When your doctor becomes a detective.
If you’ve never heard of functional medicine (FM) before or don’t know how it differs from conventional medicine, you’re not alone. Behind functional medicine is a wonderfully simple philosophy that treats the body as a whole, interconnected system which looks at mind, body, and spirit as contributing elements to a person’s overall state of health. Functional medicine is evidence-based medicine and seeks to identify the root cause of disease by probing into the unique history of a patient’s life and genetics, as well as environmental and lifestyle factors.
In contrast, conventional medicine can be one dimensional and often results in treatment by medication. In acute cases, this may be very appropriate, but because we are not one-dimensional beings in most cases there is much more to the story. When it comes to complex, chronic disease, many physicians are, unfortunately, not adequately trained – and often don’t have time – to assess what may be the underlying cause(s) and apply diet, nutritional supplementation, exercise, and awareness of lifestyle stressors that are contributing to their patient’s illness.
As FM practitioners, we look upstream to assess the interactions of the patient’s history, physiology, lifestyle, unique genetic makeup, and mind-body-spirit that affect the function of the body as a whole.
What does this look like in an initial evaluation?
As a functional medicine practitioner, I start by asking what their story is and often that story starts with “I was fine until…” This is when we need to put on our detective hats and go back in time to reveal clues that may typically be overlooked; sometimes even going as far back as the time of mom’s pregnancy! For example: What was your mom’s pregnancy like? Was there a Caesarean section or vaginal birth? Were you breast or bottle-fed? Were there a lot of antibiotics used in childhood? The answers to these questions may indicate alterations of the microbiome in the gut (the bacteria that support our immune system). This is immensely important as research is uncovering a multitude of new data that shows how deeply interconnected our immune system is with the gut.
Other questions may include: Were there traumatic events in childhood or later? Was there ever exposure to environmental toxins like mold in the living or working environment? Were there ever infectious exposures or injuries? What are the patient’s diet, exercise regimen, sleep and emotional support system like? Is there ongoing stress at work or in personal life? Every answer peels away another layer of the mystery.
Besides a comprehensive history, there are a number of functional medicine diagnostic tests that may be necessary. This could include a sleep study, digestive testing (stool, urine, breath), saliva testing to assess cortisol (which can indicate stress or inflammation), thyroid and other hormone testing, nutritional testing, mold, heavy metals, and infections like Lyme or Epstein Barr. A consultation with our dietitian, psychotherapist, meditation instructor, or treatments such as acupuncture, herbal therapy, massage therapy, physical therapy or injection therapy may also be appropriate.
Fortunately, medicine as a whole is moving in the direction of functional medicine, but this approach takes time and a commitment in partnership between a patient and their physician.