Some things can’t be simplified!
A scroll through socials would have me believe that my skin issue or my pain is not because of the food I’m eating or my dairy intake or the topical products I’m using, but it all comes down to my gut health or my hormones or xxx. And yes, it might be a factor but is it just that simple? Fix this one problem and my xxx will resolve. Well, the simple answer is no!
Thinking about underlying factors is essential and with most patients I see, there is often more than one thing happening, particularly in chronic pain or autoimmunity and even in skin diseases (eczema and psoriasis co-existing!). Often patients will have been told the cause of their condition is xxx and they will have been put on a protocol to treat it. But when that doesn’t work, there is no deeper analysis of the underlying biological mechanisms to try to understand what is happening.
A reductionist approach, even a naturopathic one (single root cause approach) will focus on a primary cause and treatments will be applied to address this cause. This reductionist tendency has led to the approach that everyone with the same diagnosis, has the same problem and should be treated the same way. For most chronic illness / chronic skin conditions, that doesn’t work. One common example I see is with acne, when patients come and tell me that they have been told their breakouts are hormonal…but treatment approaches didn’t help.
What if there are multiple contributing factors? Most symptom patterns those patients with chronic issues – skin, pain or otherwise bring to the clinic setting have variety of causal origins.
It could be dietary intake patterns, gastrointestinal dysfunction, skin microbiome imbalance, metabolic dysregulation, inflammation, autoimmune disease, hormonal issues, nervous system dysregulation, chronic infection, and a host of other issues arising from our complex, interconnected biology and social interactions, which can be completely different from one person to another, despite their symptom presentations being similar or having the same diagnosis.
And it is not just about identifying the primary trigger but also addressing sustaining factors and disrupting reinforcing loops that maintain dysfunctional patterns. For example, in a skin condition it is important to consider the primary triggers, but also secondary triggers and reinforcing loops, for example it might look like this:
Primary trigger – stress and infection
Secondary – hormones, microbial imbalance, nutritional deficiency, poor sleep
Reinforcing loops:
stress > poor sleep > immune dysfunction > infection risk > skin flare > stress
skin acid mantle disruption > over production of oil > abundance of c. acnes > acne flare > use of benzyl peroxide > skin acid mantle disruption
Reductionist approaches don’t help!
Triggers, sustaining causes & reinforcing loops all contribute to chronic illness.
Most often, I find it’s the reinforcing loops that sustain chronic conditions. It can be the case that the primary trigger is a bit like a hammer that broke a window. The hammer was the first cause of the illness but doesn’t account for the interconnected and reinforcing loops of dysregulation that are sustaining the condition. Throwing away the hammer doesn’t fix the window. I find that disrupting the cycle of reinforcing loops and addressing primary and secondary triggers is crucial for progressing with chronic conditions, be they pain or skin related or other.
Addressing any chronic condition effectively requires a holistic perspective—one that considers not just symptoms but the underlying and connected causes and their reinforcing loops. Understanding this complexity allows for more personalised and effective approaches to healing, rather than one-size-fits-all solutions, which can seem so appealing but often yelid disappointing results