By Mark Hyman, MD Chairman, Institute for Functional Medicine Founder and Medical Director, The UltraWellness Center
Our society is experiencing a sharp increase in the number of people who suffer from complex, chronic diseases, such as diabetes, heart disease, cancer, mental illness, and autoimmune disorders like rheumatoid arthritis.
Chronic disease is a food-and lifestyle-driven, environment- and genetics-influenced phenomenon. New approaches to management and prevention are required if we are to stem the rising tide of chronic disease, expected to outpace deaths from infectious disease twofold within the next decade. It can be conquered by integrating what we know about how the human body works with individualized, patient-centered, science-based care that addresses the causes of chronic disease, which are rooted in lifestyle choices, environmental exposures, and genetic influences. This is exactly what functional medicine does – it is indeed a medicine appropriate for the challenges of the 21st century.
The Hallmarks of a Functional Medicine
A patient seeing a functional medicine practitioner can expect to spend considerable time in the clinician’s office. Not only is critical information collected about factors that may have set the stage for (or may be contributing to) the present problems, but a comprehensive understanding of the patient’s habits of daily living, prior illnesses and traumas, environmental exposures, and genetic influences must be gained.
Patients may be asked to complete questionnaires on a variety of topics, such as toxic exposures at home and at work/school, a diet history, and characteristics of chronic and acute symptoms. Answers provide the clinician with in-depth health-related information that is difficult to gather by interview alone.
Laboratory tests are often recommended, including tests both familiar (e.g., CBC) and less conventional (e.g., stool analysis). These tests help determine which key biological processes are functioning properly and which are not essential information for the development of a customized, comprehensive treatment plan to restore health.
Treatments may include drugs, botanical medicines, nutritional supplements, therapeutic diets, detoxification programs, and counseling on lifestyle, exercise, or stress-management techniques.
The patient is an active partner with the functional medicine practitioner, taking a leading role in improving health and changing the outcome of disease.
A look at the process of taking the patient’s history reveals some key differences between functional medicine and conventional medicine. To simplify, the conventional practitioner has been trained to ask questions that narrow down the patient’s story, focusing efforts as rapidly as possible on achieving an organ system diagnosis. Once that diagnosis is made, the next step in conventional medicine is selecting the drug(s) or surgical procedure(s) that address the diagnosis.
Why Diagnosis Is Just the Beginning
For the functional medicine practitioner, the diagnosis is the beginning, not the end, of the detective work. Functional medicine has been referred to as the “medicine of why” because it asks, “Why this diagnosis, for this person, and why now?” The extensive information collected from the patient’s history and lab work is used to determine the underlying imbalances and influences (whether genetic, environmental or psychosocial) that have produced the context for disease or dysfunction. The clinician evaluates seven key functional systems to understand the full network of vectors underlying the disease.
Once a comprehensive understanding of where and how these systems have gone awry is developed, planning is initiated to reestablish balance and functionality.
Functional medicine practitioners understand that there are often common pathways underlying what may seem like very different conditions or complaints; therefore, interventions affecting several systems may be identified. For example, improving the patient’s sleep beneficially influences the immune response, melatonin levels, T-cell lymphocyte levels, and often helps decrease oxidative stress throughout the organism.
Tools in a functional medicine practice are drawn from both conventional and integrative medicine, including lifestyle adjustments based on clinical scientific research.
The interventions are individualized and unique, because two people with the same diagnosed condition often have completely different underlying causes. One person’s heart disease or diabetes is not necessarily the same as another’s (one disease, many causes). A single trigger (e.g., food sensitivity) may produce very different signs and symptoms in different individuals (one cause, many diseases).
Small steps – for instance, removing allergens from an individual’s diet – can make a significant improvement in function and further clarify the clinical picture. More advanced practitioners will devise therapeutic regimens that (among other things) improve detoxification, balance hormones, reduce inflammation, lessen autoimmunity, or improve cellular energy production, as the patient’s health requires.
Functional medicine offers a paradigm shift in clinical practice, encompassing the uniqueness of each person, the importance of the therapeutic partnership, and the role of environment and lifestyle in the development and treatment of disease, thus producing a more effective response to clients’ chronic conditions.