What is Functional Medicine?

by 
Dr. Shawn Greenan, DACM, CFMP®
What is Functional Medicine?

Functional medicine is exploding in popularity - and for a good reason. What was once considered “alternative” is now becoming mainstream medicine as more and more patients seek answers to their chronic health conditions.

A skilled functional medicine practitioner can help patients with complex, chronic conditions that allopathic medicine hasn’t been able to cure.

Navigating the world of functional medicine can be confusing, so we built this guide to answer all your questions, starting with the basics.

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What is Functional Medicine?

Imagine visiting a doctor, and instead of leaving with a handful of prescriptions, you left with a grocery list. That certainly doesn’t sound like modern conventional medicine, but a functional doctor isn’t your typical physician.

Functional medicine is an individualized root cause medicine approach to healthcare. These practitioners consider factors like diet, genetics, hormonal changes, and other lifestyle components as potential causes and treatments for patients’ diseases.

Functional Medicine practitioners also focus on optimal lab values, which are more narrow than the standard lab values used in allopathic medicine. Anything outside of those optimal values can show patterns and markers that spot trends toward disease. By catching these markers early on, functional medicine practitioners have a chance at reversing or stopping disease progression altogether.

The History of Functional Medicine

In the 1950s, 1960s, and 1970s, people began looking for alternatives to conventional medicine. “Natural medicine” entered the American lexicon, and the focus turned to a more holistic approach.

In 1971, however, Jeffrey Bland, an assistant professor of chemistry and environmental science at the University of Puget Sound, studied vitamin E and discovered that it protects the body’s red blood cells from the effects of aging.

Bland probably didn’t know at the time that he was about to change the trajectory of modern medicine forever.

By the 1980s, medical providers were using Dr. Bland’s studies to further test amino acid levels, fatty acids, toxic metals, minerals, vitamins, antioxidants, and hormones to spot disease progression.

With this information, they could personalize treatments with nutrition, supplements, and exercise, and they were getting outstanding results.  

The Father of Functional Medicine

In 1975, Bland attended a meeting of the Northwest Academy of Preventative Medicine in Seattle, WA. The keynote speaker happened to be Nobel Laureate Linus Pauling.

Bland and Pauling developed a solid professional relationship. In fact, Bland cites Pauling as his mentor. Bland went on to work for the Linus Pauling Institute of Science and Medicine in Palo Alto, CA as the director of nutritional research.

Since then, Bland has written several books and published more than 120 peer-reviewed studies.

In 1990 Jeffrey Bland, Ph.D., coined the term Functional Medicine and started conducting regular seminars throughout the United States, sharing his knowledge on various subjects such as gastrointestinal health, immune health, hormone balance, and detoxification.

In 1991, Bland and his wife Susan founded the first Functional Medicine Institute and was dubbed the Father of Functional Medicine.

Functional Medicine Education

To be eligible for certification as a functional medicine practitioner, practitioners must have a graduate degree in a health-related field with one of the following credentials: Medical Doctor, Doctor of Osteopathy, Doctor of Chiropractic (DC), Naturopathic Doctor (ND), Dentist, Nurse Practitioner (NP), Acupuncturist (LAc), Pharmacist, or an equivalent degree from countries outside of the US.

Physician Assistant (PA), Registered Nurse (RN), Registered Dietitian (RD), Occupational Therapist (OT), and Physical Therapist (PT) must hold at least a bachelor’s level degree in their field as long as their education was completed prior to the entry-level education change.

Many functional practitioners have to adhere to strict regulations to maintain their certification in their related discipline.

How is Functional Medicine Different from Integrative Medicine?

Many people use the terms interchangeably, and they’re similar but slightly different.

Both are focused on getting to the root cause, are holistic and individualized, and prioritize lifestyle, nutritional, and behavioral changes over pharmaceuticals. The difference is with the approach to getting to the root cause diagnosis.

Functional medicine uses in-depth bloodwork and specialty lab testing to get at the root cause, while integrative practitioners may focus on standard lab testing.

Additionally, the credentialing is different. Integrative medicine is a board-certified fellowship that MDs and DOs can take and obtain as an official credential, and functional medicine offers both fellowships and post-graduate certifications.

What Conditions Does a Functional Medicine Doctor Treat?

Most patients who go to a functional medicine practitioner usually have a chronic condition or “mystery illness” for which allopathic medicine has no diagnosis.

Functional medicine practitioners are like a personal medical detectives and are equipped to solve complex and multifaceted health issues. Examples include endocrine disorders, hormonal imbalances, mental health, and chronic pain conditions like arthritis and fibromyalgia. They also treat autoimmune and inflammatory diseases like multiple sclerosis, Lyme’s disease, celiac, and inflammatory bowel disease (IBD).

Many patients without chronic disease also choose to see functional medicine practitioners annually for preventative care.

Functional Medicine vs. Conventional Medicine

Today’s conventional medicine practitioners are overworked and burnt out. Many doctors are required to see upwards of 20 patients each day.

The daily patient quota health insurance companies put on these practitioners doesn’t allow for comprehensive care. Even if they wanted to spend more time with you, there wouldn’t be enough hours in the day.

Beyond that, only 1/5th of medical schools require 25 hours of nutritional training over the four years of school.

Many conventional doctors know that their patients should eat right and exercise, but the time constraints only allow a cookie-cutter approach, treating the symptoms of chronic disease rather than finding the cause.

In comparison, functional medicine’s primary focus is treating disease with dietary and lifestyle changes, which is enforced throughout the whole educational program.

This is why many practitioners are leaving behind the insurance based healthcare system, learning about functional medicine, and going with more concierge-type services, giving patients a more comprehensive approach to their healthcare needs.  

What a Functional Medicine Appointment Looks Like

Functional medicine appointments are much more in-depth than a typical allopathic appointment. They include a detailed intake and a series of specialty labs to get a comprehensive overview of how well your body is performing.

Typically, a patient fills out a comprehensive medical history, which includes family history, lifestyle history, personal health history, diet, exercise, traumas, and of course, the symptoms that brought the patient there in the first place.

After that, the patient will provide blood and possibly urine, saliva, breath, and a stool sample to be tested to see what is going on at the cellular level. The practitioner may also run a DNA test or ask for the results of existing DNA tests.

After the initial appointment and lab work results are reviewed, patients come in for a follow-up visit to be educated on their personalized treatment regimen to address their root cause diagnosis.

Many Functional Medicine practices also work with nutritionists, mental health counselors, and health coaches to give patients a complete approach to their health care needs.

Common Functional Medicine Lab Test

Comprehensive Stool Tests

What does the stool test cover?

  • Inflammation levels
  • Digestion and absorption levels
  • Gut microbiome levels
  • The existence of parasites and worms
  • Bacteria such as Campylobacter, Clostridium difficile, and h. Pylori

Saliva and Urine Tests

What do saliva and urine tests cover?

  • Hormone levels
  • Metabolite levels

Breath Tests

What do breath tests cover?

  • Hydrogen presence to rule out bacteria overgrowth in the small intestine
  • Methane presence to rule out bacteria overgrowth in the small intestine

Blood Tests

What do blood tests cover?

  • What’s going on at the cellular level.

Merging Conventional Medicine with Functional Medicine

Conventional and functional practitioners can often work in tandem to treat chronic illnesses, for example, severe high blood pressure. A traditional doctor may prescribe pharmaceuticals to bring blood pressure down to a safer level in the short term and refer out to a functional doctor to prescribe lifestyle changes aimed at treating the root cause of the high blood pressure, ultimately phasing the patient off of their medications.

The Cleveland Clinic, which is routinely ranked one of the top hospitals in the United States, examined more than 7,000 patients treated by functional medicine practitioners over two years. The results? Researchers found that patients who were offered functional medicine services significantly improved their quality of life.

The CDC is also finally acknowledging that lifestyle changes are vital in preventing and treating chronic disease.

How Sick are American’s

According to the Centers for Disease Control and Prevention (CDC), six in 10 American adults have a chronic disease. Four in 10 have two or more chronic conditions. In addition, more than four out of 10 Americans are obese.

Conventional medicine is often credited for the fact that life expectancy has increased over time. While there’s no doubt modern treatments for acute ailments, traumas, and modern childbirth methods save lives, the reality is that the average lifespan has begun a downward trajectory. This is expected to continue if we don’t change the way we provide healthcare.

The Cost of Conventional Healthcare vs. Functional Medicine

The Cost of Conventional Healthcare

Unfortunately, all illness has hidden costs and is expensive whether you have insurance or not. The average cost of healthcare in the United States is over $12,000 per person. Out-of-pocket spending is roughly $1,650 per person per year.

Even since the passage of the Affordable Care Act, 46 percent of adults struggle to pay their out-of-pocket healthcare costs.

Over a quarter of Americans have trouble paying their deductibles, and half of the insured adults in the United States delay or skip medical care because they can’t afford it.

3 in 10 adults report skipping doses of their medications because they can’t afford to pay for the prescribed dosage.

The Cost of Functional Medicine

As with every discipline, the cost of functional medicine treatments varies. The cost per appointment varies between an average of $150-$500.

Practitioners generally charge more in larger cities such as San Francisco, Los Angeles, and New York and less in places with less of a demand for alternative medicine.

However, when compared to the long-term costs of illness, functional medicine may be a bargain. Instead of struggling to pay yearly deductibles and prescription costs for the rest of your life, seeing a functional medicine provider over a year and treating the root of your illness can reduce your dependence on prescriptions and procedures and can save you money in the long term as well as add healthy years to your life.  

Does insurance cover functional medicine visits

In most cases, no, functional medicine is not covered by insurance. However, some functional practitioners work with practitioners who can bill insurance companies for some tests.

Health savings accounts and flexible spending accounts are tax-free options to help pay for alternative treatments such as functional medicine. Many functional medicine practitioners offer payment and wellness plans to help make appointments more easily accessible.

When Should I Choose a Functional Medicine Practitioner?

Working with a functional medicine practitioner can be life-changing for patients. Patients with chronic and complex conditions who have no clear diagnosis can often get to the root cause of their issues and ultimately get their quality of life back.

Functional medicine can also be used preventively. Yearly testing with optimal lab values reviewed can predict disease progression before the patient has symptoms, and nutritional and lifestyle changes can change the disease outcome.  

Functional Medicine Highlights

  • Functional medicine can help you get to the root cause of why you feel sick
  • In-depth appointments with your practitioner
  • Relies primarily on lifestyle, diet, and supplements rather than pharmaceuticals or surgery
  • Preventative - can save you money down the road
  • Preventative- can detect progression of the disease before symptoms appear
  • It takes into account the whole person in healing
  • In-depth lab testing
  • Allows you to find ways to optimize your health - often without pharmaceuticals or procedures


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References

Dr. Shawn Greenan, DACM, CFMP®
Website
Acupuncture Physician Certified Functional Medicine Practitioner®
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