Responding to Functional Medicine Naysayers

Posted on by Meg McElroy MS, PA-C

There are many naysayers – both people and organizations – that criticize functional medicine as “quackery” or “pseudoscience.”  As a clinician who has worked exclusively in functional medicine for over 12 years, I know that people can “function” better through functional medicine care.  But I also acknowledge that there are valid concerns, as the interest and popularity continue to increase for this type of care.

I will touch on 3 topics in this article:

  1. Criticisms of functional medicine
  2. Unique aspects of functional medicine: Optimal lab ranges, functional medicine diagnoses, and supplement guidelines
  3. Why patients (and practitioners) are seeking functional medicine

#1: Criticisms of Functional Medicine

My idea for this article came from wanting to comment on a post I saw in a Facebook group, but realized I had a lot more to say than what I could fit under the post.

In this Facebook post, which was in a group specifically for Physician Assistants, the PA writing the post mentioned a family member who had sought out care from a Functional Medicine doctor. The PA went on to ask about how functional medicine comes up with their “optimal” lab ranges and supplement prescription guidelines, and had reviewed the family member’s labs and didn’t see sufficient evidence to diagnose the family member with hypothyroidism, adrenal crisis, or diabetes (all diagnoses that the functional medicine doctor had noted).   

Many of the responses to this post were from colleagues who didn’t directly address the PA’s concerns; they focused on criticizing or supporting functional medicine as a whole.  From what I could interpret, many of the opinions I read were related to:

  • Social media and online portrayal of functional medicine 
  • Cost of functional medicine 
  • Supplement risks
  • Perceived lack of evidence to back up functional medicine testing and treatments 

Let me expand on these in more detail…

Social media and online portrayal of functional medicine. What we see online and on social media is what I would call “sensationalist” functional medicine, where a practitioner is using messages of fear or hope in their posts, citing “optimal” lab ranges, or sharing examples of functional medicine test results where someone was found to have abnormal findings for which supplements and restrictive diets were used to treat.  These practitioners may truly be helping people, and their level of confidence is admirable, but I urge people to remember that what we see online is rarely what we see in the “real world.” Just sit and observe people at an airport or a Walmart and you’ll see what I mean! 

Airport

Cost of functional medicine.  I encounter patients all the time who have spent thousands of dollars on functional medicine testing and supplements, but weren’t any better.  Skipping over whether or not the practitioner was practicing green allopathy (which is not “true” functional medicine), we have to consider multiple factors such as a patient’s perception of “expensive” and their expectations as a result of working with a functional medicine practitioner. I will touch on this topic more in my upcoming course.

Supplement risks.  Consistency in supplement quality and dosage is a big issue, but there are third-party tested and “professional-grade” supplements that exist. Yes, pancreatitis, liver failure, and kidney damage can occur after the use of poor-quality and excessive use of supplements. However, the point I like to make is that the original intention of functional medicine is to utilize “systems biology” and try to identify “root causes” of a patient’s chronic symptom or condition; it was not intended to focus on giving handfuls of supplements as treatments.  

Perceived lack of evidence to back up functional medicine testing and treatments.  Both functional and mainstream medicine use scientific studies to validate testing and treatment approaches, but not always from the same medical journals.  As an example, I know there are many practitioners who recommend drugs for “off label” use and (hopefully) consider the risks when doing so. The same goes for functional medicine: many of the supplement recommendations are analogous to “off label” use of pharmaceuticals. 

#2: Optimal lab ranges, unique functional medicine diagnoses, and supplements

Continuing from the above story about the PA that questioned functional medicine in the Facebook post…the PA had valid concerns!  

  1. Where does functional medicine get their “optimal” lab ranges from?
  2. What is the reasoning behind various functional medicine diagnoses?
  3. Are there supplement prescription guidelines?

Let me touch on these in more detail:

Optimal Lab Ranges: “Optimal” lab ranges in functional medicine do not have meta analyses or review articles on PubMed that clearly identify an optimal range or number. Most of the optimal lab ranges shared in functional medicine training organizations are derived from interpreting multiple papers or studies that had certain endpoints which aligned with various stages of health.  For example, the optimal lab range for fasting insulin is partly derived from this JAMA study on fasting insulin.  In this article, a lab value over 8 uIU/mL was identified as hyperinsulinemia with pathological consequences (i.e. higher cardiovascular risks), yet most commercial labs list 25 uIU/mL as an endpoint for high insulin.  I periodically touch on other lab optimals (and studies related to these) in my weekly newsletter.

Unique Diagnoses: The diagnoses that I see many functional medicine practitioners use are not ICD-10 diagnoses, yet are easier-to-use terms such as “leaky gut” (instead of pathological gut hyper-permeability) for which an ICD-10 code is substituted (e.g. K90.9 Unspecified intestinal malabsorption). These “diagnoses” often describe an underlying pathology that is leading to a symptom or condition, and we use ICD-10 codes to get as close as possible to align with these processes.  As an analogy, we have all likely used the term “heart attack” instead of myocardial infarction (MI), but most patients will not understand us when we use the term myocardial infarction! 

Creating an Effective Supplement Plan: Because there is no consistency in dosing or quality of supplements, and anyone can buy supplements without a prescription, there are very few supplement “prescription” guidelines.  But this does not mean that supplements are useless!  Only a handful, in my opinion, will help someone feel better within a few days or weeks.  Most supplements, if truly needed, will take 4-6 weeks to exert an effect on the biology of the body and/or symptoms that someone is experiencing (probiotics are a great example of this).  Where I see most patients and practitioners get into trouble with supplement use is when the supplement is of poor quality, dosing is not therapeutic, too many supplements are used at once, or they are not used in what I call a “methodical approach” (adding one supplement at a time, and noting when to expect an expected benefit).  I tend to lay out such expectations via my EMR templates, and I’m up front with all my patients about the pros, cons, and expectations surrounding the use of supplements.

#3. Why patients seek out functional medicine

Again, back to the original Facebook post.  We must ask the question: why did the family member seek out functional medicine care in the first place?

In my current practice, many of my patients tell me they sought out functional medicine because they feel “unheard” and have experienced gas-lighting from their mainstream practitioners.  They are experiencing symptoms affecting their quality of life, yet when the labs look “normal”, they are often told that their symptoms are a result of stress, just “getting older,” or that their symptoms are all in their head. In our current medical system, practitioners rarely have the time or bandwidth to dig deeper!

And there are other reasons I hear from patients, beyond gas-lighting, including: 

  • A need for more time with their practitioner. Patients get very limited time with their insurance-covered provider, and don’t want to feel rushed or limited on what they can discuss in a health appointment. Functional medicine visits are often at a minimum 30 minutes long, but on average are 60-90 minutes long. And insurance doesn’t like to reimburse for this time (which is why so many functional medicine practices are cash-based).
  • Efficacy of treatments. Patients seek alternative therapies when pharmaceuticals are not helping them feel better, they are experiencing negative effects from the drugs prescribed (including the cost to obtain prescriptions), or because they don’t want to take medication for the rest of their life.
  • A desire to use more “natural” treatments or get more testing. Although misguiding, many patients see supplements as “natural” and prefer to put something like this into their body over pharmaceuticals. And many are curious to see through testing what (if anything) can be found that explains why they have a symptom or condition. 
  • A desire to be more empowered. Some patients want to understand why a symptom or condition is occurring, and feel more in control with how they can improve their health. They may also have a family member who they witnessed go through a health struggle such as diabetes or dementia, and want to do anything they can to prevent themselves from going through the same struggle (even if they are aware that there is no universally proven (or easy) way to prevent a disease like Alzheimer’s).
  • Inadequate care for chronic health conditions.  I suspect many are in agreement that the U.S. medical system is great at acute medical care, but is not great at preventing and treating chronic health conditions.  Functional and integrative medicine is the opposite – great at addressing chronic health issues, not intended to be used for acute issues.

Note, to put this into another perspective, only 25-30% of potential patients are willing to put in the work to make a functional medicine approach effective; the remaining 70-75% of patients continue to rely on mainstream medicine. 

In Conclusion

Whether you are a clinician or a patient, I invite you to genuinely be open-minded, curious, and keep in mind that what we see online is not reality. In this article, I discussed some of the top criticisms of functional medicine, unique aspects of functional medicine care, and why patients seek out functional medicine.  I continue to see so many people improve through a functional medicine approach, but I am also practical and aware of the shortcomings of functional medicine as we know it today.  

We need to accept that functional medicine is not going away, and in the hands of a skilled clinician, it IS getting people better. And I’m not saying this without proof!  The company I currently work for keeps track of subjective patient responses to our care via validated patient symptom scores, and as a company we see over 70% of patients with chronic ailments improve through our care. 

Yes, functional medicine clinicians have a different approach to lab interpretation, we tend to offer and run more tests than mainstream practices, and we focus more on treatments such as nutrition and supplements over pharmaceuticals.   

Thus, in summary:

  1. Don’t define functional medicine by what you see online 
  2. Functional medicine is unregulated, but that does not mean that it is ineffective or unsafe.  As with mainstream medicine, efficacy and safety of care often come down to who is administering the care. 
  3. Using supplements in place of pharmaceuticals is NOT functional medicine – it’s green allopathy!
  4. Functional medicine is exponentially growing in popularity amongst patients and practitioners.
  5. No one can, or ever will, know everything. 

And I leave you with this: for those that are not willing to ask questions or be curious, or who prefer a pill over a lifestyle modification, we have to give them grace for their experiences and move on, knowing that many have or can have a better outcome through other forms of healthcare.

Stay curious and healthy!

Meg

More resources

There are not many clinicians questioning the “sensationalist” functional medicine I noted above, but here are a few who you can look into if interested:

For more related information on this topic, check out some of my past articles:

Or, if you are a clinician, join my weekly clinical tips newsletter if you want the less sensationalist, more practical/methodical approach to the clinical practice of functional medicine. This is also where I will be sharing more information on my upcoming course tentatively titled Becoming a Functional Medicine Clinician: How to Confidently Get Started and Turn Your Passion into Practice.