WHAT IS FUNCTIONAL MEDICINE?

Functional Medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, Functional Medicine addresses the whole person, not just an isolated set of symptoms. Functional Medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, Functional Medicine supports the unique expression of health and vitality for each individual.

HOW FUNCTIONAL MEDICINE CHANGES THE WAY WE DO MEDICINE

  • Functional Medicine offers a powerful new operating system and clinical model for assessment, treatment, and prevention of chronic disease to replace the outdated and ineffective acute-care models carried forward from the 20th century.
  • Functional Medicine incorporates the latest in genetic science, systems biology, and understanding of how environmental and lifestyle factors influence the emergence and progression of disease.
  • Functional Medicine enables physicians and other health professionals to practice proactive, predictive, personalized medicine and empowers patients to take an active role in their own health.

Functional Medicine is a personalized, systems-oriented model that empowers patients and practitioners to achieve the highest expression of health by working in collaboration to address the underlying causes of disease.

PRINCIPLES OF FUNCTIONAL MEDICINE

Functional Medicine is guided by six core principles:
  1. An understanding of the biochemical individuality of each human being, based on the concepts of genetic and environmental uniqueness;
  2.  Awareness of the evidence that supports a patient-centered rather than a disease-centered approach to treatment;
  3. Search for a dynamic balance among the internal and external body, mind, and spirit;
  4. Interconnections of internal physiological factors;
  5. Identification of health as a positive vitality, not merely the absence of disease, and emphasizing those factors that encourage the enhancement of a vigorous physiology;
  6. Promotion of organ reserve as the means to enhance the health span, not just the life span, of each patient.

A patient-centered approach refers to health care that is respectful of and responsive to individual patient preferences, needs, and values, and that ensures that patient values guide all clinical decisions. At IFM, patient-centered care is the core of what we call the therapeutic partnership; the relationship that forms between a patient and clinician that empowers the patient to take ownership of their own healing. The power of the therapeutic partnership comes from the idea that patients who are active participants in the development of their therapeutic plan feel more in control of their own well-being and are more likely to make sustained lifestyle changes to improve their health.

HOW IS FUNCTIONAL MEDICINE DIFFERENT?

The illustration to the right uses a tree to visually represent the core aspects of the Functional Medicine paradigm and highlight the difference between conventional medical care and Functional Medicine. The graphic itself has undergone some changes through the years, but its essence remains the same. In order to keep a tree healthy and allow it to flourish, you need to support the most basic and essential elements first; the foundation: the roots and soil. Similarly, if a tree is not healthy, the first place you should look for answers is those same foundational elements.

In Functional Medicine, the same approach applies to patients. The most important factors, and the ones we examine first when gathering information about the patient, are the foundational lifestyle factors; sleep, exercise, nutrition, stress levels, relationships, and genetics. These are the roots and soil, which are in turn influenced by specific predisposing factors (antecedents), discrete events (triggers), and ongoing physiological processes (mediators), and may then result in fundamental imbalances at the trunk. These can eventually result in the signs and symptoms that are grouped into a diagnosable constellation that we call disease, represented by the branches and leaves.

Conventional medicine tends to look at the constellation of symptoms first (the branches and leaves), which usually results in a disease diagnosis. Often, this diagnosis is associated with a drug or drugs that can be prescribed to treat this constellation of symptoms, and that is the end of the story. But this approach neglects the more fundamental aspects of health that reside in the roots and the trunk of the tree. It treats all patients that present with similar symptoms the same and completely neglects both the inherent differences among patients as well as the myriad possible causes that a “disease” can have.

If you are tired of spending your time in the leaves and watching as your patients with chronic disease go through the cycle of diagnosis and drugs without getting any better, IFM invites you to climb down from the canopy and join us at ground level. We will provide you with the tools to make your patients better, without ever needing to leave the ground.

FUNCTIONAL MEDICINE AND INTEGRATIVE MEDICINE

How does functional medicine complement a clinician’s integrative training?

Integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.

If you’re already studying and practicing integrative medicine, then you know something about whole-person modalities. Functional Medicine provides an architecture that will help you organize and apply all that knowledge in a systematic way, digging deeper into the origins of disease and the determinants of health.

The Functional Medicine model considers the diagnosis, of course, but also seeks to answer the question, “Why does this person have this illness?” The answer to this question is revealed by discovering the antecedents, triggers, and mediators that underlie symptoms, signs, illness behaviors, and demonstrable pathology. Further, medical genomics can identify the phenotypic expression of disease-related genes and their products, affording another lens through which to view illness. Chronic diseases cut across multiple organ systems, and this calls for a systematic method of viewing each patient.

How is Functional Medicine different from other integrative medicine models?

Practitioners of Functional Medicine use the Functional Medicine model to organize their findings. It’s a kind of flexible and adaptive information-gathering-and-sorting architecture for clinical practice that deepens the clinician’s understanding of the often overlapping ways things can go wrong. The patient’s story is organized according to seven common underlying mechanisms that influence health, which clarifies the level of present understanding and illuminates where further investigation is needed. An operating system guides clinicians through the entire process from gathering information to initiating treatment and tracking the patient’s progress.

All healthcare disciplines—including integrative medicine—can, to the degree allowed by their training and licensure, use a Functional Medicine approach, including integrating the Functional Medicine operating system and tools to organize knowledge and recognize patterns. Functional Medicine provides a common language and a unified model to facilitate integrated care.

The Evidence

When people ask to see the evidence for Functional Medicine, they often mean, “Where are your research trials, comparing Functional Medicine to conventional medicine in a clinical setting?” Unfortunately, current research models do not have a way to test each individualized, patient-centered therapeutic plan that is tailored to a person with a unique combination of existing conditions, genetic influences, environmental exposures, and lifestyle choices. Clinical trials do play a significant role in evaluating and comparing the efficacy of new pharmaceutical treatments, especially when it is important to rule out placebo effects, but they have many inherent limitations which constrain their ability to inform clinical decision making.

Fortunately, there is a vast array of evidence supporting the Functional Medicine approach to care:

  • The scientific community has made incredible strides in helping practitioners understand how environmental and lifestyle influences, moving continuously through an individual’s genetic heritage, psychosocial experiences, and personal beliefs, can impair basic biological functions. Using that knowledge to find the sources of each patient’s problems is powerful science!
  • Scientific support for the Functional Medicine approach to treatment can be found in a large and rapidly expanding evidence base concerning the therapeutic effects of nutrition (including both dietary choices and the clinical use of vitamins, minerals, and other nutrients such as fish oils); botanicals; exercise (aerobics, strength training, flexibility); stress management; detoxification; acupuncture; manual medicine (massage, manipulation); and mind/body techniques such as meditation, guided imagery, and biofeedback.
  • Medical science has recently provided strong evidence that the relationship between patient and clinician has a powerful effect on patient health outcomes. The Functional Medicine focus on the therapeutic partnership is clearly an important part of how patients heal.

Making effective healthcare choices involves the Functional Medicine clinician and patient in a relationship where information and belief, attention and insight, communication and trust all have value. Functional Medicine practitioners are taught how to craft a personalized, systems-oriented therapeutic plan for each unique patient using evidence and insight, art and science.

©The Institute for Functional Medicine