Rosalynn A. Vega’s new book, Nested Ecologies: A Multilayered Ethnography of Functional Medicine, is a study informed by the experiences of doctors and patients, and the author’s own health crisis. Through research focused on healing and health as processes, Vega explains how functional medicine leverages systems biology and epigenetic science to treat the microbiome and reverse chronic disease without adopting a one-size-fits-all approach. In this Q&A, Vega offers a window into her book’s claims and her writing process.
Can you discuss how our internal ecologies are shaped by inequalities embedded in our physical and social environments, and what this means for our understanding of health disparities?
“Internal ecologies” refers to a multitude of factors that comprise our bioindividuality. Examples include our microbiome (i.e., all the bacteria, fungi, yeast, protozoa, and viruses living everywhere in and on ourbodies) and our unique genomes. An individual’s microbiome is shaped by environmental factors like food, and even the microbiomes of others with whom we spend a significant amount of time. The expression of our genomes is also influenced by our physical and social environments via epigenetic mechanisms. Understanding that both our microbiomes and genomes are directly shaped by our physical and social environments helps to elucidate biological mechanisms undergirding health disparities. Furthermore, if we consider health to be a human right, then equity and security in our physical and social environments is a matter of social justice.
In your book, you discuss your own experience with chronic illness. How did this experience shape your research and writing, particularly in the interludes between chapters?
This book was inspired by a debilitating health crisis I experienced. I made functional medicine the object of my academic research in part to identify resources for my own healing. Given this background, I felt that full transparency (i.e., autoethnography) was the only honest way to tell the story. While the book traces the experiences of more than one hundred thousand patients and hundreds of functional medicine practitioners, my story appears throughout the book in the form of interludes between chapters. These interludes forced me to be more vulnerable with my reading audience than I have ever been, but I believe that sharing my story helps readers to understand what is at stake for individual patients.
Your book emphasizes the need for a paradigm shift in our understanding of health and illness. Can you discuss some of the key shifts you propose and how they differ from the current biomedical model?
Functional medicine interlocutors, many of whom are MDs trained in conventional medicine, argue for multiple paradigm shifts with regard to patient care. Functional medicine rejects binary thinking (e.g., ill vs. well, mind vs. body, pro-vaccination vs. anti-vax), instead taking a personalized, whole-person approach to patient care.
Furthermore, functional medicine critiques medicalization of bodily processes (e.g., menopause) and human experiences (e.g., deep sadness) alongside ongoing pharmaceutical management of chronic disease. Alternatively, they advocate for the reversal of chronic disease using health-promoting resources such as quality nutrition, stress management, sleep hygiene, social support, and exercise. That is, the focus of functional medicine is to create health, not to prescribe medicine to assuage symptoms. In order to do this, functional medicine interlocutors argue for the denormalization of illness. They recount the illness narratives of patients who have gone through life thinking, “I’ve always had [X symptom]—that’s just who I am.” They suggest that individuals can (and should) strive for resiliency instead of “functional illness.”
To accomplish these goals, functional medicine practitioners close the “translational gap” in medicine by applying findings from emerging research in their clinical practices. They fine-tune their approach to each patient by listening closely during clinical encounters, approaching each case without preconceived notions, and expressing their willingness to adapt as needed.
How can we approach chronic illness differently to address systemic inequalities?
Instead of chasing pharmaceutical “band aids” to help manage symptoms, we can harness our understanding of “nested ecologies” (how our internal ecologies are shaped by physical and social environments) to demand the dismantlement of systemic inequalities. This begins with addressing our food system. I argue, alongside functional medicine interlocutors, that quality nutrition is a primary pillar of health. Lack of access to nutritious food leads to chronic disease for many low-income and minority communities. Furthermore, food policies surrounding “commodity crops” and food assistance programs such as SNAP often contribute to the problem by supporting industry interests at the expense of citizens, including young children. Systemic change is everyone’s responsibility. I argue that it is not enough to “vote with your fork” (a consumption-based approach)—we must also engage in a politicized struggle to transform the food system. Doing so would produce benefits across society and across species.
Your book reflects that health is a process. Can you explain what this means and how it differs from the current emphasis on individual responsibility for health outcomes?
When we think about disease as a biological fact that “just happens” to individual patients, issues of “compliance” with pharmaceutical protocols come to the fore, and with them, the current emphasis on individual responsibility for health outcomes. However, from a functional medicine perspective, individuals do not go through life totally well until—boom!—one day they are suddenly suffering from chronic disease. Although patients may suddenly receive a chronic disease diagnosis, the process of developing a chronic disease generally occurs over multiple years. The same is also true for healing. Health is a lifelong pursuit. Health and illness unfold along a spectrum, and functional medicine patients are engaged in the ongoing process of creating health. Viewing health in this way emphasizes the importance of access to health promoting and health sustaining resources such as quality nutrition, safe communities, nontoxic and biodiverse environments, etc.