Should I care about functional medicine?

Holistic. Lifestyle based. Root cause oriented. Extensive lab testing. Patient centered. Understanding history back to pre-conception. Prevention over treatment. Supplements over medications. 

These are the defining characteristics of functional medicine, and over the past several years its popularity has surged. It’s no wonder why—ask most people how they’d like a doctor to approach their health, and it’s likely they would name many of these features. The existing US healthcare system does not deliver that. It’s set up to disadvantage prevention, dehumanize patients, treat advanced disease with piles of expensive meds, and shine only a narrow spotlight on the issue at hand, rather than consider the broader context.

Functional medicine is not a substitute. It’s an overlay to traditional medicine. The best practitioners have advanced training from prestigious medical schools, and have chosen to layer this additional methodology on top of their training. Functional medicine techniques augment the toolbox rather than replacing it.

Functional medicine practitioners check a lot of lab work—blood, saliva, urine, stool. But this isn’t simply testing for testing sake. This lab work enables an optimization framework. Traditional medicine has set normal and abnormal definitions at extremes, where a lab result isn’t abnormal unless it’s at the point of causing severe disease. But functional medicine recognizes nuance. Some labs may come back normal, but in reality are insufficient or non-optimal, causing real symptoms.

Take ferritin—a measure of total body iron storage. At severely low levels for prolonged periods of time it can cause anemia. But some patients with insufficient levels experience fatigue and other symptoms well before hitting that threshold. They are often told their results are in the normal range, when they could be benefitting from iron supplements. 

Many intuitively understand the aphorism “an ounce of prevention is worth a pound of cure.” Yet the traditional healthcare system is set up to prioritize treating disease only once it manifests. And even then, the focus may be on downstream symptoms of a root cause. In practice, this could look like treating nerve damage in the foot—when years earlier the rising blood sugar levels could’ve been caught and managed, before poor nutrition did its damage. 

At this point the statistics are well known about how little time medical students spend learning about nutrition, exercise, sleep, stress management, and the importance of healthy relationships. But that doesn’t mean the average practitioner has changed their advice. Functional medicine doctors may spend more than half of a visit focusing on these foundational elements of wellness in great detail, because once the frame is shifted to focus on root causes and prevention, the value is clear. 

Fundamentally, functional medicine views the body and physiology through an alternative set of systems. Traditional medicine is oriented around organ systems—heart, gut, kidneys, brain, skin, are all viewed as separate entities. If organ systems are vertical columns in a spreadsheet, then functional medicine looks at the same issues through a series of horizontal rows. These horizontal rows are:

• Assimilation (digestion, absorption, microbiome) 

• Structural integrity (gut barrier, blood-brain barrier, cell membranes)

• Defense and repair (immunity and inflammation)

• Biotransformation and elimination (detoxification)

• Communication (hormones, neurotransmitters)

• Energy (mitochondrial function)

• Transport (cardiovascular and lymphatic systems)

This shift in orientation is another reason functional medicine can be so illuminating in the search for an underlying cause in seemingly disparate symptoms.

Ultimately this paradigm represents the best of modern medicine – blending the tools of precision medicine with a helpful alternative orientation. This combination surfaces more humane and effective insights and care—a goal that we can all agree should be our first priority.

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A note from Dr. Keith 

The foundational principles of functional medicine—looking upstream, understanding how lifestyle and environment shape biology, and getting to know patients deeply over time—are principles we've always found clinically valuable. They provide a framework for asking better questions and defining what optimal looks like for you. I think about it less as functional medicine and more as thorough medicine. That's not alternative care. That's just good care.

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