Sean McCloy, MD, MPH, MA
“So, what do you do?”
“I’m a doctor.”
“Oh, really? What kind of doctor are you?”
“A good one.”
Before the person I’m talking with thinks I’m just being glib, I go on to explain that I practice Functional Medicine. “What’s that?” The short answer (quoted from Institute for Functional Medicine website): “Functional Medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both the patient and practitioner in a therapeutic relationship.” The longer answer involves discovering the Meaning of Life as well as saving our healthcare system.
Let’s talk about Functional Medicine first. Here are some key principles:
- Biochemical diversity. Simply put, we are all different. Our uniqueness means we don’t all respond the same way to our environment. A recent field of science called Epigenetics shows that our DNA gets turned on and off by what we eat, how we handle stress, the presence of toxins, shifting hormones, and even the seasons (Nature Communications, March 2015). Some of us drink a cup of coffee and feel a nice buzz, while others stay up for days after a few sips, and still others can drink a jug of joe and fall fast asleep. That’s because the enzymes responsible for breaking down caffeine work great for some of us but not so well for others. This genetic uniqueness plays a role in everything we do, and our medical treatments need to account for biochemical diversity.
- Patient-centered care. Functional Medicine practitioners are trained to listen to the whole patient, to hear their story. Studies show that the average physician interrupts the patient all too quickly: 23 seconds in 1999 (JAMA) and 12 seconds in 2001 (Fam Med). Our insurance system is partially to blame, as the pressure is on physicians to see as many patients as possible in a day. William Osler, the 19th century “Father of Modern Medicine” said, “Listen to the patient because he is telling you the diagnosis.” We use a powerful tool called the Functional Medicine Matrix (See Figure 1) to organize this story in a way that explains why this patient is sick and how to help them get better. I find this tool especially helpful for patients who have suffered for many years from complex and chronic problems. Once they both understand what is going on, the patient and the practitioner become partners in care, both members of the same team who share the same goal.
- Web-like interconnections. Functional Medicine practitioners view the body as a complex network of systems that all talk to each other, as well as receive information from outside the body. This communication explains why people can “fall apart” after a triggering event like an accident or acute illness. The dominos fall one by one as the systems shut each other down. It also helps to put people back together again, by using this beautiful interconnected web to heal the very wise human body.
- Dynamic balance. We hear it all the time, but strive to achieve it: Balance. Functional Medicine seeks to promote physical, emotional, and spiritual health. All are important to a person’s vitality and well-being.
- Health is not the absence of disease. Our bodies are built for health. By removing harmful factors and promoting healing and vitality, Functional Medicine practitioners enjoy watching their patients not only recover from illness, but go on to truly thrive.
- Organ reserve. This is another way of saying Functional Medicine helps us to achieve the longest, happiness, healthiest lives we can live. We talk about the health span, not just the lifespan, of each patient. Remember Jack LaLane? In my mind the “first fitness superhero” lived the ideal health span. At age 70, he towed 70 rowboats one mile through rough waters against strong wind and current. While handcuffed and shackled. Talk about organ reserve!
Here’s what it comes down to: Functional Medicine practitioners strive to fix the root cause of the problem rather than simply covering up symptoms with pills. That’s what I really mean when someone asks me what kind of doctor I am.
Now, what about the Meaning of Life? For me, it’s: Be Happy and Make the World a Little Better. I find the most happiness by helping others. This realization led me at an early age toward a medical career. As I worked my way through medical school, I began to notice the limitations of allopathic, or conventional medicine.
Allopathic medicine is based on the “Reductionist Principle”. If you look closely enough at any disease, you’ll eventually find some chemical process that has gone awry. If you can discover another chemical (i.e., a drug) that alters this process, you can reduce the symptoms of the disease. Sometimes this works great: if you have a bacterial infection, you want to kill the bacteria with antibiotics. But where the Reductional Principle falls short is chronic illness. Obesity, Diabetes Mellitus, Cardiovascular Disease, Cancer, Dementia…there is no One Pill To Fix It solution for the diseases that kill most of us and cost the most money to care for.
Conventional medicine is powerful — if I’m in a bad car accident, I want to go to the hospital — but it can be plain lousy at helping people be healthy. As a young medical student I knew that Family Doctors deal mostly with long-term, chronic illness. My conventional medical education taught me boatloads about pharmaceutically-driven disease care but almost nothing about health care. In four years of medical school I had one lecture on nutrition…and that was how to order IV food for patients in a coma! Sadly this is the norm for Medical Doctors. If I was going to help people (and Be Happy and Make the World a Little Better), I needed more tools for my toolbox than just my prescription pad.
As I began to explore additional training, I was confused at first by terms like Holistic, Complementary, and Alternative as opposed to Conventional, Western, or Allopathic Medicine. I prefer the term Integrative Medicine, which uses the most effective solutions from all these modalities. Over the next several years I sought elective education in nutritional science, mind-body techniques, biofeedback therapies, and anything else I thought would help. Each step of my journey taught me more about treating my patient as a whole human being, about being a detective doctor, and about true Healing.
Functional Medicine cleverly ties all these concepts into a model of care that made sense to my scientific-yet-holistic brain. When I need to prescribe drugs, I will. They are powerful and can quickly calm an out-of-control situation. But they have their drawbacks as well. Functional Medicine is an Integrative Medicine approach, using a personalized blend of healthy lifestyle changes, therapeutic diets, prescribed pharmaceuticals and/or nutraceuticals (i.e., botanical medicines), detoxification programs, biofeedback techniques, and other treatments.
Let’s look at an example through the lense of Functional Medicine. Sally is a 46 year-old woman who came to me describing years of fatigue. Chronic Fatigue Syndrome is one of the most common issues I see in my practice. These patients often get bounced from doctor to doctor seeking answers for why they feel so drained all the time. Unfortunately many of them get labeled as simply depressed or anxious, or worse yet, as malingering to get some kind of secondary gain. Chronic Fatigue Syndrome wasn’t even a recognized diagnosis in standard medical textbooks until recently. Now we call it Systemic Exertion Intolerance Disease (SEID).
Actually, as a diagnosis I don’t like it. It’s more of a description. It means one is really tired, most of the time, for more than 6 months and there are no other identifiable causes for the fatigue. As a Functional Medicine practitioner, I want to figure out why this patient is tired. We are discovering that there are probably many different contributing factors to SEID, ranging from infectious to hormonal to genetic.
In Sally’s case, like with all of my patients, I started by listening to her story. We talked about childhood issues (she was 6 weeks premature, breast-fed, remembered having lots of ear infections with rounds of antibiotics, and had bad acne as a teenager), had a couple of major stressful events in her twenties (bad breakup, several moves around the country, career changes), hormonal shifts (gained 25 pounds after her first pregnancy and never lost it), possible toxin exposure (well water tested positive for arsenic), possible lingering infections (had Mono when she was a teenager, likes to garden and recalls many tick bites), and what her life is like now (too busy to care for herself, no time for exercise, feels like she has lost her purpose in life). I also did a thorough physical examination, looking for subtle clues of nutritional deficiencies and other diseases.
This takes time. My typical first patient intake visit is 90 to 120 minutes. One can easily understand that the 7 to 12 minutes average physicians are “allowed” to spend with their patients in their typical schedule isn’t sufficient to address the roots of chronic illness.
I used the Functional Medicine Matrix tool to identify Sally’s ‘Antecedents’ (the set up for illness, see Figure 1). Her mother had a lot of food allergies; breast milk may carry antibodies against these foods which would have “primed” Sally’s immature gut to be inflamed and reactive. There was a possible imbalance in beneficial gut bacteria from the childhood antibiotics, leading to “Leaky Gut Syndrome” or Intestinal Hyperpermeability. This often results in food sensitivities as the inflamed gastrointestinal system can’t digest food properly. This inflammation can show up as teenage acne, irritable bowel syndrome, or even cause more systemic problems like thyroid issues or depression…or chronic fatigue.
Sally had several ‘Triggering Events’ in her twenties, any of which could have caused significant internal stress and set her up for illness. Major life events like divorce, moving, job loss are further drains, and Sally had a string of these. She also had a happy Triggering Event — the birth of her child. But this was yet another strain on her system. The 25 pound weight gain could have partially been due to high levels of cortisol in her system. Cortisol is a stress hormone that affects insulin, blood sugar, and weight gain.
Looking again at the Functional Medicine Matrix, there were several possible Mediators/Perpetuators that kept Sally sick. I ran some tests that showed persistent arsenic as well as mercury and lead in her body. She had fluctuating antibody levels against Epstein-barr Virus, the bug that causes Mononucleosis. Most people fight off Mono and never get it again, but some patients have immune system dysfunction that makes them vulnerable to chronic infections. Her lifestyle habits weren’t optimal: she lacked regular physical activity and a healthy diet as well as stress management exercises.
When I lay out Sally’s case like this it seems obvious why she felt tired all the time. But remember, she had seen numerous smart physicians who didn’t have the tools they needed to put it all together. She had a very competent Primary Care Physician who performed an appropriate evaluation. Her regular blood testing (thyroid, anemia panel, chemistries, celiac disease) were all normal. She didn’t “look sick”. Her PCP had tried some antidepressants and sleep medicines without success, then basically told her he didn’t know what was wrong with her. Fortunately there is a happy ending.
One of the cardinal rules of Functional Medicine is “heal the gut first”. If Sally’s gastrointestinal system wasn’t working properly, she wouldn’t absorb the healthy foods I recommended for her, and she wouldn’t eliminate the toxins that needed to come out of her body. I ordered a functional stool panel which confirmed the presence of unhealthy bacteria, a mild yeast overgrowth, and immune dysfunction from likely food sensitivities. A combination of natural antimicrobials, essential fatty acids, and a medical food shake helped to heal her gut. I started her on an anti-inflammatory diet. For the first time in 20 years, she wasn’t constipated and her belly pains and gas began to improve.
Over the next several months we made progress with her exercise and stress reduction techniques. She started practicing some relaxational breathing, at first just for 1 minute a day then longer as she began to see how good it made her feel. But her energy still flagged.
I ran some more functional nutritional testing that showed a blockage in her mitochondrial metabolic pathway, or Kreb’s cycle. (The mitochondria are the power plants of our cells, turning our food into energy.) Guessing this was from combination of vitamin depletion and heavy metal toxicity, I started a nutraceutical regimen to support her detoxification enzyme function. As her body cleaned itself up, she felt better. She had more energy to exercise, which helped her feel even better. Without going on a diet, she lost 15 pounds in the next 5 months. She got stronger, happier, and healthier.
There was no miracle cure here. Sally still had her ups and downs and fell off the health wagon a few times. But because she was a member of her own healthcare team, and because she understood the factors that made her feel ill, she was able to keep picking herself up. There was light ahead. She’s still working on herself, as we all are. Will she be able to tow 70 rowboats when she’s 70 years old? I don’t know. But I’m eager to see how Functional Medicine will help Sally achieve her genetic potential.
One can apply this paradigm to Diabetes, Cardiovascular Disease, and the other chronic maladies that so many of us suffer from. Numerous clinical studies show Functional Medicine simply works. It is an effective model of healthcare that can save our dysfunctional system. We spend by far the most per person in the world on our health. But we rank dead last in the top 11 developed nations (Commonwealth Fund, 2014). As Dr. Mark Hyman puts it, we have a Diabesity Epidemic that is not only killing us, but bankrupting us. Functional Medicine is designed to help people get healthy again, meaning they don’t need all those expensive drugs and surgeries. And perhaps our leaders are listening: the Cleveland Clinic (a mainstream medical center) just opened a Center for Functional Medicine, the first large institution to do so.
In finding Functional Medicine, I enjoy a career that brings meaning to my life. I have avoided the burnout that so many physicians face. I hope more of my colleagues embrace a healthier approach to healthcare, and perhaps they too can Be Happy and Make the World a Little Better.
For more information, or to find a Functional Medicine practitioner near you, visit www.functionalmedicine.org
Originally published July 6, 2015 in Essential Living Maine magazine.
Sean McCloy, MD, MPH, MA is dual board-certified in Family Medicine and Integrative Medicine. He is the medical director of the Integrative Health Center of Maine. When away from his busy family practice, he enjoys running a woodworking business, doing anything outdoors, as well as exploring Maine with his family.