Functional Labs: One Arm of Evidence-Based Medicine

Integrative medicine is rapidly expanding across the globe. Patients want this kind of approach, as do practitioners. For good reasons, because putting our toolboxes together gets the best results and satisfaction all around.

But what is integrative medicine? There’s a lot of descriptive words you’ve probably heard besides integrative, such as holistic, complementary, alternative, traditional, and functional. Do all these words mean the same thing?

In one sense they do, as they all have one thing in common: a break from the Western conventional medical model. However, many of us practitioners choose to use the word integrative, because it encompasses all disciplines that embrace evidence-based medicine.

what the heck is evidenced-based medicine?

It sounds kind of scientific, and it is! However, the evidence that we use is different. Let’s back up. Western conventional medical education and practice is typically based on whatever research happens to be accepted (the most prestigious being the RCT or randomized controlled trial), even if this research is poorly designed, biased or outdated.

The conventional medical approach is actually slow to change. This is partly why you may feel dissatisfied with it.

Evidence-based medicine is a contemporary medical model that is open to change based on various arms of evidence. These include:

1. Research that includes RCTs, however we critically analyze the validity of these trials, and take into account newer well-done trials that discount the old ones. We aren’t married to the old way if the the old way no longer makes sense!
2. “Qualitative” research that takes your experience, story, feelings, and culture into account. This may be harder to measure, but there are ways to do so.
3. Our own clinical experience, as well as the experience of colleagues and mentors, which can be shared in the form of case studies.
4. A fresh look at conventional labs, and the inclusion of functional labs.

how does an evidence-based practice look?

We may spend more time staying up to date with current research, as well as researching your case and your questions. We see fewer patients, in order to spend more time with you at appointments, because your experience is just as important as research. It’s essential that we hear and understand you, in order to figure out how to help you best. We can’t just apply the same strategy to every person with the same condition.

In essence, we have to find the right gate to go through, so we can walk with you on your healing path.

We also collect data – through physical exams, measurements, and labs. This data, along with your story, and our teachings and experience, all influence your individual treatment. Yes, the research arm (#1) is important. But so are these other arms: your story, our experience, and the data we collect.

how do functional labs fit in?

Integrative practitioners use the same labs as conventional providers. We order blood, stool and urine tests, and depending on our specialty, other tests that inform diagnosis. However, the specific tests, especially in regard to blood work, often expand beyond what’s conventionally ordered.

Why? Because if evidence points to further testing in order to get an accurate diagnosis, then it’s appropriate to use it!

Here’s an example: it’s conventionally common to only order TSH (thyroid stimulating hormone) to screen for thyroid problems. However, TSH is indicative of what your pituitary gland is doing, and in no way can accurately measure your thyroid function. Still, this is considered the norm, even if it’s outdated. Lots of outdated practice happens because the agencies that dictate conventional practice are very slow to change.

Another important aspect of an integrative approach to labs is to use what we call “functional ranges” rather than the lab’s ranges. This isn’t true for every single marker, but when evidence shows the range should be tighter, we pay attention to that. So we tend to look more closely at labs, beyond what the lab has flagged as abnormal. Click here to read more about functional blood work.

what about kits you do at home or bring to the lab?

There’s a number of unconventional labs who do tests that you just can’t get at your local Quest, LabCorp or hospital. These labs are typically used by integrative practitioners. The practitioner gives you a kit, you follow the instructions and supply samples of urine, blood, saliva, stool, etc. Many of these you can do at home, but some of them (like blood draws) require a lab to fill the sample for you. Participating labs will then take care of processing your blood correctly and shipping it off.

Insurance companies rarely pay for these. It’s unfortunate but not a big surprise. There are some exceptions. However, these outside-the-box labs can give really valuable information that you can’t get otherwise. It’s important that your practitioner has vetted the lab and its methods. Ideally your practitioner has clinical experience using the lab, and found it to be valuable and worth the expense.

Besides vetting the lab’s methods and clinical relevancy, many of us go out of our way to find the most affordable means to get the right information. Here is the list of labs I rely on.

what is a functional approach and why is it so special?

Some integrative medical practices use what we call “green pharmacy,” which may not be that different from the conventional “pill for an ill” approach. Masking symptoms is so deeply ingrained in our Western culture, it’s easy to buy into this approach. Eventually it just becomes like the game whack-a-mole, because when you mask a symptom, whatever is causing that symptom doesn’t go away. It often rears its head with a different symptom. Or, the pill – be it a medication or a supplement – causes a side effect or a nutritional imbalance that then needs to be whacked.

A functional approach is to look at all of the evidence that we’ve talked about here – and to investigate what started the symptoms in the first place. Often it’s about what happened right before the first symptom erupted. We look at lifestyle triggers including the sum of your stress, diet, exercise habits, drug and alcohol use, toxic exposures, past traumas, and infections. We check out what systems have gone awry rather than obsessing on a single symptom or part of the body. Then we try to find the key that will unlock healing for you, from the inside.

Hopefully this concept jives with you! I’d love to hear, in the comments below.