Ten years ago, a young woman came to Dr. Cynthia Li, seeking treatment for fungal overgrowth causing chronic fatigue and digestive disorders. Drawing on years of internal medicine training, Li dismissed the patient’s self-diagnosis. “I thought it was probably some quackery she found on the internet,” she recalled. Little did Li realize that she, too, would soon turn to alternative solutions for her own mysterious medical condition, in a development that would change her approach to life and to medicine.
A twist of fate
Up until her thirties, Li was living every well-intentioned doctor’s dream. She worked at the San Francisco General Hospital and taught UCSF medical residents, volunteered with Doctors Without Borders at an HIV/AIDS clinic in rural China, lived in a classic Victorian-style house in San Francisco, exercised regularly and ate a mostly vegetarian, organic low-fat diet.
Not until the spring of 2007 as she was being rushed to the hospital, heart rate over 200, delirious and slipping out of consciousness, did she realize she was spiraling into an inexplicable chronic health crisis.
Li had experienced severe fatigue and dizziness after her first pregnancy, but brushed it off because she felt “well enough.” This time in 2007, while visiting her family in Beijing, she experienced the perfect storm – pollution exposure, stomach flu, unusual foods and a second pregnancy left her bedbound for six months after the emergency room visit and another two years housebound. Having endured 36-hour shifts, Li was no stranger to fatigue, but what she felt now was a completely different animal. “I couldn’t move my muscles and didn’t feel like I had the energy to draw my next breath,” she said.
Her primary care doctor, endocrinologist and psychiatrist shuffled her around in a referral merry-go-round. Screening tests including the thyroid-stimulating hormone, TSH, were normal. No sign of depression or mental health disorders. She had become one of the invalids – those with a medical case that went unrecognized and deemed incurable.
Growing up, Li was not one to deviate much from the norm. Her parents emigrated from Taiwan and held a high regard for authority. She lived her life by the book – went to church on Sundays and always turned in her schoolwork on time. In her third year of medical school, she shoved a nasogastric tube down the nose of an unwilling patient because a resident told her to. She attributed repeated instances like this to unknowingly stifling her curiosity and will to question what happens in medicine and why.
It came as a shock, then, when she violated medical norm and became “the difficult patient.” Desperate but still skeptical of alternative treatments, she began with acupuncture, and then slowly integrated other paradigms like environmental health (how pollutants and chemicals disrupt hormone function) and ancestral health (how an evolutionary perspective helps define diet and lifestyle) into her personal healing routine.
She understood diets had to be personalized — there is no one-size-fits-all perfect diet — and ditched vegetarianism for more nutrient-dense foods like bone broth soup, learned to rewire her brain and dampen inflammatory stress responses through a technique called neural retraining, took up Qigong practice, and supplemented with things ranging from amino acids like L-glutamine for repairing the gut lining to vitamin B-complex with active folate and B12 for healthy detoxification support.
A new approach to medical practice
Li, 46, eventually diagnosed and slowly healed herself from autoimmune thyroiditis, multiple food sensitivities and chronic fatigue syndrome. Her personal health journey profoundly changed the way she now practices medicine. In 2012, she opened her own practice in Berkeley, based on an approach known as “functional medicine,” which seeks to find root causes and mechanisms for chronic disease instead of ruling out and reducing problems.
Matthew Sade’s son was one patient who walked through Li’s door last year. When the 8-year-old boy’s eyebrows and eyelashes began to fall out, their pediatric dermatologist diagnosed him with alopecia areata, an autoimmune disease that causes excessive hair loss. Treatment included monthly injections of steroids in his scalp and daily topical creams. It was “labor intensive” and after three to four months of very minimal progress, Sade decided to take his son to see Li.
Li ordered a battery of stool, urine and blood tests and found that his son’s gut flora — the microorganisms that resided in his gut — was “out of balance.” She prescribed a cocktail of probiotics and prebiotics to restore the dysbiosis, and vitamins and minerals to support his immune function. In addition, his celiac panel testing for gluten sensitivity turned up positive, and Li provided articles citing an increased incidence of alopecia in celiac patients. Sade’s son remains gluten-free today.
Sade, CEO of natural food company Kite Hill, admits that conclusions can never be definitive, but says that for his son, the results were significant. “Four weeks into the new regimen and boom, it was just like night and day. His hair grew back like it had never happened,” Sade said.
He’s a “big believer” in Li’s work and has referred a half a dozen people to her this past year whom he felt, much like his son, were not getting the answers and relief they needed from their conventional Western medicine practitioners.
From guarded hesitation to dogmatic rejection
Not everyone is enamored by Li’s less-than-standard method of care. When Sade shared the good news of his son with a physician at UCSF Benioff Children’s Hospital Oakland, she replied that this was a new body of medicine with insufficient research to speak to it.
“It was a little bit disappointing because it felt there was this undertone of adversity to the possibility that there are other practices that could be yielding different and potentially better outcomes,” Sade said.
Christopher Gardner, professor of medicine and director of nutrition studies at the Stanford Prevention Research Center, said what functional medicine practitioners do is “plausible and makes sense” and may work well for some. (EDITOR’S NOTE: Peninsula Press is a project of the Stanford Journalism Program and not affiliated with Stanford Medicine.) However, his impression is that “they believe in a lot of non-standard diagnostic tests, many of which are related to the gastrointestinal tract and system,” which have limited scientific evidence to either support or refute their claims.
More outspoken critics include Wallace Sampson, the late oncologist and emeritus professor of clinical medicine at Stanford University, who wrote that functional medicine is nothing more than a treatment of “phantom diseases” and a “non-scientific, ineffective, jingoistic, cultic approach to dysfunctional somatoform, non-disease conditions.”
Li is undeterred by the naysayers. She said that functional medicine does not replace her medical training but instead enhances it. In addition, in randomized controlled trials, “people become statistics.” The idea that this gold standard of research always produces the best evidence-based medicine is limiting, she claims. Standard practice has been proven ineffective time and time again and off-label uses of drugs are often prescribed. Conversely, functional medicine is not without the more “out there” practitioners. Integrative medicine people “can be equally dogmatic,” Li said, chuckling.
While sitting at a bustling Berkeley brunch spot picking at her fruit salad, Li articulated a keen awareness and respect for the complexity of the human body, while remaining pragmatic and skeptical throughout the conversation. Of course, she would research each of her patients’ cases thoroughly, scouring PubMed articles and natural supplement databases, but her humility stood out the most. “The most valuable thing that I learned in my health journey was to come to the place of not knowing,” she said.