If you spend much time reading about health and nutrition issues, it is likely that you have come across the term ‘Functional Medicine’. Functional Medicine has been described as a paradigm shift in healthcare (1) and is a different approach to treating chronic health conditions than the standard medical model. As a qualified Functional Medicine practitioner, I have seen first-hand how people’s health can be improved. Functional Medicine offers valuable approaches to health, particularly in areas that may be overlooked by conventional medicine, such as personalised nutrition, root-cause analysis, and lifestyle interventions.
However, it is important to approach it with balance and discernment. While it can provide powerful tools for addressing chronic issues and promoting overall well-being, it should not be viewed as the sole solution. I believe it's crucial to combine evidence-based practices from both functional and conventional medicine, and to remain critical of any approach that presents itself as a one-size-fits-all or definitive solution to complex health issues.
What is Functional Medicine?
Functional Medicine focuses on identifying and addressing the root causes of disease, rather than just treating symptoms. It is important to understand that it does not seek to replace traditional medicine, but to complement it by looking at the areas traditional medicine does not adequately address. Traditional western medicine often has a focus on treating conditions via surgery or pharmacology, while Functional Medicine attempts to identify and remove the factors that might be perpetuating a person’s poor health. While the NHS in the UK recognises the importance of addressing root causes, budget and resource considerations mean that it is often not possible to implement this (2).
Functional Medicine may not be suitable for every health condition, but has been found to be particularly effective in treating chronic conditions, such as diabetes, autoimmune disorders, and digestive issues (3). If you decide to visit a Functional Medicine practitioner, they will strive to create a personalised protocol that considers your unique genetics, environment and lifestyle factors. A responsible Functional Medicine practitioner will never steer you away from seeing your doctor or following their advice, but will use a combination of traditional medicine, nutrition, exercise, and other therapies to promote overall health and well-being. The goal is to identify where one or more of the body’s systems, such as digestive, immune or hormonal, has become imbalanced and seek to support this with targeted adjustments.
What are the Benefits of Functional Medicine?
As discussed above, Functional Medicine seeks to target the root causes of health issues, suggesting that health benefits are likely to be long term. Because the changes and protocols usually involve making healthy lifestyle changes, a protocol will often result in better overall health, in addition to addressing the patient’s particular area of concern (4).
A Functional Medicine practitioner will spend much longer with a patient than a GP could, giving them time to really understand the patient’s background, environment and lifestyle. This can uncover important information about what might be causing a bodily system to malfunction that might not be noticed by a GP who has often at least another twenty patients to see that day.
Functional Medicine may help metabolic function via targeted nutrition (5). Metabolic dysfunction is associated with various health issues, often related to the body's ability to regulate energy, blood sugar, and fat storage. Some common health issues linked to metabolic dysfunction include obesity, type-2 diabetes, liver disease, cardiovascular disease, polycystic ovary syndrome, hormonal imbalance and some cancers.
A 2020 study into the use of Functional Medicine to treat inflammatory arthritis over a 12-week period, alongside standard treatment, found the approach to have a greater level of pain reduction and overall physical health improvement compared to a control group (6). A further study that used a Functional Medicine approach to treat patients with Hashimoto’s (a type of autoimmune disorder that affects the thyroid gland and often leads to hypothyroidism) found the patients reported a significantly improved quality of life, including noticeable symptom reduction.
Criticisms of Functional Medicine
Functional Medicine is not without its critics, who have highlighted several issues with the approach. I am going to list the main criticisms here, along with my personal reflections on these, as a Functional Medicine practitioner myself.
There is a Lack of Evidence That it Works
Many people have highlighted the lack of randomised control trials or systematic reviews that could provide an evidence base to support the use of Functional Medicine, which is certainly an issue. When researching this article, I was able to locate some small-scale studies that showed promising results. However, they are too few and with too small a sample size to give adequate reassurance, showing mixed results. While there is currently a lack of large-scale, evidence-based studies on the functional medicine model as a whole, there is research supporting many of its individual components. The field is also likely to see more studies in the future as the demand for personalised, preventive healthcare grows, and institutions begin to invest more in research on holistic approaches.
Although the lack of research may be an issue, I want to highlight that the data does not demonstrate that Functional Medicine doesn’t work, it is just that the data isn’t there. My own clinical experience is that when people make changes to poor nutrition and lifestyle habits by improving sleep, moving more, addressing stress and improving the quality of their food choices, these changes support any healing protocol and clients often do report positive health outcomes and feeling overall better.
There is a Lack of Standardised Protocols
This criticism is actually a double-edged sword. Medical institutions, such as the NHS in the UK, have standardised treatments with a limited leeway for doctors to make judgement calls. This means that, in theory, every patient should expect the same level of care, regardless of which doctor they see. On the other hand, humans are incredibly complex and a one-size-fits-all approach may not be suitable for everyone.
Functional Medicine attempts to address this by treating each patient as an individual with unique needs and issues. In my experience, this can be helpful as I am able to draw on the most up-to-date evidence and create a tailored plan for each client without waiting for the green light from an over-sized institution. The downside for me is that I often meet with clients who have been through several practitioners and have received completely different protocols, often with expensive tests and supplements, based on each practitioner’s own beliefs and research.
There is an Over-Reliance on Testing and Supplements
Functional Medicine often relies heavily on testing, such as tests for food sensitivities, hormone levels, gut microbiome analysis, genetic testing, and more. The interpretation of these tests can vary significantly among practitioners. For example, some might emphasise the role of certain biomarkers that are not widely recognised or validated within mainstream medicine, leading to different diagnoses and treatment plans for similar symptoms.
While I do use a limited amount of testing with my clients, I find that it is easy to be fixated on markers and get swamped with data, making a course of action unclear. Testing can also be very expensive, which is fine if you can afford the outlay, but my ethos is that good health should be for everyone and so I will never recommend a test unless I believe it is necessary.
The same can be said for supplements. It is not uncommon for a client to have a deficiency that is contributing to a chronic health condition, but that is usually only part of the picture and in many cases, the answer is to adopt a more holistically healthy lifestyle with a balanced diet, rather than substituting expensive supplements.
Too Much Time, Effort and Money Can Be Spent Trying to Identify Root Cause/s
While root cause identification is a valuable concept in Functional Medicine, it’s essential to strike a balance. In complex or chronic cases, where the root cause may never be fully identified, focusing on improving nutrition, addressing lifestyle factors, and removing barriers to healing (like toxins and infections) can be a more pragmatic and effective approach. By avoiding excessive focus on uncovering the root cause, the patient can focus on actionable steps that promote overall healing and well-being, rather than spending excessive time, money, and effort chasing an elusive root cause.
My Approach
As both a qualified Nutritional Therapist and certified Functional Medicine practitioner, my approach is as follows:
Build strong foundations and start with the pillars of good health: diet and nutrition, sleep, exercise and stress coping mechanisms.
Identify which of the tests is most appropriate for my client. My go-to tests are:
A Good Comprehensive Stool Test: A comprehensive stool test like the Genova GI Effects provides a thorough evaluation of gut health by analysing the microbiome, digestive function, inflammation, immune response, and detoxification processes. It offers valuable information to identify imbalances and dysfunction that contribute to digestive issues, systemic inflammation, and overall health, allowing for personalised, targeted interventions to support gut and overall well-being.
The Dutch Complete Hormone test: It is a popular test used to assess a wide range of hormone levels. This test measures sex hormones (like estrogen, progesterone, testosterone), adrenal hormones (like cortisol and DHEA), and their metabolites to provide a detailed picture of hormonal balance.
The Organic Acid Test (OAT): This test offers a comprehensive assessment of metabolic health by evaluating gut function, mitochondrial energy production, nutritional status, neurotransmitter balance, detoxification pathways, and oxidative stress. It is a powerful tool for identifying hidden imbalances that contribute to chronic conditions and allows for targeted interventions to optimise health. Importantly, it can also help detect mould exposure by measuring specific organic acids that are byproducts of fungal and mould metabolism. These markers indicate whether a person has been exposed to mould or has an overgrowth of mould in the body, particularly in the gut. The OAT is especially beneficial for people with complex, unresolved health issues, fatigue, gut dysbiosis, or mood disorders.
Standard Blood Markers: I have been extensively trained in interpreting the results of blood tests. It is important to give significant credibility to blood markers in health assessments as standard blood tests offer reliable, evidence-based insights into an individual's health status. These markers can reveal critical information about metabolic health, inflammation, organ function, and more, and should not be disregarded in favour of newer or alternative testing methods.
By focusing on these foundational blood markers, we can make data-driven decisions to address underlying health concerns effectively. If client’s have already had blood tests with their GP before consulting me, I always use these results as a guideline as to whether it may be necessary to go deeper into one or more specific areas. Functional Medicine blood tests typically test more markers and go deeper into specific areas related to nutrition, metabolism, hormones, inflammation, and gut health. This broader range of testing allows Functional Medicine practitioners to identify underlying imbalances or early signs of dysfunction that might be missed with standard conventional tests, thus offering a more comprehensive approach to health assessment. Functional Medicine also often uses tighter reference ranges when analysing blood markers compared to the broader reference ranges used in conventional medicine. This approach aims to identify potential imbalances or suboptimal health conditions before they develop into more serious illnesses helping to detect subclinical imbalances and to focus on optimal health rather than just preventing disease.
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