Holistic Healthcare isn't Alternative

Making a case for higher quality care

I recently met with a client who had just discovered she has slightly elevated thyroid antibodies (TPO, if you’re curious). This means she has started developing early stages of autoimmunity toward her thyroid, but her other thyroid markers were still in a healthy range (TSH, T4 and T3). So, technically she doesn’t have hypothyroidism but the presence of those antibodies increases the risk she will eventually develop.

Her primary care provider (PCP) told her that everything was fine, and she would just monitor it. Disappointed with a lack of options outside of just waiting for things to get worse, the client consulted with me about other efforts she might make to try and keep her thyroid as healthy as possible.

During our visit, we discussed her health history, family history, symptoms, diet, supplements and medications, stressors, goals and overall life circumstances. I then explained the nutrients essential for thyroid hormone production (e.g. iodine, selenium, and others), and I shared some suggestions for nutrition and lifestyle strategies she might use that would incorporate those nutrients and support thyroid health.

In the middle of our conversation, she paused.

“I just don’t understand why this isn’t part of conventional medicine. This is exactly what I wanted to know.”

Interestingly, this client is married to a doctor. So, she knows well the strengths and pitfalls of conventional medicine.

Stories like this aren’t uncommon in my world. People seek out providers like me to take a “holistic” approach to their health either before trying a medication or in conjunction with their conventional medical treatment. It’s unsurprising and not new that patients seek alternative options. Among other reasons, they do so because they’re unsatisfied with their conventional care. (1)

Some in conventional care call holistic or alternative providers “quacks” or “grifters”, but many of us are just trying to connect with and think deeply about the person in front of us, taking a comprehensive look at the factors that affect their health. This comprehensive look is often perceived as missing from conventional health consumers. (1)

At its foundation, I’m just thinking like a scientist:

What are the variables that influence this client’s problem or support their desired outcome(s)?

What biochemical and nutritional influences are at play?

Which of these variables might the client have control over?

How can we change one (or several) of these variables to try to resolve or alleviate the problem(s)?

Let’s try not to change too many things at once so we know what might be helping (or not).

I told her that I was writing about this exact issue (the article you’re now reading): that “holistic” care isn’t (or shouldn’t be) considered “alternative”. It shouldn’t be outside insurance-based healthcare, and it certainly shouldn’t be an uncommon experience as a healthcare consumer.

I don’t want patients to be pleasantly surprised when a practitioner asks them about their daily lives, their stressors, their sleep, what they eat, what supplements they take, or even details about their digestion. This is normal health assessment because these and other factors are what add up to someone’s overall health.

Chatting with my client about her overall health and explaining the metabolic changes of the thyroid in relation to nutrition doesn’t seem alternative to me. I see myself filling a hole in the healthcare system; a system that doesn’t offer time for patients and physicians to sit and discuss and think together to solve a problem. Instead, we have a myopic system made of a one-diagnosis to one-treatment (often medication) form of care.

Interestingly enough, the Journal of the American Medical Association (JAMA) recently republished an article (2), verbatim, from 1948 called “Holistic Medicine” about this exact issue. Doctors know this is a problem. It’s not a new problem, but it’s also not an easy one to solve. Otherwise, I expect they wouldn’t find it pertinent to republish the article 75 years later.

The establishment of a single diagnosis, which is often assumed to be the proper effort, followed if possible by prescription of a specific remedy, fails to meet the total problem of the patient. This method may frequently cure the lesion but not the person.

In 1948 (and likely prior), doctors knew that giving a diagnosis of one problem and “solving” it by prescribing a medication was insufficient healthcare.

Unfortunately, physicians aren’t encouraged to help the person as a whole. That takes too much time, and thus, money. Our current system has a “churn and burn” reputation; a business model that expects a certain return ($) per patient per day, and physicians are just plain burned out. (3)

Each of my clients (and every person) has their own, unique health fingerprint. While many may have the same diagnosis, their causes and contributing factors often vary. Clients and patients want to be viewed and treated as a whole person, they don’t just want their doctor to “throw another pill at [them]” (in the words of another client).

The well-accepted definition of health from the World Health Organization (WHO) is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. (4) This means that health care providers need to consider all aspects of health to not only avoid disease but to promote wellness.

Also from the WHO (5), quality health care should be (among other things), “People-centered – providing care that responds to individual preferences, needs and values.” So, if a person values knowledge, wellness, agency and personal responsibility, then I think providing “holistic” care is actually just providing quality health care (at least according to the WHO).

As health care providers, we serve our patients and clients best when we ask not only about people’s symptoms but also their life and goals. This will help us all to provide the best possible care (and in effect, better outcomes) for the people we serve.

I don’t know whether this client will develop thyroid disease, but I am certainly going help support her, as much as I can, to keep her thyroid healthy. Like many other clients I’ve worked with over the years (with the collaboration of their doctors), it is possible to avoid or prolong medication. And while lifestyle changes aren’t as simple or easy as taking a pill, they have benefits beyond just the absence of disease, they support wellness and well-being.

Holistic health care is quality health care; I hope we can all agree on that.

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References

1. Astin JA. Why patients use alternative medicine: results of a national study. JAMA. 1998 May 20;279(19):1548-53. doi: 10.1001/jama.279.19.1548. PMID: 9605899.

2. Holistic Medicine. JAMA. 2023;330(23):2310. doi:10.1001/jama.2022.16161

3. Yates SW. Physician stress and burnout. The American journal of medicine. 2020 Feb 1;133(2):160-4.

4. Larsen LT. Not merely the absence of disease: A genealogy of the WHO’s positive health definition. History of the Human Sciences. 2022 Feb;35(1):111-31.

5. World Health Organization. Quality of Care [Internet]. World Health Organization. 2023. Available from: https://www.who.int/health-topics/quality-of-care#tab=tab_1