Practice Focus: Nutritional, Environmental, & Functional Medicine
President & Founder, Ecopolitan Eco-Health Network (www.ecopolitan.com)
President Emeritus & Professor of Nutrition and Functional Medicine, University of Natural Medicine
What is Functional Medicine?
Functional medicine is the clinical application of holistic thinking combined with rigorous scientific principles. The term "functional medicine" was first coined about 20 years ago in order to define the comprehensive, multi-specialty, integrative medicine of the future. Functional medicine combines scientific research with innovative tools for accurate diagnosis and safe and efficient medical treatment of complex and chronic conditions. The emphasis is to elucidate how different aspects of an individual's life - the physical and emotional environment, general lifestyle, as well as genetic factors - can all lead to deviation from health and manifest in disease over time. This is highly relevant today, since the vast majority of chronic conditions seen in clinical practice are attributable to these lifestyle and genetic factors.
Many degenerative or chronic conditions are caused by various combinations of disease triggers and promoters, such as nutritional deficiencies, toxin accumulation, allergenic exposures, emotional stressors, metabolic imbalance, and infectious load in food, water, and air. Additionally, digestive disturbances may cause nutrient malabsorption and exposure to toxic compounds, as in the prevalent "leaky gut" syndrome. Functional medicine practitioners focus on diagnosing the triggers and promoters of disease and the patho-physiological changes that can manifest during disease progression. They utilize advanced, scientific functional laboratory tests and other diagnostic procedures - including comprehensive medical and socio-emotional history - to uncover tacit illness or the initial deviation from health even in the absence of overt or significant symptoms. The goal is to effectively and sustainably address the triggers, promoters, and biochemical imbalances in order to stop the progression of symptoms, reverse them whenever possible, and prevent the appearance of new conditions, while increasing overall wellness and improving the body's resistance towards disease.
How does Functional Medicine Differ From Allopathic Medicine?
The common approach of allopathic (orthodox) medicine focuses mainly on suppressing the symptoms using artificial substances, which pharmacology and toxicology experts agree are toxic and poisonous for the body, as their central or primary effect. Paradoxically, the occasional alleviation of symptoms is in fact the “side effect.” For example, the allopathic approach would recommend a pill to lower temperature for high fever, prescribe a synthetic pill to elevate mood in treating depression, or a pharmacological anti-inflammatory drugs for simple immune reactions. Functional medicine, on the other hand - rather than simply "chasing symptoms" while ignoring the causes - searches for and addresses environmental factors, nutritional deficiencies, genetic tendencies, biochemical dysfunctions and emotional and social stressors that can together cause the development of symptoms.
Using drugs to suppress the outward expression of underlying dysfunctions does not truly facilitate healing. The causes continue to accumulate until there is a perceived "need" to use even more poisonous drugs, in ever-increasing doses, which inevitably cause new illnesses. This leads to gradual (sometimes rapid) deterioration of the patient's health, which the orthodox allopath assumes is "the normal progression of disease" - when in fact it is the toxic intervention (and the neglect of causes) that created this deterioration. Consequently, a "statistic" is born, allowing the practitioner to "predict" the unfortunate outcome of treatment, thereby creating a self-fulfilling prophecy. The chronic orthodox disregard for environmental or nutritional causes is the reason for the ever-present "idiopathic diseases" – which is the medical textbook's description for syndromes or conditions that allegedly have "no known cause." Therefore, pharmacological symptom suppression, despite its toxicity and futility in addressing chronic disease, becomes justified as the only viable therapy by "conventional" medical training centers (benefiting the Medical Industrial Complex and big Pharma). By diagnosing and treating the underlying causes (or just a few of them) in a scientific manner, functional medicine practitioners can promote improvement or healing of many health conditions considered chronic or incurable by allopathic doctors.
Functional medicine is characterized by a personalized approach to each patient, since similar symptoms or dis-eases can derive from different causes. The patient is approached as a whole being of integrated body, mind, and spirit.
The clinical application of functional medicine is based upon a profound knowledge of the following:
- Physiological and biochemical function of the body, from the cellular level to the organ and system level.
- The biochemical uniqueness of each individual, based on personal and family history, environmental and nutritional exposure, life style, genetics, and emotional factors.
- The appropriate clinical interventions for beneficial alteration of gene expression.
- The basic biological processes in all the body systems and their mutual interactions, requiring integration of all areas of medical specialization.
- The influences of nutritional, environmental, social, emotional, and physical factors on human function.
- Scientific diagnostic tests (functional lab tests) designed to expose non-linear diversity of causes for any health complaint: Each symptom may have several factors acting simultaneously, therefore the treatment has to be multifaceted, relying on scientific diagnosis of multiple elements of health.
How Functional Medicine Defines Health and Disease:
The Functional Medicine Model defines "health" as complete physical, social and emotional vitality, and not as the mere "absence of detectable pathological signs and symptoms." Functional Medicine defines "sickness" not merely as a combination of pathological signs and symptoms, but as a continuous process that starts with a slight deviation from health. This model expresses a unique medical approach that offers highly individualized treatment, which focuses on achieving health goals through optimally improving biochemical and physiological function. This is expressed by the following overlapping principles:
- Having no symptoms is NOT an indication of health.
- Lack of medical evidence for the existence of illness (by routine physical examinations and typical lab tests that can only detect advanced pathology) is NOT a demonstration of health.
- Even a relatively minor symptom can point to a diagnosable disease worthy of non-toxic treatment, despite the absence of pathological medical evidence for illness. Dismissal of patients as being merely "hypochondriacs" or "hysterical" or "mental" is very rare in functional medicine.
- Even when apparently there are no symptoms at all, scientifically diagnosing nutritional, biochemical or metabolic deviations (utilizing functional lab tests along with complete medical history) may prove the existence of departure from health. Treating the patient to reduce those deviations may improve health in a predictable and measurable way, thereby enhancing the patient's quality of life.
What Do Functional Medicine Practitioners Treat?
Functional Medicine does not revolve around specific sets of diseases and syndromes - it concerns itself with an extremely wide variety of health disturbances. Although many of these "disturbances" seem to differ a lot in symptomatic appearance - including diverse conditions such as fibromyalgia, irritable bowel syndrome, heart disease, diabetes, mood and cognitive disorders, various autoimmune disorders, PMS, TMJ, chronic pelvic pain, interstitial cystitis, chronic low back pain, chemical and food sensitivities, allergies, asthma, and cancer - they all seem to share common courses of formation.
The common denominator for these disturbances appears to be chronic stress, which may typically be thought of as deriving from mental or emotional origin, although many other factors can stress the body, like unhealthy food, nutritional deficiencies, environmental toxins, insufficient rest, infections, physical strain, and injury. All these factors contribute to the body's level of "total stress" - causing it to cross a previously invisible threshold where chronic health disturbances can manifest. The current global epidemic of chronic diseases is especially marked within industrialized nations, where the inhabitants experience relatively high levels of "total stress." While some acute stress factors may help us survive and even thrive, chronic stress factors that seem unpleasant, undesirable, or painful can lead to unhealthy changes in our immune system and in other body systems.
Recent findings indicate that these common stress factors - whether nutritional, environmental, physical, or psychological - can in fact alter, from day to day, the expression of genes in the cells. These alterations can lead to significant changes in physical symptoms and general health. Functional Medicine researchers are now convinced that syndromes of functional nature such as fibromyalgia, chronic headaches, and irritable bowel syndrome are likely to be initiated by different stress factors that can change the expression of DNA and lead to symptoms of chronic disease. Accordingly, when a person is suffering from chronic or aggravated symptoms, assessing and addressing all or most of the stress factors involved can be the key to recovery.
As a result of the completed human genome project, which has mapped the entire human DNA sequence, we are now able to understand the patient's genetic structure and address the individual's unique needs based on that structure. Each one of us has a "personal limit" of one or more stress factors in a special combination that is individually unique. Once we exceed that "limit" we are no longer able to control our disease risk (our inherited or acquired sensitivities or susceptibilities), and symptoms may develop. Under the influence of these stressors, we lose our capacity to handle other environmental and nutritional factors - we no longer have sufficient "reserves" and any additional physical or emotional stress may cause a major breakout of disease or exacerbation of it. By modifying the patient's activities, nutrient levels, toxic exposure, emotional status, and behavioral patterns based on the individual's unique genetic structure, functional test results, psycho-emotional and medical history, examination findings, and environmental exposures, we can create the necessary biochemical changes that enhance the protection of DNA in times of undue stress. This protection can help stabilize the DNA, reducing predisposition to functional illnesses like fibromyalgia and depression, as well as other illnesses like cancer and heart disease. Additionally, knowledge of the individual's DNA structure and how to modify its expression enables us to focus on specific clinical measures to reduce the risk for preventable conditions like mood disorders, high blood pressure, or even prostate enlargement and cancer. Functional genetics and genomic lab tests have been available during the past decade to Functional Medicine practitioners who have been trained in the interpretation and interventions relevant to these tests.
Beyond the assessment of underlying genetic factors, several functional lab tests that have existed for at least 15 years are focusing on the present physiological and biochemical condition of the patient. By combining the diagnosis of innate genetic tendencies with the functional diagnosis of acquired (current) deviation from optimal health, it is possible to build a comprehensive treatment program based on the actual (manifested) expression of the patient's genetic susceptibilities. Thus, we can simultaneously treat the presenting clinical condition as well as the genetic potential for illness.
Potential Problems and Opportunities in Functional Medicine:
As in any professional field, functional medicine practitioners are predisposed to human errors and to complacency, even with the best of intentions. For example, some may choose the path of least resistance in selecting the laboratories they work with, focusing on convenience and cost considerations. Others may be unwisely influenced by marketing efforts of labs and vendors of clinical equipment, or may act upon dogmatic belief systems or hearsay, rather than study the available science-based evidence. Many neglect to focus on healthy lifestyle education, which requires more time and yields lower compensation. Another important issue is that most functional medicine providers fail to provide their clients with the most comprehensive diagnostic array for early detection of cancer and other conditions, thereby missing an opportunity to invite many patients needing comprehensive clinical support into the realm of traditional functional medicine assessments.
Functional doctors should frequently utilize accurate and innovative screening tests that possess none of the risks present in current standard tests. With regard to cancer, these safe and non-invasive tests can detect malignant developments much earlier and with greater precision, allowing for preventative measures that can save lives and improve quality of life. Examples include the AMAS test, a very accurate blood test that acts as a marker for early cancer detection by measuring the immune system's anti-cancerous activity; the M2PK stool test, a marker for colon and rectal cancer, which is more convenient, more efficient, and less risky than colonoscopy; and radiation-free breast thermography (Digital Infrared Thermographic Imaging – DITI). Whenever cancer activity is detected, preemptive intervention is achieved by utilizing appropriate functional diagnostic (and therapeutic) procedures; by increasing the body's resistance to cancer; and by treating the stress factors and other triggers (and genetic susceptibilities) mentioned above. Frequently, such interventions - especially when offered very early - can stop and even reverse the progress of the cancerous process (leading to "clear" results in follow-up tests). Such treatments may also prevent the recurrence of cancer, as revealed by follow-up tests. Functional Medicine should always emphasize “routine” preventative lab tests that are often ignored by most allopathic doctors, such as assessments for vitamin D and B12 status, homocysteine, CRP-cardiac, thyroid evaluation, accurate heavy metals analysis, and others.
Functional Medicine's "anti-stress" approach is applicable to all degenerative and chronic disturbances, since they are all activated by the same triggers, related to similar genetic tendencies, and share similar nutritional, metabolic, hormonal, infectious, emotional, digestive, and chemical factors that appear in different combinations and lead to a clinical picture that is unique for every patient. Because of the high levels of stressors nowadays, practically every adult (and almost every child!) are affected and burdened by chronic disease. This fact justifies a comprehensive functional diagnosis and a thorough treatment of almost every person that has been exposed to our "modern" life.
As with any new field of research, the application of advanced science is often fraught with hazards, inaccuracies, and even outright distortions resulting from human tendencies to oversimplify complex facts and to capitalize upon new ideas for profit's sake. On the other hand, the area of preventive, cause-oriented health care is rich with new opportunities that can be incorporated into the practice of functional medicine to increase its beneficial contribution to humanity. These issues will be summarized thoroughly in a separate article in the near future.
The medicine of the future must link the knowledge of the micro-environment - within which our DNA operates - with an understanding of the macro-environment surrounding our cells, organs, and systems, in order to provide us with the tools we need to enhance our self-healing capabilities. Functional medicine, with its attention to the intimate connection between our internal ecology and the external ecology, already attempts to embody the medicine of the future, creating a symphony of resources that can lead us along the path to optimal health and well being.
"Textbook of Functional Medicine" / Institute for Functional Medicine (IFM), David S. Jones, MD, Editor in Chief "Immunotics" / Robert Roundtree, MD
"Genetic Nutritioneering" / Jeffery S. Bland, PhD
"Functional Nutrition" / Institute for Functional Medicine (IFM)