,
whether they be autoimmune, heart, neurodegenerative, arthritic
diseases, or cancer, for example.
6) Neuro-Hormonal-Immune communication signaling, as a
result of the intimate cross-talk between these major systems.
7) Vascular biology, and the health of the endothelial
cells which line the inside of our miles of vessels that deliver
blood flow to the entire body, while communicating with the
numerous neuro-hormonal-immune signals and removing waste.
8) Genetic factors, such as specific risk factors the
patient has inherited, which might increase the risks of certain
diseases or vulnerabilities.
9) Epigenetic factors, which are factors that modify gene
expression rather than the genome itself. These factors
are often under the control of the environment, such as through
diet, lifestyle, circadian rhythm, physical activity, and can
have profound effects altering gene expression. The
emphasis of specific epigenetic factors allows a patient to feel
more empowered to make positive changes, as it proves that not
everything is genetically-determined.
10 Structural factors, which are perhaps best described
through the concept of "tensegrity," a building principle that
was first described by the architect R. Buckminster Fuller
[1961, Tensegrity. Portfolio Artnews Annual 4, 112-127)] and
first visualized by the sculptor Kenneth Snelson (1996, Snelson
on the tensegrity invention, Int. J. Space Struct. 11,
43-48). The "tensegrity" system was defined by Fuller as
structures that stabilize their shape by continuous tension or
"tensional integrity" rather than by continuous
compression. Thanks to foundational early research done by
Dr. Donald Ingber [2003, Tensegrity I. Cell structure and
hierarchical systems biology, J of Cell Science, 116 (7):
1157-1173], the concept is now applied to describe the mechanics
of cellular structure, explaining concepts such as how cell
shape, movement, biological networks and mechano-regulation, and
how this model predicts many aspects of cell behavior, thereby
having systemic impact on the body.
11) Stress, whether acute or chronic, and its potential
system-wide impacts, which also affect a patient's ability to
resist and recover from stressors. Since stress is
something that our bodies have to be able to immediately handle
upon demand, a large part of the brain and body with very
specific circuitry is dedicated to handling perceived levels of
stress and increasing the immediate ability to meet those
demands.
12) Nutrition and lifestyle factors, including physical
activity, sun exposure (vitamin D synthesis), excessive sitting,
work demands, and ergonomics, which will obviously affect
structural "tensegrity" factors in the body.
13) Toxin exposures from all sources, and ability to
detoxify.
These are just some of the factors that Dr. Chen tries to keep within the framework of the whole person when evaluating a patient's medical concerns. For further details regarding Dr. Chen's general approach, please see how these principles are applied to real patients under Case Histories.