Functional Medicine is a Third Kind of Medicine
I (Dr. C.E. Gant) have practiced functional medicine since the term was coined over 30 years ago and during these decades I have reluctantly overlooked being mislabeled as an “alternative medicine ” (1) doctor. Healthcare consumers and practitioners alike often fail to recognize that functional medicine has virtually nothing to do with alternative medicine practices such as homeopathy, acupuncture, herbal medicine or hands-on-healing. Functional medicine is also not conventional medicine.
Functional medicine is a third and completely different discipline. Functional medicine’s uniqueness stems from its heavy reliance on certain basic sciences – toxicology, biochemistry, physiology, anatomy and genetics – which in widely varying degrees are part of the educational curricula of all licensed healthcare professionals. These basic sciences are also referred to as “pure sciences” because they conform more rigorously to scientific method. Scientific method refers to a body of techniques for investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge.
To be termed scientific, a method of inquiry must be based on gathering observable, empirical and measurable evidence subject to specific principles of reasoning. A scientific method consists of the collection of data through observation and experimentation, and the formulation and testing of hypotheses. Once a hypothesis has been proven, the new information can be added to that of previous amassed studies and provide a predictable model which can then be used to formulate further hypotheses and experimentation.
Functional medicine differs from conventional or alternative medicine because it conforms to a far more rigorous application of scientific method and utilizes a far greater volume of amassed scientific data (see diagram below) to investigate what is causing symptoms, illness and dysfunction. I routinely apply my knowledge of cell biology, physics, genetics, anatomy, toxicology, physiology, microbiology, biochemistry, clinical chemistry, medical anthropology, organic chemistry and/or bio-identical endocrinology in evaluating virtually every patient I see. Essentially, the vast knowledge which has emerged from centuries of amassed scientific inquiry into the biological and basic sciences is used to investigate the unique biological, biochemical, toxicological, genetic and physiological situation in each and every patient I see.
When was the last time your family doctor tested your citric acid cycle intermediaries to see if there were problems with production of ATP, the fuel that drives life? Has your cardiologist measured your carnitine, CoQ10, glutathione and taurine levels, which are essential for heart function? This attention to scientific detail is not the bread and butter of conventional practitioners, because we conventionally trained doctors are not taught to think physiologically. We are trained to think pathologically, which entails making a diagnosis and prescribing a drug, a surgical or a radiological procedure to offset the disorder diagnosed, and which is often the right approach for many problems, especially acute, life-threatening disorders when thoughtful, time consuming biochemical analysis is impossible.
However, in the treatment of chronic disorders, where there is time to investigate the root causes of symptoms and the presumptive diagnoses, conventional medicine’s accepted standards of care are becoming increasingly obsolete. The process of formulating a presumptive diagnosis based on an exam and history, and perhaps ordering a few superficial laboratory tests, while ignoring the astonishing advances in the basic sciences which are listed above and in the diagram below, becomes increasingly ridiculous. Then to make wild guesses about treatments with potentially toxic, pharmacological substances, with very little attention paid to the unique biochemical, genetic, hormonal, toxicological and metabolic makeup of each patient, is frankly dangerous.
As a functional medicine practitioner, I simply strive to not ignore the science, and as a result I am privy to looking much more deeply into the very substance of my patient’s biochemistry, physiology and genetic makeup and determine the actual cause of their symptoms. Knowing causes allows me to formulate rational treatments.
Like my conventional or alternative medicine counterparts, as a functional medicine practitioner, I begin an assessment by making a “presumptive diagnosis” based on my initial examination and my patient’s medical and psychiatric history. But unlike my conventional or alternative medicine colleagues, I base my next inquiry on hundreds of years of amassed, peer-reviewed studies and data bases, which have proven beyond a shadow of doubt that toxicological, biochemical, structural, physiological and genetic abnormalities are the root cause of my patient’s presumptive diagnoses and/or chronic symptoms. I order an extensive battery of laboratory (2) and/or radiological tests to determine if the expected causative abnormalities – the true diagnostic factors (not presumptive) – are present or not. Guesswork is thus avoided, intuition is unnecessary and factual evidence is gathered.
Based on the proven fact that human beings all share a similar genetic code, and the proven fact that all human beings have a similar biochemistry, anatomy and physiology in a healthy state, any laboratory results which deviate significantly from the healthy norms, especially those which have been proven in amassed scientific studies to be risk factors for the presumptive diagnosis made on initial assessment, are taken seriously as potentially causative abnormalities. Unlike my conventional or alternative medicine colleagues, as a functional medicine practitioner, I then formulate the following hypothesis based on amassed scientific studies and the laboratory-determined abnormalities:
The prescribing of certain targeted supplements, bio-identical hormones, herbs and even medications (in that order of preference) will correct the abnormalities discovered through testing and will result in sufficiently optimizing the genetic expression of my patients to the extent that their symptoms and/or disorders will disappear.
This testing of a hypothesis via scientific method constitutes a revolutionary advance in medicine, and defines the uniqueness of functional medicine. If the hypothesis is proven to be true, and the symptoms or diagnosed disorder vanish, then the “experiment” so to speak has come to a successful conclusion and my patient is usually discharged.
If however, the hypothesis is shown to be invalid, and the interventions which were prescribed based on the tested toxicological, biochemical, physiological and genetic variables somehow failed to correct the symptoms, further diagnostic testing is warranted to look deeper into other laboratory-determined risk factors which could be causative of their unrelenting symptoms. The basic assumption (also a hypothesis) is that we now have gathered enough scientific data and that our prodigious technologies of assessing the fundamental machinery that runs life, is so advanced in fact, that we only have to look deeply enough to find what is awry and correct it. If my patient fails to respond as expected with the first round of investigation and treatment, I formulate a new hypothesis:
The prescribing of certain additional targeted supplements, bio-identical hormones, herbs and even medications (in that order of preference) based on the initial and this deeper analysis of additional test data will correct the abnormalities and will result in sufficiently optimizing the genetic expression of my patients to the extent that their symptoms and/or disorders will disappear.
If that hypothesis is found to be invalid, an unusual occurrence in my experience, then a third round of diagnostic testing is warranted to repeat the cycle again or as many times as necessary. At each stage, a hypothesis is tested and found to be valid or not. Scientific method is applied based on hundreds of thousands of amassed studies derived mostly from the basic sciences, not guesswork. Sometimes I order a repeat of the original diagnostic testing to certify that the reported lab results were accurate and that proper laboratory test procedures were followed. I am constantly on the phone discussing the results with clinical pathologists, and asking them to check their controls and normative values.
Diagnostic testing can be repeated to also determine whether or not previous treatments did indeed correct the abnormalities originally found. Rarely do patients need more than 2 or 3 rounds of this process to achieve good results, provided they comply with suggested interventions which can be complicated and costly. The data on my patients is compiled and aggregated and added to accumulating data bases on functional medicine, which will then be used for further research and further innovation in treatment.
I don’t mean to invalidate either my alternative or conventional medicine colleagues simply because they fail to ascend to the science-based standards of care on which functional medicine rests. I mix both conventional and alternative medicine approaches with functional medicine in most of my patients, which altogether is properly labeled as integrative medicine. I even add mindfulness-based psychotherapies to my approach which has even less of a scientific basis than alternative medicine (see diagram below).
Although mindfulness-based psychologies, alternative medicine and conventional medicine is riddled pseudo-scientific poppycock, my position on these relatively unsubstantiated kinds of healthcare has been and will always “Voltaire-like” and libertarian. I may not believe in much of what mindfulness-based psychologies (or psychology/psychotherapy in general), alternative medicine and conventional medicine has to offer, but I will “defend the death” (so to speak) the right of healthcare practitioners to practice what they fell in their hearts is ethical and valid. The worst case – and deadliest – scenario is dictatorial bureaucrats dictating standards of care to honest practitioners.
I rely on the expertise of my alternative and conventional medicine colleagues and frequently refer my patients to them to benefit from their expertise. In fact, the massive quantity of biochemical, toxicological, metabolic, anatomical and genetic information which results from a thorough functional medicine evaluation helps to define which conventional or alternative medicine interventions would be more likely to be effective.
I blend alternative medicine, conventional medicine, functional medicine and mindfulness-based psychotherapies into my practice (see diagram below) and devote a significant portion of my clinical time to providing free, educational, coaching webinars for all of my patients in basic lifestyle choices, such as drinking enough purified water, exercising intelligently, avoiding poor food choices, managing stress levels, etc.; basically all of the lifestyle issues which are relevant to aging and disease prevention.
Despite my embrace of all types of medicine, I am no longer willing to ignore being mislabeled as an alternative medicine or complementary/alternative medicine doctor. Functional medicine has nothing to do with alternative medicine or conventional medicine. However, I stand firmly on a Voltaire-like position (3) when critiquing my functional, alternative or conventional medicine colleagues. Their way of practicing healthcare may not ascend to my standards of what I believe science-based medicine should be, but I will defend “to the death” so to speak their right to practice in a manner which they believe is ethically in the best interests of their patients. Intrusion by draconian government regulations and insane healthcare political manipulations threatens the very foundations of freedom and scientific method in healthcare and must not be allowed to stand in the way of innovation and practitioner liberty.
I trust that educated and informed consumers and practitioners alike will eventually be able to separate the wheat from the chaff. Any form of medicine based on a more rigorous code of scientific method will by definition achieve better results because the universe we live in follows predictable laws of cause and effect. A denial of this fact (4), as I observe increasingly occurring in both alternative and conventional medicine, threatens to take civilization back down a dark path of superstition and witchcraft. As long as healthcare consumers have the liberty to choose the care they want, and practitioners have the liberty to keep perfecting their standards of care, consumers will gradually and naturally gravitate to those delivering care which achieve superior outcomes.
Functional medicine is a third type of medicine which is neither conventional nor alternative medicine. Functional medicine is poised to revolutionize all medical care because it is based on far more rigorous standards of scientific method and a far greater volume of amassed scientific data. Functional medicine will ultimately be shown to achieve better outcomes than either conventional or alternative medicine, especially for the treatment of chronic medical and psychiatric disorders.
(1) According to the National Center for Complementary and Alternative Medicine of the National Institutes of Health (NIH), complementary and alternative medicine (CAM) is: acupuncture, Alexander technique, aromatherapy, Ayurveda, biofeedback, chiropractic, diet therapy (not based on laboratory/functional testing), herbalism, holistic nursing, homeopathy, hypnosis, massage therapy, meditation (not mindfulness), naturopathy, nutritional therapy, (not based on laboratory/functional testing), osteopathy, Qi gong, reflexology, Reiki, spiritual healing, Tai Chi, Chinese Medicine, yoga.
(2) A typical panel of diagnostic tests I would order includes all of the usual screening tests which a conventional practitioner often orders, such as a CBC, blood chemistries, a urinalysis and thyroid studies. I typically also order genetic panels for common polymorphisms, an amino acid analysis, urine organic acids, elemental analysis of nutrients (e.g., magnesium, selenium, and zinc) and heavy and toxic metals (e.g., lead, cadmium, mercury and arsenic), fatty acid analysis, oxidative stress markers like glutathione, toxicological panels looking pesticides etc., food allergies and many other test panels, depending on the needs of the patient. As a well-known, functional medicine colleague recently quipped, “If you care about your suffering patient (called providing “care”), exactly what biochemical and toxicological variables which could be making them ill would you not want to know about!”
(3)“I may not agree with what you say but I will defend to the death your right to say it.”
(4) Spectter, Michael. Denialism: How Irrational Thinking Harms the Planet and Threatens Our Lives