Although the idea of using food as medicine leaves some skeptical, in all reality it is the very purest of therapies dating back thousands of years and elevated over time through science, practice and technology. The worlds of human and equine medicine have paralleled each other in countless ways throughout history, but perhaps the greatest similarity of our time is the cataclysmic shift occurring today in how we prevent and treat disease and injury. For the past two centuries, the rise of pharmaceuticals has taken place at lightning speed, propelling modern medicine into realms never before thought possible. With the tremendous good that has resulted from pharmaceutical therapies, there have been unforeseen effects that have caused several in the medical community to take pause and dare to seek a better way, a bolder approach and a new thought process that is slowly redefining medicine. What if we could treat patients better with fewer side effects? What if pharmaceuticals were complemented by — or perhaps, in some cases, replaced by — whole foods and therapeutic nutrients? What if we saw better results with fewer drugs? And what if we could actually prevent many chronic diseases that plague both horses and humans through the creative use of nutrition? It turns out, we can.
“As nutrition has been increasingly recognized as a science that is essential to the maintenance of equine health, an improved understanding of how to feed horses to optimize their health and performance has emerged.”
— Dr. Meri Stratton-Phelps, Veterinarian & Equine Clinical Nutritionist
The idea of using food and therapeutic nutrients as medical therapy is a well-established practice, grounded in science and experiencing a burgeoning movement brought about by practitioners and patients seeking improved, more advanced and more personalized care with longer lasting results. Functional Medicine is the term used to describe the approach that has captured the attention of not just a more naturalistic breed of physician or veterinarian, but many in the greater medical community. “Functional Medicine really is a root cause approach to chronic disease,” says Dr. Nate Bergman of the Cleveland Clinic Center for Functional Medicine, a leading institution in the science and practice of using food to heal. “Rather than trying to fit the patient into a diagnostic box, instead we are more interested in understanding, ‘why is this person not feeling well or why are they not performing optimally? What are the perturbations on a fundamental level?’ It’s the questions of why,” he explains. Dr. Bergman and his colleagues are at the forefront of redefining what is possible in preventing and treating chronic disease with less reliance on pharmaceuticals, and in many cases, no reliance at all. It’s no coincidence that the movement has taken hold in veterinary medicine as well, with researchers and practitioners realizing the impact of a more ‘natural’ approach to care not simply due to strong anecdotal evidence, but thanks to convincing science and ever-evolving hard data. “Over the past few decades veterinarians and horse owners have come to realize the importance of nutrition in helping to maintain health and prolong life in horses,” says Dr. Cliff Honnas of Texas Equine Hospital. “Trends from human medicine have shifted focus away from pharmacotherapy-derived medical care and toward more ‘natural’ means of maintaining health.”
The Functional Medicine movement has pushed boundaries, questioned the status quo in medicine and dared to forge a new path that both complements and, ultimately, is very often capable of replacing standard drug-reliant treatments with greater long-term success. “It’s a way of thinking about the problem rather than trying to give the problem a name and prescribe medication that will put a Band-Aid® on that problem,” says Dr. Bergman. This root-cause approach to health sees physicians and veterinarians treating patients at the core of their ailments, identifying then targeting the ‘why’ of their disease, then treating them with diet, therapeutic nutrients and lifestyle medicine. The result has been healthier patients, improved outcomes for serious chronic diseases and a greater role in the mainstream medical community that questioned the practice of Functional Medicine for so long. “In certain areas it’s (i.e. food as medicine) a standard of care now, such as cardiometabolic cases — meaning cardiovascular disease, high cholesterol, hyperlipidemia, hypertension and, to a certain extent, diabetes as well,” says Dr. Bergman. Positive results are being seen in treating the prolific rise of auto-immune conditions, as well as many cancers, although there is still much to be done and learned. In equine medicine, a similar shift in thinking has been building for over twenty years. “I think the shift has resulted in the equine world because of our observations of how nutrition improves the health and look of horses,” says Dr. Honnas. “For example, if you look at a race horse prospect, cutting horse prospect or any other discipline that transitions from a pasture situation to a training barn, and observe the change in appearance and overall look of health that results from a good feeding program, you begin to put the pieces of the puzzle together on just how important nutrition is to physical condition and a healthy appearance. If you take that one step further and start adding supplements that are formulated correctly using good scientific research, you begin to provide the building blocks for improved tissue resilience and help build body systems that are more resistant to the wear and tear that comes from high intensity exercise.”
The science and widespread patient successes are continually building a strong foundation for a more functional approach to medicine, but it’s the daily work in practice that is creating this tide of change in the medical community. Physicians and veterinarians are taking notice of the principles of Functional Medicine, and adopting them in their own practices. The approach is simple at its core, but it’s supported by advanced technology and testing that allows practitioners to have a whole-body picture of the state of a patient’s health. At the Cleveland Clinic Center for Functional Medicine, numerous vitamin levels are measured, along with an omega-3 fatty acid index. Levels are analyzed, along with a detailed look at a patient’s diet, lifestyle, medical history, pharmaceutical regimen, stress level, activity level and overall quality of life. Armed with that knowledge, practitioners then go to work. “We focus on the pillars of health, which are recognized to be diet, movement, sleep, stress, community and connectedness. We then give patients a robust plan, show them their numbers, and show them how those numbers are changing. Patients do really well and frequently reduce dosages or get off medications,” says Dr. Bergman. Part of the process is breaking down how patients have always viewed food, then rebuilding their understanding of food as a crucial tool in their journey to attain health. “Even in the supermarket, oftentimes there’s not high-quality food that you’d want to feed yourself or your family once you get into the nitty gritty of what’s actually in some of these things. I wouldn’t even call some of these things that are shelf stable for 6 to 12 months, ‘food,’ ” he says candidly. “We eliminate things that are highly processed and have a lot of additives, as well as omega-6 fatty acids that are pro-inflammatory, then we put people on an anti-inflammatory, mostly plant-based diet while solving their food sensitivities, if they have any. Our data suggests half to two-thirds of people get considerably better with fairly basic intervention in the way of measuring nutrient values, providing a plan for a nutrient-dense diet and sometimes including the right supplements to fill in the gaps. We routinely see patients improve symptomatically from cognitive issues, headaches to IBS, diabetes, cholesterol issues, several auto-immune conditions, and on and on when they eat plant-rich whole foods while eliminating foods they’re sensitive to. We really do see the needle moving on many of the chronic diseases. It’s really exciting.”
The results are astounding, and yet they’re derived from something so simple. Choosing the foods that nature intended us to eat can have profound impacts on our health. In horses, the same has proven to be true, with a return to a more natural, forage-based, omega-3 fatty acid rich diet yielding exceptional results. “As nutrition has been increasingly recognized as a science that is essential to the maintenance of equine health, an improved understanding of how to feed horses to optimize their health and performance has emerged,” says Dr. Meri Stratton-Phelps, veterinarian and equine clinical nutritionist. “Nutritional advancements in human medicine, like the use of antioxidants and omega-3 fatty acids in a variety of disease states, has also influenced the way horses are currently fed.” It’s a translational approach to medicine where human and equine researchers and practitioners freely exchange data, ideas and successes to better treat their respective patients.
Functional Medicine has taught us that for horses and humans alike, having the ability to accurately measure nutrients is crucial, but beyond that the key is identifying not only deficiencies but optimal nutrient levels as well. Identifying what is optimal has led to the Scientific Wellness movement that treats each patient as an individual, with therapies, diet and nutrient levels being tailored to that person’s — or horse’s — ideal levels and needs. “The tools of big data are going to be important in helping us to make the determination of what’s optimal for a population and what’s optimal for an individual,” says Dr. Bergman. He quotes Dr. Jeff Bland, founder and pioneer in the field of Functional Medicine as saying, “ ‘There is no such thing as a statistically average human being.’ ” An obvious yet startling statement when we realize that a good percentage of modern medicine has been based on treating patients to societal norms. As science and data rapidly emerge we’re seeing that each individual human and equine patient has its own ideal levels, and while they may be similar to those of the greater population, treating to those individual needs can produce results that would otherwise be unattainable.
“If you give people good food and real food, there will be a lower instance of disease. We can take a proactive and preventive approach by being careful with what we put in our bodies. It’s not just food, but how food is prepared, where it comes from, the environment that the animal is raised in, and the use of pesticides and herbicides.”
— Dr. Nate Bergman, Cleveland Clinic Center for Functional Medicine, a leading institution in the science and practice of using food to heal
“What causes disease?” Dr. Bergman asks the rhetorical question that the medical and veterinary communities have worked tirelessly to answer. “We know that poor diet contributes to disease,” he says plainly. “If you give people good food and real food, there will be a lower instance of disease. We can take a proactive and preventive approach by being careful with what we put in our bodies.” Dr. Bergman challenges his patients to take this method a step further. “It’s not just food, but how food is prepared, where it comes from, the environment that the animal is raised in, and the use of pesticides and herbicides.”
While the results seen from a dietary shift can be monumental, the so-called ‘rules’ for such a diet are simple. Choose real, whole, unpackaged and unprocessed foods. Vegetables should be the dominate force in the diet. Avoid packaged, processed and preserved foods with additives, flavoring and coloring. Sugar is a magnet for disease. Avoid added sugars and excess carbohydrates. Healthy fats, such as omega-3 fatty acids, olive oil and whole foods, like avocados, can be excellent choices, whereas pro-inflammatory omega-6 fatty acids, most processed oils and trans fats are detrimental to health. Supplement to fill nutritional gaps, maintain healthy vitamin and mineral levels and support individual needs from inflammation to joint health and cognitive health to digestive function.
The philosophy for a horse’s diet follows suit to humans. “Nutrition can be viewed as a primary means of disease prevention in the horse,” says Dr. Stratton-Phelps. When an ideal ration is fed to an individual animal, the risk of a variety of diseases can be reduced. Preventing diseases from developing is a more efficient and cost-effective way to manage equine health and promote longevity compared to treating diseases and health complications once they have occurred.” To best prevent disease and injury from a dietary perspective, horses should be fed what nature intended. High-quality forage is the basis for the ideal equine diet, supplemented with omega-3 fatty acids, antioxidants and the vitamins and trace minerals that may be lacking in the forage. Grains and concentrates should be used modestly and, in many cases, are not required at all. Supplementing with the right nutrients is critical to help keep horses in optimal health, as well as to aid in recovery and optimal performance. “We can best help our patients stay healthy by providing the building blocks for good health through nutrition,” says Dr. Honnas. “This also helps tissue remain strong and less prone to injury. In our practice, we use Platinum Performance formulas as nutritional tools to enhance our patients’ health. Whether that be for overall prevention, joint health, bone health or the treatment of non-sweaters, geriatric horse issues, skin issues and a host of other preventive or clinical issues, we believe that excellent nutrition and therapeutic nutrients is the key to keeping these athletes healthy.”
Recognizing the power of nutrition, 10-time Olympic medalist Gary Hall, Jr., claimed 6 of his 10 medals after being diagnosed with Type I Diabetes.
By taking a whole-body approach to health, focusing on prevention, identifying the root cause of an individual human or horse’s illness and deploying a dietary shift with the right foods and therapeutic nutrients, practitioners are seeing results that had previously been considered impossible. “When you focus on the core elements — food, nutrient density, nutrient levels, food sensitivities, gut health, environmental toxicants, rhythms of life, stressors — and you have a fairly sophisticated way of measuring these things, then doing something about them with people who are continually motivated, you have results,” says Dr. Bergman. “I’ve had patients who have gotten off of biologic medicines, or people who have continued on their biologic medicines but feel considerably better.”
The individuality of a scientific approach to wellness is perhaps where the greatest key to success can be found. Each person and each horse is biologically similar to their herd, yet unique in their own chemical make-up. “It really comes back to the idea of bio-chemical individuality and trying the right whole foods-based diet while measuring for results,” says Dr. Bergman. The measurement is key. While anecdotal results are powerful, it’s the growing data set that will continue to propel a more functional approach to health and medicine further into the mainstream. “We’re part of a group that’s collecting outcomes data, hoping to show that this makes a difference,” Dr. Bergman says with enthusiasm. “People are feeling better; their numbers are getting better, and that’s what the data is starting to show. I think the tide is turning.”
Meri Stratton-Phelps DVM MPVM, DACVIM, (LAIM), DACVN, All Creatures Veterinary Nutrition Consulting
Cliff Honnas DVM, DACVS, Texas Equine Hospital
Nate Bergman DO, MBA, Cleveland Clinic Center for Functional Medicine
by Jessie Bengoa,