Functional medicine is a model of medical diagnosis and management that is an all-inclusive science based model. It has been described as patient-centered rather than disease centered. That is because functional medicine tries to understand the patient rather than put a label on a set of symptoms. At its core, functional medicine tries to understand physiologic systems that are out of balance, determine the cause(s) of the imbalance, correct those imbalances by addressing the cause(s), and allow the healing power of the body to take over.
My simple definition for functional medicine is "Applying basic science in clinical practice." That is because, unlike conventional medicine, functional medicine practitioners draw on knowledge and testing in biochemistry, genetics, immunology, microbiology, neuroscience, pharmacology, physiology, and toxicology in assessing patients. This is in addition to statistics; a science discipline that is shared by both conventional medicine and functional medicine. However, saying functional medicine is applying basic science in clinical practice does not do justice to this model of practice. Functional medicine is based on principles designed to address issues of uncertainty in practice.
- Biochemical individuality based on genetic and environmental uniqueness
- Patient centered versus disease centered
- Dynamic balance of internal and external factors
- Web-like interconnections of physiological factors
- Health as a positive vitality – not merely the absence of disease
- Promotion of organ reserve – healthspan
Biochemical individuality is based on genetics as well as environmental exposures. Genetic individuality means that we are not all made the same. That is why two people will smoke for a lifetime, and one gets lung cancer, while the other does not. Or one gets emphysema while the other gets heart disease or stroke. Differences in environmental exposure may be the reason why two people with the same diagnosis, such as migraine may not respond the same treatment, but to different approaches to treatment. A production worker, who is constantly under stress at work may not respond to the same treatment as a mechanic who is exposed to fumes all day long. These two persons may have the same diagnosis, but very different causes. A functional medicine approach, which does not depend on "the migraine medicine," but identifies the different causes for these persons is likely to benefit both.
In patient centered care, the doctor: Explores the patient’s main reason for the visit, concerns, and need for information; Seeks an integrated understanding of the patient’s world - that is, the whole person, emotional needs, and life issues; Finds common ground on what the problem is and mutually agrees on management; Enhances prevention and health promotion; Enhances the continuing relationship between the patient and the doctor. For these reasons, a typical functional medicine visit takes much longer than a conventional office visit. Every aspect of the patient’s health history is explored and used in identifying and addressing their health issues. "The individual, not the disease, is the target of treatment" in patient centered care. Rather than a top-down approach, patient centered care is based on a therapeutic partnership between doctor and patient. It involves explanation of findings, and shared decision making regarding treatments and recommendations. A typical functional medicine patient is therefore well informed about their health condition.
Internal factors such as genetic predisposition determine risk, but that risk may never materialize as disease unless environmental inputs such as diet, exercise, smoking and other exposures interact with an individual’s genes or interfere with biochemical and physiologic processes to create disease.
Imbalances in one functional system affects, and creates imbalances in other functional systems. An understanding of the connections between different functional systems allows for treatment approaches that address the whole body.
"Health is much more than the absence of disease ... For the individual, maintaining and enhancing health requires a proactive approach characterized by behaviors, choices and interventions that maximize function and wellness," Fontanarosa. Functional medicine promotes lifestyle factors such as proper nutrition, exercise, healthy sleep, spirituality and relationships to promote a healthy vitality, and delay the onset of chronic disease and disability.
These principles of functional medicine define what functional medicine is. The beauty of functional medicine is its application across clinical disciplines. There are clinicians from allopathic, osteopathic and naturopathic medicine; chiropractic; acupuncture and other disciplines using basic science and the principles of functional medicine to enhance patient outcomes.