A quick look at the foundational concepts of functional medicine.
When it comes to the prevention and treatment of chronic illness, the conventional medical system is broken. I know this, you know this, and your grandma certainly knows (or knew) this.
If you were going to design a different medical system, what would it look like? What would talking with your doctor feel like? How would your body be understood and cared for?
Functional medicine is one answer to those questions. It is an approach to healing that sees the body as an integrated whole and treats root causes of disease rather than bandaging symptoms.
Many of you, maybe most, have little to no exposure to functional medicine. For those of you that have, you may have come across buzzwords like root-cause, exposome, systems-based, and personalized medicine. In this article, I will give you a taste of the paradigm of functional medicine by explaining what these concepts mean.
Before I dive into those concepts, I want to introduce a common scenario to set the stage for why a new approach to medicine is needed. Imagine you are struggling to conceive a child. I am sure you already know that your OBGYN is not going to spend an hour listening to the weird things happening with your menstrual cycle or talk to you about how your chronic constipation points to an issue in your gut microbiome, which might be impacting your reproductive health. Even if these were topics they knew much about, there isn't the time in a typical office visit to talk through nuanced menstrual issues and there isn't the structure in insurance billing to cover treatments for your microbiome. Instead, after unsuccessfully trying to conceive for a certain amount of time, you would be referred for IUI or IVF.
Here's the thing: it's not just that it feels good to be truly heard about the weird things going on in your body, or that investigating the relationship between your gut and fertility is sexy (if you, like me, get off on that sort of thing). It's that the weird things going on with your cycle could tell us why you aren't getting pregnant. And that supporting a healthier gut microbiome could allow your body to produce hormones appropriately, potentially allowing you to get pregnant. By regulating your cycle or addressing your microbiome, you might be able to avoid costly, draining, and often unsuccessful interventions.
Even more, the weird cycle and constipation are symptoms indicating an underlying imbalance. They are the canaries in the coal mine. By addressing the underlying imbalances, you help to prevent other health issues from developing in the future.
Instead of bandage semi-solutions, we all need medicine that investigates deeper and empowers us to not only resolve the immediate health issue but to build longterm health resilience.
Root Cause Medicine
Diagnosis at the root, treatment at the root. The most important principle of functional medicine is that we diagnose and treat whole people rather than a set of symptoms.
Dr. Mark Hyman calls functional medicine, “the medicine of ‘why?’” We believe knowing a diagnosis is not enough; we want to know why a person is struggling with insomnia, fatigue, sub-fertility, pain, or whatever is causing them distress.
When we understand the root cause(s) of a person’s disease or symptoms, we are able build a roadmap for healing that treats at the root level - making long term health possible while also reducing the chance that additional health issues will arise.
Most diseases and symptoms arise from problems in what we call the exposome, which is a term that describes the sum of environmental factors that influence a person’s health. These are problems like lack of sufficient nutrition, foods that are causing inflammation, poor sleep, chronic stress, trauma, insufficient or excessive movement, unsatisfied sense of purpose, and too little connection with others and nature. In functional medicine, we investigate whether any aspects of a person’s exposome - both past and present - might be contributing to the health challenges that person is facing now.
We can also use an analysis of a person’s present exposome to assess what changes need to be made for healing now. When our bodies are supported by a great exposome, they are fantastic self-healing organisms. By improving what we are surrounded by, how we move, what we put into our bodies, and our emotional life, we can leverage our body’s ability to come back into balance without the use of interventions like drugs and surgery. These higher interventions may be necessary at times - I’m not against them at all - but I believe strongly in making the most out of our self-healing capacity.
In functional medicine we think about the body as a set of integrated systems. Functional medicine systems are dynamic systems, meaning they are organized around how things move and function in human physiology. These systems are always viewed in relation to each other. The systems are:
Defense and repair - immune system, inflammatory processes, infection, and microbiota.
Assimilation - digestion, absorption, microbiota and gastrointestinal function, and respiration.
Biotransformation and elimination - toxicity and detoxification.
Communication - hormones, neurotransmitters, immune messengers, and cognition.
Energy - mitochondrial function and energy regulation.
Transport - cardiovascular and lymphatic systems.
Structural integrity - from subcellular membranes to the musculoskeletal system.
As functional medicine practitioners, when we listen to a patient’s story, analyze their symptoms and diagnoses, and look at their lab work, we begin to categorize all that information into these systems. In doing so, we create a complex map of a person’s physiology. In what systems are things going awry? How might that system be influenced by what is happening in other systems? How might we use one system to better support another system?
Deep Listening and Personalized Medicine
Gathering all the relevant information about a person’s life and health takes time and focused attention. There is wide variation in how functional medicine practitioners work with clients, but my way of practicing is centered on deep listening and taking the needed time. I get to know all my patients very well.
Personalized medicine has two meanings: 1) treatments that are tailored to each person’s specific physiology, and 2) a partnership model of treatment that is based in respecting each person’s specific life circumstances.
I appreciate how complex my patient’s lives are. I listen to each person’s values and dig into the question of exactly what sort of support is going to be the most effective for them. By effective, I mean both what will bring health changes and what each person wants to do and feels able to do. A treatment is not effective if someone doesn’t do it because it feels too hard or requires changes they are not ready for.
Working to find the root cause of illness, taking into account a person's past and present exposome, and analyzing how well their body is functioning in interrelated systems doesn't just sound good; when applied correctly, this approach also leads to amazing outcomes.
The next article in this series introducing functional medicine, I will walk you through how I work with patients and in what ways my approach to functional medicine is unique, and, I hope, uniquely awesome. ;)