I trained in conventional family medicine residency over 20 years ago, but within a few years of practice, I began to question the conventional approach to disease management. I wondered how much longer could I just prescribe medications and talk briefly about lifestyle knowing this did not work. So I changed to integrative medicine for ten years before focusing on functional medicine. With this perspective, I understand when to use conventional medicine, functional/integrative medicine and when they can be used complementarily.
The best way to explain the difference between these approaches is to review a patient case.
LS is 28 year old female with a past history of irritable bowel syndrome diagnosed in her teens, iron deficiency anemia, and anxiety who wants a different approach for her chronic gut issues. She has a bowel movement 1-2 times per day, usually soft and mushy, never formed (healthy bowel movements should look like long snakes!). The frequency increases and becomes mushier with stress. She has intermittent abdominal cramping, bloating and gas which are worse with her period but can be present at other times. She does not have any alarming symptoms of bleeding, weight loss, fevers, or chills. She has managed her symptoms with over-the-counter probiotics, iron most days, fiber and trying to eat cleaner. She still eats out, drinks on the weekends, stays out late on the weekends, exercises most days, and has work stress due to deadlines and travel. She is in a committed relationship and has good relations with her family. Her GI recommended she continue the course since she is stable. Her iron deficiency anemia is from heavy menstrual periods with premenstrual symptoms of fatigue, bloating, headaches and breast pain about 3-5 days before her cycle.
When she came to see me, I spent one hour with her. I created a timeline to assess Antecedents, Triggers and Mediators (or ATM’s). Antecedents are predisposing factors such as genetics, family history, and prenatal exposures. Triggers are the events that occur prior to disease onset or provoke the onset of disease. This can be infections, accidents, surgeries, etc. And lastly, Mediators are factors that perpetuate continual symptoms or disease. The goal is to understand the interconnectedness of timeline and the different organ systems from a biochemical and physiological process.
Her timeline showed many insults to her gut and stressors that she was not aware of. Her antecedents (predisposing factors) were the mode of delivery at birth, an emergency C-section, and being exclusively bottle fed. The gut microbiome of every baby comes from the vaginal microbiome during the delivery which is then solidified with breastfeeding. She unfortunately did not have either one so the question was:
what species were present early in life? She then had multiple ear infections, eventually having ear tubes placed. This was another insult to her gut. Antibiotics wipe out both good and bad bacteria from the body, so what happens to the gut microbiome, the balance of bacteria in our GI system that help us with everything? Usually, this pattern of heavy antibiotic use leads to a loss of microbial diversity and yeast overgrowth. She ate a standard American diet of processed food, fast food and 1-2 vegetables per day which did not help her rebuild her gut microbiome and most likely continued to exacerbate the possible yeast. She attended schools in older buildings that had obvious water leaks, so perhaps there was a mold exposure she may not have known. She played soccer and unfortunately had multiple hits to the head, but no concussions were reported. Remember, the brain is the consistency of Jell-O, so “head hits” are still detrimental to the brain. When the brain gets hurt, the powerful brain/gut axis becomes derailed, leading to more gut issues and possible anxiety. In her teen years, her parents divorced. This event was her Trigger and was diagnosed with anxiety and IBS after this.
She also became a vegetarian (well actually, more of a “carbetarian” because she only ate 1-2 vegetables per day as a vegetarian, but a lot of bread, pasta, noodles, pastries, etc.). Her periods became heavier and a few years later, she was diagnosed with iron deficiency anemia. Her mediators were her diet, her stress, vitamin deficiency, possible yeast overgrowth and “head hits”.
My evaluation included blood work and a functional medicine stool test. Functional medicine stool testing is different than conventional medicine because it is evaluating the body’s ability to digest, measures inflammation rate, microbial diversity and balance, yeast, bacterial, viral or parasitic infection. Her blood work included labs for iron deficiency anemia, full thyroid panel, vitamin testing such as omega 3, vitamin D, zinc, magnesium, cholesterol, insulin, hemoglobin A1C, and hormone levels.
Her lab work showed many areas that we could optimize; low cholesterol (total cholesterol of 140), low progesterone, low vitamin D, zinc, magnesium and continued iron deficiency anemia. To treat this, I recommended high doses of vitamin D for two months and then decreasing it to 4000-5000 units daily, Magnesium 600-800 mg to help her sleep at night and calm the system, zinc 40 mg daily for 3 months, and her iron was changed to a better absorbing iron that contained vitamin C. I also recommended a good broad spectrum multivitamin and omega 3. For her diet, I recommended a gluten free, dairy free diet, which she could try to reintroduce after two months. I also encouraged her to eat phytonutrient dense diet with all colors of the rainbow, at least 4 vegetables per day with a good amount of greens and cruciferous vegetables like cauliflower, broccoli, cabbage, Brussel sprouts, and 1-2 brightly colored fruits per day. I recommended more good fats at each meal to help improve
her cholesterol, which can help with hormone and neurotransmitter production, as well as a probiotic food with meals.
Her stool study showed low microbial diversity, high inflammation, and yeast overgrowth. I provided high doses of probiotics, prebiotics, a gut healing supplement and an antifungal. She was encouraged to meditate or make quiet time daily. Her workouts were changed to include restorative work, such as yoga, Tai Chi, and hiking with her weight training. I wanted her to spend more time in nature, doing activities that calmed her, like coloring and dancing.
She came back after a few months glowing! She felt great. Her stool was usually normal even when she was stressed! She continued with her multi, omega 3, vitamin D, magnesium, and iron. She had completed all other supplements and ate a diet low in gluten and dairy, and incorporated lots of vegetables. She continued to hike and bike in the metro parks, sometimes sitting to breathe or color.
I performed repeat testing which was essentially normal, if not optimal. She continued with her core supplements and lifestyle changes. She sees me about every 2 years to make sure she is on the right track, but she has not seen anyone else for four years. She is married and pregnant with her first child as I write this and wants to raise her child using functional medicine so they won’t have to suffer like she did!
Cases like this illustrate that “classic” symptoms can be ameliorated with a different approach. Many of my patients are substantially sicker than this and take longer to heal but they continue with functional medicine because of the improvements they are making. For me, I think functional medicine can be for chronic illnesses and symptoms as well as those desiring optimization. Conventional medicine is great when there is an acute problem or life-threatening emergency. For patients who have multiple medical conditions, I slowly add functional medicine while improving disease processes with the goal of weaning them off pharmaceutical medications whenever possible. Health improvement is synergistic with our lifestyle and nutrition!