What is “Functional Medicine”?

I have drunk the koolaid. Or at least the açaí-chia-maca-based elixir that is boosting my vitality and vigor. Okay, I made-up the elixir. But I am studying Functional Medicine and I am one of many MDs who feels that Functional Medicine is the future of conventional medicine.

(Me after the magical elixir that I hope to invent)

So what exactly is Funtional Medicine? Functional medicine and integrative medicine are synonyms and I will use these interchangeably. Holistic medicine is another synonym but also more of a cliche so I don’t use this term as often, but you get the idea.

Instead of just treating symptoms, Funtional Medicine looks at the root causes of disease. It also acknowledges that systems in the body are integrated. A cardiologist cannot just look at the heart to figure out the cause of palpitations. She needs to look at the endocrine system and the neurological system and needs to know a person’s lifestyle. Maybe those palpitations are from an over-active thyroid or because the person drinks 5 cups of coffee a day. Most Western-trained cardiologists would examine these other factors, but in general many of us MDs tend to focus on our areas of expertise, myself included.

This has been a slow evolution for me as a physician. In residency in the 1990s, any concept that was not proven by a randomized double-blinded controlled trial (RCT) was bogus.

RCTs are the standard for what we call evidence-based medicine. Evidence-based medicine is the opposite of anecdotal medicine. An example of anecdotal medicine is this: you had heart-burn when you were pregnant and your kid had lots of hair when he was born. This means that heart-burn = hairy newborn. Not so! New flash: most pregnant women have heart-burn and most babies have hair. One is not related to the other.

My favorite example of an anecdote is my patient who’s spouse would not get a vasectomy, even though this was safer than her getting her tubes tied. She confided in me that his cousin had a vasectomy and then became gay. Uh, nope. No cause and effect there. (Then again, there has never been an RCT to see if vasectomy changes sexual-orientation . . .)

This evolution probably started when I was in residency. A patient was having severe kidney pain from kidney stones but the pain persisted even after these stones were long gone. She was eating percocets like candy. Then a western-trained anesthesiologist offered acupuncture. He had done some training on his own and thought it might help. Boom! Pain gone after one treatment. Okay, this is also anecdotal but it still was impressive and my first experience with non-Western medicine.

Over the years, I would see women with persistent health issues and many would seek complimentary medicine as a last resort: traditional Western medicine simply was not giving them answers and relief. Many would tell me stories of significant improvement or resolution of their symptoms. Sure, some of it was placebo, but all of it?

In 2014, I stopped delivering babies and moved my practice to Portland, Oregon– a mecca for alternative medicine. My skepticism slowly dissolved as I collaborated with naturopaths as well as MDs who practiced what they called Functional Medicine. When I had my own thyroid issues, I saw a (MD) Functional Medicine practitioner who helped me a lot. I decided to take the leap and learn this type of medicine for my gynecologic patients.

There are a lot of critics of FM and one of the most vocal is Dr. David Gorski, an oncologist. He says “Functional Medicine combines the worst features of conventional medicine with a heapin’ helpin’ of quackery.” (I do love his hillbilly linguistic sensibilities.) He mentions Dr. Mark Hyman’s description of FM: “looking into interactions among genetic, environmental and lifestyle factors.” Dr. Gorski pronounces these as “weasle words of woo.” (Dr. Gorski is good at alliteration too!) Finally, he criticizes FM for “exagerating the power of diet.”

At heart, I am a skeptic and so I understand some of his skepticism. But let’s consider these weasle words of woo. First of all, how can a doctor not consider genetic and environmental factors in treating a patient? To me, this is absurd. Yes, there are certain universal truths about how our bodies work, but there are so many things that make us unique. One woman’s Stage 3 Breast Cancer can be vastly different from another woman with the same diagnosis. Maybe the tumor is the same size and place, but we likely will not treat these two women the same.

Also, I do not think that the importance of diet can be exagerated. Hippocrates said “Let food be thy medicine.” This is even more relevant in today’s world where over-processed foods abound. How can a little pill (any pill, just pick one) cancel-out all the other chemicals that go into our bodies every day? Now I would love to say that I always eat organic produce and grass-fed meats, but I have been known to inhale a bag of Cheetos (crunchy, not the puffy ones). At least I acknowledge that this may be contributing to some of my ailments.

I am not against medications, but let’s be clear that a lot of research is sponsored by Big Pharma. One cannot patent natural substances like ginseng or estrogen, so there is no incentive to do a randomized controlled trial to prove efficacy. Evidence-based medicine requires money, and corporations have the money to do this research. Your local herb farmer is not going to sponsor a large trial to see if his Ashwaganda really lowers cortisol levels.

I am studying Functional and Integrative Medicine because Western Medicine simply does not have all the answers. It has many answers and has helped millions of people live better and longer lives, but to ignore non-Western medicine is to eliminate another important tool. When it comes to treating patients, I want as many tools as possible in my tool box.

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