What is Functional Medicine?
People often ask me, “What exactly is functional medicine?” It’s the right question, but there isn’t a straightforward answer. I could simply respond, “Functional Medicine is for everyone, but not everyone can benefit from functional medicine”. At this time, this explanation might lead to more confusion. According to the Institute for Functional Medicine, (Medicine, 2022) “functional medicine is a systems biology-based approach that focuses on identifying and addressing the root cause of disease”.
When studying medicine, we were taught the etiology, epidemiology, prevention, genetics, pathophysiology, clinical manifestations, symptoms, treatment, and prognosis of diseases.
Longevity. Reversal of disease. Or at the very least, a reduction of symptoms. In this sense, functional medicine demands an appreciation for how the disease took place in the first place.
Who is functional medicine for?
Allow me to present, Bridget, a 43-year-old-female who works as an accountant for one of the Big Five. She is married and a mother to her 5-year-old daughter and 7-year-old-son. Lately, Bridget has been working fifty plus hours a week and has loosened up on her diet and exercise routine, something must give. Her husband, although supportive, is undergoing a career transition which has left Bridget responsible with most of the childcare and household duties. She’s noticed a ten-pound weight gain in the last year despite not changing much of her food intake. In addition, she has been experiencing, constipation, an increase in eczema flare ups, acid-reflux and not to mention, some classic perimenopausal symptoms (low energy, mood swings, insomnia, and hot flashes). Her past medical history includes eczema, one spontaneous vaginal birth, an emergency C-section, and Hypothyroidism (or underactive thyroid).
She has a good relationship with her primary care physician of eighteen years, yet feels every time she presents with symptoms, she is offered the option of taking another pharmaceutical medication to mend her symptoms. At other times, her physician orders diagnostic studies only to rule out more serious conditions, and once the ominous ones are ruled out, she’s sent on her way and asked to return for her next routine check-up.
What lingers are her symptoms. Bridget would like to talk about her health in a different context; one that focuses on her quality of life and longevity versus the probability of her having a terminal illness.
After having her first consultation of ninety minutes with a certified functional medicine practitioner, Bridget feels heard. What adds value to her experience is that her Functional Medicine practitioner is a licensed health care provider. In hindsight, she realizes the necessity of having her Primary Care Physician to ensure she is not ignoring symptoms that might lead to more serious implications. At present, she is grateful for having a complimentary health care provider listen to what seems like her laundry list of symptoms that nag her daily. Feeling she is the centreof her health and empowered about her wellbeing are also taking charge.
How Functional Medicine Heals
Bridget appreciates how different her experience is with her functional medicine practitioner in comparison to previous medical encounters. From the flow of dialogue to the content, Bridget is amazed at how many aspects of her life are relevant to the conversation about her current state of health. They discuss her milestones, high and low points in her life, but when Bridget is asked when she last felt “well”, she is shocked at her answer, “about a decade ago”.
Unlike a conventional Primary Care Physician who listens intently to a patient’s symptoms and concerns, a functional medicine practitioner digs deeper to understand the root cause that brought on the patient’ ailment. And then the real work takes place. Bridget is assigned a five-day lifestyle journal where she documents her food intake, sleep quality and quantity, movement, emotional status, and relationships. At her next visit, Bridget’s functional medicine practitioner shares different approaches to improve her health while being sensitive to her time commitment and budget.
Bridget chooses a modest option that includes some functional lab investigations including a salivary sample to check her cortisol and DHEA levels, a blood test that checks her thyroid function in a more detail than conventional tests and a stool analysis to check her gut’s microbiome.
Since functional medicine places an emphasis on the importance of modifiable lifestyle factors (nutrition, sleep, and movement), functional lab results persuade a person to take a bigger leap toward change by convincing the person that a contentious effort may be the difference between experiencing symptoms and not. This is why a team of professionals, including but not limited to: health coaches, mental health professionals, acupuncturists and nutritionists composes a functional medicine practice.
According to Bridget’s salivary test results, she is advised to decrease her caffeine intake and begin a supplement at bedtime to help with her elevated cortisol levels which are behind her new onset of insomnia. To her surprise, she is advised to discontinue intermittent fasting as it provokes her cortisol to spike, a mechanism that can inhibit weight loss. Her thyroid function tests suggests that although she was on the appropriate thyroid hormone replacement dosage, she is not getting optimal benefit. In addition to continuing her thyroid medication, she is asked to increase her vitamin D3, zinc and selenium intake. The remainder of recommendations are based on Bridget’s stool analysis and are intended to help her holistically. Bridget’s stool analysis is eye opening to say the least.
She also becomes aware she has a leaky gut which is the probable cause for her recent eczema flares and acid reflux. And the level of inflammation in Bridget’s digestive system is impressive enough to aggravate her perimenopausal symptoms. An extended elimination diet of thirty days is recommended to mend Bridget’s leaky gut and to extinguish her gut’s inflammation.
Fast forward to Bridget’s three-month follow-up, her eighty percent improvement in overall symptoms speaks volumes to her functional medicine provider. Not only does Bridget report a complete resolution of constipation, acid reflux and eczema. Or put another way, Bridget avoids beginning three additional pharmaceutical drugs. She is also amazed at how she seemed to sleep the best sleep she had in years and gain more energy which inevitably alleviated her mood swings. The only nagging symptom on Bridget’s laundry list were those pesty hot flushes. Upon further discussion, Bridget decides to embark on epigenetic testing to see whether any single nucleotide polymorphisms (SNP) indicate an increased risk for cardiovascular disease, an important observation if she were ever to begin hormone replacement therapy (HRT) for her hot flushes. Furthermore, Bridget’s functional medicine practitioner advises her to return to her Primary Care Physician for a screening mammogram as an extra precaution since breast cancer runs in her family. If Bridget’s results prove her to be a less than ideal candidate for HRT, she is assured that there are non-hormonal pharmaceuticals and herbal remedies alike that she can explore to manage her hot flushes.
Myth Busters and Big Takeaways of Functional Medicine
To return to the origin of this article, “What exactly is functional medicine?”, and taking Bridget’s situation into consideration, one might realize what functional medicine does not entail. It’s not a one-stop shop. It’s not a quick fix nor a band aid. It’s not snake oil. As indicated in Bridget’s case, functional medicine is not alternative to conventional medicine but rather complementary. Functional medicine addresses functional conditions (those of which are not explained medically) as well as non-functional conditions by restoring the body to its natural homeostasis. It takes a holistic approach to address the whole body and whole person. It can push one’s longevity by medicating one’s lifestyle with good quality sleep, nutritious food, a healthy mind set, invigorating movement, and thriving relationships. Just because someone is be born with bad genetics, does not mean they are destined to their mortality sooner than their “healthier” counterparts.
Functional medicine is for everyone, but not everyone benefits from functional medicine.
For example, a person who is having a heart attack will not be treated with functional medicine. They will be admitted to Hospital, undergo a sent placement or open-heart surgery, be started on a minimum of six pharmaceutical medications depending on their history and presentation, and be referred to cardiac rehab. Whereas someone with high cholesterol, borderline hypertension, a family history of heart disease and a stressful lifestyle will benefit from functional medicine when it helps prevent a heart attack in the first place. Depending on several factors, they might be fortunate enough to completely eradicate their high cholesterol and have a stellar blood pressure. However, still, a person with a history of a heart attack can benefit from functional medicine tremendously by reducing the likelihood of having a second heart attack. Scenarios including but not limited to patients with a diagnosis of cancer who need regular follow up with their oncologists may also benefit from functional medicine to help with their symptoms of chemotherapy and radiation. Still from another perspective, not everyone benefits from functional medicine if they are not willing to go on the journey that entails forming a professional and trusting relationship with their practitioner.
Lastly, it is imperative that one chooses a licensed healthcare provider who holds a certification in functional medicine.
In the circumstances where there is no evidence-based benchmark, they are held accountable to provide their patients with “the standard of care”. The standard of care as defined in the journal of Innovations in Clinical Neuroscience, “….is the degree of care a prudent and reasonable person would exercise under circumstances” (Vanderpool, 2021). Another advantage to working with a licensed healthcare provider is often, they collaborate with their colleagues, including a patient’s primary care physician to ensure that patient’s health is addressed three hundred and sixty degrees.
Many, like Bridget, who are out of Hospital and do not necessarily take an endless list of medications, are by conventional medicine standards, “healthy individuals.” The rationale of what it means to be healthy is dynamic and changes depending on the environment of research and what history has taught us. Perhaps functional medicine is the methodology of care that meets the demands of society’s yearning to function optimally and holistically.
What is functional medicine? IFM. The Institute for Functional Medicine. (2022, October 3). https://www.ifm.org/functional-medicine/what-is-functional-medicine/
Vanderpool, D. (2021, September 18). The standard of care. Innovations in clinical neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8667701/