Functional medicine versus dysfunctional medicine

Dr. Eric Potter  ·  Apr 30, 2018

Functional or dysfunctional medicine?  Easy choice right?  Who wants dysfunctional medicine? By definition, it does not work. But, what makes a medical model “functional”?  If only the answer was simple. Wait, it is simple. Functional medicine works by getting patients back to living a healthier, more abundant life through the best of natural and conventional medicine aimed at root causes while treating the patient as an interconnected whole—simple but not simplistic.

Let’s walk through what my imaginary, yet average patient, “Mrs. Jill,” experiences in the dysfunctional conventional world. Jill is a 40-year-old fatigued patient, tired of not only her chronic stomach issues, but the way she is treated by the 10 well-meaning doctors she has seen over the years. Her visits have been quick, disjointed, and non-productive affairs. She still has no diagnosis or relief. Some of the medicines she has been told to try have actually made her worse. She has given up on most of them. All the standard tests, even a stomach scope, yielded nothing significant. Now eight years into this chronic mess, she struggles with additional weight around the hips along with intense menstrual cramping. The specialists can only agree on two things: that they don’t know what is wrong and that the gut and other systemic issues are not connected. No one seems interested in the big picture here.

Jill runs out of conventional specialists and decides to take a different approach with a functional medicine M.D. Maybe this M.D. will be able to put some of things together for her. After all, this functional M.D. has requested her past records so her case can be reviewed prior to the visit. In addition, the pre-visit questionnaire strikes her as refreshingly extensive. She realizes just how much further this one goes into each area of her life. She dutifully answers questions about the composition of her diet. How much wheat and dairy? She thoughtfully answers questions about how many courses of antibiotics she has taken over the span of her life. Was she a C-section and was she breast-fed?  The questionnaire asks and she calls her mom to verify the answers. This whole experience is becoming rather surreal. This functional M.D. will know a lot of information about her before they even meet.

The appointment day finally comes, none too soon. She arrives early for her 90-minute initial visit, wondering what would fill a 90-minute visit. Normally, she would try to get her top two or three concerns out, but now she has all this time. Oddly, the waiting room is not filled with a crowd of people checking their watches. Then, the nurse brings her back to an exam room for a final informational review and the standard vital signs. This is another reminder of the 10 extra pounds she has collected in the preceding six months. That part is all too familiar. 

After the nurse leaves, Jill glances around for the usual pharmaceutical propaganda promises. It’s not there. Then she is startled by knock on the clinic room door. Dr. Functional enters and introduces himself. After a short description of the visit plan, Dr. Functional asks Jill to start at the beginning with her story. With a few questions from the doctor, Jill spends 30 or 40 minutes describing her disappointing path toward wellness. This time she gets to tell the whole story.

Dr. Functional continues the dialogue with a review of that detailed pre-visit questionnaire. As he walks through her life story, he explains that birth by C-section alters a patient’s gut bacteria later in life. He continues describing how multiple rounds of antibiotics in the childhood years can further disrupt gut bacterial balance. He turns to dietary habits and explains how her low fiber, high dairy, high sugar diet almost guarantees gut problems by this time in her life. Dr. Functional definitely has her attention. She’s beginning to understand her body. Finishing the story of her health, Dr. Functional hints at more connections.

Dr. Functional asks Jill to sit on the exam table to run over a few physical findings—clues.  She expects the usual and brief exam. Interestingly, Dr. Functional methodically works down from her eyes, through a detailed exam of her mouth and teeth, then her thyroid, skin stretch, fingernails, joints, skin moisture, a detailed neurologic exam including a tuning fork buzzing her joints. Of course, the heart, lungs, and abdomen receive their due attention. This is definitely more detailed.

They return to their seats and Dr. Functional begins. “Thank you Mrs. Smith for this opportunity to be a part of your healing journey. Let’s discuss the big picture of your health as we relate the details together. First, being a C-section baby and receiving multiple antibiotic rounds as a child set your gut up for imbalances and maybe yeast overgrowth. By the time you were in your 30s, your diet of inflammatory foods had a few years to make this even worse. The stress of motherhood, lack of sleep, fast food, and little time for exercise took a toll on your body. Your defenses against the gut inflammation and imbalance began opening the walls of your intestines for both food proteins and bacterial chemicals to cross the threshold leading to inflammation. The unhappy intestinal lining and surrounding muscles responded with many of the expected symptoms of pain, bloating, occasional nausea, and diarrhea. Because the changes in your gut cannot be seen with scopes, your gut looked normal to the GI specialist. We have some advanced tests that help us confirm this situation and guide how to treat your issues specifically. These tests look at the extensiveness of your leaky gut and whether food sensitivities, parasites, or yeast may be contributing to your overall picture. 

“Earlier I mentioned that I would surprise you with other connections. Women with leaky gut and bacterial imbalances (called dysbiosis) often experience hormone imbalances. These may be simple cramps and irregular cycles, or polycystic ovaries, fibroids, and infertility. Basically, the inflammation from the gut spills over and bathes the ovaries with inflammatory hormones. This means that your gut issues are likely causing your hormones issues. Let’s take this two steps further. First, these hormones and the inflammation in the gut trigger weight gain through interacting with other hormones. Depending on whether the inflammation or the hormones are stronger, the weight may settle in the waist or the hips respectively. Second, inflammation and hormones combine forces to affect energy levels. Because inflammation triggers higher cortisol from your adrenal glands, you are experiencing chronic fatigue from chronic elevation of cortisol.

“So, your symptoms have a cause rooted in your life both present and past. By recognizing this root cause in your gut, we can target therapies that have far-reaching benefits for you. We will start with a few tests. At your next visit, we will discuss how these tests impact your treatment program. The treatment program will address nutrition and other lifestyle factors as well as supplements that will restore proper functioning to your GI and hormonal systems. My last question is, “Are you ready to move towards a healthier more abundant life?’”

Finally, someone interested in the whole picture. Jill gets a twinkle in her eye as she says “yes.” In the coming months, she works hard to clean up her daily nutrition and follow the program. Month by month, progress builds. It seems slow at first, she begins to doubt, but she keeps pressing. As the changes take hold, so does her hope.  One morning she wakes and says, “Yes, I am beating this. Functional Medicine has helped me to function again, to live a healthier life.” 

Samaritan member Dr. Eric Potter is the founder of Sanctuary Functional Medicine, a Direct Primary Care in Franklin, Tennessee.

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