Functional Medicine
 

Functional medicine is becoming increasingly popular as it works to evaluate the antecedents, triggers and mediators of disease, even before they begin. This is one of the most comprehensive forms of medical care available to determine overall health and wellness. During the examination, your individual genetic makeup, personal health history, nutrition, family history and environment will be evaluated to identify what is affecting your health.

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Functional medicine seeks to identify the risks of developing a certain condition before it does develop as well as look for root-causes of illness. For example, if one's blood sugar levels come back elevated or are continuously fluctuating, functional medicine would seek to stabilize those blood sugar levels before diabetes even develops and to access with our patient what is driving the high blood sugar. 

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Functional medicine can help by fine-tuning the internal environment. This is done by optimizing metabolism, vitamin levels, and ruling out the presence of elevated environmental toxins.  In-depth tests such as blood, urine, saliva, stool, and genetics are the underpinning of functional medicine. 

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Seeing a functional medicine provider is especially helpful when conventional medicine has not provided good answers. It’s also a good path when a diagnosis has been made, but the drugs prescribed caused too many side effects. By digging deeper, a variety of treatments including clinical nutrition and nutraceuticals can be applied therapeutically. Digging deeper means asking a lot of questions and often having specialized testing performed.

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 Functional Medicine utilizes many modern testing and laboratory methods. For example, we may order genetic marker testing and/or gastrointestinal laboratory analysis. We combine this information with in-depth patient interviews to construct a holistic view of the individual and their lifestyle. The resulting “deep dive” is a highly personalized and detailed analysis of the patient’s health. This personalized, systems-based approach has proven particularly effective in treating chronic diseases like Hashimoto’s Hypothyroidism, fibromyalgia, and depression

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Case Study: Persistent Gut Issues Solved by Functional Medicine

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Let’s look at an example of where functional medicine can help.

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Symptoms: In this case the patient has bloating, gas, and intermittent diarrhea. They also have a persistent skin rash for which the dermatologist prescribed hydrocortisone. The hydrocortisone helps a little but the rash never completely goes away.

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Test Performed: A functional medicine stool test is performed which shows elevated antibodies to wheat, excessive candida, abnormal fat levels, major imbalances in intestinal flora, and low pancreatic enzymes. A food allergy test is performed and a number of food allergies are discovered.

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Functional Medicine Treatment: Food allergies will often trigger an irritating and persistent rash. In this case, it would be possible to completely cure this patient’s problem by treating all the findings by eliminating the triggering foods, stopping consumption of wheat, treating the yeast, taking a pancreatic enzyme, and a probiotic.

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Case Study: A 30 Year Old Woman with Allergies and Eczema

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To really capture the difference a Functional Medicine approach makes over conventional medicine, consider a case study:  

 

A 30 year old woman (we’ll call her “Linda”) complaining of eczema and allergies. 

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The Conventional Approach: Suppress The Symptoms

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Conventional medicine had an entire toolbox of medications and creams designed to suppress Linda’s symptoms for 30 years of her life.  She was given antihistamines, steroids and inhalers.  She managed okay, but found all these treatments were short-lived and/or resulted in further problems that left her with an overall poor quality of life. 

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The Functional Medicine Approach:  A Deep Dive 

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The functional medicine approach begins with collecting an extensive history from Linda.  A true deep dive into someone’s medical and environmental history is essential to uncovering the root cause of an illness, but it’s impossible in the context of the conventional less-than-15-minute appointment.  Our initial appointments are 45-60 minutes, one-on-one with our nurse practitioners.  

  

Uncovering Triggers and Root Causes

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With a through intake visit, it was found that Linda’s mother was exposed to numerous pesticides as well as antibiotics during her pregnancy.  Linda had eczema as a baby and developed allergies to animals, plants, and food in quick succession. 

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Linda coped through her 20’s but then landed an incredibly stressful job.  She also worked part time at a restaurant where she began to eat fried foods, consume more alcohol, and was exposed to massive amounts of smoke.   Her stress and symptoms further increased when her father fell ill to cancer. Through the lens of functional medicine, it’s obvious to us why her symptoms worsened significantly at this point in her life. 

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She first sought the help of an Ear Nose and Throat (ENT) Doctor and dermatologist.  They gave her multiple medications to control her skin rashes and allergies, but she continued to feel “unwell" and didn't like the side effects of the medications which made her feel drowsy. Much to her frustration, she also began to have poor energy, gastrointestinal complaints, and weight gain.

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As part of Linda's Functional Medicine care plan, a micro-tailored, highly personalized treatment plan focused on identifying and tackling the root causes was started to address the following concerns:

• Toxic Exposures

• Food Reactivity

• Stress

• Gastrointestinal Imbalances

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The functional medicine plan for Linda included various diagnostic tests as well as integrative approaches to provide interim relief while the treatment plan attacks the root causes of her illness:

• Nutrient Laboratory Work (to look at all the nutrients that are integral to the immune system)

• Functional Stool Test (to assess the health of her microbiome and digestive capacity)

• Elimination Diet (to target and remove any foods in her template that were worsening her symptoms)

• Integrated Mind-Body Practices

• Acupuncture for Symptom Management

• Toxin Analysis and Assessment of Baseline Removal Capabilities 

• Advanced Stress Management Techniques

• Botanical Supports (to alleviate her symptoms while the rest of our Treatment Plan delivered its results)

 

Linda’s Results: Full of Energy and Empowered

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Today, Linda is eczema free, full of energy, and down to her college weight.  She continues to live with some outdoor allergies but they are manageable and controlled, as long as she is careful about certain triggers and sticks to the health regimen.  She’s been medication free for the last two years! Most importantly, she’s empowered.  She can identify triggers before her immune system goes off the rails, and she has a plan of attack.  She is a great example of benefits of a Functional Medicine approach, as well as teamwork between clinician and patient.  

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 Conventional Vs Functional Medicine Approach: A case study on diabetes

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1. Conventional Medicine Approach

Diabetes is a disease entity defined by a random sugar over 200, three fasting sugars over 125 or a hemoglobin A1c of 6.5 or greater. Once one of these levels is reached, then the first line medication of metformin is started. Diet and lifestyle changes are recommended. If adequate control is not reached then second line meds are begun (i.e.- Januvia, Onglyza, Invokana, Jardiance). If these don’t result in control, then other medications and ultimately insulin is begun and the disease process often continues until there is organ failure. 

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2. Functional Medicine Approach

Functional Medicine, compared to conventional medicine, would include an individualized systems biology approach which would look vastly different for individuals based on their evaluation. Based on the most recent medical literature, insulin resistance is a spectrum in which an A1c over 5.5 or fasting sugar over 100 are markers of insulin resistance and treatment would begin at this stage rather than wait until the A1c is at 6.5. 

 

Herbals and supplements would be considered for treatment. Herbs like cinnamon or traditional remedies such as apple cider vinegar have been used to help with insulin resistance. Supplements such as berberine, fenugreek, fiber, alpha lipoic acid and curcumin are also sometimes used. Many diabetics have mineral deficiencies in B vitamins and magnesium as well as Vitamin D so these would be considered as treatment options. At times a cleansing type diet or a detox diet are implemented. We spend a lengthy amount with our patients to customize a disease-preventing or disease-reversing nutritional plan as well. 

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Diabetes is a part of a larger spectrum of diseases commonly called Metabolic Syndrome. For example, an individual may have detoxification issues resulting in systemic vascular inflammation and insulin resistance. Or another could have pancreatic or biliary insufficiency resulting in incomplete food digestion and inadequate nutritional absorption which can affect blood sugar regulation. Someone else could have an immunologic reaction with a certain food like gluten causing vascular inflammation and insulin resistance and a fourth person could have all the above. Function Medicine would address these.

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