What is Functional Medicine?
Functional medicine is a science-based field of health care that is grounded in the following principles:
Biochemical individuality describes the importance of individual variations in metabolic function that derive from genetic and environmental differences among individuals.
Patient-centered medicine emphasizes "patient care" rather than "disease care," following Sir William Osler's admonition that "It is more important to know what patient has the disease than to know what disease the patient has."
Dynamic balance of internal and external factors.
Web-like interconnections of physiological factors - an abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems, rather than individual systems functioning autonomously and without effect on each other. For example, we now know that immunological dysfunctions can promote cardiovascular disease, that dietary imbalances can cause hormonal disturbances, and that environmental exposures can precipitate neurologic syndromes such as Parkinson's disease.
Health as a positive vitality, not merely the absence of disease.
Promotion of organ reserve as the means to enhance health span.
Functional medicine is anchored by an examination of the core clinical imbalances that underlie various disease conditions. Those imbalances arise as environmental inputs such as diet, nutrients (including air and water), exercise, and trauma are processed by one's body, mind, and spirit through a unique set of genetic predispositions, attitudes, and beliefs. The fundamental physiological processes include communication, both outside and inside the cell; bioenergetics, or the transformation of food into energy; replication, repair, and maintenance of structural integrity, from the cellular to the whole body level; elimination of waste; protection and defense; and transport and circulation. The core clinical imbalances that arise from malfunctions within this complex system include:
Hormonal and neurotransmitter imbalances from cellular membrane function to the musculoskeletal system
Oxidation-reduction imbalances and mitochondria
Detoxification and biotransformational imbalances
Immune imbalances
Inflammatory imbalances
Digestive, absorptive, and microbiological imbalances
Structural imbalances
Imbalances such as these are the precursors to the signs and symptoms by which we detect and label (diagnose) organ system disease. Improving balance "in the patient's environmental inputs and in the body's fundamental physiological processes" is the precursor to restoring health and it involves much more than treating the symptoms. Functional medicine is dedicated to improving the management of complex, chronic disease by intervening at multiple levels to address these core clinical imbalances and to restore each patient's functionality and health. Functional medicine is not a unique and separate body of knowledge. It is grounded in scientific principles and information widely available in medicine today, combining research from various disciplines into highly detailed yet clinically relevant models of disease pathogenesis and effective clinical management.
Functional medicine emphasizes a definable and teachable process of integrating multiple knowledge bases within a pragmatic intellectual matrix that focuses on functionality at many levels, rather than a single treatment for a single diagnosis. Functional medicine uses the patient's story as a key tool for integrating diagnosis, signs and symptoms, and evidence of clinical imbalances into a comprehensive approach to improve both the patient's environmental inputs and his or her physiological function. It is a clinician's discipline, and it directly addresses the need to transform the practice of primary care.
Working with a Functional Medicine Practitioner
Functional medicine practitioners promote wellness by focusing on the fundamental underlying factors that influence every patient's experience of health and disease.
The Functional Medicine Approach to Assessment
The Functional Medicine training teaches practitioners how to assess the patient's fundamental clinical imbalances through careful history taking, physical examination, and laboratory testing. The functional medicine practitioner will consider multiple factors, including:
- Environmental inputs - The air and water in your community, the particular diet you eat, the quality of the food available to you, your level of physical exercise, and toxic exposures or traumas you have experienced all affect your health. Lifestyle is a major factor; research estimates that 70-90% of chronic disease risk is attributable to lifestyle.
- Mind-body elements - Psychological, spiritual, and social factors, including how you deal with stress, can have a profound influence on your health. Considering these areas helps the functional medicine practitioner see your health in the context of you as a whole person, not just your physical symptoms.
- Genetic makeup - Although your individual genes may make you more susceptible to some diseases, your DNA is not an unchanging blueprint for your life. Emerging research shows that your genes may be influenced by everything in your environment, plus your experiences, attitudes, and beliefs. That means it is possible to change the way genes are activated and expressed.
- Fundamental physiological processes - These are the body's processes that keep you alive. Some occur at the cellular level and involve how cells function, repair, and maintain themselves. These processes are related to larger biological functions, such as:
- how your body rids itself of toxins
- digestion and absorption of nutrients
- regulation of hormones and neurotransmitters
- musculoskeletal integrity
- psychological and spiritual equilibrium
- immune system function
- how you manage stress
- inflammatory responses
- how much energy you have
All of these processes are influenced by environment and by genes, and when they are disturbed or imbalanced, they lead to symptoms, which can lead to disease if effective interventions are not applied.
A Comprehensive Approach to Treatment
Most imbalances in functionality can be addressed; some can be completely restored to optimum function, and others can be substantially improved.
Prevention is paramount. Virtually every complex, chronic disease is preceded by long-term disturbances in functionality that can be identified and effectively managed.
Changing how the systems function can have a major impact on the patient's health. The functional medicine practitioner examines a wide array of available interventions and customizes a treatment plan including those with the most impact on underlying functionality.
Functional medicine expands the physician's tool kit. Treatments may include combinations of drugs and/or botanical medicines, supplements, therapeutic diets, or detoxification programs. They may also include counseling on diet nutrition, lifestyle, exercise, or stress-management techniques.
The patient becomes a partner. As a patient, you become an active partner with your functional medicine practitioner. You may be asked to make dietary and activity changes that, when combined with nutrients targeted to specific functional needs, will allow you to really be in charge of improving your own health and changing the outcome of disease.
Functional medicine is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just an isolated set of symptoms. Functional medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, functional medicine supports the unique expression of health and vitality for each individual.
Why Do We need Functional Medicine?
Our society is experiencing a sharp increase in the number of people who suffer from complex, chronic diseases, such as diabetes, heart disease, cancer, mental illness, and autoimmune disorders like rheumatoid arthritis and fibromyalgia.
The system of medicine practiced by most physicians is oriented toward acute care, the diagnosis and treatment of trauma or illness that is of short duration and in need of urgent care, such as appendicitis or a broken leg. Physicians apply specific, prescribed treatments such as drugs or surgery that aim to treat the immediate problem or symptom.
Unfortunately, the acute-care approach to medicine lacks the proper methodology and tools for preventing and treating complex, chronic disease. In most cases it does not take into account the unique genetic makeup of each individual or factors such as environmental exposures to toxins and the aspects of today's lifestyle that have a direct influence on the rise in chronic disease in modern Western society.
There's a huge gap between research and the way doctors practice. The gap between emerging research in basic sciences and integration into medical practice is enormous-as long as 50 years-particularly in the area of complex, chronic illness.
Most physicians are not adequately trained to assess the underlying causes of complex, chronic disease and to apply strategies such as nutrition, diet, and exercise to both treat and prevent these illnesses in their patients.
How is Functional Medicine Different?
Functional medicine involves understanding the origins, prevention, and treatment of complex, chronic disease. Hallmarks of a functional medicine approach include:
Patient-centered care. The focus of functional medicine is on patient-centered care, promoting health as a positive vitality, beyond just the absence of disease. By listening to the patient and learning his or her story, the practitioner brings the patient into the discovery process and tailors treatments that address the individual's unique needs.
An integrative, science-based healthcare approach. Functional medicine practitioners look "upstream" to consider the complex web of interactions in the patient's history, physiology, and lifestyle that can lead to illness. The unique genetic makeup of each patient is considered, along with both internal (mind, body and spirit) and external (physical and social environment) factors that affect total functioning.
Integrating best medical practices. Functional medicine integrates traditional Western medical practices with what are sometimes considered "alternative" or "integrative" medicine, creating a focus on prevention through nutrition, diet, and exercise; use of the latest laboratory testing and other diagnostic techniques; and prescribed combinations of drugs and/or botanical medicines, supplements, therapeutic diets, detoxification programs, or stress-management techniques.