What is Functional Medicine?

Functional medicine is an evolutionary approach to caring for patients. It is simply a new way of THINKING, particularly about chronic diseases, like diabetes and heart disease. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, functional medicine addresses the whole person, not just one organ or isolated set of symptoms. It recognizes the body as one integrated system.

Conventional medicine looks at medicine in silos. It is excellent at treating acute illnesses – heart attacks, strokes, trauma, etc. It is also good at looking very deep into specific areas of the body which has led to the development of specialties and subspecialties and within different areas of medicine like cardiology, neurology, and gastroenterology, they identify the immediate diagnosis for different symptoms. However, our bodies are so much more than the sum of their parts.

Unfortunately, conventional medicine is not structured in a way that does a good job at treating chronic conditions, like diabetes and hypertension. Our current “healthcare” system is really focused on disease and specific symptoms. In other words, the providers listen for the symptom, give it a diagnosis, and give it a treatment, which most often involves a prescription for a drug.

The body is a network of systems (nervous system, cardiovascular system, respiratory system, immune system, gastrointestinal system, hormonal system, and others)  and ALL of them are interdependent and interact with each other. As a result,  when there is dysfunction or imbalance in one system, it frequently impacts other systems. For example, when some people eat certain foods like gluten, they develop a leaky gut, which leads to inflammation, which can manifest as so many different conditions including autoimmune disease, heart disease, hypertension, and hormonal imbalances.

Let’s say, you have an underactive thyroid – you see an endocrinologist and you are likely given thyroid replacement therapy. Let’s say you are depressed – you see a psychiatrist and maybe get a prescription for an antidepressant. But what if the depression was caused by the underactive thyroid which was caused by an autoimmune reaction to gluten? The functional medicine approach and treatment would be very different and in the end, save you a lot of suffering and money.

Functional medicine helps us to understand how everything works together in the body as one system. Rather than looking at the systems as separate silos, functional medicine looks at the underlying phenomena that are occurring simultaneously across multiple organs, like inflammation, poor nutrition, toxicity, and stress. These root causes affect our gene expression which results in “symptoms” and “disease”.

Functional medicine is NOT alternative medicine, not that there’s anything wrong with alternative medicine. Functional medicine does not renounce conventional guidelines.  It uses science to do a deep dive into the root cause of dysfunction. The emphasis is not on making a diagnosis. The emphasis is on uprooting the common mechanisms that create dysfunction in various systems.  When appropriate, It utilizes the strategies and tools of conventional medicine that work as well.

I am a traditionally trained cardiologist, board-certified in Internal Medicine, Cardiology, and Interventional Cardiology. Throughout the many years of training and practice, I look for and follow the evidence. Functional Medicine is no exception. It is also evidence-based, but we ask different questions. Rather than ask what is the symptom or disease and what is the prescription, the question is WHY does the individual have the condition in the first place. Functional medicine is the medicine of why.

Another important distinction between functional and conventional medicine is the goal of care. A conventional medical approach to chronic illness is to manage it, i.e. suppress the symptoms. A functional medicine approach is to identify and treat the underlying root cause to potentially reverse the condition.

 

Why is this important to you?

Among US adults, more than 90 percent of type 2 diabetes, 80 percent of coronary artery disease, 70 percent of stroke, and 70 percent of colon cancer are potentially preventable by a combination of lifestyle factors – nonsmoking, healthy diet, and physical activity (Willett 2002).

According to the CDC, 6 in 10 adult Americans have a chronic disease, 4 in 10 have two or more chronic diseases. About half of all Americans have at least one risk factor for heart disease, the leading cause of death globally. Thirty-four million Americans have type 2 diabetes and 85 million Americans (more than 1 in 3)  have pre-diabetes, where the blood glucose is higher than normal but not high enough to be classified as type 2 diabetes. But don’t let the “pre” fool you into thinking you’re okay. Untreated, pre-diabetes will turn into type 2 diabetes. Type 2 diabetes and pre-diabetes are predominantly caused by our lifestyle and completely reversible.

Some more startling statistics from the CDC – 83 million (1 in 3) American adults are obese and about 130 million Americans are categorized as obese or overweight (1 in 2). More disturbing is the rise of obesity in children. One in 11 young children (ages 2-5) is obese! These young kids can not even choose their own foods. What are we doing to our children?

What is the underlying root cause? I think we all know the answer – the standard American diet (SAD) which is highly processed, high in sugar and saturated fats, and low in nutrients. Obesity and being overweight puts you at risk for ALL chronic diseases. Not just heart disease and diabetes, but arthritis, osteoporosis, and cancer.

So, should we continue doing what we’re doing while faced with these epidemics of diabetes and obesity? Isn’t the definition of insanity “doing the same thing over and over again and expecting different results? More pills for diabetes is not the answer. A functional medicine approach, focused on all integrated systems, can reverse the exponential rise in chronic diseases by identifying and treating the root causes – the mechanisms of imbalance – inflammation, nutrition, toxicity, and stress.

 

What can you expect from a Functional medicine provider?

Two of the most common complaints among healthcare consumers is not enough time spent with the medical providers and not being heard. Functional medicine practitioners spend time with their patients, listening to their stories to find the root causes of their concerns.

 

Functional Medicine is personalized medicine.

A functional medicine provider will ultimately weave together the genetic, lifestyle, and environmental factors that interact and influence YOUR health. Treatment always involves lifestyle modifications that require patient participation and commitment to health. If you don’t want to take a bunch of pills for your disease, you have to commit wholeheartedly to your health. Yes, sometimes supplements are recommended. But they are predominantly nutrients that have been found to be deficient in an individual.

I’ve read claims (Wikipedia) that functional medicine is a hoax and potentially dangerous. I don’t know how they came to this conclusion. As you can see, in functional medicine, we just ask more questions to get to the real drivers of disease and we work closely with our patients to help them achieve true health rather than give them a disease or symptom management.

 

What about medications?

As I mentioned earlier, functional medicine is not alternative medicine. Functional medicine is evidence-based and does not renounce guidelines. When indicated and necessary,  traditional diagnostic studies, procedures, and medications are prescribed and appropriate referrals made.

 

How has Functional medicine changed the way I interact with my patients?

First of all, I take the time necessary to get to know my patients. The devil is in the details. So, I listen for clues and ask lots of questions about their lifestyles – how they eat (what, when, why), how they sleep, how they exercise, and how they manage their stress and relationships. Secondly, I am interested in all the integrated body systems. As an integrative cardiologist, I know that the cardiovascular system can not be treated in isolation. Cardiovascular disease is a disease of inflammation and oxidative stress. I have to ask the question, “Where are the inflammation and stress coming from”? There is also the undeniable link between the gut and the heart. It is the conduit for inflammation to enter the body. It is the source of diabetes and obesity. All of these underlying phenomena need to be addressed and treated to prevent and reverse cardiovascular disease.

 

“Life is like a tree …. Once we tend the root, the tree as a whole will be healthy. “ Deepak Chopra

 

Willett W. C. Balancing Lifestyle and Genomics Research for Disease Prevention. Science. 2002;296:695–98. [PubMed] [Reference list]