According to the Institute of Functional Medicine website,
“Functional Medicine determines how and why illness occurs and restores health by addressing the root causes of disease for each individual. The Functional Medicine model is an individual, patient-centered, science-based approach that empowers patients and practitioner to work together to address the underlying causes of disease and promote optimal wellness. It requires a detailed understanding of each patient’s genetic, biochemical, and lifestyle factors and leverages that data to direct personalized treatment plans that lead to improved patient outcomes.”
Some simply call FM ‘the medicine of why’ as it focuses on root causes for any current symptoms.
In my words, Functional Medicine is a systems-biology based (wholistic) approach to patient care that focuses on reaching and maintaining optimal health and wellness by prioritizing personalizing care for each person within the context of their life, using first diet, lifestyle, mental patterning and ongoing detoxification with the addition of targeted treatments (medications, supplements, additional techniques & procedures) as necessary.
Find out more about Functional Medicine: www.functionalmedicine.org
Functional Medicine is NOT at odds with the current medical system. FM recognizes that our current medical model gets excellent outcomes for urgent and emergent medical states and has done miraculous things with pharmaceuticals, imaging and other treatments. As well, there is incredible technology currently available and the emphasis on data, research and scientific investigation is elemental to continuing the improvement of clinical practice.
Conventional medicine was not originally designed and developed with chronic disease in mind and this is where FM really shines. Instead of treating high blood pressure with one pill, high cholesterol with another, depression with a third and insomnia with a fourth, FM goes upstream to look at what might be a unifying root cause- finding one treatment, generally within the diet, lifestyle and mental patterns- and then treats that to solve all the downstream problems.
“Chronic disease results from the emergence of a disturbed metabolism. Lifestyle and environment are the major factors altering gene expression that results in disturbed metabolism” ~MD Patrick Hanaway, IFM lecture 3/19/2018
Consider the agouti mice… genetically engineered (poor mice) for 50% to develop diabetes BUT, with the right diet in utero, the presence of diabetes is reduced to 12%. Functional Medicine notes that we have choices about how our metabolism moves forward and gives us the knowledge to steer this ship in the direction of our choosing.
Functional Medicine has a matrix from which it works. This matrix has focused its center on the mental, emotional and spiritual aspects of life. That core is surrounded by the seven clinical nodes which are how we think about categorizing symptoms. Where symptoms that seem unrelated are clustered in one node, that points the way for investigation and treatment.
This matrix is flanked by the “ATMs”. A is for ‘antecedents’ which are the conditions and experiences that set the stage for imbalance. T is for ‘triggers’ that have tipped the scale towards acute or chronic disease. This is the singular straw that broke the camel’s back- while it may have been a small single trigger, the camel was already carrying quite a load and hence disease develops from that point forward. M is for ‘mediators’ which are the elements and/or conditions which maintain the disease state. Our DNA doesn’t code to produce ongoing disease in absence of a trigger or a perception of a trigger. Mediators keep us sick, generally as protective mechanisms against some environmental or mental distress.
One easy example is the having of a pebble in your shoe. The antecedent is walking, the shoe & the lack of awareness about what is or isn’t there. The trigger is the pebble, which causes the resulting blister and/or wound. The mediators then are the persistent lack of awareness and all the sequelae of the wound. Conventional medicine gives pain medication, perhaps mental health treatment about the depression caused by persistent pain, treats the wound, pads the foot, and might change the shoe. Functional Medicine examines the foot, the shoe, the terrain and the awareness and takes out the pebble.
The bottom of the matrix emphasizes the ‘modifiable personal lifestyle factors’. Here is where you’re encouraged to list what is working and what is not in regards to the ways our daily life supports awareness and health, or does not. Feel free to fill out the matrix periodically to look at and evaluate your life.
This matrix happens within the context of our lives. FM starts with the timeline. Disease and imbalance don’t just fall out of the sky- every imbalance has some origin, whether we can see it or not. In our next section, we’ll review our chronological life. Even consider, like the agouti mice, the influences in utero.
There are multiple ways to work with an FM practitioner. The most basic level is to learn the principles and tenets of FM and how to apply these to your daily life. Working in a healthy diet, intentional periods of relaxation, maintaining movement and establishing a life of purpose obviously don't require a medical professional.
The medical professional comes in when more fine-tuning is needed. A first visit is likely to walk through your whole life, from in utero to the present moment, reviewing the influences & experiences along your time line. The FM clinician then puts the whole picture together- re-telling back your story from the FM perspective, including what have been antecedents, triggers and mediators for past, current and possibly future symptoms.
Then, the plan is established, which is always a negotiation of what is desired, what is possible and what sounds most inspiring to embark on first. There may be recommendations for further lab investigation (some conventional, some specific to functional medicine) of blood, saliva, serum or stool, perhaps imaging or referrals. The plan is often more 'buckshot' then seeking a 'silver bullet' to resolve symptoms- meaning, multiple recommendations are often made at once. Regardless of how many elements and which elements are chosen, it is always personalized for you in this moment of time with your health.
Often there are multiple close follow-ups initially as the old health groove is worked into a new health groove. The goal is always to establish your optimal health & educate you in how to stay there on your own. The highest compliment is the patient who doesn't return because they no longer need me to have an able body & a contented mind- they know how to address stressors and challenges as they inevitability come into their life.
The Institute of Functional Medicine is the main educational body regarding functional medicine. Certification includes a 5-day basic course, 6 weekend modules, case-based assessment and extensive testing as well as continued membership and learning. Gillian Ehrlich, ARNP, completed this certification program spring 2014 and has continued with seminars and conferences (and personal reading) ever since.
Find out more about certification: https://www.ifm.org/certification-membership/certification-program/