Functional Medicine, a relatively new term in Western medicine, came about in the 1990s as part of a significant scientific paradigm shift that began in the 20th century. This is a shift from a “reductionist” approach to a “systems” approach. I will explain the nuts and bolts of Functional Medicine, but first let’s examine the greater context which led to its development.
The Roots of Reductionism
Reductionism became the dominant scientific and medical paradigm during the era of Descartes and Newton. These two philosophers were at the forefront of the scientific revolution of the 17th century, during the Renaissance.
In a nutshell, reductionism is best described by Descartes’s metaphor of a clockwork universe, in which all things are similar to the mechanistic workings of a clock. Everything in the universe can be broken down into subunits, and by investigating the subunits or parts, we can understand the whole. This approach is rooted in the assumption that complex problems are solvable by dividing (or reducing) them into smaller, simpler, more manageable units, hence the term reductionism.
Reductionist, or mechanistic, thinking has been the predominant paradigm of modern science since the Renaissance. It dictates scientific research and medical practice, affecting the way we diagnose, treat, and prevent disease. Reductionist thinking is clean, simplistic, logical, and appealing.
Reductionism in medicine allowed for important medical advancements in the 20th century. Emergency medicine, acute care, vaccines, and surgery, are among the major healthcare advances of the past century that have stemmed from the linear, cause-and-effect thinking of reductionist medicine.
The Dawn of a New Scientific Revolution
Meanwhile, the 20th century also marked the beginning of dynamic systems theory, with various permutations across different scientific fields. Systems thinking has multiple origins in disciplines as varied as biology, anthropology, physics, psychology, mathematics, management, and computer science. Physics was one of the first fields to change:
Ever since Newton formulated the first laws of gravity, the conceptual model of the physical world had successfully described the shape, movements and actions of the objects within it. But as physicists began to explore especially the atomic and subatomic realms in the early twentieth century, their observations became partially meaningless. The new discoveries required a paradigm shift and a new intellectual framework to understand events at the subatomic level, which eventually resulted in quantum physics.
The term systems thinking is associated with a wide variety of 20th century scientists, including biologist Ludwig von Bertalanffy, who developed General System Theory; anthropologist Gregory Bateson, who pioneered the field of cybernetics; and computer engineer Jay Forrester, who launched the field of systems dynamics.
One could say that we are currently in a new scientific revolution;
a 20th/21st century change from reductionism to systems theory.
The medical fields tend to change at a much slower pace than scientific philosophy. While systems theory sprung forth in every scientific discipline in the 1990s, medicine remained reductionistic. Medicine is slow to change. Then, when scientists finished mapping the human genome, it was virtually impossible not to realize that humans are living biological systems beyond DNA. Our genetic code is a small part of determining who we are and who we become.
The completion of the human genome project in 2003 led scientists to confront a challenge they could not address before; namely, how do genes interact to collectively create a system-wide behavior? How does consciousness arise from the interactions between neurons? How do normal cellular functions such as cellular division, cell activation, differentiation, and apoptosis emerge from the interaction of genes? These questions highlight the difficulty of understanding complex biological systems through a parts-oriented perspective:
The moment the lens is directed toward the components of a biological system,
the behaviors and properties of the whole system become obscure.
One loses sight of the forest for the trees.
Whereas genes hold our DNA blueprints, phenotypes are individual characteristics that emerge, such as having green eyes, for example. Phenotype expression calls upon a collective action of thousands of individual molecules. This brings in epigenomics, the science of how genes are expressed or silenced. A single gene or genetic mutation is not responsible for a complex disease. It’s an orchestra of complex molecular events, involving complicated feedback systems and emergent properties, concepts embedded in dynamic systems.
As quantum physics required going beyond reductionist theory in physics, the “-omics” fields in biology are likewise moving beyond reductionist thinking.
An increasing number of scientists argue that the reductionist approach can no longer cope with both the enormous amount of information that comes from the so-called ‘-omics’ sciences and technologies—genomics, proteomics, metabolomics [epigenomics] and so on—and the astonishing complexity that they reveal. The assumption that complex biological systems can be completely explained by Descartes’ clockwork model has been repeatedly questioned.
The Birth of Systems Biology and Medicine
Questions such as these arose: How should these complexities be addressed? How do we shift our lens from the pieces to the whole, from the parts to the system? The answers to these questions come from a relatively new branch of science called systems biology. Systems biology was conceived to address the molecular complexities seen in biological systems. Rather than dividing a complex problem into its component parts, the biological systems perspective appreciates the holistic AND composite (parts) characteristics of a problem.
The systems perspective is rooted in the assumption that
the forest cannot be explained by studying the trees individually.
Systems biology is based on a network of interacting components—such as the coordination of internal systems (nervous, endocrine, respiratory, etc), with gene and gene product expression, and behavioral and environmental factors—and how these components contribute to the course of health and disease. Stemming from systems biology, systems medicine incorporates interactions between all components of health and disease. Care for the whole person exemplifies the connectivity and integration at multiple levels of systems medicine, expanding medicine beyond reductionism.
Systems biology is now a field of its own, as is systems medicine. There is even a systems medicine program at Georgetown University. This new medicine is in its infancy in Western culture. We have much to learn about mapping complex systems with our sophisticated mathematical and computational technology; however, systems medicine by definition is not new. In older medical cultures, systems medicine has existed for thousands of years. Two primary examples of this are Ayurvedic * * and Chinese Medicine. * * *
A Deeper Examination of Conventional Medicine
Conventional Western Medicine continues to take a reductionist, mechanistic, allopathic approach. It aims to fight disease with tools (usually drugs or surgery) to get rid of, or mask diseases symptoms, without necessarily understanding why they exist. Sometimes the treatment creates more symptoms, such as side effects from medications.
A General Practitioner (GP) nowadays often serves to solely provide annual exams, and to refer to specialists for conditions beyond common colds and flues. There is a specialist for every illness, and each organ and its related parts: from gynecology, to dermatology, to oncology, and so on. Very often one patient is seeing multiple specialists, each prescribing different medications, without communicating or coordinating care. There is a lack of understanding how a person’s separate parts, diseases, and systems connect, and how they may be related to a common root cause.
There is also a disturbing lack of collaboration between specialists. It can be dangerous for a patient who is on multiple uncoordinated medications. Often it’s the pharmacist filling the prescription who catches serious contraindications between prescriptions. Who is overseeing the specialists? Who is connecting the dots? Who is viewing your body’s systems as an interconnected whole? Unless you have an exceptional GP who is really on the ball, these questions do not have a good answer.
The linear approach of conventional Western medicine places the same symptoms (conditions, diseases) with the same cause, and the same treatment. Here are some examples:
|Broken bones||Traumatic injuries||Cast, surgery|
|Pneumonia, sinus infection, bronchitis||Bacterial infections||Antibiotics|
|High cholesterol||Dietary cholesterol||Statin medications|
|Depression||Chemical imbalance||Antidepressant meds|
|Rheumatoid Arthritis||Unknown autoimmune||Medications|
|Cancer||Unknown||Chemotherapy, radiation, surgery|
|Grave’s disease||Unknown autoimmune||Radiation, surgery, medication|
|Osteoarthritis||Wear and tear, aging or degenerative||Medication, joint surgery|
|Atherosclerosis||Dietary saturated fat, aging or degenerative||Medication, surgery|
|Hashimoto’s||Unknown autoimmune||Thyroid medication|
|Dementia, Alzheimer’s||Aging or degenerative||No treatment|
|GERD||Usually unknown||Acid blocker medications|
|Irritable Bowel syndrome||Unknown||Various medications or no treatment|
|Ulcerative Colitis||Autoimmune unknown||Medications|
|Medication side effects||Medications||More medications|
|Symptoms that aren’t explained||Undiagnosable, psychosomatic||Psychiatric medication, no treatment|
|ADHD, autism, ADD||Unknown||Medication or no treatment|
|Parkinson’s late onset||Unknown, aging, degenerative||Medications|
|Multiple Sclerosis||Unknown autoimmune||Medications|
|Fatigue||Often unknown||No treatment|
This table could continue with more conditions, and you will see the following patterns:
- Conventional medicine has good tools for mechanical “fix it” acute conditions. There is certainly a time and place for this care.
- There aren’t a wide range of tools overall: prescription medication and surgery are the primary tools. Additional medications are used to cover up or ameliorate the side effects of an original prescription.
- You’ll also see that chronic conditions that are due to unknown causes, autoimmunity, genetics, or aging, are not well treated by conventional medicine. There’s a gap there.
Of total healthcare costs in the United States, more than 75% is due to chronic conditions. . . . Our current healthcare model fails to confront both the causes of and solutions for chronic disease and must be replaced with a model of comprehensive care geared to effectively treat and reverse this escalating crisis.
Rescue for Chronic Care with a Functional Systems Approach
Functional Medicine fills in the need for care for the 75% with chronic conditions. These are typically complex conditions requiring a complex systems approach. Functional Medicine is defined as individualized medical care that recognizes the interactions between genetic and environmental factors and between the body’s interconnected systems. It is a bridge between complex systems theory in biology to treating patients in the clinic.
Functional Medicine clinicians are experts at looking at the whole person to understand the interrelated causes of underlying illness. We see your body as an interconnected whole, connected to your lifestyle, environment and the planet. We recognize that in order to treat one part of your body, all other parts and systems must also be considered. Symptoms are a signal that there are root causes to figure out. We are like detectives and each person requires an individual approach.
One very distinct tenet of systems theory and Functional Medicine is the use of models. This model from Introduction to Functional Medicine published by the Institute for Functional Medicine visually shows the individual approach of all systems medicine approaches. For every disease (condition), there are different causes (imbalances). For every cause (imbalance), there are different diseases (conditions).*
Defining Functional Medicine
In a nutshell, when caring for you, a Functional Medicine clinician:
- Takes lifestyle factors (The Amazing Exposome) into account, including diet, exercise, stress management, and sleep.
- Examines the interconnections between your body’s systems instead of focusing on parts.
- Attempts to get to the root of your problem or illness instead of masking symptoms.
If a biological system [a patient] is stable under small changes in its variables, so that it does not change radically when interventions [stresses or perturbations] occur, then it is said to be robust. Generally, complex systems increase in robustness over time because of their ability to organize themselves relative to their environment. Our job as Functional Medicine clinicians is to go far beyond simply masking, hiding, or fixing symptoms of stress or illness, like a dog chasing its tail.
Rather, we need to examine the complex relationships between the whole person and her or his environment, with treatment plans that achieve actual stability and robustness.
The California Center for Functional Medicine has a good list to describe Functional Medicine attributes:
- Investigative. Addresses symptoms by focusing on the underlying cause of the problem, which leads to more profound and longer lasting results.
- Holistic. Envisions the body as an interconnected whole that is in dynamic relationship to its environment, and recognizes the importance of these connections in health and disease.
- Safe. Treatments have mild or no side effects, and other unrelated complaints often improve spontaneously.
- Patient-centered. Treats the patient, not the disease. Treatments are highly individualized based on patient needs.
- Participatory. Patient is respected, empowered, educated and encouraged to play active role in healing process.
- Integrative. Combines the best of both modern and traditional medicines and emphasizes importance of diet and lifestyle.
- Restorative. Tests and treatments designed to promote optimal function, prevent and reverse disease, and improve quality of life.
- Preventative. Guided by the ancient Chinese saying, “The superb physician treats disease before it occurs.”
- Evidence-based. Based on the latest research from peer-reviewed medical journals, and uncorrupted by corporate and political interests.
Nuts and Bolts of Functional Medicine
Who Practices Functional Medicine?
All types of clinicians with a medical license can apply Functional Medicine principles. These people have sound backgrounds in medicine, anatomy, and physiology. Sometimes conventional clinicians incorporate Functional Medicine into their clinic or practice, other times they move outside of the conventional setting to practice solely Functional Medicine. There are clinics and practices devoted to Functional Medicine as the primary methodology. Clinicians include doctors, acupuncturists, nurses, psychiatrists, dentists, and many more.
Functional Medicine is not considered an “alternative”
to conventional allopathic medicine, rather it’s considered “integrative.”
Not either/or, but both. The best of both worlds.
What Kind of Training and Licensing is There for Functional Medicine?
At this time (May, 2016), there are only a handful of reputable Functional Medicine training programs in the United States. These training programs are designed as advanced trainings for medical clinicians. There is no licensing for Functional Medicine clinicians; however clinicians who do practice Functional Medicine have usually completed a training program, and may have a certification from that training program. They also have a prior medical license in their area of practice beyond Functional Medicine.
What Can I Expect From Functional Medicine Care?
Expect that your practitioner will take a very thorough medical history that includes things you may have never been asked about, such as childhood events, and details about your diet, stress, or sleep habits. Expect your practitioner to spend more time with you than your conventional doctor. You’ll be able to provide in-depth information, and you will be listened to. You will be treated as an individual, and your case will be studied before a plan is recommended. You will probably be prescribed research-based lab work that provides information about your digestive function, your intestinal microbiota, your hormones and nutrient status. Your treatment plan can include changes in diet, movement and exercise, stress management, and sleep practices. All recommendations will be based on your individual findings, not a one-size-fits-all plan. Often many health concerns and nagging symptoms will resolve with these changes alone. If not, your practitioner will dig in to discover deeper root causes of your symptoms. She may order more lab work, or use research-based medicinals based on her medical background. These can include supplements, herbal remedies, and medications, along with other treatment recommendations.
Who Should Get Functional Medicine Treatment?
Everyone can benefit from Functional Medicine, by improving wellness and vitality, and reducing risks of future illness. Many diseases believed to be inevitable because of aging or genetics are actually preventable. Relatively healthy people come because they want to learn more about how to improve their diet and lifestyle, and what supplements to take, if any. If you have nagging health concerns or symptoms, such as allergies, chronic sinus congestion, digestive complaints, low energy, aches and pains, and more, Functional Medicine can be a standalone approach to resolve the cause of many of these symptoms. Many people come seeking for a way to resolve symptoms without resorting to prescription medication, or to get off prescription medication. Western pharmaceuticals can be a slippery slope, because they usually only mask symptoms, while causing more symptoms (side effects) as well as nutrient deficiencies. In cases of chronic or acute illness, Functional Medicine can be a great adjunct to Conventional Medicine.
How Do I Find a Functional Medicine Clinician?
You can find a clinician the same way you find any type of clinician. You can ask people you know, such as other medical professionals or trusted friends, for referrals. You can search on the Internet, usually searching the terms “functional medicine” and “your city.” Then you can look at websites that come up. You should review the clinician’s background, Functional Medicine education, experience, and treatment philosophy. You should also go by your feel for the person, as the relationship between patient and practitioner is important. Just as in every medical practice, no two practitioners are alike, and you need to find one that fits.
My personal recommendations are to find a practitioner who:
- Has a professional, easy to navigate website, which lists her or his credentials.
- Combines Functional medicine with a deep knowledge of evolutionary, ancestral nutrition.
- Emphasizes food as a primary sources of nutrients, and is minimal with prescribing supplements
- Conducts all patient communication and record keeping with private, HIPPA compliant practices
- Offers clear information and transparency about all fees
- Provides excellent, clear customer service
- Has completed a solid Functional Medicine training program
- Has a solid medical license, with Functional Medicine as additional training
My bias is to recommend practitioners who have studied at the Kresser Institute. The approach taught at the Kresser Institute is thorough and logical. There’s a strong emphasis on improving the foundations of your lifestyle: sleep, stress management, evolutionary diet, and movement/exercise. Lastly, the Functional Medicine practices taught at the Kresser Institute are all rigorously research-based. I also have a preference towards practitioners who work with you directly, rather than assigning their staff to work with you.