Expert Voices: Functional medicine for people with multiple sclerosis

Lifestyle changes, 'biggest missing piece' of MS care, are at its core

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In this installment of our “Expert Voices” series, Multiple Sclerosis News Today asked Dr. Susan Payrovi, MD, to answer some of your questions about seeking functional medicine care with multiple sclerosis (MS).

Payrovi is a clinical assistant professor at Stanford’s Department of Anesthesiology, Perioperative and Pain Medicine. She practices integrative and functional medicine at Stanford’s Center for Integrative Medicine. Her area of expertise is in incorporating integrative and functional medicine strategies into complex disease care, using the shared medical appointment model. 

She earned her bachelor’s degree in microbiology and molecular genetics at University of California, Los Angeles, and completed her medical education at UC San Diego in 2003. She completed a residency in anesthesiology at the University of Southern California in 2007. Payrovi is board certified in anesthesiology, hospice, and palliative medicine, as well as integrative medicine. She has additional training in functional medicine and acupuncture.

Payrovi, who has MS, is founder and chief scientific adviser at TRUE Medicine, an online lifestyle program for people with multiple sclerosis. She brings her personal and professional experience with MS to the online wellness program she has created to fill in the biggest missing piece in comprehensive MS care.

Dr. Susan Payrovi is founder and chief scientific adviser at TRUE Medicine, an online lifestyle program for multiple sclerosis patients. (Photo courtesy of Dr. Susan Payrovi)

What is functional medicine?

Functional medicine is a holistic system of medicine that is evidence based and takes into account all dimensions of the person, including the emotional, social, spiritual, and physical. It is based on functions of the body rather than organs, so it’s a different lens through which to look at the body.

For example, we pay a lot of attention to the function of assimilation, which has to do with the process of bringing external elements into the body, such as the process of bringing food into the body through the gut. Another key function is that of energy production. This delves into processes within mitochondria, which are the cell’s power plants. Here in the mitochondria, energy is extracted from food to create energy in the form of ATP molecules. We also spend a lot of time thinking about our defense and repair functions that have to do with the immune system. Once this system has gone rogue, we can end up with inflammation and autoimmunity.

Studying functional medicine involves learning a lot of biochemistry to understand how basic science is translated into clinical care. With this knowledge, functional medicine practitioners guide patients toward creating a healthy environment to unleash the body’s built-in healing mechanisms. The main tools of functional medicine are lifestyle habits such as nutrition, sleep, exercise, stress management, and toxin avoidance.

What are some misconceptions about functional medicine?

That it is not evidence based. The main therapies prescribed by functional medicine practitioners are lifestyle interventions, which are backed by robust evidence from the scientific literature. Functional medicine is a really deep dive into biochemistry, looking at the most intricate reactions that ensure our bodies run.

The other misconception is that functional medicine is all about supplements. Lifestyle therapies are at the heart of function medicine, with supplements being used as just that — supplements. Of course, every practitioner practices differently, but it would not be accurate to say that supplements are the mainstay of functional medicine therapies.

You write elsewhere that your MS’s course was altered by functional medicine. What led you to trying out functional medicine? 

When I could no longer practice anesthesiology due to a weak left arm as my main symptom of MS, I began searching for what else could help me beyond medications. Ironically, as a physician, I had no clue as to what else I should be doing to improve my health. I soon landed at an integrative medicine conference, which introduced me to functional medicine. The more I studied functional medicine, the more I was fascinated by how our external environment — largely composed of how we eat, sleep, destress, and move our bodies — impacts our bodies at a cellular and DNA level. Even though I was at first interested in finding a way to heal myself through functional medicine, it quickly became apparent to me that this was the biggest missing piece in chronic disease care, and I needed to share what I was learning with patients.

What lifestyle changes did you make?

Being unable to practice anesthesiology due to my weak left arm turned out to be a blessing in disguise. I no longer had to stay up and work long shifts, so my sleep returned to a more normal pattern. I stopped eating unhealthy hospital food and started learning about nutrition. I cut out sugar and added more vegetables and color to my diet. I practiced yoga regularly, which helped me get strong in my body, and it also doubled as my meditation. I also started learning about where man-made toxins lurked in my home and work environment and worked toward minimizing my exposures, like eating organic foods as much as possible.

What improvements did you notice?

Within two years of my MS diagnosis which resulted in me changing my habits, I would say my arm strength returned to about 90% of baseline. Now 12 years out, I’d say I’m 95% of baseline. I can easily say this is the best shape I’ve been in, which is due to a daily commitment of taking small steps to make healthier choices.

What words of caution do you have for those seeking functional medicine care?

  • Find a reputable practitioner who is well trained and certified. You can check for a directory of practitioners, although IFM is not the only body that trains functional medicine practitioners.
  • Not all practitioners that practice functional medicine are physicians. Nonphysician providers are also very capable, but it’s important to know the background of the person treating you. For example, a chiropractor’s formal training differs from that of a physician, so you would have to adjust your expectations of what each provider can and can’t provide.
  • If you have a very complex medical history, make sure the person treating you has the experience and knowledge to safely treat you. For example, certain supplements may interact with your medications or general medical condition, and it is the job of your prescribing functional medicine practitioner to catch any interactions.
  • Avoid starting with thousands of dollars of testing and supplements. In my experience, you can squeeze a lot out of lifestyle habits before testing is needed. In fact, often testing is not needed. The same goes with supplements. Always start with lifestyle first.

What is often overlooked in typical MS healthcare approaches?

Lifestyle. It is the biggest missing piece in MS care. There is so much data to support the use of lifestyle therapies that have a powerful impact on health. This is why I created TRUE Medicine, an online lifestyle program specifically for MS so that those of us living with this condition can access functional medicine without the high cost of working with an individual practitioner, which is often not covered by insurance.

If you would like to work individually with a practitioner, you can search practitioner databases through the Institute for Functional Medicine and the Academy of Integrative Health and Medicine.

In what ways is a functional medicine care plan specific to an individual?

Working one-on-one with a functional medicine professional, you will begin with a detailed history, dating all the way back to when you were in utero. It’s important to know what happened to you over your lifespan to be able to identify triggers and patterns that have mingled over your lifetime to create your current health issues.

After a detailed history is obtained, I almost always start with how we can max out on lifestyle habits before pursuing testing or supplements, which are often costly. I often find that once people sleep better, eat better, manage stress better, and move more, their symptoms improve, and they may not need testing or supplements.

What are some of the most common lifestyle changes recommended to a person with MS seeking functional medicine care?

  • Eat a whole-food, plant-based diet to flood your body with healing molecules, like antioxidants, phytonutrients, and healthy protein and fat.
  • Move and exercise every day to stay conditioned and strong. This will increase the chances of returning to a higher level of function after a relapse and slow down disease progression.
  • Prioritize restorative sleep. This is the foundation that all other lifestyle habits rest on. If you can get this right, you are more than 50% of the way there!
  • Create balance between your mind and body. Stress is a known factor in the onset and progression of MS, so anything you can do to minimize its impact on your immune and nervous systems will go a long way.
  • Avoid environmental toxins. We are exposed to unprecedented levels of man-made toxins that overload our detox pathways. Learn where these toxins hide so that you can avoid them. The next step is to support your detox pathways through nutrition and other key lifestyle habits.
  • Optimize vitamin D. It’s the single most important molecule in bringing regulation to your immune system to help you move away from autoimmunity.

Expert Voices is a monthly series involving a Q&A with an expert in the MS space about a specific topic. These topics and questions are curated from a survey in which we ask readers what they want to learn more about from experts. 

Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.