What is Functional Medicine?

I get this question a lot from perspective patients.  Routinely I will speak with potential patients on the phone before they schedule their appointment.  It allows me to get a general sense of the issues they are dealing with and whether or not I think I can help them.

Inevitably I end up using the term “functional medicine” somewhere in our conversation.  Most people don’t know what that means.  They’ve heard the term medicine before.  However, they always associate it with traditional medicine.  By that I mean going to your family doctor with a complaint and they give you some pill (pharmaceutical in nature) that takes away the symptom.

I’ve also spoken with many other types of physicians who don’t know what functional medicine is.  They assume there’s one way to treat disease and it’s with drugs.  Fortunately, that’s not true.  Modern medicine is a reactive practice.  They wait for disease to develop before treating it.  Here is a scenario that occurred today in my office:

Dr. Vreeland: “Hi Mrs. Smith, how are you today?”
Mrs. Smith: “I’m doing ok, but I brought some blood tests I’d like you to look at with me.”
Dr. Vreeland: “Sure, let’s have a look.  Well it looks like your blood sugar is running a little high.  This is suggestive of pre-diabetes.”
Mrs. Smith: “Yes, I saw that and asked my family doctor about it.  He said he wouldn’t treat it until diabetes developed fully.  I didn’t like that answer.”

This is a scenario that plays out over and over again in my office almost every day.  There is no proactive solutions given to most patients in modern medicine today.  Everything is about treat disease once it develops instead of preventing it in the first place.

Mrs. Smith will not go on to develop diabetes because she is now working with on her diet, exercise program and is going to take the appropriate supplements to prevent her from heading down the long, dangerous road that diabetes creates.

Traditional Medical Approach to  a Common Condition

Traditional medicine focuses on the symptoms of the health problems that one might face, not the cause of the symptoms.  For example, someone with fibromyalgia is almost always treated symptomatically.  They are given pain medications to help cover up the pain; they are given sleep medications to help them sleep at night; they are given reflux medication to reduce their reflux – the list goes on and on.  Unfortunately, none of those medications is addressing the causes of any of those symptoms.

Functional Medicine Approach to a Common Condition

Functional medicine wants to know why you are experiencing these issues.  The pain in fibromyalgia is caused by an aberrant processing of sensory information in the central nervous system.  Through a program of neurological rehabilitation you can change the way you brain interprets sensory information.  Over time this effectively reduces pain levels.  Sleep disturbances are often a result of low levels of serotonin in patients with fibromyalgia.  To correct this a supplement called 5-HTP is given.  This allows the body to replace the depleted stores of serotonin which is actually the cause of the problem.  Reflux may be caused by a hiatal hernia – a condition in which the stomach slips through the diaphragm.  Through a simple manual reduction this hiatal hernia can be reduced and the symptoms of reflux go away.  Providing a drug to these patients that reduces acid production does relieve the symptoms but does nothing to address the hiatal hernia so they become dependent on the drugs.

First and foremost functional medicine is about being proactive with regards to your health.  Should a condition develop functional medicine seeks to fix the physiology not cover up the symptom.  A person who has no symptoms because they are covered up by pharmaceutical agents is still a sick person, they just don’t know it.

My advice to most people is to be as preventative as possible when it comes to your health.  Do everything you can to prevent as much as you can.  The best way to treat a disease is to prevent it in the first place.  This is what functional medicine is about.

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6 Comments

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6 responses to “What is Functional Medicine?

  1. Christopher S. Spaulding

    Your example of how a so called “traditional” physician would treat a pre-diabetic patient is grossly inaccurate. Real doctors-you know the folks with initials “MD” after their last name, who actually graduated from legitimate medical schools and had actual residencies and fellowships, would advise and guide their patients how to eat healthier and live more active lives. It strikes me as ironic when , ahem “doctors” of chiropractic “medicine”, attack actual physicians. A chiropractor couldn’t pass Step 1, 2 or 3 board exams if their lives depended on it. In fact, an MD, PA-C (physician assistant certified, or a Nurse Practioner endures so much more didactic and clinical training then a chiropractor, it is not even remotely comparable. Please just stick to adjusting backs and leave the real patient care to those trained in actual, verifiable clinical medicine.

    • I am sorry you feel that my assessment of how traditional medicine treats a pre-diabetic is inaccurate but this has been my experience over and over again. Individually, I believe there are many good medical doctors out there. I work with them routinely. But as a whole, medicine does a very poor job in true preventative care. As evidence I would point to the poor state of health that the vast majority of our country is in. Unfortunately, traditional medicine is still the primary route through which most people get their health information and the health statistics in the United States would suggest they are doing a very poor job. I would make the argument that medical doctors are poorly qualified to even make nutritional and lifestyle recommendations. I have seen many medical curriculum and one 15 hour course on nutrition is not enough to actually understand it. In my view MDs are not adequately equipped to offer nutritional advice if they’ve had only the basic education. I took pharmacology in school. It was a 15 hour course. I do not offer advice on medication in my practice because I am not qualified.

      For years I have heard the ridiculous argument that chiropractors aren’t “real doctors.” My experience has been that those who use that argument are unaware of the rigors of the chiropractic education. After their undergraduate education chiropractors are trained in all aspects of health, not simply ‘adjusting backs.’ The education involves many thousands of hours of training in basic sciences such as anatomy, physiology, biochemistry, pathology, microbiology, histology/cell biology, neuroanatomy, public health, embryology, nutrition and research methodology. The clinical education includes such topics as neurology, orthopedics, physical rehabilitation, adjusting, biomechanics, diagnostic imaging, physical diagnosis, laboratory diagnosis, GI/GU, cardiorespiratory diagnosis, EENT, geriatrics, pediatrics, clinical nutrition, rheumatology, dermatology, gynecology, clinical psychology and toxicology. This list is by no means all inclusive either. Our clinical training (actual patient interaction) is included in our last year and includes rotations at teaching clinics and hospital rotations are an option for those who wish to pursue it. Some of the above courses are actually taught by MDs. In addition, the school I attended collaborates with Washington University school of Medicine on research routinely. Wash U is considered by some to be the best medical school in the country.

      We, too, must past nationally accredited board exams. We have Part I-IV as well as a physical therapy section to complete before we can become licensed. The boards are very difficult and require much preparation to pass. The boards and education process prepare Doctors of Chiropractic to be primary care physicians and we are considered so in almost every state.

      In addition, chiropractors may go on to specialize in other areas such as neurology, radiology or nutrition. I myself completed the neurology program. This program is also federally accredited through the same accrediting bodies that accredit many medical sub-specialties. (National Organization for Competency Assurance (USA) and the National Commission for Certification Agencies.) To become certified there is a separate 4-day board exam which each candidate must pass.

      This entire education process that you view to be so inferior to traditional medicine is actually longer than medical training. Here are your references for that:
      1- Meeker W, Haldeman H. Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine. Annals of Internal Medicine 2002, Vol 136, No 3.
      2- American Physical Therapy Association. 2005-2006 Fact Sheet, Physical Therapist Education Programs. January 2007.

      I have great respect for my MD counterparts as well as NPs and PA-Cs. As a matter of fact, my mother-in-law is a PA-C and the maid of honor at my wedding is an NP. They both value my opinion greatly on clinical matters. MDs, NPs and PA-Cs serve a wonderful purpose helping people with a myriad of health problems. It is my opinion, however, that they lack the knowledge necessary to help people truly prevent disease primarily because the paradigm of ‘a-pill-for-a-problem’ is inherently flawed. Prevention is where I believe functional medicine shines.

  2. Christopher S. Spaulding

    Thank you for your thoughtful reply. Let me be clear in that I think you are a very well educated professional who genuinely cares for your patients. Let me also apologize for the tone of my previous post. Upon rereading, I find it to be rather confrontational. I was at the 17 hour mark of my shift at the hospital, and was a little burnt out and I took offense at your stereotype of allopathic practioners and my reaction was impolite. That’s no excuse, however, and I’m sorry. Although, I may strongly disagree with you on whether a chiropractor is as qualified as an MD, PA-C or NP to do primary care, I should disagree politely. There is much about certain aspects of chiropractic that is absolute nonsense, like the ever ellusive “Subluxation” theory, the need for and safety of upper spine/neck “adjustments” and the hypocracy of accusing medical practioners of pushing pills to make the drug companies rich, while chiropracters push many unproven and potentially dangerous “alternative” treatments and supplements which fatten their own bank accounts. As one can give examples of poor doctoring, there are many charlatans and quacks who endanger and take advantage of nieve patients in the name of chiropractic. As traditional care providers must be vigilent to guard against abuse and influence by big pharma, true ethical chiropractors like yourself must defend your specialty from frauds and the promotion of non efficatious treatment modalities. I must also state I agree with a great deal of what you teach your patients in regard to preventive medicine, proper nutrition and avoiding drug centered quick fixes. Patients need to take responsibility for their health, when possible. You do that and I respect you for it. Thank you for this forum and I wish you the best.
    CSS

    • Thank you for your candor. I like to use this blog as a forum to help educate people about chiropractic and preventative medicine.

      Your view that chiropractors are not qualified as primary care is not consistent with most state boards of medicine and state boards of chiropractic. In almost every state chiropractors are considered portal-of-entry physicians and do not require a referral to see.

      I do agree with you about the subluxation theory. In my opinion it is outdated and has very little (if any) evidence to support it. Chiropractic has a nasty habit of trying to prove that D.D. Palmer and BJ Palmer (the men who ‘discovered’ chiropractic) were correct in their observation of a ‘bone on a nerve’ causing interference. In my opinion, they came up with the best hypothesis they could based on the knowledge at the time but it was incorrect. It’s time to move on from that. However, just because their explanation was incorrect does not invalidate the fact that chiropractic is beneficial.

      The safety of cervical spine adjustments is another hot topic. Groups with powerful financial backing have set out to scare the public into believing adjustments of the neck are dangerous without really looking at the facts. As evidence, interstates in the Northeast are beginning to be populated with billboards that say ‘chiropractic is dangerous’ and ‘have you suffered a chiropractic stroke?’ They offer no real statistics and are tantamount to slander because the facts do not support that cervical spine adjusting is dangerous. The most recent and well designed study to examine this puts the risk at 1 in 5.85 million. (Previous studies included manipulations performed by PTs, OTs, and MDs who are most certainly not qualified to manipulate.) To put this into perspective, I’d have to perform 321 cervical spine adjustments every single day for the next 50 years to have a statistical chance of causing one vertebral artery dissection. These are roughly the same chances that it would happen while getting my hair washed at a salon or turning my head rapidly in the car in traffic. I do not discount that there is a small chance, but it is exceedingly safe. There are also ways to adjust the neck so these numbers are even lower. It involves little to no rotation and more lateral flexion. We must also consider that spontaneous vertebral artery dissections are just as prevalent as spontaneous carotid artery dissections and those are not complications in cervical spine adjustments.

      I hope some of this information has perhaps shifted your view of chiropractors, even if it’s just a small shift. Misinformation about chiropractic is abundant. My goal is to provide the correct information and let people decide for themselves.

  3. Christopher S. Spaulding

    I know you’ll find this amusing; the other day I went to the pharmacy to pick up a ‘script and a bottle of Vitamin D3, 1gm tabs. I have a type of medical insurance savings account which I access via a kind of Anthem Insurance credit card. The payment for the ‘script goes through no problem, but Anthem refuses to pay for the Vitamin D. Now, in medicine, everything is going toward “evidence based” care and treatment, I’m sure its the same for chiropractic practioners. So, you can imagine my distain when those of us who try to impliment best evidence in our patient care are well aware that the beneficial effects of vitamin D are well documented, yet the insurance company wont pay for $5 worth of a product clinically proven to prevent illnesses ranging from certain cancers to the flu. Anthem would rather pay for the drugs to treat the illness after one is sick rather than an inexpensive preventative vitamin. Ridiculous, don’t you agree?

    CSS

    • This is, perhaps, my patients’ biggest complaint. Evidence based approaches to keeping people healthy is the way medicine should be practiced, traditional or otherwise. The research on vitamin D, as you are obviously aware of, is astounding. Current research links vitamin D to over 2,000 genes in the human genome! That’s only slightly under 10% of our total genes. It is clearly important for optimal health and, in my opinion, if insurance companies would cover these types of things they’d save millions (maybe billions?) in future costs. This of course brings us back to the current paradigm of health care in this country. It is primarily about trying to help people once they get sick rather than putting the emphasis on true prevention.

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