One of the trends in the medical-based wellness industry involves a switch from pharmaceutical pills to “natural” supplements, otherwise known as “green allopathy.”
Our society teaches us that pills are the treatments for medical ailments. When considering a functional medicine-based approach, many patients and practitioners have the misperception that functional medicine treats disease with “natural” supplements. But this should not be the approach (especially since most supplements are not “natural” – they are obtained through a variety of lab processes).
Let me share a little story.
The other day, I was shopping at my local Natural Grocers. As I walked through the supplement section, I heard a customer discussing some allergy-type symptoms with the employee. The employee was well-versed in which supplements to suggest, and recommended a couple of options for symptom relief.
As I listened to this brief exchange, I realized that many think that I am a highly educated health care practitioner that does just what that grocery store employee does all day – recommend supplements. But the truth is that 80% of my practice is focused on being a “detective” (looking at patterns in health history, environment, labs, and more). I actually try to educate on ways to avoid the need for pills – but the pills I do recommend are a means to an end.
But many highly educated practitioners end up looking like over-paid health food store employees, practicing green allopathy instead of practicing “original” functional medicine (seeking and reversing the cause of symptoms, rather than just treating the symptoms).
If I recommend a supplement for symptom relief, I want patients to start with one or two, and look for tangible benefits before adding others.
Patients (and practitioners) want a pill to fix ailments, and there is nothing wrong with wanting this convenience. However, the practice of green allopathy involves an overuse of supplements, focused on using a “natural” pill to treat almost every symptom and every abnormal lab result. Eventually, patients end up spending hundreds of dollars on supplements every month, but don’t know which ones are actually helping them – if any are helping at all. In fact, I find that these often hinder health!
Example of a Good Functional Medicine Approach
Take the MTHFR gene, for example. If a patient has a variation of this gene that MAY impact their ability to methylate optimally or appropriately use certain B vitamins, many practitioners immediately place these patients on methyl-B12, folate, and other vitamins that support the methylation pathway. I rarely find a practitioner that actually looks to see if this gene is actually “turned on” (not all genes are “expressed”), by looking at vitamin B12 levels, homocysteine levels, RBC folate levels, and more. If these biomarkers are significantly abnormal, a titrated low dose of certain B vitamins and supplements known as “methyl-donors” may be beneficial. High dose is not necessarily better – too many of these may actually increase the risk for cancerous processes secondary to “hypermethylation”. The way I look at this is: why would something that is found in 50% of the population suddenly require supplements, when these genes have been present for thousands of years? Seems like a common sense questions we should all ponder.
“Patients should seek out my services because of the way I think..”
There is no doubt that supplements can be useful, and they are a part of my practice. However, patients should seek out my services because of the way I think – my knowledge of biochemical pathways, the art of identifying patterns in test results, listening to the clues found within a patient’s story, and the personalization of lifestyle plans. In my practice, a supplement is either “therapeutic” (i.e. serves a short-term purpose) or “maintenance” (long-term use). If I recommend a supplement for symptom relief, I want patients to start with one or two, and look for tangible benefits before adding others.
Looking for the “What” Instead of the “Why”
I cannot fault my colleagues and friends for their lack up understanding about how a functional medicine practitioner works. After all, the majority of conventionally-trained practitioners that are working in this “specialty” are new to it, and tend to be misguided in their education. Our educational background in conventional medicine teaches us to seek out “what” can help a patient rather than think “why” a patient is ill. The “whats” of our practice tend to be diagnoses, pills, or procedures. Since this is our thought pattern, this is what we tend to “pick out” from the conferences that we attend for functional medicine training. It’s a lot easier than trying to clinically apply molecular biology and biochemistry!
As more practitioners and patients adopt the functional and integrative medicine mindset, I encourage them to focus on “real” functional/integrative medicine. Learn the tough sciences that impact our biology. It is in these scientific applications that you will find the cause of an ailment. A pill can aid in addressing the causes, but will rarely reverse the cause. After all, no one can “out-supplement” a poor diet, a poor set of lifestyle habits, or a poor environment.
In the end, it is always appropriate to prescribe something that will give a patient relief. But don’t call this “functional” medicine if a practitioner doesn’t actively search for the true biochemical cause of illness. To truly practice medicine from an integrative/functional mindset requires a lot more work and a different approach. Knowledge of supplements is essential, and is a good first step for practitioners, but the ultimate goal is to teach patients resiliency, via lifestyle habits and education, so if the problem returns, the patient has the tools to address these and do so with limited help from a practitioner.
Best in health!
P.S. Click here for another similar perspective on green allopathy (written by a naturopath).
P.P.S. I’m leaving CCM and joining the amazing team at Parsley Health! I will start seeing new patients in January 2021 – click here to learn more.