Functional Medicine

Somebody posted a link to a video about functional medicine in another thread on the boards and I found it extremely interesting. I am curious if anybody has tried it and what your results were?

I am thinking of going to a local functional medicine clinic but I will have to pay out of pocket then get reimbursement for out-of-network benefits with insurance. I don't want to waste money but I am open to any help I can get at this point.

Any input would be greatly appreciated.

Link to video if you're interested:

My psychiatrist works from a functional medicine perspective, and it's been really helpful for me. I live with chronic physical illness as well, and I've really appreciated that he looks at me as an entire person. I have these specialists who look at just one narrow part of me, but his broader approach has been really useful. He's identified problems that none of my specialists have.

I do sometimes get frustrated because he often recommends alternative treatments and supplements I can't afford, but he's also cut me deals on stuff because he can get it at wholesale price and sell it to me at cost. But there are things he's prescribed me that have helped immensely, but I can no longer afford them. So just be aware that that might happen.

Yes, I expect this to happen but I really have exhausted many possible treatments and I'm willing to try nearly anything at this point.

I am trying to find a good holistic pdoc but haven't had luck finding a true practicing holistic one. I went to a few who claimed to be and the first word out of their mouth was Prozac, WTF?

Well, I can't speak for all functional medicine docs, but mine is not entirely opposed to mainstream medicine, including psych meds. He's tried me on a couple of antidepressants that have come out in the last few years, but I've found that he's much more willing to accept that psych meds don't work for me. All the other psychiatrists I've had just kept insisting that we hadn't found the right combination yet, despite my having been on psych meds since age 5 and having been on almost everything on the US market. I can't even remember the last time my current doc suggested psych meds to me.

I also feel like he involves me in my treatment much more than most doctors. (To be fair, my mainstream gastroenterologist is great at this too.) My experience with most doctors, particularly psychiatrists, is that they tend to be dictatorial, and they get threatened if you suggest things. And god forbid if you mention going off psych meds to any of them! But my doc is really respectful of my knowledge and recognizes that I'm the best judge of what will and won't work for me. That's been incredibly valuable.

I find that I have a different experience with pdocs. They are all open to my suggestions and never force anything on me. Actually I do so much of dictating that I feel they are incompetent and a waste of money. Although I needed them to write the script I guess.

I'm just tired of that... I need to see a doc that will give me a better solution then give me a treatment plan. So far I feel like I have to do all the work in that regard.

I do not in the least intend this to be challenging but as far as I can see "functional medicine" is just one of the many and mutually exclusive versions of comp/alt med.

I confess that my BS detector quivers when a health practitioner uses a question-begging term like "functional medicine" to describe their approach.

A question for you to ponder:

Do you know of any health practitioners who advocate "dysfunctional medicine" or "non-functional medicine"?

Caveat emptor.

"Functional medicine" just means that it focuses on restoring proper physiological function. It's not calling other types of medicine dysfunctional.

Well functional medicine is just looking at the root cause of your issues and not focusing on treating the symptoms. They still use traditional medicine if needed. They view the body as a whole system and treat it as such to get everything in balance.

Dr Hyman has a Web site with a very pretentious and question-begging label: "The UltraWellness Center". It is not common for evidence-based health professionals to use pretentious and question-begging labels like that for their Web sites.

His site includes a "Patient Store" in which members are very kindly given a chance of buying various "nutritional supplements".

How important consuming nutritional supplements (unless of course they have been recommended by an evidence-based health professional like a dietitian) may be to the concept of "Functional Medicine" is outside my knowledge.

Well, you could say that the mainstream psychiatry fails so many it could be considered dysfunctional.... eh

The good doctor has been hired by the Cleveland Clinic to head a new dept. Center for Functional Medicine. That gives him a lot of street cred in my view.

Mark Hyman, MD - Center for Functional Medicine, Cleveland Clinic

Determining root causes is the tricky part.

Yes I can see that being difficult but if you run all the labs they say they can run maybe it becomes more clear.. especially when focusing on the whole body instead of one area of specialty. I don't know if it will help but at this point I'm willing to try almost anything. ECT is a very scary thought but might become my reality. I really hope not and i'll do what ever I can to prevent that.

I watch Dr. Hyman and other professionals like himself on public television stations. It is true that each of them is earning a ton of money from their books, internet programs, supplements, and other products. My solution to all of this, because I really like their message..... don't buy into their products. I don't have a problem with them making money at the same time they are providing a valuable service AND changing the way traditional medicine approaches things like mental health.

Tell me this... when you were diagnosed with a mental health disorder, did your primary care physician run a series of medical tests on you first to rule out any other physical issues that could be causing some of your symptoms, including nutritional deficiencies? That is one of the major differences you will find between functional medicine and traditional medicine.

That's the thing... they didn't run any tests. I filled out a short questionnaire, maybe 20 questions. After that she told me I'd be on medicine for the rest of my life and sent me home with a script for Celexa and I went on my marry way for 11 years. I was 20 at the time and very naive. Although since it "fixed" me I didn't question it or what the repercussions might be. Now after 11 years I can't take that medicine anymore, let alone any other conventional antidepressants so now I'm in this predicament.

That is why I think functional medicine might be a better route now. I think it would be useful to run a series of tests to see if I have an imbalance somewhere (providing the tests are accurate). If I am, then I can feel more confident about following a treatment plan. At least then it's based on something other than opinion.

I would like to know which labs they run? Besides thyroid which should be standard along with a standard blood panel. At least all my pdocs have ordered that.

Sent from my iPhone using Tapatalk

May I ask why you are unable to take any antidepressant anymore?

My comment about the testing was that a typical traditional doctor will just ask some questions and treat you for depression, but a functional medicine doctor wants to see how your whole body is working together, so they are going to run a lot of tests first, including ones to see if you have any nutritional deficiencies. I love my primary doctor, but she is your typical traditional doctor. I haven't left because she is practically my therapist, lol.

Dr. Hyman is going to change your whole diet first. Food is medicine.

One example I think is important about the difference is if you have a thyroid disorder. Your treatment will be different with functional medicine, addressing both T3 and T4. Typically, a traditional doctor will only address T4. Since thyroid dysfunction can contribute to mood dysregulation, this could be an important reason to consider functional medicine.

When I was diagnosed with severe Major Depressive Disorder I (at the suggestion of my psychiatrist) spent about a month IP. The first week of that entailed a very detailed clinical examination, including investigation of my nutritional status. Nothing of clinical interest emerged from that examination.

That is just evidence-based medicine in action. With respect, I think that you are making a false dichotomy between "functional medicine" and "traditional medicine" - there is just evidence-based medicine.

Making a more general point, eating in a healthy way (minimal junk food, lots of fresh fruit, vegetables, whole-grain products, animal protein in moderation, etc) is good for both physical and mental health.

Dietitians are evidence-based health professionals who can offer their clients advice about healthy eating. That might (if indicated) include taking nutritional supplements.

The contrast is with self-medication (buying nutritional supplements from Web sites like Dr Hyman's among many others). I don't think that self-medication is a good idea.

A dichotomy??? Two separate and usually opposing forces? With respect, I believe that functional medicine is an approach to medicine, just as to use the term "traditional" medicine in the United States in an approach to medicine. It is not a separate medical profession. You are correct, there is just evidence based medicine, and when you get the experts to agree, let me know.

I suspect that we are in substantial agreement.

As part of my day job I teach medical students in their pre-clinical years. This involves supervising a group of them while they consider case-notes about a hypothetical patient. The process takes about 8 hours and is spread over a couple of days.

Their first job is to discuss the clinical evidence, decide what additional investigations might be indicated and consider whether the patient should be referred to a specialist (psychiatrist, endocrinologist, dietitian...). They are actively encouraged to use *all* that they have learned (anatomy, biochemistry, immunology, pharmacology, physiology...) in that process.

At the end of the process, having thought about *all* of the data, they come up with a possible Dx and suggest possible treatment.

If a student jumps to conclusions ("Oh, that is easy, just prescribe drug X or recommend nutritional supplement Y - can we go home now?" then my job is to tell him/her to go back to square one and look at *all* of the data.

The meaningless distinction between "functional medicine" and "traditional medicine" is irrelevant in this process - it is training future GPs in the skills of evidence-based medicine.

But I am not interested in debating the "meaningless" distinction between functional medicine and traditional medicine with you. That debate is meaningless to me for the reason I am in this forum.

In the United States, it is my opinion, that if you want to go back to the beginning and look at it all over again because what you have done isn't working anymore, and the experts in your life do not have the answers, then your best bet is to pay out of pocket and to go to an evidence based trained physician who practices with a functional medicine approach.

The fact that the Cleveland Clinic would take him on and open a department seems to say they think there is something different about his approach. I suspect much more focused on nutrition. I have a lot of respect for the Cleveland Clinic. We will see how his trials go and his claims.

Cleveland Clinic to open Center for Functional Medicine; Dr. Mark Hyman to be director | cleveland.com

I am not sure what the distinction is here. I would think any physician would want to get to core causes and not just focus on symptoms and use evidence based medicine. Without symptoms how do you have any evidence that will put you on a path to discovering core causes?

I believe that physicians want to get to the core causes, but there is a debate over how to do that or what is necessary. In the United States, when you go to your primary physician under insurance and report symptoms of a mental health issue, they are going to try to figure out the diagnosis and prescribe medication. Before they do that, they are going to give you the standard blood work and most likely run a thyroid test on you if your symptoms are that of depression. Tests I believe you noted in a previous post.

A more thorough general practitioner is going to go deeper than that, and rule out other issues that may not be included within our standard blood work. The problem is that most insurances will not pay for the extra labwork or your doctor is going to have to jump through loop holes. I personally believe that our standard protocol is driven by insurance companies with lots of money and their own experts to keep insisting on what evidence we should be following while ignoring any contradictory evidence.

There are also debates because evidence, research, can also be interpreted differently. Vitamin E use to be prescribed to ease the effects of antipsychotics, then there was a controversy over whether using Vitamin E could be dangerous. I don't know what the recommendations are today.

There is also a controversy over what the standard treatment for thyroid disorder should look like. Presently our traditional doctors will test for T4 as I stated in an earlier post. There is evidence that supports testing for both T3 and T4, but there is a debate on whether or not this is necessary. In our community, when symptoms don't seem to abate, then it may be worth looking at T3. However, you will have a hard time convincing most primary care physicians to break protocol.

There are many deficiences in nutrition that could also produce symptoms that appear to be depression...Zinc, Folate, Chromium, Iron, Vitamin D, Vitamin B, etc.

I keep reading or hearing that most Americans are deficient in Vitamin D. I had been treated for depression for years before it was realized that I actually have bipolar II disorder when I had a breakdown. It has been an awful struggle. I couldn't get anyone to hear that the antidepressants made me feel worse, not better, because I would go from not being able to get out of bed, to having energy (of the agitated irritable type). I still felt depressed. It turns out that the antidepressants were throwing me into a mixed state that wasn't recognized by the experts, sometimes even making me obsess over suicide. I eventually would go off the antidepressants until the next time I couldn't get out of bed, but trust me, the prescribers were not too happy with this. It gets you labeled as non-compliant, blamed, and shamed. Only my therapist supported my decision, so each time I couldn't get out of bed, I would go to a new pdoc, and get the same results. It occurred to me at the time of my breakdown that maybe there had been other things going on with me for which I had never been tested. I have a great relationship with my primary doctor, but she flat out told me that the chances of an American being deficient in these areas would be very slim because our diet covers all of this. She also told me that testing T3 was not necessary. In otherwords, she is following the standard protocol. I have trouble pushing for what I want, reassurance that there are not other things going on that have contributed to years of suffering, you know, because the doctors had gotten it wrong in my case.

I too have thought about going to someone who uses a functional medicine approach because I know I will get the thorough lab workup that I want - the reassurance that there isn't anything else going on. I cannot afford to pay out of pocket on a social service salary. Although our SAD diet may cover all of these things, my primary care physician is aware that I have horrible nutrition with an eating disorder NOS. I see her monthly to support caring for my nutrition, but when asked which type of nutritional plan she recommends, she is happy with the one that I can live with that keeps my blood sugar in check. One of the issues over which Dr. Hyman and his colleagues seem to be in agreement is gluten and wheat. There is evidence of a link between gluten and schizophrenia, so I think we should be listening.

I have recently taken a nutritional course for nursing studies, and questioned the instructor. Trained in our standard ways, she told me that it was nonsense. Yet there is evidence supporting it.

So personally, I have begun listening, as are many "traditional" physicians like Dr. Oz, to what these other evidence trained physicians who practice functional medicine are saying.

Because I get too many side effects. Side effects that are intolerable. The only drug I could tolerate was Celexa but after 11 years more and more side effects came up until I was ultimately taken off it. As of right now I seem to itch and get a rash on nearly everything I take so docs don't want me to try any more drugs right now.

If you cannot tolerate antidepressants, then I think you a definitely going in the right direction.

Froggy: I think you have a fairly balanced view which I appreciate. I think a lot of people on web forums don't believe clinicians are looking for the root cause and really do only address symptoms, and it saddens me for them if they have had such experiences, because mainstream medicine does support looking deeper into certain causes and diagnostic evaluation. It's true that often free T4 is the only thyroid hormone initially tested when a thyroid imbalance is suspected, but this doesn't show that a doctor will frequently re-order additional thyroid studies at follow-up if there is still strong concern for thyroid issues or add other additional testing. It's rather a tightrope because it's also seen as clinician's responsibilities to try to keep medical costs from spiraling even further out of control.

I have a keen interest in "integrative medicine" which is an approach which blends mainstream western medicine with alternative/holistic treatments with scientific evidence base. I haven't read into functional medicine in great detail, but integrative medicine follows similar principles of the interconnectivity of the different systems and seeing the body and person as a whole (including mental, physical, spiritual and environmental components. It sounds like functional medicine falls under the holistic medicine umbrella, with certain aspects being in line with integrative medicine.

I see in the wikipedia article that functional medicine in general supports the discredited study linking vaccines to autism. Hopefully this is a belief supported by a minority in functional medicine.

Do you have a link to the gluten-schizophrenia research? I'd really like to read it.