Functional Medicine: a new paradigm for managing and preventing chronic disease
Conventional medicine has made miraculous advances in many areas, including emergency conditions and subspecialty care. However, the prevalence of the most common chronic diseases in our society – obesity, type 2 diabetes, coronary artery disease, depression, and autoimmune disease, to name a few – continue to grow. The number of Americans diagnosed with two or more chronic diseases has now reached 50% of adults, and in the current paradigm, most of these conditions, at best, can only be managed and rarely cured1. Meanwhile, the burden of caring for patients with chronic disease is becoming financially unsustainable2. The situation is particularly poignant for people with complex or subtle conditions for which conventional medicine offers less effective treatments, such as chronic fatigue, chronic pain, irritable bowel, and vague cognitive dysfunctions (i.e., “brain fog”). These people find their dealings with the health care system frustrating and costly, without much result. At the same time, many patients who are more health conscious and tech savvy are increasingly wary of pharmaceutical treatments, which may add problems of their own3. Many would prefer diet, lifestyle, or even botanical treatments instead of pharmaceuticals.
A potential solution to the chronic disease conundrum lies in Functional Medicine, an emerging discipline within Integrative Medicine that utilizes cutting-edge science to understand the complex biological systems of the human body and the interrelationships between them. Using a personalized approach, Functional Medicine examines a person’s history, looking at antecedents (genetic or acquired factors that predispose an individual to an illness), triggers (events in a person’s life that provoked the appearance of symptoms or illness), and mediators (biochemical or psychosocial factors that contribute to ongoing pathological responses). Sophisticated laboratory analysis is then performed, which looks at things like oxidative stress4, single nucleotide polymorphisms (SNPs)5, intestinal flora, micronutrient status, hormonal balance, a detailed metabolic panel, or inflammatory markers. Analyzing these results for patterns can allow practitioners to determine underlying causes of the patient’s symptomatology. Examples of such underlying etiologies might include inflammation caused by a metabolic syndrome as the root cause of a patient’s depression, or chronic stress leading to Hypopituitary-Pituitary-Adrenal hormone axis dysfunction, causing chronic fatigue. Many of these causes are interrelated. A patient with Hashimoto’s thyroiditis might have undetected Celiac Disease and, when exposed to gluten, have increased intestinal permeability to foreign antigens, leading to an activation of the immune system and to an exacerbation of the thyroiditis6.
Since the pathways to illness are individual, and mediated by the patient’s daily habits, treatments are based on a personalized regimen with indications for diet, stress management, physical movement, and sleep. Patient implication in treatment is essential for such life changes to occur, often with the support of a health coach. Nutritional supplements are often used for a limited time to correct micronutrient imbalances. Pharmacologic agents are used as well when necessary7.
The functional approach is based on an ever-growing body of scientific evidence of the individual treatments used. Because there are multiple treatments, and they are individualized for each patient, randomized control trials demonstrating efficacy of treatment for a particular disorder present a challenge. This has hampered the acceptance of Functional Medicine in mainstream medicine. Nevertheless, as word of positive patient experiences have spread, interest in Functional Medicine has grown rapidly amongst patients, with practices springing up around the country, especially along the coasts, and particularly in Northern California. The Cleveland Clinic was the first academic center to open a functional medicine center in 2014. A landmark trial is currently underway at the Cleveland Clinic Center for Functional Medicine using a combination of methodologies to evaluate the efficacy and cost effectiveness of this approach8,9.
With an aging population, it’s clear that innovative approaches to chronic disease management are needed as we move into the future. Functional Medicine provides a coherent response to this challenge by addressing the causes at their root. While there can be increased expenses initially due to the complex testing, this can be more than offset if we are able to stem disease progression, complications, and the myriad of costly, downstream effects arising from that. Meanwhile, enhancing peoples’ health and vitality can lead to substantial long-term benefits. Patients who are normally very high functioning but have health issues hampering their ability to perform intellectually demanding work are particularly suitable for this approach, as it can address more vague symptoms that are challenging to resolve in the conventional context, and because the lifestyle changes achieved can lead to lasting wellness and optimal function.