Functional Medicine:
A Distinctly Different and 3rd Kind of Medicine which is neither Conventional nor Alternative Medicine
by CE Gant, MD, PhD
I have practiced functional medicine since the term was coined over 30 years ago and
during these decades I have reluctantly overlooked being mislabeled as an “alternative medicine[1]”
doctor. Healthcare consumers and practitioners alike often fail to recognize that functional
medicine has virtually nothing to do with alternative medicine practices such as homeopathy, acupuncture, herbal
medicine or hands-on-healing. Functional medicine is also not conventional
medicine.
Functional medicine is a third and completely different
discipline. Functional medicine’s uniqueness stems from its heavy reliance on certain basic
sciences - toxicology, biochemistry, physiology, anatomy and genetics - which in widely varying degrees are part of
the educational curricula of all licensed healthcare professionals. These basic sciences are also referred to as
“pure sciences” because they conform more rigorously to scientific method.
Scientific method refers to a body of techniques for
investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge. To be termed
scientific, a method of inquiry must be based on gathering observable, empirical and measurable evidence subject to
specific principles of reasoning. A scientific method consists of the collection of data through observation and
experimentation, and the formulation and testing of hypotheses. Once a hypothesis has been proven, the
new information can be added to that of previous amassed studies and provide a predictable model which can then be
used to formulate further hypotheses and experimentation.
Functional medicine differs from conventional or
alternative medicine because it conforms to a far more rigorous application of scientific method and utilizes a far
greater volume of amassed scientific data (see diagram below) to investigate what is causing symptoms, illness and
dysfunction. I routinely apply my knowledge of cell biology, physics,
genetics, anatomy, toxicology, physiology, microbiology, biochemistry, clinical chemistry, medical anthropology,
organic chemistry and/or bio-identical endocrinology in evaluating virtually every patient I see. Essentially, the
vast knowledge which has emerged from centuries of amassed scientific inquiry into the biological and basic
sciences is used to investigate the unique biological, biochemical, toxicological, genetic and physiological
situation in each and every patient I see.
When was the last time
your family doctor tested your citric acid cycle intermediaries to see if there were problems with production of
ATP, the fuel that drives life? Has your cardiologist measured your carnitine, CoQ10,
glutathione and taurine levels, which are essential for heart function? This attention to
scientific detail is not the bread and butter of conventional practitioners, because we conventionally trained
doctors are not taught to think physiologically. We are trained to think pathologically, which
entails making a diagnosis and prescribing a drug, a surgical or a radiological procedure to offset the disorder
diagnosed, and which is often the right approach for many problems, especially acute, life-threatening disorders
when thoughtful, time consuming biochemical analysis is impossible.
However, in the
treatment of chronic disorders, where there is time to investigate the root causes of symptoms and the presumptive
diagnoses, conventional medicine’s accepted standards of care are becoming increasingly obsolete. The process of
formulating a presumptive diagnosis based on an exam and history, and perhaps ordering a few superficial laboratory
tests, while ignoring the astonishing advances in the basic sciences which are listed above and in the diagram
below, becomes increasingly ridiculous. Then to make wild guesses about treatments with potentially
toxic, pharmacological substances, with very little attention paid to the unique biochemical, genetic, hormonal,
toxicological and metabolic makeup of each patient, is frankly dangerous. As a functional
medicine practitioner, I simply strive to not ignore the science, and as a result I am privy to looking much more
deeply into the very substance of my patient’s biochemistry, physiology and genetic makeup and determine the actual
cause of their symptoms. Knowing causes allows me to formulate rational
treatments.
Like my conventional or alternative medicine counterparts, as a functional medicine
practitioner, I begin and assessment by making a “presumptive diagnosis” based on my initial examination
and my patient’s medical and psychiatric history. But unlike
my conventional or alternative medicine colleagues, I base my next inquiry on hundreds of years of
amassed, peer-reviewed studies and data bases, which have proven beyond a shadow of doubt that
toxicological, biochemical, structural, physiological and genetic abnormalities are the root cause of my
patient’s presumptive diagnoses and/or chronic symptoms. I
order an extensive battery of laboratory and/or radiological tests to determine if the expected
causative abnormalities - the true diagnostic factors (not presumptive) - are present or not. Guesswork is thus avoided, intuition is unnecessary and factual
evidence is gathered.
Based on the proven fact that human beings all share a similar genetic code, and the proven
fact that all human beings have a similar biochemistry, anatomy and physiology in a healthy state, any
laboratory results which deviate significantly from the healthy norms, especially those which have been
proven in amassed scientific studies to be risk factors for the presumptive diagnosis made on initial
assessment, are taken seriously as potentially causative abnormalities.
Unlike my conventional or alternative medicine colleagues, as a functional medicine
practitioner, I then formulate the following hypothesis based on amassed scientific studies and the
laboratory-determined abnormalities:
The prescribing of certain targeted supplements, bio-identical hormones, herbs and even
medications (in that order of preference) will correct the abnormalities discovered through testing and
will result in sufficiently optimizing the genetic expression of my patients to the extent that their
symptoms and/or disorders will disappear.
This testing of a hypothesis via scientific method constitutes a revolutionary advance in
medicine, and defines the uniqueness of functional medicine.
If the hypothesis is proven to be true, and the symptoms or diagnosed disorder vanish, then the
“experiment” so to speak has come to a successful conclusion and my patient is usually
discharged.
If however, the hypothesis is shown to be invalid, and the interventions which were prescribed
based on the tested toxicological, biochemical, physiological and genetic variables somehow failed to
correct the symptoms, further diagnostic testing is warranted to look deeper into other
laboratory-determined risk factors which could be
If my patient fails to respond as expected with the first round of investigation and
treatment, I formulate a new hypothesis:
The prescribing of certain additional targeted supplements, bio-identical hormones, herbs
and even medications (in that order of preference) based on the initial and this deeper analysis of
additional test data will correct the abnormalities and will result in sufficiently optimizing the
genetic expression of my patients to the extent that their symptoms and/or disorders will
disappear.
If that hypothesis is found to be invalid, an unusual occurrence in my experience, then a
third round of diagnostic testing is warranted to repeat the cycle again or as many times as
necessary. At each stage, a hypothesis is tested and
found to be valid or not. Scientific method is applied based on hundreds of thousands of amassed
studies derived mostly from the basic sciences, not guesswork. Sometimes I order a repeat of the original diagnostic testing to
certify that the reported lab results were accurate and that proper laboratory test procedures were
followed. I am constantly on the phone discussing the
results with clinical pathologists, and asking them to check their controls and normative
values.
Diagnostic testing can be repeated to also determine whether or not previous treatments did
indeed correct the abnormalities originally found.
Rarely do patients need more than 2 or 3 rounds of this process to achieve good results, provided
they comply with suggested interventions which can be complicated and costly. The data on my patients is compiled and aggregated and added to
accumulating data bases on functional medicine, which will then be used for further research and
further innovation in treatment.
I don’t mean to invalidate either my alternative or conventional medicine colleagues simply because they
fail to ascend to the science-based standards of care on which functional medicine rests. I mix both conventional and alternative medicine approaches with
functional medicine in most of my patients, which altogether is properly labeled as integrative
medicine. I even add mindfulness-based
psychotherapies to my approach which has even less of a scientific basis than alternative medicine (see
diagram below).
Although mindfulness-based psychologies, alternative medicine and conventional medicine is riddled
pseudo-scientific poppycock, my position on these relatively unsubstantiated kinds of healthcare has been
and will always “Voltaire-like” and libertarian. I may not believe in much of what mindfulness-based
psychologies (or psychology/psychotherapy in general), alternative medicine and conventional medicine has
to offer, but I will “defend the death” (so to speak) the right of healthcare practitioners to practice
what they feel in their hearts is ethical and valid. The worst case – and deadliest - scenario is
dictatorial, Obamacare, bureaucratic goofballs dictating standards of care to honest
practitioners.
I rely on the expertise of my alternative and conventional medicine colleagues and frequently refer my patients
to them to benefit from their expertise. In fact, the massive
quantity of biochemical, toxicological, metabolic, anatomical and genetic information which results from a
thorough functional medicine evaluation helps to define which conventional or alternative medicine
interventions would be more likely to be effective.
I blend alternative medicine, conventional medicine, functional medicine and mindfulness-based psychotherapies
into my practice (see diagram below) and devote a significant portion of my clinical time to providing free,
educational, coaching webinars for all of my patients in basic lifestyle choices, such as drinking enough
purified water, exercising intelligently, avoiding poor food choices, managing stress levels, etc.; basically
all of the lifestyle issues which are relevant to aging and disease
prevention.
Despite my embrace of all types of medicine, I am no longer willing to ignore being mislabeled as an
alternative medicine or complementary/alternative medicine doctor.
Functional medicine has nothing to do with alternative medicine or conventional medicine. However, I stand
firmly on a Voltaire-like position
when critiquing my functional, alternative or conventional medicine colleagues. Their way of practicing
healthcare may not ascend to my standards of what I believe science-based medicine should be,
but I will defend “to the death” so to speak their right to
practice in a manner which they believe is ethically in the best interests of their patients. Intrusion by
draconian government regulations and insane healthcare political manipulations threatens the very foundations
of freedom and scientific method in healthcare and must not be allowed to stand in the way of innovation and
practitioner liberty.
I trust that educated and informed consumers and
practitioners alike will eventually be able to separate the wheat from the chaff. Any form of medicine based on a more rigorous code of scientific
method will by definition achieve better results because the universe we live in follows predictable laws
of cause and effect. A denial of this fact, as I observe increasingly occurring in both alternative and conventional
medicine, threatens to take civilization back down a dark path of superstition and witchcraft. As long as
healthcare consumers have the liberty to choose the care they want, and practitioners have the liberty to keep
perfecting their standards of care, consumers will gradually and naturally gravitate to those delivering care
which achieve superior outcomes.
Functional medicine is a third type of medicine which is neither conventional nor alternative
medicine. Functional medicine is poised to revolutionize all
medical care
because it is based on far more rigorous standards of scientific method and a far greater volume of amassed
scientific data. Functional medicine will ultimately be
shown to achieve better outcomes than either conventional or alternative medicine, especially for the treatment
of chronic medical and psychiatric disorders.
[1]
According to the National
Center for Complementary and Alternative Medicine of the National Institutes of Health (NIH),
complementary and alternative medicine (CAM) is: acupuncture, Alexander technique, aromatherapy, Ayurveda, biofeedback,
chiropractic, diet therapy (not based on laboratory/functional testing), herbalism, holistic nursing,
homeopathy, hypnosis, massage therapy, meditation (not mindfulness), naturopathy, nutritional
therapy, (not based on laboratory/functional testing),
osteopathy, Qi gong, reflexology, Reiki, spiritual healing, Tai Chi, Chinese Medicine,
yoga.
“I may
not agree with what you say but I will defend to the death your right to say
it.”
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