What is Functional Medicine?

What is Functional Medicine?

When I was introduced to functional medicine, I was attracted to it because it was what I always thought medicine should be. It approached healing an individual’s issues by first looking at the root cause of those issues. I found myself often frustrated by a medical paradigm where treatment was dictated by the dogma that “this symptom goes with this diagnosis, which goes with these tests, which go with these drugs—end of story.” I mean, that’s great when it works, but my years of observations from inside healthcare told me that there were many, many people for whom that was definitely NOT working. Functional medicine offered me a way to think outside the diagnosis-code box.

When does the conventional model work? It’s usually effective for people who are generally healthy and then have something that’s a big change from their norm happen in short order—a minor infection, a poisonous bite, a broken bone, or even pregnancy. But what about all the people that fall outside of that? The people who have conditions that develop over months or years. The people who have symptoms that aren’t dire, but annoying, and cause them to fall short of what they know could be their optimal function. The people who have conditions that don’t respond the way we want to our staid symptom-diagnosis-test-drug approach.

As humans progress and get to living longer, suffering relatively fewer fatalities from accidents and infectious disease, these are increasingly the ways in which our bodies start to fail us. Nobody wakes up one morning and suddenly just HAS rheumatoid arthritis, or type 2 diabetes, or chronic fatigue syndrome. Something—or some set of things—had to CAUSE the process that started the person down the path of the disease. And more than likely, that set of factors is not exactly the same for the patient I see at 9 AM as it is for the one I see at 2 PM the same day. If they were, the exact same treatments would work for both—something we all intuitively know simply cannot be true—medical education or no.

What’s more, we understand that those factors had to have been in place for years or decades before the person met the disease’s “diagnostic criteria”—something that, in modern medicine, serves almost exclusively as a contrivance of Big Insurance to dictate when they are or aren’t required to pay for treatment. But does the person in my office who has a fasting blood sugar of 99 (just below the diagnostic cutoff of 100 that qualifies him to be called “pre-diabetic”) really benefit from my waiting until I get a 102 on his lab results before I start looking for why this is happening? Obviously not. Either way, this patient is having a problem with processing sugar, whether or not I’m “allowed” to give it a name. The blood sugar problem is the downstream effect. What happened upstream to cause it? Exchange pre-diabetes here with virtually any chronic condition, and the scenario is the same. It doesn’t take an expert to understand that there has to be a better, earlier, lasting way to help these people.

I have observed enough patients with varying conditions in enough different sectors of healthcare to feel qualified to say that, on the whole, conventional/Western/allopathic medicine as it stands now does a paltry—no, pathetic—job of helping these people. I know I’m not the only clinician who has had the defeating experience of watching this phenomenon before my eyes while feeling appallingly under-equipped by my top-notch education to really help these people return to health.

Believe it or not, I’m not against allopathic medicine. I am proud of my education, and it was a conscious choice. I do believe that if medicine heals you, it has accomplished its goal, and that conventional medicine does do that very well in many cases. The thing I’ve come to adore about functional medicine is that it gives me a way to start approaching everybody else.

A tenet of functional medicine is that all disease originates from five basic “root causes”: toxins, allergens, stress, infection, and diet. In thinking of health conditions originating in this way, a functional medicine practitioner is seeking to identify, for any given patient, which of these is disturbed or out of balance and, most importantly, why. Of course, when we are thinking of health conditions in this way, you can easily see that we’re often looking at things that have shifted, accumulated or occurred over months, years, or decades.

For this reason, functional medicine often doesn’t offer a quick fix. This can feel a little unusual, or sometimes even frustrating, for those of us who have received care for most of our lives in the “pill for every ill” culture of modern medicine. Because functional medicine is seeking to remedy a highly individual set of factors, there’s not always an exact test that tells us what will work. In order to be successful, functional medicine is highly reliant upon the patient observing himself and partnering with the clinician to fine-tune the plan of care based on those observations. The patient-clinician relationship is the most important tool in functional medicine.

In other words, there may be some trial and error involved. Also, sometimes even when we know exactly what we need to address in order to stimulate healing, it isn’t a quick fix. When the “root cause” has been going on for a prolonged period of time, the remedy will often involve a fair amount of effort (either short or long term) on the patient’s part. Even when the person is able to adopt these new habits right away and stick to them, it still might take quite a long time for full healing to take place. Functional medicine is not for the faint of heart!

The good news is that, in most cases, the techniques of functional medicine are compatible with those of conventional medicine. Because of its emphasis on treating every patient as an unique whole person, functional medicine is flexible. For example, just because I’m a functional medicine nurse practitioner and you’re in my office with your fourth sinus infection this year, that doesn’t mean I can’t give you a prescription for antibiotics! It just means that I want to delve deeper than that. Maybe there are some nutrients you’re missing out on, or something about your immune system isn’t firing quite right, or your sleep patterns are throwing you out of balance, or your stress level is depleting the hormones that should help protect you against repeat infections. Having a functional medicine education means I don’t use a one-size-fits-all approach, and I have more tools in my toolbox. Don’t want that prescription? I just might have an option for you. And if I think the pharmaceutical drug is the best option in spite of all the alternative things I know how to do, I’ll tell you that, too. I want you to feel better and be happy.

Which brings me to the other thing that “functional” refers to, at least in my practice: restoring the patient’s function as she herself defines it. In other words, meeting the patient where they are in the process of healing. Perhaps, in the case of your multiple sinus infections, we determine that the root cause is X, and in order to remedy that, in your case, we will have to do Y and Z. But let’s just say that Y and Z both take a little bit of effort to implement, and Y also takes a fair amount of pre-planning in your particular case, but you’re about to go to Illinois to see your family, so you don’t really have the energy right now, but maybe after you get back you could start on some, but not all of it. And that’s not even to mention Z, which is also going to involve having a discussion with your partner about changing something in your household, and you’re not really sure he’ll get it, and on top of that, it’s also a little pricey.

In this scenario, you want to address the root cause, but right now you just want to feel better with minimal side effects and get on your way to go visit your family. If I am a cognizant functional medicine practitioner, I will do my best to support your “function” at every step of the process. So, in this case, let’s do a prescription today and I’ll give you a few extra tips to avoid short-term problems, then when you get back you start a small, modified version of the plan, and we schedule you for a follow-up at a time your partner can come so we can all get on the same page before you get started on really addressing things. I keep the emphasis on true healing, but I do what I can to keep you functioning the best you can at each stage in the process.

I sometimes have a hard time answering when someone asks “what is it you do?” It’s so different for everyone! Sometimes I just want to say “I help people to get as healthy as they can and want to be.” I recently heard Dr. Mark Hyman put it much more eloquently when he said that functional medicine is about “creating resilience.” I thought, “OH! Right.” It’s not that I expect my patients to live in a bubble, or never to have any bumps in the road of health. I just want to help them bounce back, the way the humans are designed to do. My particular entrée into that process of creating resilience with people is nutrition, but someone could just as well do it with neurology or gynecology or psychiatry. Functional medicine is not a panacea, it’s a process. For me as a clinician, I feel like it gave me my career back! While I once felt only despair about the brokenness of the healthcare system and my role in it, functional medicine helps me believe that there are solutions, and it gives me the confidence to start looking for them with my patients in my small corner of the world. It was just the prescription I needed.

For more great reading on this topic, I can’t recommend highly enough the book Just Be Well by Dr. Tom Sult.