What is Functional Medicine?

Allopathic medicine is by nature a reductionist philosophy, whereas FDM takes the opposite approach, which can be termed “wholism”. (Not to be confused with the generic term “Holistic Medicine” that encompasses everything from A to Z in “alternative health care”). A reductionist philosophy of health care attempts to reduce or simplify a patient’s issues by placing a name to a disease, then treating it with a specific drug that has been designed and approved for that disease. The ultimate goal is to label a patient as having a disease. To the doctor, the patient then becomes “my Parkinson’s patient” or “my diabetes patient”. The patient becomes the disease and can claim it for their own, as “my Parkinson’s Disease” or “My Diabetes”. This reductionist philosophy not only applies to allopathic medicine but also to many different practitioners in the “alternative medicine” field as well. A drug or supplement is used to treat a named disease in a “cookbook” approach. If a diabetes patient went to see their primary care provider, he or she may use various drugs or insulin to treat the condition. Similarly, an alternative provider would see the elevated blood sugar and treat with various herbs, vitamins or minerals. Whereas the latter approach may generically address some of the underlying metabolic causes of the elevated glucose better than a drug that only lowers the sugar levels without regard to the causes; neither approach treats the patient as a whole person (hence the term “wholism), by looking for the underlying reasons for the dysfunction unique to that individual patient.

Allopathic medicine teaching is largely organ specific. Hence we have doctors that specialize in the heart (cardiology), GI system (gastroenterology), lungs (pulmonology), and kidneys (nephrology) and so on. To be sure, specialized knowledge is a valuable thing, but to the extent that extensive knowledge of one organ or system limits treatment to that system only, to the exclusion of others; it may well miss the fact that the body is an integration of all systems. Last time I looked, every part of the body is connected to every other part, either directly or indirectly. This is how, for example, periodontal disease (gum disease) acts to increase the risk of cardiovascular disease.

When it comes to the use of drugs, of course there are many times when they are necessary, but should they be the first choice for treatment of a non-acute, non-immediately life threatening condition? Studies have shown that drug company advertising on TV significantly influences what drug a patient receives. Treatment becomes drug centered, not patient centered. Pharmaceutical companies largely control through their drug reps the information a doctor receives about treatment approaches, so they rely on that drug rather than view the patient as an individual.

With FDM, the opposite approach is taken. Rather than ask “What is the disease or pathology (the end-point in the reductionist philosophy), one asks “What are the underlying physiological and metabolic changes that lead to the pathology, and how can that knowledge be used to treat the patient?” Dysfunction and disease are rarely limited to one organ. Naming the disease is not the holy grail of treatment. Remember that overt disease is the final manifestation of alterations of normal biochemistry, with attendant loss of typical homeostatic mechanisms. FDM seeks to locate those core level imbalances and treat them at the fundamental physiological level. Patient care presumes that each patient is a genetically, biochemically and environmentally unique individual. The individual- not the disease- becomes the target of treatment.

What processes are used to determine where and how to intervene? First, it is critical to obtain the patient’s entire story. To be fair, this is impossible in the overworked primary care provider’s office, where visits are typically limited to 15 minutes. This process requires a comprehensive set of patient questionnaires, a minimum of 60 minutes of review with the patient, review of pertinent medical records, a functional physical exam, basic in-office screening or “gateway” tests, standard lab tests and advanced FDM lab tests.

Following is an example of the difference between the standard allopathic approach and that of FDM. A 49 year old female was diagnosed with Inflammatory Bowel Disease (and later microscopic colitis) after a colonoscopy and placed on two different drugs. Despite this, she continued with diarrhea 5-6 times per day. She was placed on Prozac for depression and Thyroid for hypothyroidism. She tried Pepto Bismol with significant improvement as long as she took it. She had a prior history of hypothyroidism and Epstein-Barr virus. Spicy food, caffeine and gluten aggravated her condition, which began after a kayaking trip some years before. After review of medical records and her 40 page health history forms it was apparent that additional assessment of her GI system was needed. A Comprehensive Digestive Stool Analysis revealed that she had significant intestinal dysbiosis (presence of deleterious opportunistic bacteria) that has been caused by an infection with the nasty parasite blastocystis hominis. This was treated with resolution of all her complaints. It was apparent that she had been infected during her kayaking trip. Unfortunately, for many years she suffered with and treated for a diagnosis that did not accurately reveal her true condition. If you have suffered for years with a diagnosis and been treated without successful resolution of your problems, you may wish to explore your options through a Functional Diagnostic Medicine assessment.