Functional medicine is easy in description, but difficult to practice! As its name implies, the focus is improving how the body functions via the use of lab interpretation, supplements, and pharmaceuticals (if indicated).
Answers to Common Questions:
Most functional medicine clinics are privately owned, and there is no standard for who can practice this type of medicine. A lot of these practices abide by the following:
- Don’t take insurance
- Order a lot of labs that aren’t covered by insurance (these run from $150 to $600+ per lab). Many may profit from ordering these specialty labs (i.e. add on a fee for ordering the lab)
- Sell supplements on site and/or online
- Charge a LOT for single visits or membership (I know many that charge over $4000 for one visit – no labs or treatments included! And a lot of memberships start around $500)
- P.S. This is why I joined Parsley, which charges a lot less per month for membership (and Parsley takes some insurance for patients based in NY and CA)
- The “best” patient for functional medicine is one that:
- Wants to decrease reliance on pharmaceuticals
- Wants to do more for their health beyond pills (for example, modify habits such as avoiding coffee on an empty stomach)
- Wants to be an active participant in his/her health
- Wants an investigative provider
- Wants longer appointments
- Wants to set an example for their family (or transfer what is learned in a functional medicine visit to support the health of his/her family)
- Functional medicine is best for those that:
- Want to understand their body, be educated.
- Understand that there is no magic pill or quick fix for a chronic illness or symptom.
- Want to optimize health for the long-term, to improve overall quality of life.
- Primary goal is addressing/improving symptoms that affect everyday functioning (hence, “functional” medicine)
- We look at labs a little different (and often order more than a mainstream provider). This looks like:
- Interpreting patterns (for example, comparing the patterns between a HgA1c, fasting insulin, and fasting blood sugar)
- Looking for “optimal” levels (versus the lab reference ranges listed on the labs); for example, most labs say 4.5 and above is high for TSH; an “optimal” value is actually 0.5 to 2.5)
- Considering the biological process going on behind a lab (for example, if hsCRP is high and ferritin is high, this can disguise a true iron deficiency)
- Most intake forms ask questions that we’d normally need to ask in a visit, so filling these out in advance saves time (if patients don’t fill out the forms, it typically takes 2-3 hours to ask these questions which wastes time and money)
- The intake forms will ask about a lot of factors that we often don’t think can impact health, for example:
- Environmental exposures
- Type of water filter used (if used at all)
- When and what you eat
- Recent events that may impact health
- Habitual preferences (for example, what one does to relax); I also like to find out how much time is spent in front of a screen and on social media (especially if someone has anxiety), how much time is spent outdoors, and more.
- The foundation is based on good diet and lifestyle habits, which often get overlooked in favor of “new” treatments (particularly new supplements that have good marketing behind them!).
- Nutritional supplements do play a role in improving health by enhancing biological functions of the body, or helping to replete deficiencies caused by the environment or genetics. However, a great provider will aim to avoid the practice of “green allopathy.”
- As a licensed practitioner, we do prescribe pharmaceuticals when/if needed (even if it’s a long-term medication)
- We treat people, not lab results. But the goal isn’t perfection since labs are dynamic and results can change daily
- What patients don’t see is the amount of time behind the scenes (i.e. not done during the visit), reviewing detailed lab results and connecting these to details in a patient’s chart
- Functional medicine PROMOTES HEALTH and has a model for addressing/reversing CHRONIC diseases. Chronic disease burden is mainly caused by lifestyle issues – best corrected by lifestyle changes, which are not easy to change.
- Functional medicine is a MODEL – not a specialty.
- Unlike allopathic medicine, there are no treatment algorithms in functional medicine (algorithms often imply a “one-size-fits all approach” to disease or illness).
- Most functional medicine-trained practitioners may have a general guideline for how he/she approach care, but rarely treat all patients in the same manner (hence, this is why functional medicine is considered “personalized” medicine).
- Conventional medicine is focused on TREATING DISEASES and taking care of ACUTE healthcare needs. This is needed in our society, but isn’t the best model at addressing persistent symptoms or chronic diseases!
- In conventional medicine, medical and graduate level universities are founded on preparing students to pass standardized tests, tests that test knowledge on algorithms for diagnosis and care. This is important for medical care, but they cannot account for the nuances of personalized patient care, nuances that primarily involve adjustments in lifestyle habits.
- There is no license or degree in functional medicine.
- However, the majority of practitioners that practice functional medicine have previously received a degree or training in a related healthcare field (MD, DO, PA, NP, OT, PT, DC, LAc, RD, nutritionist).
- When you see a functional medicine practitioner who has education in mainstream medicine (MD, DO, PA, NP), treatments options may include the use of pharmaceuticals, injections, ordering x-rays/imaging exams, and ordering labs that may be covered by insurance.
- Medication – whether pharmaceutical or over-the-counter-supplements – is utilized, but not overly-relied-upon.
- Functional medicine practitioners are trained via a variety of organizations, with the most popular programs via the Institute for Functional Medicine (IFM) and the American Academy for Anti-Aging Medicine (A4M).
- However, anyone can call themselves a “functional medicine practitioner,” even without training, since there are no licensing or certifying organizations that regulate this model of medicine. This can make it very confusing for both patients and practitioners!
The labs that are utilized in FxMed include those that a mainstream allopathic provider may use, but majority of the lab companies are independent and do not have insurance-company involvement (i.e. they are not micro-managed by insurance companies).
We test not only blood, but urine, stool, saliva, nasal passages, and more. There are a variety of companies that provide these labs, and these will differ between functional medicine practices. At CCM, we work with more than 10 lab companies, including Cyrex, Doctor’s Data, Genova, Cleveland Heart Lab, Precision Analytical, Great Plains Lab, MicroGen, and more.
Not all functional medicine providers are well-versed in functional lab interpretation, particularly when unfamiliar companies are used.
Simple definition: Functional testing isn’t taught in medical schools, so practitioners don’t know how to interpret these. Interpretation requires additional training and experience. In addition, functional testing is detailed and extensive, and results cannot feasibly be covered in a typical 10-15 minute visit at a mainstream practice.
There is no “perfect diet” or “perfect exercise” for everyone. No pill or procedure will truly create a foundation of good health. Patients will not succeed if they don’t address lifestyle habits, and this is the foundation of functional/integrative medicine.
Lifestyle habits include nutrition, exercise, stress management and relaxation, sleep optimization, and community (aka healthy relationships). As you experience the care of a functional medicine practitioner, you will notice that as a patient, you are engaging in a partnership with your practitioner. Thus, instead of relying on your practitioner to “treat” you, you become responsible for actively pursuing treatment recommendations. There is never a “quick fix” or a “magic pill”. You are in control of your daily habits, and your health care practitioner can only guide and educate you.
Response to treatment may be immediate, or it may take time to see improvements. In someone who is chronically ill, treatment often needs to be slow and steady, to avoid unwanted side effects. It can sometimes feel like you are taking “one step forward and two steps backward,” and just because something worked for one patient does not mean it will work for another. We are used to quick responses to medications, which are potent and come with potential side effects (either felt as symptoms, or cumulative over time). When changing lifestyle habits, results can take longer to experience, but last longer in the long term.
As Dr. Robin Berzin says:
1. IT KEEPS YOU HEALTHY INSTEAD OF JUST KEEPING YOU ALIVE
Conventional medicine is great at making sure you don’t die, but has nothing to do with improving your health and quality of life today.
2. IT’S PERSONALIZED
One size fits all, cookie cutter medicine no longer cuts it. Functional medicine uses advanced testing and genetics in combination with the art of listening to your story to piece together a plan that is 100% tailored to you, your body and your life.
3. IT’S ALWAYS AT THE CUTTING EDGE OF SCIENCE
In conventional medicine, it takes on average 17 years for new information to work its way into medical education. Functional medicine, however, is able to take advantage of new research in real time. Instead of battling with insurance companies for hours a day, many functional medicine practitioners put that time and energy into reading the latest research studies to determine if these studies are useful for application in the “real world”.
4. IT MAKES YOU FEEL GOOD
It’s about helping you feel your best now and teeing you up for a long healthy life in the future.
5. IT CHANGES YOUR LIFE
Functional medicine teaches you how to listen to your body and tap in to your health in ways you never forget. Ultimately how you live each day determines your health and quality of life. Functional medicine is designed to teach you how to live well and to support you in maintaining that lifestyle despite the many toxic inputs and influences – chemicals in products and food, sedentary lifestyles, chronic stress – we are all exposed to in today’s world.
The reality is, we all get sick at some point. Functional medicine is designed to prevent chronic debilitating illness like diabetes, heart disease and cancer that are the number one killers in modern society and to deal with temporary things, like viruses and bacterial infections, in a more natural way that does less long term harm to the body. It also supports you with the guidance and tools to handle the inevitable challenges in the best possible way so that you live well and generate as much happiness in your life as you can.