The past couple of decades have seen a revolution in healthcare. There is public outcry for a new and more comprehensive approach that both views the patient as a whole being and full participant in their treatment, in addition to harnessing the best medical advances that research has demonstrated. Functional medicine is one model that has been developed to address this demand.
As stated by The Institute for Functional Medicine, this model is an “individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness.” Functional medicine searches for the underlying physiologic and biochemical dysfunctions to determine the causes of an individual’s illness. It embraces the concept of “whole-ism” and recognizes that it is critical to evaluate each person as a whole—physically, emotionally, mentally and spiritually instead of categorizing people into a fragmented collection of separate systems (e.g., respiratory, cardiac, digestive, etc) which operate independently from each other and that exist separately from our emotional, mental and spiritual aspects.
Functional medicine acknowledges that most chronic medical conditions are preceded by a long period of declining function in one or more of the body’s systems. These dysfunctions have to be understood in the context of each affected individual in order to intervene appropriately to return the individual to health. Attention is first directed towards understanding and correcting core imbalances, fundamental physiologic processes, environmental influences and genetic predisposition that has led to illness, as opposed to the traditional Western medicine approach of making a diagnosis and then initiating similar treatment to everyone without regard to the person’s unique individuality. It is more time consuming and intentional than traditional medicine and requires a more nuanced approach. While reliant on current scientific research, a strong knowledge of biochemistry and physiologic processes, the practice of Functional Medicine also depends on experience, intuition, mentoring, patience and compassion.
At NEFM we believe in this approach having seen the positive impact /results it has had on patient’s health and well being.
Here is are some examples of our approach:
1. Irritable Bowel Syndrome: a condition affecting 25 to 45 million Americans. Traditionally, patients are screened for autoimmune disease (ulcerative colitis, Crohn’s disease), cancer and sometimes celiac disease and small bowel bacterial overgrowth (SIBO). If all the tests come back negative, they are given anti-diarrheal or constipation medication, fiber supplements, pain medications, generic diet recommendations and a referral for stress reduction. A functional medicine practitioner will step back and consider the digestive functions from biochemical, physiologic and psychologic perspectives looking for dysfunction. This will entail a careful dietary history looking for food sensitivities, patterns of eating that might affect the digestive tract, specific symptoms and their timing. The patient’s story also will be examined for a history of antibiotic or other medication use, travel, food poisoning and gastrointestinal infections.
Specialized testing could include blood testing for food allergies and food sensitivities, celiac disease, adequacy of pancreatic digestive enzymes and stomach acid, adequacy of intestinal absorption, evaluation for increased intestinal permeability (leaky gut), hydrogen breath testing for SIBO, DNA stool analysis and stool culture to evaluate the microbiome (the 4-5 pounds of microbes inhabiting our digestive tract) looking for adequate beneficial bacteria as well as pathogenic bacteria, parasites, yeast/fungi and viruses, as well as measuring the gut’s immune function and amount of inflammation. At a lengthy follow-up visit lasting 30-45 minutes the tests will be reviewed, evaluated and together, the practitioner and patient will form a treatment plan.
2. Fatigue: Research from the U.S. Centers for Disease Control and Prevention found that 15 percent of women and 10 percent of men said they were "very tired or exhausted" most days or every day of the week; this represents more than 30 million Americans. In a 10-15 minute standard medical appointment, providers will gather a brief history and order some basic labs (CBC, chemistry profile, thyroid stimulating hormone), and make sure that cancer screening is up to date. If the labs come back normal (most common outcome), patients will receive counseling on sleep (perhaps given sleep medication), get a recommendation for stress reduction and possibly a referral for psychological therapy (perhaps given anti-depressants).
On the other hand, a functional medicine practitioner will spend 30-45 minutes carefully listening to a patient’s story, searching for clues as to underlying dysfunction. The resulting investigation could lead in many directions by asking these questions: Is there a nutritional deficiency or excess? Is there a hormonal imbalance of thyroid, adrenal or gonadal function? Is the patient’s sleep restorative, and if not, why not? Has the person been under stress, if so, what is it and how can it be addressed? Are they converting their food to energy—which entails an adequate diet, good digestion and absorption, and finally, adequate mitochondrial function? Are there toxins, such as mold, chemicals or heavy metals present? Is there evidence of infection? Specialized testing will be ordered to answer these questions, then the practitioner and patient will review the results and together they will form a treatment plan.