Practitioners share lessons from front lines of COVID-19

There is a place for functional medicine in the novel coronavirus (COVID-19) response, said Patrick Hanaway, MD, who led a panel during the virtual 2020 Institute for Functional Medicine Annual International Conference.

The panel also featured Georgia Tetlow, MD, ABOIM, ABPMR, CWSP, Mylene Huynh, MD, MPH,  Joel Evans, MD, and Kara Parker, MD, who discussed COVID-19, their personal and clinical experiences on the front lines, and how clinical practice for integrative and functional medicine will grow and adapt to a new normal. Each panelist shared their expertise and lessons learned responding to COVID-19.

Huynh, a functional medicine physician with a background in military service, said she immedately had a sense of curiosity about the root causes of the disease and dysfunction. As a functional medicine practitioner, she said she recognized how human factors drive the manifestation of the virus and ultimately care. Most patients who experience severe cases of COIVD-19 have lifestyle-associated medical conditions, she said.

Her clinic transitioned quickly to telehealth and began offering a series of free weekly webinars for patients, family, and the community at large. The virtual series focused on four pillars—eat, pray, love, and play—linking lifestyle factors to their role in boosting immune function and optimizing resilience. For example, eat focused on gastrointestinal health, eating a variety of vegetables, fruits, spices, herbs, and fibers; pray focused on mindfulness, sleep, and included an additional online weekly 20-minute meditation session ; love focused on practicing gratitude and staying connecting at a physical distance; and play focused on getting outside for vitamin D,  maintaining a fitness program, and ensuring work-life balance at home.

Huynh and colleagues suggest natural supplements, simplifying to what’s available including zinc, vitamin C, and vitamin D. Her colleague coined the terms “personal protective nutrition” and “personal protective lifestyle” that, along with personal protective equipment, build resilience.

“We need to use the functional medicine thinking to influence the way ahead and build resilience in the populations we serve,” said Huynh.

Evans, an obstetrics and gynecology physician, said he focused on three main objectives with every patient: identifying fears, giving them something to do, and being of service. Evans, who also transitioned to telemedicine, said reducing gear requires an individual approach to understand what they’re afraid of what their concerns are. Giving patients something to do allows them to feel empowered with tools that can reduce their fears and prevent their concerns, while working to find a treatment of prevention regimen they can embrace. Lastly, being of service amidst tragedy or trauma is the fastest route to healing, Evans said, so he encourages his patients to find ways to help others.

Additionally, Evans said practitioners can work with these three pillars in their own lives. Personally, he said he worked to identify his own fears and shift his focus to improving health, wellbeing, and self-care. To be of service, he cut clinic fees and offers free webinars and meditations to help patients.

“We need to shift our focus from the telescope to the microscope, from the big picture to the microscopic view of individual patients,” Evans said. “The focus needs to be on prevention, addressing inflammation and oxidative stress. Functional medicine works and we need to educate our patients about it.”

Tetlow, a physician, said healthcare provider wellbeing is the next frontier and providers can learn to put themselves first. Working in an outpatient setting, Tetlow worked alongside other physicians treating infected patients and using an applied phased approach in preventing hospitalization and progression of infection. She said she uses agents such as vitamin A, C, D, and K, as well as zinc, to reduce insulin resistance and glucose utilization. For some patients, she may use melatonin or glutathione. In COVID-19, Tetlow said in transition from the innate immune response to the adaptive immune response, cells are damaged and sometimes destroyed, so she supports natural killer (NK) cell response with astragalus, Andrographis, and reishi. Additionally, for providers working on the front lines with an increased viral load, she may recommend berberine.

What the healthcare industry is beginning to understand is the cykotine storm that occurs in COVID-19, managing it, calming it, and targeting inflammation with agents like curcuimin and bromelain. However, even with this phased approach, Tetlow said the COVID-19 response needs more precision.

“We need a precision public health response,” she said. “Sometimes people aren’t having the same responses. The cookie cutter recipe needs to be informed by personalized lab testing and localizing to our patients.”  

Parker, a family physician working with underserved communities, said she was deployed to serve in COVID-19 testing clinics and in hospitals. Working with the underserved requires an expanded understanding of the matrix and social determinants of health that are impacting patients, she said. Many of the patients she is seeing are experiencing poverty, homelessness, racism, inability to access adequate food or sustainable safe housing, or are immigrants who may have fear of being able to access the medical system.

Early in the pandemic, Parker said she started to dig into the research, translating and filtering information for what’s appropriate for patients with low means. For example, she partnered with a local pharmacy and put together a package of three months-worth of six supplements to support immune health for $30, and said she was pleasantly surprised by how open patients with little means were to that option.

“It is great to offer these [types of] tools, said Parker. “It would be even better if lifestyle and supplement needs were covered for the underserved communities.

Parker said she worked with enhanced social services. The best tool she has found for underserved communities is group visits, which quickly shut down during the pandemic. She said she and her team took the opportunity to poll participants about group visits and how they’ve impacted their ability to cope. She said that 70 percent of respondents said group visits were either extremely or very important, noting tools such as mindfulness, creating specific, measurable, attainable, realistic, and timely (SMART) goals, and immune support as being beneficial to their coping abilities. She said many patients expressed interested in a telehealth group visit format as long as they had proper support, and they will be going life in a few weeks with their first online group visits.

Overall, the panel said there is a need to educate patients on preventative approaches and boosting resilience and calling on the greater healthcare industry to move to a more precision-based approach to COVID-19.

“The functional medicine approach works, and it applies to COVID-19,” said Evans. “It’s about the modifiable lifestyle factors and explaining why risk factors make the disease course worse.”

Editor’s note: Click here to explore our 2020 Institute for Functional Medicine Annual International Conference live coverage.