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Spotting Signals: Identifying Red Flags in the New Age of Functional Medicine Experts

As someone who has undergone extensive training in various fields such as mainstream medicine, integrative approaches, lifestyle medicine, and functional medicine (a journey spanning 10 years and significant financial investment in educational courses), I find myself grappling with what I like to call "diplomatosis." It's a term coined by one of my relatives, humorously referring to doctors who possess an abundance of diplomas, far surpassing the available wall space for display.

Oh, and let's not overlook the fact that I've also received training in aesthetic medicine, which forms another essential aspect of my practice.

I am not discussing this topic to boast about my accomplishments. Rather, it is my extensive experience and training in these various modalities that drive me to address certain adverse outcomes individuals have encountered while seeking to address underlying causes and enhance their well-being. My intention is to provide valuable insights into the factors contributing to negative experiences within the realm of health and offer guidance on recognizing red flags to ensure a more informed journey.

It is important for me to acknowledge that the patients I encounter exhibit a self-selected bias, as they typically possess good health, demonstrate a willingness and capacity to invest in their well-being, and seek a deeper understanding of how to enhance their healthspan. Additionally, there are patients who have chronic yet stable conditions and express a desire to delve deeper into holistic approaches to addressing their overall health.

With functional medicine emerging as a contemporary iteration of holistic medicine, it has undergone commercialization and extensive marketing as an alternative to mainstream medical approaches. However, due to the lack of rigorous oversight, it is crucial for individuals to exercise their own due diligence when engaging with functional medicine practices.

Let's briefly identify the common philosophies adopted by functional medicine practitioners or practices:

  1. Individualized Approach: Functional medicine emphasizes personalized care, recognizing that each person's health needs are unique. It seeks to understand the underlying root causes of health issues specific to an individual rather than merely treating symptoms.

  2. Holistic Perspective: A holistic viewpoint is central to functional medicine, recognizing the interconnectedness of various systems within the body and the influence of lifestyle factors, genetics, environment, and mental well-being on overall health.

  3. Systems Thinking: Functional medicine adopts a systems-oriented approach, considering the complex interactions between different bodily systems and how imbalances in one area can impact other areas.

  4. Patient Empowerment: Functional medicine places a strong emphasis on patient participation and empowerment in the healing process. It encourages patients to take an active role in their health, making informed decisions and adopting lifestyle changes to support well-being.

  5. Root Cause Investigation: Instead of solely addressing symptoms, functional medicine aims to identify and address the underlying root causes of health conditions. This involves thorough assessments, and exploring factors such as diet, stress, toxins, infections, and imbalances in bodily systems.

  6. Integrative Therapies: Functional medicine embraces a wide range of therapeutic approaches, combining conventional medicine with evidence-based complementary and alternative therapies. This may include nutrition, supplements, lifestyle modifications, stress management techniques, and mind-body interventions.

It's important to note that functional medicine is a diverse field, and specific approaches and philosophies may vary among practitioners.

The aforementioned principles are ideals that I firmly believe are also upheld in mainstream medicine, both during medical school education and in the way we are trained to practice clinically to this day.

Nevertheless, it is important to acknowledge that the tools, resources, and structural framework within which mainstream medicine operates tend to prioritize acute disease care over addressing the escalating prevalence of chronic lifestyle conditions that are increasingly prevalent in our society today.

If you were to consult any ethical medical practitioner, their dedication to serving and enhancing health would stem from a genuine desire to make a positive impact rather than being driven solely by academic achievements, financial gain, family expectations, or societal status. By exploring their vision of an ideal world, you would discover that it aligns, in various ways, with the six principles mentioned earlier—albeit expressed through different terminologies and perspectives.

Examining the factors behind the limited adoption of these principles in mainstream practice is a multifaceted issue that merits further discussion, as the answer extends beyond a mere lack of desire and is beyond the scope of this topic. (A related blog here). Maybe in a future blog post, I could share my personal experiences, looking through the lens of a doctor, regarding the challenges I've encountered in promoting its growth and progress.

Now, let's circle back to the six principles in functional medicine and dive into the potential pitfalls or red flags associated with each of them.

  1. The Individualized Approach: aims to identify the drivers and triggers of poor health or symptoms and address these instead of treating symptoms. However, a common observation is that many patients, by the time they consult with me, have amassed an average list of 15 supplements, each recommended as a remedy for a specific "root cause," with no clear endpoint in sight. I refer to this phenomenon as 'green medicine' in contrast to 'polypharmacy.' The concern lies in the assumption that consuming 'natural supplements' is inherently safe, devoid of side effects or interactions, and equally effective as standard care. As I run through this list of supplements, there are often interactions within each, with existing medications and health conditions that have not been highlighted or addressed.

  2. Holistic Perspective: doesn't necessitate elaborate and costly testing for every individual symptom. Mainstream medicine emphasizes the judicious use of laboratory testing as a supplementary tool, not a substitute for a comprehensive clinical evaluation. We recognize the limitations of false positives, false negatives, and predictive values associated with tests. Thus, there exists a systematic approach to assess the relevance of each test in contributing to a diagnosis, rather than employing a haphazard "spray and pray" method of problem-solving.

  3. Systems Thinking: while acknowledging the intricacies of the human body is crucial, adopting a linear perspective that attributes all symptoms to a single system, without comprehending the physiological hierarchy of homeostasis and the progression of pathology, can impede timely access to medical care, accurate diagnosis, and, in certain cases, exacerbate underlying pathological processes. Examples include missing bowel symptoms as food allergies when it is in fact an inflammatory bowel disease requiring a diagnostic colonoscopy. Another case I have seen is extreme carbohydrate restriction and a high-fat diet without monitoring for elevations in cholesterol, and lipoproteins and fully assessing cardiometabolic risks such as blood pressure, visceral adiposity and the presence of coronary artery disease.

  4. Patient Empowerment: Individuals grappling with chronic diseases often find themselves in vulnerable situations, and not everyone possesses the means to avoid certain food groups and consume organic or whole foods exclusively. The quest for optimal health should not be reserved solely for the privileged few. Empowerment does not entail imposing rigid rules, dispensing complex advice or complicated protocols; rather, it involves identifying the resources accessible to each person and nurturing their potential and capability to embrace behavioural changes.

  5. Root Cause Investigation: this ties in with point 2 and spending time required to take a careful history and if appropriate physical examination. Decades ago, one medical professor, before our short and long case viva voce exams, would tell us that you should be able to identify your working hypothesis 80-90% of the time without labs (as they didn't even have some of the conventional labs back then). We were not presented with the labs in these exams, just the patient and we had to spend 30 minutes discussing our diagnosis, differentials and management strategies. In his opinion, a good clinician will use tests to confirm, refute or monitor their assessment and therapies. Consider what value a test can have in your specific context, how it changes or improves the management of your condition and explore the alternatives. Adopt the precision of a sniper with investigations, not a landmine. This is especially true with many commercially available home test kits recommended without any clinical acumen, all promising insights that will allow you to personalise your approach. Would you have benefited from these changes anyway without the test?

  6. Integrative Therapies: complementary and alternative therapies are recognized as adjunctive approaches within mainstream medicine. However, their effectiveness is carefully evaluated in comparison to other available treatments, and doctors adhere to guidelines, that exist when recommending these therapies based on the severity and gravity of a person's condition. But outside of this, it's important to be cautious when evaluating information from marketing claims, news outlets, and media, as these sources may not provide reliable evidence of treatment efficacy (even if they are referenced, it's essential to verify their validity). Since there are no statutory regulations in place, if something appears magical or too good to be true, it is likely advisable to approach it with scepticism. When considering such therapies, it is crucial to have discussions that encompass relevant research, potential risks and benefits specific to your situation. If a provider lacks the necessary expertise to discuss medical therapies, they should offer to refer you to a qualified professional. Mainstream medicine recognizes the significance of this referral system and respects the scope of practice of each discipline. Integrative care for patients with chronic diseases or complex conditions is well structured with appropriate referrals, where professionals such as dietitians, specialists, physical therapists, psychologists, and social care workers play vital roles.

Lastly, let's touch upon another modern term that is often marketed as a shortcut to achieving optimal health: biohacking. While there are certain beneficial aspects of biohacking related to sleep and other lifestyle factors—such as maintaining a regular sleep schedule, spending time outdoors during daylight, or adjusting room temperature to promote wakefulness—there are also elements that rely on expensive, extravagant, and often exclusive methods that are beyond the reach of most people's financial means and time constraints, especially considering their already hectic schedules. I have not come across any scientific evidence suggesting that these strategies are equivalent to, or superior to, mastering the fundamental principles of health. In addition, they tend to come with higher price tags and are often presented as innovative without strong scientific foundations to support their claims.

I want to reiterate that I hold no reservations regarding the principles that underpin health, chronic disease management, or health optimization. I do not oppose the practice of functional, integrative, or holistic medicine. These approaches encompass distinct methodologies and techniques. However, it is crucial to exercise caution in their application, considering that this is an unregulated domain.

Holistic or functional medicine should not be characterized by novelty, extravagance, or exclusivity, which may make it less appealing for marketing and sensationalization.

It would be a pity to disregard the opportunity it brings to implement the fundamentals of a healthy lifestyle. At the same time, we desperately need a shift in mainstream medicine so that it can reclaim the term holistic care. Both mainstream and holistic medicine fundamentally embrace the biopsychosocial aspects of achieving optimal health. I hope this discussion helps you to steer clear of the pitfalls that I have observed many patients encounter and at the same time broaden your perspective on two seemingly exclusive tools of approaching health.

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