I have delusions of resting peacefully at home after the birth of this baby, lying in bed with baby at the breast, so I registered to attend the first of the seven requirements towards becoming a certified functional medicine provider. In the past, one had to travel for these courses, each about a week long, which just wasn’t a reality I could commit but more recently the IFM has began offering a few of its courses by live-feed. I jumped on the opportunity, with the first being the Detox Workshop.
Each course in the functional program is rather intense and requires a bit of homework prior to even attending the workshops. Admittedly, obtaining this certificate will be as costly as returning for my doctorate or obtaining my FNP certificate, which I have also considered, and may commit to after completing this functional program. Both will change my practice significantly, in that I’ll be a better midwife overall, but broadening my functional program will allow for a more appropriate life/work balance than an all maternity practice has provided. While I adore functional and integrative medicine, and they speak to my heart, expanding into this area of healthcare will allow me to sustain the home birth portion of the practice. One can only martyr oneself for so long.
What is functional medicine?
It has been defined as “a dynamic approach to assessing, preventing, and treating complex chronic disease” and an approach that “helps clinicians identify and ameliorate dysfunction in the physiology and biochemistry of the human body as a primary method of improving patient health.” Functional medicine has also been described as “acknowledging chronic disease as almost always preceding a lengthy period of declining function in one or more of the body’s systems. Returning patients to health requires reversing the specific dysfunction in one or more of the body’s systems,” (Jones, Bland & Quinn, nd).
These dysfunctions are different for each of us but results from lifelong interactions within the environment or related to our lifestyle, and our genetic predisposition. Each patient is then unique. Imagine!
How does this differ from the Conventional Model?
While functional medicine is a holistic approach to healthcare, the concentration often precedes organ system diagnosis, which differentiates it from the conventional model. Assessment and treatment first addresses the person’s physiological processes, environmental inputs, and genetic predispositions, rather than heading straight for the diagnosis. Admittedly, many of my clients struggle with this. They want to get pregnant. Now. They think they want to take a natural approach, but they want the results quickly.
While functional medicine providers certainly are expert diagnosticians, the emphasis is on understanding and improving the functional core of the human being as the starting point for intervention.
The Functional Medicine provider practices with the mindset that if scientific evidence strongly indicates that impaired physiological processes, if not corrected, lead to significant clinical imbalances one essential body systems. If left in a dysfunctional state, those clinical imbalances often progress to more significant signs and symptoms that may be the precursors or actual indicators of a disease state that can be diagnosed. Improving balance and functionality in these basic processes creates momentum toward health (Jones, Bland & Quinn, nd).
Conventional medicine on the other hand, awaits a clear diagnosis or when signs and symptoms are severe enough to demand a clinical intervention. The functional provider hopes to meet clients prior to the onset of disease and avert its onset through modifying triggers. Functional medicine providers want to make people well, not just manage symptoms, which is all most physicians have time for these days in a healthcare system that only allows for a mere few minutes to diagnose and treat.
The very basics of life are built on our environmental inputs. Our exposures are what turn on or turn off, or determine how our genes express themselves. Some of these factors we have some control over, such as diet and exercise, but others are very difficult to alter or escape such as air and water quality. Trauma and exposures to microorganisms can also impact our health for which we have little control.
Ignoring these factors in favor of a “quick fix” of writing a prescription means the cause of the underlying dysfunction remains, and often is obscured even further from the clinician’s ability to discern. More importantly, it is not eliminated. Functional providers will assess diet, nutrients, air, water, microorganisms, physical exercise, trauma, psycho-social factors, xenobiotics, and radiation.
The Big Picture
The fundamental physiological processes that ultimately determine health or disease include, as described by John, Bland & Quinn, the communication inside and outside the cell; the transformation of food, air, and water into energy; the replication, repair and maintenance of structural integrity from the cell to the entire body; the elimination of waste; protection and defense; and transport and circulation. While physiology is the initial focus of both medical and nursing students, after its introduction, our focus turns to diagnosis and system groupings. This then leads to specializations, such as cardiology, nephrology, obstetrics, dermatology and so forth. As specialists, we become exceedingly knowledgeable in a well-defined subset of ideas and within that narrow mindset we ultimately ignore the fact that the well integrated body system that does not function in separate systems.
“Focusing predominantly on organ system diagnosis without examining the underlying physiology that produced the patient’s signs, symptoms, and disease often leads to managing patient care by matching diagnosis to pharmacology,” (Jones, Bland & Quinn, nd).
It should be appreciated as well, that when pharmaceutical treatments are implemented for specific speciality issues, these are often implemented without consideration of how the therapy will impact other organ systems and physiological processes. This is when many would rant on about the pharmaceutical industry and how they have exploited this fact, and even how medical research is driven by what sales whether pharmaceutical or surgical. We have lost our ability to critically think as clinicians and rely on recipes of care. We think single disease, single agent, and single outcome.
“A deeper understanding of bio-chemistry and physiology is required of a functional medicine practitioner. The foundational principles of how the human organism functions – and how its systems communicate and interact – are essential to the process of linking ideas about multifactorial causation with the perceptible effects we call disease or dysfunction,” (Jones, Bland & Quinn, nd).
Core Clinical Imbalances
As we work to identify the trigger and ultimately the imbalance, we look specifically at the malfunction within hormonal and neurotransmitter imbalances, oxidation-reduction imbalances and mitochondropathy, detoxification and biotransformational imbalances, immune and inflammatory imbalances, even digestive, absorptive, and microbiological imbalances, and finally structural imbalances. Two years ago, many of these imbalances would have been complete Greek to me, but I am learning quickly how imbalances in these core areas are what leads to the signs and symptoms that we use to label and diagnose organ system disease. These imbalances tip our physiological processes so that our bodies can’t functional optimally. The goal is to go far beyond treating symptoms, but to address the imbalances.