Your Complete Guide to Functional Medicine

Functional Medicine Cheat Sheet

What is functional medicine?

Functional medicine is an approach to healthcare that looks at getting to the root cause of symptoms instead of just masking or treating the symptoms. It’s a way of practicing medicine as opposed to a specialty.

It’s somewhat related to integrative or holistic medicine, but is set apart by a few key factors, like its reliance on in-depth and high-tech medical testing. Functional medicine practitioners do tests most doctors don’t do, looking at things ilke nutritional deficiencies, hormone imbalances and genetic susceptibilities that might be underlying causes of disease or illness. Practitioners of functional medicine spend time with their patients, listening to their histories, mapping their personal timeline and looking at the interactions among genetic, environmental and lifestyle factors that can influence long-term health and complex chronic diseases. They are also likely to recommend supplements.

What are the basic tenets of functional medicine?

  • Each patient is unique

    • Everyone’s biochemistry is different because our genes, environments and lifestyles differ vastly and in a complex way

    • Symptoms can be categorized and compartmentalized but getting to the etiology is where functional medicine practitioners specialize

  • Treating the patient, not the disease

    • FM relies on individualized treatments that require empathy and understanding from the practitioner. Not every patient’s biochemistry can be balanced with the same methods

  • Homeodynamics

    • Definition: the constantly changing interrelatedness of body components while an overall equilibrium is maintained. FM focuses on the body’s natural ability to heal itself and swing back into equilibrium

  • Proactive care

    • FM aspires to be preventative, and to reduce your risk for diseases by optimizing health and internal biochemistry

    • It also encourages minimizing toxic exposure to interfering compounds

  • Organo-centric

    • Centered on the organs- we believe the body is only as good as its organs, so we want to increase longevity by optimizing function of each organ system.

How does it fit in with integrative medicine, holistic medicine, etc?

Conventional Medicine: Allopathic or Western Medicine (what we think of as “traditional” medicine - care you would get at UCSF or Stanford). This is highly regulated by American Medical Association (AMA)

Complementary Medicine: If a non-mainstream or alternative practice is used together with conventional medicine. E.g. Acupuncture + Oncology / Chemotherapy

Alternative Medicine: If a non-mainstream practice is used in place of conventional medicine. e.g. Acupuncture instead of Chemotherapy. Many forms of this are regulated state-by-state and nationally (for example, acupuncture, chiropractic) and some aren’t (reiki, doulas)

Integrative Medicine: bringing conventional and complementary approaches together in a coordinated way. Different from complementary because it aims for different practitioners to coordinate care and often occurs in the same practice or space. Complementary care is more coordinated by the patient themselves, and not the institution or practitioners, and therefore involves less communication between practitioners.

Holistic Medicine: also looks at the person as a whole and tries to identify the root-cause of disease. It discourages medication and encourages natural remedies. This term gets thrown around more and is less an official methodology than functional medicine, and relies less on testing methods. Integrative and functional medicine are both ALSO holistic, but have other defining features.

What’s the difference between integrative & functional?

The difference between functional medicine and integrative medicine is subtle but meaningful. While all functional medicine is integrative (meaning it’s open to integrating both conventional and alternative methods), not all integrative healthcare methods are functional.

The hallmark methods of functional medicine are its extensive testing methods that aren’t emphasized in integrative medicine. Also, functional medicine,emphasizes “the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease.”.

Key Similarities:

  • Individualized and holistic approach to patient care

  • Collaborative- often willing to work in coordinated care teams with other “integrative practitioners”, like nutritionists, acupuncturists, etc.

  • Aims to find the “root cause” of a person’s symptoms

Key differences:

  • Functional Medicine relies on in-depth testing methods that not all integrative practitioners do

  • FM encourages taking supplements as needed

  • FM is rooted in epigenetics, or gene-environment interactions. This method aims to restore body to its regular physiological functioning by turning on right genes, and is a growing field of science

  • The term isn’t yet regulated, so anyone can call themselves a “functional medicine practitioner”.

    • There are still schools that give certification in functional medicine

    • Getting a functional medicine certification doesn’t add anything to your scope of practice, though

    • “Practicing medicine” is still strictly confined to MD’s and DO’s


Who can practice functional medicine?

There are a few different institutions that offer training in functional medicine, but the biggest player is the Institute of Functional Medicine. Functional medicine is almost always an additional certification that you can add once you’re already a licensed healthcare practitioner.* Professionals that can obtain training in FM include:

  • MD’s

  • DOs

  • Dietitians

  • Acupuncturists

  • Chiropractors

  • Naturopaths

  • Nurses

  • PAs

  • NPs

  • Health coches

  • + other professionals with science backgrounds

*The exception to this is if you’re currently not a health practitioner but are getting trained to become a functional medicine health coach or a functional medicine nutritionist. These have the most limited scope of practice.

What can functional medicine treat?

Functional medicine today can be effective for a wide variety of conditions and health concerns, but is generally best suited for chronic conditions as opposed to acute ones. This includes:

  • Digestive issues, including:

    • IBS

    • food and gluten sensitivities and allergies

    • Crohn’s disease

    • Ulcerative Colitis

    • SIBO

    • Intestinal yeast (candida)

    • Leaky gut

  • Autoimmune conditions

    • Hypo- and hyperthyroidism

    • Inflammatory Bowel

    • Diabetes

    • Celiac disease

    • Rheumatoid arthritis

    • Lupus

    • Psoriasis

    • Lyme disease

  • Women’s health issues

    • Hormone and thyroid imbalances

    • Menopause

    • PMS

    • Fertility

    • Preconception nutrition

  • Mental health concerns

    • Anxiety

    • Depression

    • Insomnia

  • Stress-related issues

    • Fatigue

    • Brain Fog

    • Poor concentration or memory

    • Frequent colds

    • Constant worry

Or a combination of many of the above!

What are the tools & tests?

Types of testing involved:

  • Micronutrient testing

  • Comprehensive stool analysis

  • Adrenal stress profile

  • Food sensitivity testing

  • In-depth hormone testing

  • Genetic susceptibilities

  • Organic acid testing

  • Advanced celiac profile

  • Cardiometabolic testing

  • Heavy metal/essential element testing

See more in the section on testing below.

Does insurance cover it?

The visit. A small number of functional medicine doctors take insurance, and most insurance plans call this coverage something other than “functional medicine”. We suggest carefully going through your policy looking for anything that might be called “preventative” or “nutritional counseling”. It is usually easiest to call your insurance company to ask directly seeing whether this is covered or not.

Lab testing. Most big insurance companies won’t pay for any lab tests that are more extensive than standard protocol, like the basic blood-work associated with an annual physical, which includes cholesterol, white blood cell counts, and glucose levels. This means stool tests and hormone tests aren’t covered. However, many functional medicine testing companies (separate entities from functional medicine practitioners) partner with some health insurance companies to agree to cover the majority of the testing costs.

Supplements. While some plans do cover labs and services, they very rarely cover supplements. For other practitioners (acupuncturists, chiropractors, etc) that practice functional medicine, supplements can generally be billed under acupuncture or chiropractic, so it doesn’t change the coverage (as long as this practitioner’s services are covered to begin with).

Out of pocket pricing. You should expect to pay $200-400 for an initial consult with a functional medicine practitioner, excluding the lab costs and follow-up appointments. Even if your health insurance is accepted, be aware that you may still have to pay out of pocket for supplements and tests.  You can also use your FSA or HSA to pay for functional medicine.

The bottom line. Functional medicine costs more up front, but often patients report that it’s worth the investment long term- avoiding surgery, medication and chronic illness down the line ends up saving money. They also tend to enjoy not having to sacrifice quality of life, which often happens with traditional pharmaceutical approaches.

DEEP DIVE

Basic Info

What is functional medicine?

  • Functional medicine is an approach to health that looks at getting to the root cause of symptoms instead of just masking/treating the symptoms. It’s more of a way of practicing as opposed to a specialty. It’s somewhat related to integrative or holistic medicine, but is set apart by a few key factors.

  • Functional medicine looks at each independent symptom as one part of a root-cause issue in the body, instead of treating and masking each symptom independently. It’s more of a way of practicing as opposed to a specialty

  • Practitioners of functional medicine spend time with their patients, listening to their histories, mapping their personal timeline and looking at the interactions among genetic, environmental and lifestyle factors that can influence long-term health and complex chronic diseases

  • One of its hallmarks is its reliance on in-depth testing that most doctors don’t do, looking at things ilke nutritional deficiencies, hormone imbalances and genetic susceptibilities that might be underlying causes of disease or illness

  • It’s being practiced by both Western MD’s and some alternative providers in the US, and has gained lots of traction in the last 25 years, since it’s conception by Dr. Jeffrey Bland in 1991, who created IFM (Institute of Functional Medicine)

    • Many big hospitals are opening centers for functional medicine, such as the Cleveland Clinic (the #1 hospital in the US) that opened a center in late 2014, and has since decided to double in size due to demand

    • The google search for “advanced functional medicine” and “functional medicine doctor near me” have risen over 5000% in the last 5 years

  • Since it’s not an official specialty recognized by American Board of Medical Specialties, technically anyone can call themselves a “functional medicine practitioner”

  • It’s systems-biology based, focusing on identifying and addressing the root cause of disease, Somewhat tied to terms “holistic” and “integrative”

  • Wants to identify how your body is doing NOW instead of waiting til you get unbalanced enough to manifest a disease or disorder. It’s preventative in that way

  • It is growing in popularity as more genomics knowledge comes out and more testing forms become available. IFM was started in 1991 by Jeffrey Bland

  • Also potentially growing because rates of chronic conditions are increasing in the population

  • For example, each symptom or differential diagnosis may be one of many contributing to an individual’s illness

  • Looks at your whole life: teaching how to eat, move and live better to live healthiest life possible

Regulation/lack thereof

  • The term “functional medicine” or “functional practitioner” aren’t currently regulated in the US, so people in the internet can claim to practice these without much consequence

  • There’s an inherent problem when non-medical doctors advertise and practice functional medicine, in that the word “medicine” is included and only medical doctors (and DOs) can practice “medicine.”

  • However, many programs and certifications teach the principles and methods of functional medicine, meaning many people out there are actually educated and can help patients through these frameworks

What’s the history of functional medicine?

Functional medicine is relatively new.  It was conceived by Dr. Jeffrey Bland in 1991, who started the Institute of Functional Medicine (IFM). It’s gained lots of traction since then and is being practiced by both Western MD’s and some alternative providers in the US, in both hospitals and private practice settings. Many big hospitals are also opening centers for functional medicine. The Cleveland Clinic (the #1 hospital in the US) opened a functional medicine center in late 2014, and has since decided to double in size due to demand.

How is the functional medicine method different?

As the graphic below from Institute of Functional Medicine (IFM) shows, one diagnosis can be the result of more than one cause. In this example, we see that depression can be caused by many variables, including inflammation, low thyroid, vitamin D deficiency and antibiotic use. However, if we reframe this, a root cause like inflammation can actually cause a lot of disorders and symptoms in different parts of the body, depression being just one of them. Each individual’s bodily manifestations of inflammation are different, depending on their genes and environment. The study of gene-environment interactions is called epigenetics, which is a growing scientific discipline being researched. Therefore, only treatments addressing this root cause will heal the actual disorder and not just mask the symptoms.

[insert graphic]

Fundamentals:

  • Each patient is unique

    • Everyone’s biochemistry is different because our genes, environments and lifestyles differ vastly and in a complex way

    • WEstern medicine struggles to find a “one size fits all” treatment especially for complex diseases like autoimmune conditions

    • Symptoms can be categorized and compartmentalized but getting to the etiology is where functional medicine practitioners specialize

  • Treating the patient, not the disease

    • FM relies on individualized treatments that require empathy and understanding from the practitioner. Not every patient’s biochemistry can be balanced with the same methods

  • Homeodynamics

    • Definition: the constantly changing interrelatedness of body components while an overall equilibrium is maintained

    • A 2007 study in the New England Journal of Medicine stated that up to 50% of diagnoses and treatment are wrong

    • FM focuses on the body’s ability to heal itself and swing back into equilibrium

  • Proactive care

    • FM aspires to be preventative, and to reduce your risk for diseases by optimizing health and internal biochemistry

    • It also encourages minimizing toxic exposure to interfering compounds

  • Organo-centric

    • Centered on the organs- we believe the body is only as good as its organs, so we want to increase longevity by optimizing function of each organ system.

Who can practice functional medicine?

There are a few different institutions that offer training in functional medicine, which can be seen in the chart below, and include Institute for Functional Medicine (IFM),  FMCA- functional medicine coaching academy, SAFM- School of applied functional medicine, ABFM- American Board of Functional Medicine, Kressler institute, Functional Medicine University, and Kalish Institute for Functional Medicine.

Functional medicine is almost always an additional certification that you can get once you’re already a licensed healthcare practitioner.* The professionals that can obtain training in FM:

  • MD’s

  • DOs

  • Dietitians

  • Acupuncturists

  • Chiropractors

  • Naturopaths

  • Nurses

  • PAs

  • NPs

  • Health coches

  • + other professionals with science backgrounds

*The exception to this is if you’re currently not a health practitioner but are getting trained to become a functional medicine health coach or a functional medicine nutritionist. These have the most limited scope of practice.

Where do these people practice?

Hospitals

Many big hospitals are opening centers for functional medicine, such as the Cleveland Clinic (the #1 hospital in the US) that opened a center in late 2014, and has since decided to double in size due to demand

Integrative Centers

Often in these private practice clinics, FM practitioners work in conjunction with other doctors, nutritionists, acupuncturists, naturopaths, etc. This type of medicine encourages collaboration so your care plan is often shared with all these people. Example: Parsley Health

Insurance coverage is varied.

One-on-one private client coaching

Many FM practitioners also work one on one with patients, either in  an office setting or meeting them where is convenient. Insurance coverage is often varied, but many of these practitioners are entirely out of network.

Types and certifications? Accredited institutions? Education? Who can become one?

The ‘golden standard’ for functional medicine certification is through the Institute of Functional Medicine. There are also other certifying programs, such as:

  • School of applied functional Medicine

  • (add more)

What types of testing is involved?

  • Micronutrient testing

    • Deficiencies of micronutrients can be a root cause of symptoms for  mood disorders, depression, anxiety, sleep disturbances, fibromyalgia, and fatigue, diabetes, and heart disease. It can also be used to optimize health and fitness for athletes.

  • Comprehensive stool analysis

    • A belief in functional medicine is that all inflammation stems from the gut. Stool analyses can show the breakdown gut bacteria and give insight to one’s microbiome

    • Test looks for markers of inflammation and malabsorption

    • Essential for those with IBS, cardiac disease, diabetes, weight problems and autoimmune

  • Adrenal stress profile

    • Measures stress response, and can pinpoint acuteness of symptoms like fatigue autoimmune and mood disorders

  • Food sensitivity testing

    • igG antibodies for 30-200 different foods

    • Different than standard food allergy test

  • In-depth hormone testing

    • evaluates in-depth balance of hormone levels, ranging from thyroid to sex hormones

  • Genetic susceptibilities

  • Organic acid testing

    • Organic acids are metabolic intermediates

    • They’re produced in essential body functions like nT breakdown, microbe activity in the intestines and energy production and detoxification

  • Advanced celiac profile

    • Can identify whether a patient is on the spectrum of celiac, ranging from sensitivity to actual allergy (Celiac)

    • standard celiac testing only gives a yes or no for full blown celiac disease that leads to tissue damage

    • Researchers estimate that up to 18 million americans have some gluten sensitivity that can lead to a whole array of symptoms (https://www.beyondceliac.org/celiac-disease/non-celiac-gluten-sensitivity/)

  • Cardiometabolic testing

    • Looks in-depth at cholesterol levels, including particle size and particle amount

    • Can give insight to risk factor for heart disease

  • Heavy metal/essential element testing

    • Can show buildup of heavy metals and toxins in your body

    • Toxic exposure can adversely affect: energy levels, reproductive function, cancer risk of all kinds, neurological development and function, respiratory, cardiac, liver, and immune functions, cognitive and emotional health and degenerative conditions.

Source:https://modaycenter.com/functional-medicine-testing-tests-we-use/

more : https://www.parsleyhealth.com/blog/5-essential-blood-tests-need-every-year/


What conditions does it treat/most helpful for?

In general, functional medicine is great for treating chronic conditions as opposed to acute conditions.

Functional medicine was originally created and intended to help with the following:

  1. Chronic fatigue syndrome.

  2. Fibromyalgia.

  3. Multiple chemical sensitivity syndrome.

  4. Irritable bowel syndrome.

  5. Premenstrual syndrome.

  6. Polycystic ovary syndrome.

  7. Chronic pelvic pain syndrome.

  8. Nonulcer dyspepsia.

  9. Chronic pain of unknown origin.

  10. Depression.

  11. Minimal cognitive impairment.

  12. Interstitial cystitis/painful bladder syndrome.

  13. Restless leg syndrome.

  14. Autistic spectrum disorder.

  15. Autoimmune syndrome.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312741/

However, functional medicine today can be effective for a wide variety of conditions and health concerns, including:

  • Digestive issues, including:

    • IBS

    • food and gluten sensitivities and allergies

    • Crohn’s disease

    • ulcerative colitis

    • SIBO

    • intestinal yeast (candida)

    • Leaky gut

  • Autoimmune conditions

    • including hypo- and hyperthyroidism

    • inflammatory bowel

    • Diabetes

    • celiac disease

    • Rheumatoid arthritis

    • Lupus

    • Psoriasis

    • Lyme disease

  • Women’s health issues

    • hormone and thyroid imbalances

    • Menopause

    • PMS

    • fertility

    • preconception nutrition

  • Mental health concerns

    • Anxiety

    • Depression

    • Insomnia

    • coping with life transitions

  • Stress-related issues

    • Fatigue

    • poor concentration or memory

    • frequent colds

    • constant worry

    • nervous habits

Or a combination of many of the above!

Legal regulation of these terms?

  • Adding a functional medicine certification doesn’t increase the scope of practice for any of these practitioners, it simply gives them a new framework and tools to use

  • In the case that you’re trained as a functional medicine health coach or nutritionist, you need to follow the laws on health coaching

  • In summary, as a health coach you can only work on generalized wellness with your clients, which works for some clients to balance out minor health complaints, but for most it will not (see more below)

  • You cannot help clients with deeper health issues-- It goes against scope of practice to give advice that may be medical in nature (ie, personalized to one client’s specific health needs) and to cross that line puts you at risk of having your business shut down.

Going & paying

How much will it cost?

You should expect to pay $200-400 for an initial consult with a functional medicine practitioner, excluding the lab costs and follow-up appointments. Even if your health insurance is accepted, be aware that you may still have to pay out of pocket for supplements and tests.

Most big insurance companies won’t pay for any lab tests that are more extensive than standard protocol, like the basic blood-work associated with an annual physical, which includes cholesterol, white blood cell counts, and glucose levels. This means stool tests and hormone tests aren’t covered. Functional medicine costs more up front, but often patients report that it’s worth the investment long term- avoiding surgery, medication and chronic illness down the line ends up saving money. They also tend to enjoy not having to sacrifice quality of life, which often happens with traditional pharmaceutical approaches.

How does Insurance cover Functional Medicine?

Some insurance plans do cover functional medicine, and a small number of functional medicine doctors take insurance. We suggest carefully going through your policy looking for anything that might be called “preventative” or “nutritional counseling”. It is usually easiest to call your insurance company to ask directly seeing whether this is covered or not.

While some plans do cover labs and services, they very rarely cover supplements. For other practitioners (acupuncturists, chiropractors, etc) that practice functional medicine, coverage can generally be billed under acupuncture or chiropractic, so it doesn’t change the coverage (as long as this practitioner’s services are covered to begin with).

However, you have options:

Use a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for holistic practitioners

  • Most FSAs can be used for anything related to health - including doctors not covered in your normal insurance plan, supplements, etc.  HSAs are slightly more specific, for instance, HSA can be used to cover a chiropractor who isn't covered by regular insurance, but not supplements.  Look into your specific plan and call your insurance company if needed to provide more clarity on what is covered.

While some practices might not accept insurance, the tests they will use to diagnose you might

  • Many functional medicine test companies (separate entities from functional medicine practitioners) partner with some health insurance companies to agree to cover the majority of the testing costs.

  • For example Genova, one of the most widely used functional testing companies, has agreements with many of the big insurance companies so that if (for example) the test costs $2,200, you may only pay $149. Take this into consideration when deciding on tests. You can always call the office ahead of time and inquire about what types of tests they use and what the costs typically are with your specific insurance.

What does a first appointment look like?

Functional medicine providers will generally do a long, in person appointment the first time you go in. It’ll be in depth, and ranging from 1-2 hours. They’ll usually ask you to bring in any lab-work and test results from the last 5 years, and all supplements and medications you’re currently taking.

In addition to doing a lot of talking about your history, the practitioner will ask about your mental well-being, spiritual health, and social factors. Considering these areas helps the Functional Medicine practitioner see your health in the context of you as a whole person, not just in terms of your physical symptoms. The Functional Medicine provider may do a detailed examination of your body to see if there are any visible signs that provide clues to what is going on under the surface. They may also suggest that you submit samples for laboratory testing; some of these tests are the same ones used by conventional clinicians, but others are specialized tests that can help determine the causes of your illness. This might include genetic testing, which can show if your genes make you more susceptible to certain types of health problems.

Continuing Treatment

Once your practitioner has all your test results, they’ll work with you to create a treatment plan, deciding how often and for how long they’ll want to see you, and what kind of lifestyle modifications might be helpful. These can include changes to diet, stress management, physical activity, exposure to potentially toxic substances and other factors, such as experiences, attitudes, and beliefs. All of this is considered your  “environment”. Epigenetically, everything in your environment influences gene expression, so optimizing your “environment” for your genes will lead to optimal function and decrease symptoms you may be experiencing.

Treatment can also include a combination of drugs, nutritional supplements, botanical medicines, diets or detoxes. You’ll always have a big say in your treatment because functional medicine is super patient-centered, and you’re always an active part of planning for your health.

Functional Medicine & Telemedicine

Many functional medicine providers have options for telemedicine- or meeting with your practitioner through video calls. The telemedicine trend is growing. The benefits are:

  • Access to a specialist without the monetary and time cost of travel

  • Convenience

  • Possibly more affordable

  • Enhanced patient compliance

If you find a provider that seems perfect for you, it might be worth it to ask if they offer a telemedicine option.

Key Points on the legality:

  • Your provider must be licensed in the state you live in, as well as the state the patient is in during the telemedicine visit. Some states include phone contact in this. It’s illegal to practice without a license.

  • You’re also subject to the telemedicine laws of both states (which vary widely- when it comes to things like prescribing over the internet, etc)

  • You must use HIPAA-certified communication platform (Skype is one of these)

  • California law, for example, prohibits providers from prescribing certain drugs through the internet without first conducting an appropriate medical examination of the patient.

  • In CA, “Reimbursement is allowed for live video, store and forward and remote patient monitoring.” (a law is in progress for requiring insurance coverage for phone visits)

  • the reimbursement rate by insurance is the same as for in-person visits

  • Informed patient consent is required

  • It’s illegal for your insurance company to require face-to-face visits if the virtual option is possible

  • Some physicians try to get around this by claiming “health coaching”

  • Fine line-- “practicing medicine” under the law is diagnosing and treating, which means giving advice to an individual patient about what they can or should do

Acupuncturists & chiropractors are in the gray area when it comes to HIPAA.