The other day, I was shopping at my local Natural Grocers. As I walked through the supplement section, I heard a customer discussing some allergy-type symptoms with the employee. The employee was well-versed in which supplements to suggest, and recommended a couple of options for symptom relief.
As I listened to this brief exchange, I realized that I often feel like my allopathic colleagues and friends may (subconsciously) think that I am a highly educated health care practitioner that does just what that grocery store employee does all day - recommend supplements.
I have nothing against these employees, but as a licensed health care practitioner who has spent over $200K on my education, I would hope that there is a difference between the supplements I recommend and those that the employee recommends.
Unfortunately, my functional/integrative medicine colleagues get the same comparison, because there is a trend in functional medicine to practice “green allopathy”. Patients (and practitioners) want a pill to fix ailments, and there is nothing wrong with wanting this convenience. However, the practice of green allopathy involves the overuse of supplements, recommending a “natural” pill to treat almost every symptom and every abnormal lab result. Eventually, patients end up spending hundreds of dollars on supplements every month, but don’t know which ones are actually helping them.
Example of a Good Functional Medicine Approach
Take the MTHFR gene, for example. If a patient has a variation of this gene that MAY impact their ability to methylate optimally or appropriately use certain B vitamins, many practitioners immediately place these patients on methyl-B12, folate, and other vitamins that support the methylation pathway. I rarely find a practitioner that actually looks to see if this gene is actually “turned on” (not all genes are “expressed”), by looking at MMA levels, homocysteine levels, RBC folate levels, and more. If these biomarkers are significantly abnormal, a titrated dose of certain B vitamins and supplements with methyl-donors may be beneficial.
There is no doubt that supplements can be useful, and they are a part of my practice. However, patients should seek out my services because of the way I think - my knowledge of biochemical pathways, the art of test interpretations, listening to the clues found within a patient’s story, and the personalization of lifestyle plans. In my practice, a supplement is either “therapeutic” (i.e. serves a short-term purpose) or “maintenance” (long-term use). If I recommend a supplement for symptom relief, I want patients to start with one or two, and look for tangible benefits before adding others.
Looking for the "What" Instead of the "Why"
I cannot fault my colleagues and friends for their lack up understanding about how a functional medicine practitioner works. After all, the majority of conventionally-trained practitioners that are working in this “specialty” are new to it, and tend to recommend a lot of supplements. Our educational background in conventional medicine teaches us to seek out “what” can help a patient rather than think “why” a patient is ill. The “whats” of our practice tend to be diagnoses, pills, or procedures. Since this is our thought pattern, this is what we tend to “pick out” from the conferences that we attend for functional medicine training. It’s a lot easier than trying to clinically apply molecular biology and biochemistry!
As more practitioners adopt the functional and integrative medicine mindset, I encourage them to focus on “real” functional/integrative medicine. Learn the tough sciences that impact our biology. It is in these scientific applications that you will find the cause of an ailment. A pill can aid in addressing the causes, but will rarely reverse the cause. After all, no one can “out-supplement” a poor diet, a poor set of lifestyle habits, or a poor environment. Our approach to supplements should be different than the advice an employee at a health food store can suggest.
In the end, it is always appropriate to prescribe something that will give a patient relief. But don’t call this “functional” medicine if you do not actively search for the true biochemical cause of illness. To truly practice medicine from an integrative/functional mindset requires a lot more work and a different approach. Knowledge of supplements is essential, and is a good first step for practitioners, but the ultimate goal is to teach patients resiliency, via lifestyle habits and education, so if the problem returns, the patient has the tools to address these and do so with limited help from a practitioner.
Best in health!
P.S. Click here for another similar perspective on green allopathy (written by a naturopath).