What is functional
medicine?

What is functional medicine?

Functional medicine is a comprehensive, evidence-based approach to healthcare that is personalised to each individual. It combines the holistic approach to health seen in traditional and alternative healthcare approaches with a modern understanding of biology, disease processes, testing, and medications to deliver effective health outcomes.

The functional medicine approach involves deep and broad investigation that considers a person’s whole health picture: diet and lifestyle factors, supported by comprehensive testing. It provides a unique roadmap for recovery for each person, with an emphasis on building long-term resilience.

It is now well understood that chronic diseases are caused by largely modifiable elements such as diet, lifestyle and environmental factors that switch on genes and promote disease. Functional medicine focuses not only on disease resolution, but prevention by reducing known risk factors that promote disease.

Functional medicine also recognises that health and disease are on a spectrum, and many conditions can be prevented, reversed, or put into remission. A functional medicine practitioner is trained to look for signs of dysfunction, a state that occurs before a condition fully manifests, and can recommend treatments to improve health and prevent disease, rather than relying on medications that mask symptoms.

This approach to chronic disease management can not only halt or reverse disease – it can also improve long-term health. Functional medicine is well placed to play a crucial role in influencing the trend of rapidly declining health and the growing burden on the healthcare system, which is predicted to worsen as the population ages.

Why do we need functional medicine?

Patient Izabella found herself visiting the doctor frequently after receiving her Hashimoto’s diagnosis. She saw an endocrinologist to manage her thyroid hormone prescriptions, and a gastroenterologist for IBS-type symptoms such as diarrhoea and bloating. Izabella felt frustrated by the long wait times for specialist appointments, which often felt rushed. The prescription-based approach seemed to offer little in the way of dietary or lifestyle advice to manage her various complaints. Feeling alone and disempowered, Izabella felt caught up in a system where she didn’t feel heard or valued as a person.

Izabella is not alone. Studies have revealed that many patients feel they are receiving suboptimal care, in a fragmented system that is poorly coordinated, leaving gaps in their care that lead to poor health outcomes.

Patients are looking for better evidence-based support for chronic conditions, being engaged more in their care that has a focus on prevention and health, with improved coordination and follow-ups to ensure continuity of their care. This is precisely what functional medicine sets out to achieve. 

Who does functional medicine help?

Functional medicine can help people with chronic health conditions, including autoimmunity, neurological conditions, hormonal disorders, cardiovascular conditions, digestive issues, and skin disorders. It can also be used in acute settings such as viral infections like COVID-19.

Some health concerns elude diagnosis, yet with an in-depth understanding of human biology and pathophysiology, can be helped by following signs, symptoms and using clinical tools like functional testing to pinpoint and address potential root causes of dysfunction.​

The many chronic diseases or health challenges that functional medicine can help with include:

• Anxiety
• Asthma and allergies
• Autoimmunity – diagnosed and undiagnosed
• Brain and mood disorders
• Cardiovascular disease
• Children’s health
• Chronic fatigue
• Chronic pain
• Compromised immunity
• Diabetes
• Digestive disorders – diagnosed and undiagnosed
• Graves’ Disease
• Hashimoto’s Thyroiditis
• Hormonal imbalance
• Hypertension
• Infertility
• Insomnia
• Long COVID
• Menopause
• Metabolic dysfunction
• Obesity
• Recurrent infections e.g. Chronic UTIs, thrush
• Skin conditions: e.g. Psoriasis, acne, eczema
• Thyroid disorders
• Viral infections e.g. COVID-19, Shingles, Epstein Barr virus
• Women’s health e.g. PMS, PCOS, period pain, and irregular periods

People with seemingly unrelated symptoms that don’t fit neatly into a specific category or condition can also benefit from the functional medicine approach. A perfect example is Izabella, who had bloating and diarrhoea, as well as thyroid and autoimmune issues, which we often see in our clinic.

Many people in this situation are confused by which practitioner or specialist they need to see. With the functional medicine approach, practitioners can help by taking a 360° view of their health to determine what’s going on their body, and why. In many cases, while symptoms can seem disparate and unconnected, often the same causes or contributing factors are at play, and through a thorough understanding of the interconnectedness of systems in the human body, symptoms that seem disconnected suddenly make sense.
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Other people who benefit from functional medicine are those in good health who want to prevent disease, extend their lives, or optimise their health now, such as elite athletes, biohackers, high-performance seekers, and optimal health enthusiasts.

How functional medicine is done – the process

So you might be wondering – how is functional medicine actually practiced? Functional medicine is a framework, and because functional medicine practitioners include doctors, naturopaths, chiropractors and even nurses, the way functional medicine is practiced will vary depending on what type of practitioner you see. However, all practitioners of functional medicine follow certain principles while working with patients to help them recover their health. Let’s take a closer look.

Functional medicine is detective work

Functional medicine takes a detective-like approach to solving patient cases. It requires thinking about all the possible things that could be causing a person’s symptoms, then figuring out a way to explore and rule out each possibility. In our clinic, our practitioners create a timeline of a patient’s medical history, and map out their health picture including possible root causes and contributing factors. From there, they create a plan that they continually refine as they rule out causes until they hone in on what’s really going on with a patient. ​

This deep detective work takes time, incessant curiosity, and skill. To do this effectively, practitioners need to have a deep understanding of biology, biochemistry, and pathophysiology (disease conditions). This allows them to think creatively about potential solutions for each unique case.

Functional medicine treats the root cause – with the aim being improved long-term health

Imagine caring for a tree: if the leaves went brown and spotty, you could paint them green to make them look better, or even cut them off. The symptoms will be gone, however, without having addressed the underlying problem, they will return. This is akin to using medications for rapid relief and symptom suppression. The symptoms might disappear for a while, however the underlying problem still exists, while the treatments themselves can often lead to further problems.​

Consider the management of high cholesterol. Statins reduce cholesterol by inhibiting an enzyme used in its production. The same enzyme is also required to produce CoQ10, a critical antioxidant and cofactor involved in energy production – so synthesis of CoQ10 is reduced which can lead to side effects like fatigue and muscular pain, and an increased risk of developing diabetes mellitus.

​Meanwhile, most heart attack patients have normal levels of LDL cholesterol, and new insights show that high cholesterol is often a symptom of other imbalances in the body, such as metabolic syndrome, intestinal hyperpermeability, changes in thyroid function, stress, underlying viral infections or toxin exposure.

Functional medicine asks not just ‘what is the best drug or intervention for rapid relief of this disease?’, but also ‘why did it occur, and what needs to be resolved in order for a return to health?’.​

The health of a tree is dependent on the environment it lives in (soil, access to sun, water etc.). In the same way, human health is determined by ‘the exposome’: factors like nutrition, stress, pollution, exercise, relationships, and sleep. For a tree, the problem might be a lack of sun, or excess water. For a person with a chronic disease or other chronic health issue, it might be poor nutrition, stress or heavy metal toxicity. By addressing these factors, health can be restored, and longevity maximised.

Functional medicine practitioners look for the root causes of illness. They do this by looking for:

• Antecedents – factors that put someone at risk of developing a problem e.g. a genetic predisposition
• Triggers – an incident that is likely to induce the start of an imbalance or disease state e.g. a stressful life event, microbial or viral infection
• Mediators or drivers – something that contributes to the progression of a condition e.g. a nutrient deficiency, food sensitivity

This is why a thorough case taking is the first step in the investigative process. No stone should be left unturned, as even a minor clue can be the key to putting a person’s health puzzle together.

Functional medicine takes a holistic approach to understand how the whole body works

Functional medicine is a ‘systems biology’ approach to medicine that looks at the body as a whole rather than focusing solely on isolated body parts or systems. While specialist knowledge is a valuable part of detective work, disease states and chronic disease management can be complex, involving many different biological systems. By taking a holistic view of the body, functional medicine practitioners can provide more comprehensive and individualised care to patients.​

One of the most well-known examples of the interconnectivity of body systems is the psycho-neuro-endocrine-immune (PNEI) system. The nervous, endocrine and immune systems have been identified as a super system, which can be influenced by psychological factors, highlighting the detrimental impact that stress can have on the body. In autoimmune conditions like Rheumatoid Arthritis and Lupus, psychosocial stressors, for example, may impact the nervous system and lead to high levels of inflammatory immune cells called cytokines, pro-inflammatory hormones, and downregulation of anti-inflammatory hormones. 

The body is interconnected, with systems working together directly or indirectly to keep the body in homeostasis – a dynamic adaptability in response to the internal and external environment.

​In the case of an autoimmune condition, rather than simply seeing the immune system as the issue, a functional medicine practitioner will look to assess the health of other systems such as the nervous system or digestive system, depending on a patient’s health picture, to determine the cause.

Because of the complexity of the body, the functional medicine approach recognises that there is rarely a sole cause of a chronic disease state. As seen in the example below, there are many factors contributing to diabetes mellitus (type 2 diabetes) such as inflammation, hormones, genetics, epigenetics, diet, exercise and mood disorders.

On the flip side, many conditions can be caused by one imbalance. For example, chronic inflammation is a cause or driver of many – if not all – chronic health conditions, notably including heart disease, depression, arthritis, cancer and obesity.

This is why personalised care is a key approach of functional medicine.

Everyone is different, so care is patient centred and personalised

Taking all of this into consideration is the reason why functional medicine is a deeply personalised approach. Rather than applying one protocol to many patients with the same health problem, functional medicine practitioners take the time to learn about each individual’s diet, lifestyle and health history (including family history) in order to develop a truly tailor-made treatment plan that matches their biochemical individuality. It’s about solving a person’s health puzzle rather than solving a condition.

By combining their clinical expertise with the latest evidence in the scientific literature and their patient’s health narrative, functional medicine practitioners are able to create a strategy that is unique to each person. This approach always considers ‘what will be right for this patient?’ and, as such, patients not only discover how to get their health back, but also how to live in alignment with what their body needs to be healthy.

This means that two people with the same diagnosis will likely get a completely different treatment plan that targets the root causes and drivers of their condition.

For example, two people with the same autoimmune condition can have entirely different contributing factors and root causes, requiring distinctly different treatments.

Patient 1 – Izabella

Alongside her primary health concern of an autoimmune diagnosis, Izabella, our patient example from earlier on, was experiencing IBS (irritable bowel syndrome) symptoms like diarrhoea and bloating after eating meals, and ongoing stress due to family issues.

‍The detective work​

As autoimmunity can be triggered or driven by stress, an imbalance in the gut microbiome and food sensitivities, this led the practitioner to run a comprehensive stool analysis to understand Izabella’s digestive environment, as well as food sensitivity testing to help identify what foods might be causing her bloating after meals. The stool analysis identified an imbalance in the gut microbiome (AKA gut dysbiosis), and the food sensitivity test revealed that the immune system was reacting to gluten, which was a staple of her diet. Gluten is a known trigger of autoimmunity, as it can weaken the intestinal wall, leading to proteins leaking into the bloodstream and causing an immune reaction along with inflammation. A current theory of how autoimmunity can arise is ‘molecular mimicry‘, where the immune system creates an antibody to a foreign protein such as gluten that is similar to a protein in the body, such as the thyroid gland, causing the immune system to attack human tissue. Stress can also impact the gut microbiome and intestinal permeability, further driving autoimmunity, and can also be implicated in IBS.

‍Izabella’s personalised plan​

The personalised plan Izabella’s practitioner put together included a gut healing protocol that sought to restore the gut microbiome and improve the intestinal wall integrity, a gluten-free diet, and a plan to help her manage her stress.

Patient 1 – Christine

When discussing Christine’s health history, it was revealed she had glandular fever (Epstein Barr Virus – EBV) around the time her health started to decline. She was also feeling constantly tired, with pronounced drops in energy throughout the day, particularly after meals where she also felt irritable and anxious, was overweight, and had ongoing mood and sleep issues.

‍The detective work​

Viruses such as EBV are a known trigger for autoimmunity, with EBV recently being identified as a leading cause of multiple sclerosis. After a thorough assessment of her diet and lifestyle, it was noted that she was consuming a high intake of processed sugar and foods, mostly living on takeaway and store-bought foods, which is a key trigger and driver of autoimmune conditions. Her diet and fluctuating energy levels alongside her irritability and anxiety pointed towards suboptimal blood glucose control, which her practitioner confirmed by having Christine monitor her blood glucose levels with a glucometer before and after meals. Her ongoing energy, mood and sleep health challenges, alongside autoimmunity , led the practitioner to consider methylation as a factor. Hypomethylation of DNA has been implicated in gene expression  associated with autoimmunity, so was identified as a possible antecedent for autoimmunity to occur. As methylation is a process essential to healthy detoxification, energy production, and neurotransmitter synthesis, Christine’s practitioner ran a methylation profile to confirm their hypothesis, which demonstrated that Christine’s methylation was suboptimal.​

‍Christine’s personalised plan​

Christine’s treatment plan involved antiviral treatment using antiviral and immune-modulating compounds in the medicinal mushroom Reishi, a diet to improve blood glucose control, and micronutrient supplementation to support methylation.

As you can see, while each of those cases started at the same point, the underlying causes and solutions were dramatically different. This factor can explain why randomised controlled trials, where a group with the same health challenge is treated with the same intervention, falls short as the best source of evidence for whether an intervention will work for all people with that condition.

Functional medicine’s personalised treatment makes it difficult to replicate in this type of study to test the effectiveness of the approach, however, cohort research has been done on the functional medicine approach, with promising outcomes.

A 28-week study in 2016 demonstrated significant improvements to stress, energy, fatigue, digestive issues, and quality of life in middle-aged women, and a more recent study reported significantly better quality of life outcomes for patients with chronic illnesses such as autoimmunity, neurological conditions, hormonal disorders, cardiovascular conditions, digestive disorders and skin disorders than those treated conventionally.

Functional testing is often critical to the detective work

• DUTCH – the best current testing methodology for hormonal investigation (uses urine sample over time + shows metabolites, not just the hormones themselves).
• OAT – an organic acids test to help give clues to underlying health imbalances
  Stool testing- to test for pathogens, functional digestive capacity, microbiome health, as well as gut inflammation markers.
• Cardiometabolic testing – the latest in understanding of cardiometabolic health e.g.: lipoprotein particle profiles, oxidised LDL etc.
• Comprehensive thyroid panel – not just TSH and T4, but the full thyroid picture that includes markers TSH, T4, T3, rT3, TPOAb, TGAb and TRAb.
• Environmental toxins – Exposure to toxins such as mycotoxins, heavy metals and other environmental pollutants

Functional medicine seeks to empower patients, engaging and partnering them in their health journey

All the best testing, diagnoses and treatment strategies mean nothing without implementation. This is why functional medicine prioritises empowering patients and partnering with them on their journey to good health. People are complex creatures – not just in body, but in mind – so an effective care plan requires a deep understanding of people and behaviour change.​

Fostering a collaborative relationship helps patients feel heard and supported, while also giving them a sense of control and agency over their own care plan.​

Some functional medicine practitioners, like in our clinic, are going one step further and incorporating health coaches into their healthcare teams. Our health coaches provide ongoing support and guidance between practitioner sessions, helping patients set goals, learn self-management skills, and promote behaviour change that leads to lasting improvements in health. This allows us to focus more time and attention on each individual case, leading to better health outcomes.​

Through this empowering relationship between practitioner, health coach, and patient, we encourage our patients to take ownership of their health and participate in their healing. Part of this approach includes increasing a patient’s ‘health literacy’ – understanding the factors that contribute to their health and being in tune with their bodies. This level of connection and understanding is essential for true healing to take place, and gives people tools to manage their health for a long, healthy life.

Why functional medicine is the future of healthcare

With chronic diseases predicted to rise across the globe, and with hospital systems already overwhelmed by mostly preventable conditions, functional medicine is perfectly placed to solve the healthcare crisis, given its role not only in disease resolution, but prevention through education and empowerment.

Highly individualised care involves a substantial amount of time and effort from both clinicians and patients, and until functional medicine receives the recognition and subsidy it deserves, the testing and treatment can be expensive.

As the saying goes, an ounce of prevention is worth a pound of cure. And the benefits of investing in an approach that can prevent or reverse a condition and improve quality of life, seem certainly worthwhile. Yet, the adoption of the functional medicine approach requires a complete paradigm shift by the medical industry, to recognise that getting to the root cause of a chronic disease is more economical than managing that disease over the long-term.

Watch Mark Hyman’s TEDMED talk on why functional medicine is the future of medicine

Functional medicine is here, and perfectly placed to care for patients’ health based on the latest clinical research and insights. So if you’re after a personalised, collaborative, and supportive approach to solving your health problems, functional medicine is your best bet right now. Not only will it cost you less money in the long run, you’ll also live a higher quality, longer life. And you can’t put a price on that.

Treat the cause. Get support. Be well.

Discover how Melbourne Functional Medicine can help you find the healthiest version of you.