Functional medicine, a practice that involves looking for and treating the causes of symptoms (rather than just treating the symptoms), is a type of integrative medicine that was developed in the early 1990s. The interest and use of this type of approach is exponentially increasing, largely driven by the number of patients that are experiencing significant improvements in their health as a result of this method of treating.
Functional medicine brings back the biochemistry and pathophysiology that is taught in medical institutions, which, when we get into the "real world" of medical practice, we never really have the time to address. The demands of clinical practice and the algorithms that are primarily focused on pharmaceutical/procedural interventions take precedence over the intricacies of applied biology. Contrary to popular stereotypes, functional medicine does not ignore the benefits of pharmaceuticals (in the right context), yet focuses on the use of nutrition/lifestyle, as well as supplements, to improve health.
Many practitioners that transition into this way of practicing either experienced the benefits in their own health, or indirectly saw friends/family improve as a result of changing daily lifestyle behaviors, optimizing nutrition, and adding in some supplements. However, some conventionally-trained practitioners that start treating from a functional medicine perspective get caught up in the novelty of all the new tools/interventions at their disposal. In the process, they end up over-treating patients with supplements, ordering too many labs, and ultimately get overwhelmed and even burned out. Not to mention, they can give functional medicine a "bad name;" we struggle enough as it is to defend the validity and value of our practice!
To help out those that are just getting started, or even are experienced in practicing functional/integrative medicine, here are 5 things to remember about "true" functional medicine practice:
- Treat the PATIENT, not the LABS. This is emphasized repeatedly in conventional training as well, but unfortunately the constrictions of conventional medicine has led to mostly treating the labs (easier than trying to figure out the causes of a patient's symptoms, right?). Don't let this bad habit transfer into your functional medicine practice! For example, I've seen many free T3 levels be in the "suboptimal" range, but the patient feels great and is asymptomatic, OR circulating levels of thyroid hormones have been impacted by a stressful event. The initial reaction when seeing such results is to give or increase thyroid hormone replacement. But this can then result in unwanted and potentially dangerous side effects and unneeded medications.
- Don't treat all "ILLS" with "PILLS". This is again the way mainstream medicine practices. I had one patient who was seeing me and another integrative practitioner. Each time we'd meet, she would have more vitamins added to her list and she wasn't getting better. In fact, she was getting worse. She was already a complex patient to begin with, but after 6 months of trying to get her to stop her supplements so we could do a "reset," it took a hospital visit for her to follow through with my recommendation. Within 4 days, she started seeing improvements in her health, and she is now on less than 1/4 of the supplements she was on before.
- Just like in conventional medicine, we do not need to give pills in the form of supplements, vitamins, and herbs for every symptom or abnormal lab marker. Another example of this is if a micronutrient panel reveals a lot of nutrient deficiencies (and the patient is eating a good diet). The initial reaction is to give supplements to address these deficiencies. The treatment, however, needs to focus on improving digestion and assimilation, since a patient cannot utilize a supplement if the underlying cause is related to these processes (i.e. the deficiencies are from not absorbing nutrients, rather than a poor supply of nutrients). When considering the addition of supplements, I first think about what is causing the deficiencies, than I focus on the benefits a supplement can have on symptoms or diseases, and finally I recommend only adding 3-5 supplement options in one visit (but ask the patient to add in one to determine if there will be an adverse or beneficial response).
- Avoid the LINEAR way of thinking about disease. Our bodies are complex, and diseases or symptoms do not occur from just one biochemical pathway. It is often this thought pattern that leads to the development of pharmaceutical drugs! Of course, there will be exceptions (such as an acute infection), but in general there are many processes going on that lead to ill health and disease. In functional medicine, one treatment may work for one patient, but not for another patient with the same symptoms and test results. I often tell my patients that there will be ups and downs as we proceed through personalized treatments (i.e. the path to improved health is not a straight road). My tip? Create a "diagram" of the potential triggers/causes of a symptom, and go through these with the patient to show them the likely potential causes you will be addressing with him/her. Here is an example of one I created for fatigue:
- Avoid "DOGMA" and "ONE-SIZE-FITS-ALL". This is especially true with nutrition plans and treatment "protocols". Functional medicine is personalized medicine. I see this a lot with regards to particular foods being labeled "bad" for everyone (such as gluten, soy, eggs, dairy). Even if the majority of patients have a reduction in symptoms and inflammation by eliminating a food group (for example, most of my patients improve significantly when going off all grains), we mustn't think that ALL patients need to avoid these. I may initially start with recommending avoidance of certain inflammatory foods, but my goal is to reintroduce these in 6-12 months, unless a patient has an IgE allergy or celiac's disease. Why 6-12 months? The molecule (immunoglobulin) that is created in a food sensitivity reaction has a job to remove the offending food protein, and that molecule survives for at least 3 months - meaning that every time it encounters that food, it "attacks" it and often attacks the body in the process in susceptible individuals. For this reason, such potential problematic foods need to be completely eliminated for at least 3 months.
- Always address the GUT's role in disease - even if there are no gut symptoms. Infections, permeability, immune function, detoxification pathways, neurotransmitter metabolism/production, and more all related to the function of the gut. Don't get side-tracked by symptoms that indicate "only" hormone imbalances or adrenal "fatigue". Look at digestion, assimilation, nutrition, bowel movements - and focus on tests and treatments that address these processes. As an example, I had one patient who presented to me with primary complaints of headaches and insomnia. No gut symptoms, but I started her on a low-histamine nutrition template. Within a week, her symptoms were gone, and she didn't return until 6 months later (when she wanted to find the causes of her histamine intolerance). A stool test identified a few microcytic parasites and overgrowth of commensal bacteria, and after a thorough protocol, we were able to help her tolerate more foods (in moderation).
In summary, functional medicine does address the causes of disease, but doesn't need to be done by ordering a lot of expensive tests, putting patients on lifelong restrictive diets or a plethora of supplements, and should ALWAYS address diet and gut health.
I hope you found this article helpful and interesting! To those of you who practice functional medicine, keep up the good work - it's not always easy, but it's worth it!
Wishing everyone good health, happiness, and a life at ease,