Functional Medicine: Getting Started Guide
One of the most common questions we receive is about how to get started with functional medicine. Whether you are a health care practitioner looking to learn more about functional medicine and how to incorporate it into your practice, or a patient looking for an aligned health care practitioner, we hope to answer a lot of these questions in this episode of Pursuing Health Pearls.
What we’re doing isn’t working
Today in the United States, six out of every ten adults has at least one chronic disease, and four out of ten have two or more. Chronic conditions account for seven of every ten deaths in the United States, and together with mental health account for 90% of our $3.5 trillion annual healthcare costs. Our healthcare system has been designed around providing life-saving care for acute problems, but when it comes to chronic disease it is poorly equipped. The current standard approach relies on using primarily pharmaceutical medications to slow the progression of disease and manage symptoms rather than addressing the root causes which are often rooted in lifestyle.
What is functional medicine?
Functional medicine is a model that empowers patients and practitioners to work together to address the root causes of disease and promote optimal wellness. This model recognizes the unique genetic makeup and experiences of each individual and uses these along with the latest medical and scientific research to inform personalized treatment plans. This is a model that we have found to be much better suited for addressing chronic diseases from obesity, to type 2 diabetes, autoimmune diseases, mood disorders, and many more.
The foundations of health
The functional medicine framework aims first to ensure our bodies have the necessary ingredients to facilitate health, which include: sleep and relaxation, exercise and movement, nutrition, stress management, and meaningful relationships. When these key ingredients are not present or out of balance, the stage is set for disease or dysfunction to creep in. Many times, just improving these factors will result in the resolution of symptoms and disease. Regardless, making sure these things are in place first so that the body has the necessary ingredients for healing is important in order to allow for more advanced testing and/or treatment to be most beneficial.
A few examples
To illustrate the difference between conventional and functional approaches, let’s discuss a few examples. In the conventional system, a cluster of symptoms is diagnosed as a disease, and then the standard-of-care treatment is prescribed. For example, if you have a rash it will likely be given a name based on its appearance (for example, “eczema”). You will then be prescribed a treatment that has been shown to improve this type of rash (for example, moisturizer or steroid cream). The rash may improve with this treatment, could come back when the treatment is stopped.
On the other hand, a functional approach would look at the rash as well as any other symptoms you may be having and put them into context with your prior environmental exposures, lifestyle behaviors, and unique genetic makeup asking, “what is the underlying cause of this rash?” A multifaceted approach would then be recommended to identify and eliminate this root cause with a goal of optimizing the body’s functional and permanently resolving symptoms.
It’s important to note that one underlying cause may manifest in different symptoms or diseases in different individuals due to their unique genetics and biology (i.e. gluten sensitivity may cause diarrhea in one person and a rash in another). Likewise, one symptom may have a variety of different root causes (e.g. depression in one person may result from a nutrient deficiency, while in another could be due to excess stress or isolation).
In a conventional approach, a patient with a rash, diarrhea, and a headache might see a dermatologist, a gastroenterologist, and a neurologist and receive three different diagnoses and three different treatments. A functional medicine approach, on the other hand, would take all of these symptoms into consideration and search for a root cause that would link all three while optimizing the body’s function through nutrition and lifestyle factors.
Functional, integrative, and lifestyle medicine
Another question we are frequently asked is about the difference between functional, integrative, and lifestyle medicine. This is a whole topic in and of itself, but for now here is one analogy we like to use.
If someone was diagnosed with depression:
- A conventional approach would be to prescribe an antidepressant medication.
- An integrative approach would be to prescribe a supplement called St. John’s Wort.
- A lifestyle approach would be to prescribe exercise, nutrition, sleep, meditation, and relationships.
- A functional approach would be to ask: “Why is this person depressed?” and craft a treatment approach in response to the answer.
As this analogy illustrates, functional medicine is a framework for assessing health and disease and is agnostic to the treatment approaches used, whether they are based in conventional, alternative, or lifestyle approaches.
Functional Medicine Resources For Patients
#1 A Primer
To deepen your understanding of functional medicine and how it might help you, we recommend reading or listening to Disease Delusion: Conquering the Causes of Chronic Illness for a Healthier, Longer, and Happier Life, a book written by Dr. Jeffrey Bland, the “father of functional medicine.”
#2 Find a practitioner
If you decide you’d like to move forward and work with a functional medicine practitioner, we recommend using the Institute for Functional Medicine’s Practitioner Finder to locate those who practice in your geographic area. This practitioner finder features those who’ve completed the Institute for Functional Medicine’s (IFM) five-day introductory course and are members of IFM. Those who are noted as an “IFM Certified Practitioner” have completed six additional training modules and passed a rigorous examination. Do keep in mind, much like CrossFit affiliates and coaches, functional medicine practitioners come from a variety of backgrounds and experiences. Practitioners range from MD and DO physicians, to nurse practitioners, physician’s assistants, chiropractors, naturopathic doctors, dietitians, health coaches and others. Functional medicine is not one-size-fits-all and each practice and practitioner will be different. We’d recommend checking out their websites or inquiring about a free consultation to better understand the scope of practice and services offered.
#3 What to expect
Again, each practice will implement functional medicine in its own unique way, but here are some things you may expect to see:
- An pre-visit questionnaire asking you about everything from your family and birth history, to courses of antibiotics as a child, to stressors and environmental exposures over your lifetime
- An in-depth first visit reviewing your health timeline and symptoms you are currently having
- A heavy emphasis on lifestyle change including dietary and exercise interventions, meditation, and stress management
- The use of advanced testing and supplements as part of an individualized plan
- Many practices (though not all) operate on a cash basis outside of insurance, due to the increased up-front time investment necessary to utilize this approach
- Each practitioner may have a slightly different role. For example, some may specialize in treatment of GI-related symptoms while others may have expertise in brain health. It’s important to clarify your practitioner’s role up front. You should also ask whether they will act as your primary care doctor, or whether you should continue to go to your primary care physician for certain needs.
#4 Keep learning
If you’re interested in furthering your knowledge of concepts related to functional medicine, you may be interested in listening to the podcasts below:
- Ep 07 – Dr. Mark Hyman on Functional Medicine, the Future, and Community
- Ep 22- Brigid Titgemeier on Functional Nutrition
- Ep 26 – James Maskell on Functional and Integrative Medicine and the Impact of Community on Health
- Ep 105 – Sleep, Stress, and Brain Health with Dr. Nate Bergman
- Ep 109 – All About Functional Medicine with Dr. Elizabeth Bradley, Medical Director of the Cleveland Clinic Center for Functional Medicine
Functional Medicine Resources For Practitioners
#1 Get your feet wet
For exposure to the foundations of functional medicine and nutrition, we recommend these free online courses offered through the Institute for Functional Medicine. Each take 1-2 hours to complete and should give you a good idea of the framework that functional medicine offers.
#2 Do some reading
For anyone interested in functional medicine, we feel that the two books below are must reads. They will give you a better understanding of how functional medicine fits into the bigger picture of our healthcare system and provides a much-needed solution for chronic disease:
- The Evolution of Medicine: Join the Movement to Solve Chronic Disease and Fall Back in Love with Medicine by James Maskell
- Unconventional Medicine by Chris Kresser
#3 Deepen your learning
For ongoing learning, we recommend these resources:
- IFM Grand Rounds Presentations
- Revolution Health Radio
- Evolution of Medicine Podcast
- Functional Medicine In Primary Care: Together, We will Get You Better by Dr. Aunna Herbst
- Curiosity Heals the Human: How to Solve “Unsolvable Medical Challenges with Better Questions and Advanced Technologies by Dr. David Haase
#4 Taking it to the next level
For those interested in using a functional medicine approach in your day-to-day practice, we recommend these two programs
- IFM Applying Functional Medicine in Clinical Practice: This is the five-day foundational course offered by IFM that will give you the foundation for using a functional medicine framework, and act as a launching point for more advanced learning through Advanced Practice Modules and the IFM certification program.
- ADAPT Practitioner Training Program: This is a year-long online course taught by Chris Kresser which provides a practical education in how to implement functional medicine principles in day-to-day practice.
Functional medicine is the tip of the spear of modern medicine. With genetic, biochemical and environmental individuality in mind, it aims to address the root causes of disease and optimize overall health and function. It takes from the old and new, conventional, holistic, and alternative, and incorporates the latest advances in genetic and pharmaceutical science to create a framework that might just be able to save us from the tsunami of chronic disease we are facing today. We hope you’ll use some of the resources above to explore functional medicine further for your own health or practice.
Disclaimer: This post is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.