Functional Medicine - A Description
Functional medicine may be viewed as an extension of conventional (allopathic) medicine. In this model, conventional medicine is most appropriate for the treatment of acute conditions; functional medicine offers an approach to the treatment of chronic conditions.
Functional medicine is defined by the Institute of Functional Medicine as “patient-centered health care that addresses the unique interactions among genetic, environmental, and lifestyle causes of complex, chronic illness.” A more comprehensive definition offered by the Institute is “a science based field of health-care grounded in the principles of (1) biochemical individuality based on genetic and environmental uniqueness, (2) patient-centered care as opposed to disease-centered care, (3) health as a function of dynamic balance between internal and external factors (homeodynamics), (4) web-like interconnections of physiological factors, (5) health as a positive vitality rather than merely the absence of disease, and (6) promotion of organ reserve.” The science of functional medicine is grounded in the marriage of molecular medicine, nutritional biochemistry, physiology, and cognitive sciences.
The focus in functional medicine involves viewing disease and chronic conditions as a function of imbalance in (1) environmental inputs, including nutrition, (2) GI function, (3) immune system function/inflammation, (4) oxidative stress, (5) detoxification/bio-transformation of the internal and external toxins (6) hormones and neurotransmitters and/or (7) structural alignment. In this model, the mind/spirit of the individual is considered the foundation for the web of interconnections amongst the above factors.
The functional medicine model of web-like interactions, which focuses on the pathophysiology of each chronic disease or condition, is based upon the theory of systems biology. A clinician using a functional medicine approach organizes the major elements of the history (the story), the physical exam, and diagnostic data into the above categories (i.e. GI imbalance, hormone imbalance, environmental toxicity, inflammation). The phenotypic expression of disease is a function of interconnections amongst these processes.
Conventional medicine, by way of contrast, is based on reductionism and a linear approach, with a focus on organs and organ systems as the basis of disease. The practitioner generates a differential diagnosis based on data from the history (the patient’s story), the physical examination of the patient, and diagnostic data (if diagnostic data has been obtained). The practitioner then narrows the differential diagnosis and makes a specific diagnosis. Treatment is usually diagnosis-specific, as opposed to functional medicine treatment which is specific to the individual.
Diagnostic data in functional medicine may include single nucleotide polymorphism (SNP) profiles, neurotransmitter profiles, fatty acid profiles, amino acid profiles, testing for toxic metals (arsenic, cadmium, lead, mercury), and comprehensive digestive stool analysis (CDSA). These types of tests are offered by specialty laboratories, including Doctor’s Data, Genova, Immunosciences Lab, Metametrix, NeuroScience, and Spectracell, amongst others.
Treatment in functional medicine is aimed at modification of the biochemical substrate of disease. This is achieved primarily by modifying nutritional intake and prescribing a variety of dietary supplements.
Jeff Bland, Ph.D., is considered by many to be the "father" of functional medicine. He founded the Institute of Functional Medicine. Dr. Bland wrote an interesting editorial on the history of functional medicine in the October/November issue of Integrative Medicine: A Clinician's Journal (IMCJ. 2015. 14. 18-20). Dr. Bland writes that concepts of and the term functional medicine arose from 2 meetings in Victoria, BC in 1989 and 1990, organized by Dr. Bland and his wife. The goal of the meetings was to define the principles of an operating system to bridge the gap between molecular medicine and integrative medicine - functional medicine can be thought of as the operating system which allows for the application of molecular medicine and systems biology to integrative medicine.
Certification in functional medicine is available to M.D.’s, D.O.’s (osteopaths), D.C.’s (chiropractors), N.D.’s (doctors of naturopathy), CCN’s (certified clinical nutritionists), and pharmacists. The Institute also offers a variety of advanced practice modules in specific areas such as "Nutrition" and "Hormones."
Reviewed July 3, 2017; Page Updated June 14, 2018