What is Integrative and Functional Medicine?
What do these terms mean and why is there new public interest in a parallel health philosophy? How can we better address disease and guide our patients towards optimal health?
The fact that no one can deny is that our healthcare system is deathly ill. It's on it's last leg, financially bled dry, doctors are on strike and patients feel like cattle, wearing their insurance codes like ear tags as they are shuttled through generic processing plant hospitals.
Time is money in medicine, personal touches and attention to empathy, last on the list.
Doctors who entered the field because of a deep desire to ease the suffering of fellow human beings become robots entiering data behind a computer screen. We agonize about where to put the details of our patient conversations in the EMR (electronic medical record) rather than actually hearing the pain they are trying to express to us. We struggle with insurance forms while in the moment forgetting that often our patients need a kind word or a hug so much more than they require reimbursement. We are allowed 12 minute visits and brainwashed to believe they should all end with a little white piece of paper granting access to scheduled substances. This is not medicine. This is absolutely not healing. This is business as usual, and if it is not disrupted quickly, federal spending on preventable chronic diseases will mean a completely broken system.
In the conventional medicine system the aim in not to get people better. The goal is often maintaining patient numbers, creating a standardized protocol and becoming more efficient at moving people through the system.
Patients are distrustful and doctors are disillusioned. There must be a better way.
Enter Integrative Medicine
Integrative medicine was born from the naturopathic principles of seeing clients as more than just a medical diagnosis and creating individualized treatement plans to address underlying causes of dysfunction. Integrative medicine is a patient centered approach that considers factors such as toxic exposures, lifestyle, diet and nutritional status, emotional well being and much more when asking the question as to why someone is sick. Unlike the conventional model, it does not simply assume genetics and bad luck as causes of disease. In terms of therapies integrative medicine is open to employing more than just drugs and surgery. Integrative medical doctors (or licensed Naturopathic Physicians) will use modalities including, acupuncture and TCM, nutrition and lifestyle interventions, dietary supplements and herbal therapies, mind body techniques, exercise prescriptions, bioidentical hormones, injectable therapies as well as conventional treatments.
Essentially integrative medicine is more concerned with addressing underlying pathology rather than providing quick fix solutions. If you imagine a warning light on your car’s dashboard; the conventional approach would be akin to taping over the light with black tape so it doesn't bother you anymore. The integrative medicine approach would be to notice the light, go to the mechanic for a proper workup, then making the necessiry repairs.
Functional medicine then, is a way of organizing the thinking around an integrative medicine case. It provides the practitioner with a structural framework to apply their knowledge in a systematic fashion while examining determinants of health or causes of disease.
The functional medicine model uses an elegant matrix design which allows practitioners to input triggers, antecedents, underlying symptoms and lab test results into a one page format which facilitates pattern recognition and more creative visualization and problem, solving (see photo above).
The primary question an integrative or functional medicine practitioner is always asking themselves is WHY? WHY did this patient get sick, WHY did they get sick NOW, WHY did they responded to therapy or not. Contrast this to the conventional system, which primarily is interested in WHAT. WHAT is the diagnosis, and WHAT is the treatment. End of story. While both are completely valid, WHY questions allow a deeper understanding into a case.
Integrative medicine is the model and functional medicine (and its associated matrix) is the tool.
Here is an example of a real life integrative medicine case:
Sarah is a 45 yr old mum of 2 kids, she takes a multivitamin and has been on birth control pills on and off since 19. She works full time as an account manager for a shipping company, then comes home and must help kids with homework and do chores before bed. She is exhausted and has terrible brain fog. To make matters worse, even though she is absolutely frazzled- she has been experiencing problems sleeping. She can't seem to fall asleep, and when she does, like clockwork she wakes up at 2-3 am, mind racing. With everything going on Sarah is beginning to feel really hopeless, she is failing at work and seems to be constantly bitchy, snapping at the kids and her husband for no reason.
Sarah first sought help with with her GP. In the 10 minute visit Sarah struggled to remember all the details of her case. Her doctor gave her a sleeping pill prescription and sent her on her way.
The sleeping pills helped her sleep but now Sarah’s energy and mood were worse. She was sleeping but waking groggy, with even less energy than before. She went to her see her GP again and this time her GP suggested she try an antidepressant for her recent emotional outbursts and low mood.
Sarah was feeling more and more frustrated. After 4 months of sleeping pills and antidepressants, she came to see us at Bloom.
Needless to say Sarah was not suffering from a sleeping pill and antidepressant deficiency, so while these medications helped symptomatically, they caused a host of other problems and did not address the real cause. The antidepressants made Sarah’s libido disappear and she became quite apathetic, straining the already challenging relationship with her husband.
After a 90 minute consult spent data collecting, it was obvious that Sarah’s hormones were completely out of whack. This was confirmed with functional laboratory testing of her urine, saliva and blood. Years of stress were causing her body to make excessive cortisol (leaving her wired and tired, turning off her thyroid hormones and stealing her progesterone). Without adequate progesterone, Sarah's sleep was disturbed and she was irritable. Without adequate testosterone, she was putting on weight and had no libido or drive. As she was not sleeping due to chronically elevated cortisol and low progesterone her body was not repairing properly, and her brain was unable to consolidate memories and replenish neurotransmitters at night. This left her with brain fog and depression. Due to her history of taking oral contraceptives she was exceptionally low in vitamin B6 and folate, both of which are needed to make neurotransmitters like serotonin and dopamine, likely also contributing to her sleep and mood disturbances. We also discovered she has a genetic abnormality in the way she processes folate (a variation of the MTHFR gene), so that the folic acid form in her multivitamin likely was making her feel worse.
Finally we discovered that Sarah was using a very high fluoride toothpaste and mouthwash. This was interfering with her thyroid function and further contributing to her low energy/ sleep problems. On removing this her thyroid function improved over a few months. As we worked to lower her cortisol her thyroid function continued to improve.
Over the course of 6 months we worked together to reduce Sarah’s stress, improve her nutrition and rebalance her hormones. Within a few weeks she was able to wean off her antidepressants, learned to sleep again and was feeling better than she could ever remember feeling - without drugs!