Category Archives: 2. Functional Medicine Basics

Functional Medicine Lab Testing

Believe it or not, most doctors don’t order nearly enough testing.  The human body is extremely complex, consisting of many different systems that interact in an intricate web, with every system influencing all of the others.  All of the different major physiological functions have special relationships with each other and all affect each other.  This is all well and good, as long as your body is humming along pleasantly, with everything working the way it should.

I might boldly venture to say that there is not a single person on this planet who fits that description.  Instead, stress, environmental toxins, food and environmental allergies, lack of proper nutrition, lack of exercise, dysbiosis, hormone fluctuations, infections, and even genetics, all throw a monkey wrench into this smooth interaction between all of your body systems.

And that’s where the domino effect starts.  Before you know it, a problem in one area becomes a problem in multiple areas; pretty soon everything seems to have gone haywire.

This is why comprehensive testing is important.  Since this level of testing is unfamiliar to most people, I thought it might be helpful to outline some of the lab testing most commonly run by a good Functional Medicine practitioner.  (Notice I said “a good Functional Medicine practitioner”!  Not all are created equal.)

Conventional blood testing – this usually includes a blood cell count, a metabolic panel, a lipid panel, a basic thyroid panel, and a few other miscellaneous tests, such as iron and/or B12 and others.

Adrenal stress testing – this often includes several readings of cortisol (the adrenal stress hormone) and DHEA (another important adrenal hormone).  There are several variations of this panel; depending on which type I order, it may also include screening for anti-gliadin antibodies, progesterone, or other male/female hormones.

Digestive analysis – this assesses your digestion and absorption, and often includes screenings for harmful microbes such as yeasts, parasites, and opportunistic bacteria that can interfere with intestinal function.  There are many varieties of this test available as well; some may include pancreatic function while others include stomach acid levels.  Some tests only screen for antibodies to a known pathogen such as candida or giardia, whereas others analyze the DNA of the microbes and compare it against a comprehensive database of microbes known to cause problems in humans.

Liver detoxification – unfortunately, the liver enzymes commonly tested for in a routine blood test don’t tell the whole story.  In fact, your liver can be in pretty rough shape and those tests will still be well within the normal range.  They don’t even start to show a problem until a liver issue is very advanced.  The good news is, there are much more efficient tests that assess liver function.  They do this by measuring levels of end-products of liver metabolism.  This gives a much more accurate picture of how the liver is functioning now, rather than waiting until advanced stages of damage and dysfunction have set in.

Heavy metal and nutrient mineral screenings – surprisingly, hair analysis is NOT the most accurate method of checking for the presence of heavy metals.  This is because hair analysis depends on proper excretion of heavy metals and some people tend to retain heavy metals inside their bodies instead of excreting them.  Luckily, there are several other methods of testing.  Some versions of this test only check for heavy metals, while other versions also evaluate the more beneficial nutrient minerals such as molybdenum and zinc to assess mineral levels.  These tests are much more accurate and reliable than blood-test versions of these minerals because the body will actually sacrifice tissue levels of nutrients to keep the blood levels constant.

Immune system panels – we can use several different tests to check various functions of your immune system.  One such test gives us clues regarding whether your immune system is fighting a foreign invader, or your own body.  Another test tells us whether your immune system is balanced (which is extremely important!) or whether one side has gotten a little overzealous and out of hand.

Thyroid test panels – to test TSH alone is never enough.  That’s like being blindfolded and trying to get an idea of what an entire elephant looks like by simply touching its trunk.  The trunk is what it is, but it does not tell you very much about the rest of the body.  I view the TSH test the same way; it is important, but it does not give the whole picture and testing TSH alone falls very short of good testing.  Thyroid test panels vary, but they can include the thyroid hormones themselves, how much of those hormones are being taken up by your body, the level of thyroid hormone transport protein lives in your blood, or even whether or not your body has started to attack your thyroid gland (i.e. the presence of thyroid antibodies).

Nutrients (Vitamins and Minerals) – there is a huge variety of different nutrient test panels available.  Some assess fat-soluble vitamins (A, E, D, and K), while others check water-soluble vitamin (B-complex, Vitamin C) levels.  Some evaluate minerals, like we talked about above.  Some measure other nutrients such as CoQ10 and/or glutathione.

Food allergy/sensitivity testing – here again, there is a variety of testing available.  In fact, there are several different types of reactions to problem foods.  One type is an immediate reaction involving histamine; another type is a delayed reaction that does more damage in the long run, but it is less obvious at first.  Several different companies test for several different types of reactions, and may include a wide variety of different panels or groups of foods.  In fact, some tests also include environmental irritants such as pollens, molds, and others.

Male/Female hormone panels – these tests look at the levels of various forms of estrogen and testosterone.  Some even include progesterone.  Most tests involve a “snapshot” of the present levels, while another test measures a female’s monthly cycle over the entire duration of the cycle!

Note 1: This list is by no means complete!  Functional Medicine doctors literally have thousands of individual tests at our disposal, which means we can explore lots of possible avenues and get to the root of the problem.

Note 2: truth be told, I order testing based on what I believe the patient needs.  Some people may need more testing, while others need less.  Some may need a particular test, while others may not.  I don’t order every one of these lab tests for every patient, but I do order every test I feel is necessary for that particular person so that I have all of the information I need to help them heal.

What Functional Medicine is NOT, Part 2:

In the last post, I brought up a few myths that I frequently come across and dissected them.  As I mentioned before, when different practitioners use the same term (in this case Functional Medicine) to mean various things (such as nutrition, bioidentical hormones, or fad diets), this confuses people.  People are just starting to find out about Functional Medicine as it is, and many people aren’t exactly sure what it means.  And who can blame them?  It seems as though there is too wide a variety and not enough consistency, and people aren’t sure where to turn or who to trust.  I thought I’d help sort things out.

Since the last post got longer than I expected, I decided to split it into two parts.  Here is the second part…

Truth #5: Functional Medicine is not a scam, voodoo witch-doctor healing, or old wives’ tales.  The Institute for Functional Medicine (IFM) has published an authoritative textbook that covers nearly all aspects of true Functional Medicine.  The author page boasts an enormous amount of inter-disciplinary collaboration, meaning that Medical Doctors, PhDs, Doctors of Chiropractic, Doctors of Osteopathy, Naturopathic Doctors, Certified Clinical Nutritionists, Dentists, Massage Therapists, Physical Therapists, people with Masters degrees including Masters in Public Health, and Acupuncturists have all worked together to produce this resourceful body of knowledge.  The book cites numerous solid references to genuine studies published in standard, respected peer-reviewed journals across the world.

And that’s just the textbook that many of us use.  In addition, there are classes affiliated with educational institutions that are recognized and accredited by the US Department of Education.  There are cutting-edge authoritative books written for the public by esteemed authors such as Datis Kharrazian, whose protocols I follow (with a few modifications for individual needs and sensitivities), which by itself cites over 600 genuine references.

True Functional Medicine bases their holistic treatment approaches on diagnostic lab test results ordered through standard blood laboratories (the same ones that any hospital or conventional doctors would use), and other CLIA-certified specialty laboratories.  The reference ranges used to interpret lab work are narrower than these labs have set, but are nonetheless based on respected organizations such as the American Endocrine Society and the Vitamin D Council.

Truth #6: Functional Medicine has nothing to do with muscle testing or AK.  Some practitioners utilize “muscle testing”, also known as Applied Kinesiology (AK).  This involves having you hold your arm out, resisting the practitioner’s attempts to push/pull your arm in a certain direction (or directions).  Once he or she establishes that the muscle group s/he’ll use for testing is working properly, s/he’ll have you touch certain points on your body, make certain movements, hold certain positions, or hold certain objects.  These practitioners claim that the results of this “testing” can show if you have a liver problem or adrenal issue.

I have several significant problems with this.  First, the test itself may not be accurate or reliable.  Not only is it incredibly vulnerable to practitioner manipulation (whether he or she is aware of their influence or not), but the scientific research has not been done to back up the validity of this so-called testing.  Not only that, but even if its results are accurate (and let’s say the test really is valid for adrenal dysfunction), there are multiple kinds of dysfunction.  There is overactivity, underactivity, and normal activity but in a chaotic rhythm.  Muscle testing can’t reliably break things down that far, and it certainly can’t quantify it into objective numbers like real lab testing can.

Truth #7: Functional Medicine is a real, recognized form of medicine, not something the alternative medical community made up.  Functional Medicine is not a “chiropractic thing”; in fact, it’s not specific to any single healthcare discipline.  It’s definitely not a fly-by-night approach to be considered second to conventional medicine, with conventional medicine holding the ultimate authority, from whom everyone else (patients and other practitioners) must seek approval.  Functional Medicine, in most situations, can very well be regarded on an equal playing field as any medication-based approach, and Functional Medicine doctors are every bit as knowledgeable in their approach as (and sometimes even moreso than) conventional practitioners who have not studied this approach.

Functional Medicine is indeed a medical subspecialty; its non-pharmaceutical approach allows any non-drug practitioners, including Naturopathic Doctors (in states that license them–of which Texas, where I live, is not one), Doctors of Chiropractic, and others to practice.  Essentially, as long as the practitioner is licensed in the state in which they practice, and their license covers the ordering of diagnostic lab testing, then they may also legally interpret the results and offer a Functional Medicine approach.

I hope that clears up some of the confusion out there. 🙂

What Functional Medicine is NOT, Part 1:

The term Functional Medicine has become a buzzword.  This is only a natural phenomenon; several practitioners have built lucrative Functional Medicine practices that are becoming well-known and receiving a lot of attention.  Practiced correctly, it truly is the next wave of medicine, or at least we can only hope.  Naturally, many practitioners want to catch the wave and “cash in”.

The only problem is, many practitioners who say they are practicing Functional Medicine aren’t really doing so.  They have attempted to bend the term to fit their practice, without really adapting or changing anything they were doing.

When practitioners use one term to mean several different things, the public gets confused.  So, since we already know what Functional Medicine is, I thought I’d ease the above situation by spelling out what Functional Medicine is NOT.

Truth #1: Functional Medicine is not bioidentical hormones.  In fact, bioidentical hormones are not even utilized in genuine Functional Medicine, because exogenous hormones (i.e. hormones that the body itself did not make, that come from the outside of the body) is, by definition, an allopathic treatment.  (That’s not to say that you don’t need them or they won’t do some good.  It simply means that someone who claims to be a Functional Medicine practitioner simply because they give you Armour instead of Synthroid to jumpstart your thyroid is full of baloney.)

Allopathy is the branch of medicine that most doctors practice – they seek to eliminate symptoms by introducing a substance that changes the body’s internal chemical environment such that it can’t sustain the disease or symptoms.  For example, the standard allopathic treatment for diabetes (high blood sugar) is to introduce insulin (which lowers blood sugar).  High cholesterol is treated with statin drugs that lower cholesterol.  In the allopathic approach, little thought is given to the cause of the problem; the focus is on eliminating symptoms through biochemical manipulation.

Back to bioidentical hormones… Bioidentical hormones may indeed be beneficial and they may be necessary.  They may also indeed be superior to synthetic hormones.  I don’t disagree with that one bit.  And Functional Medicine DOES aim to balance hormones, after all.  What I DO find problematic, is when a doctor says they practice Functional Medicine because they balance hormones using bioidentical hormones.  That is NOT Functional Medicine.  The litmus test is this: do I need a prescription to obtain any of the remedies the doctor wants me to take?  If the answer is yes, than it’s not Functional Medicine.  Pure Functional Medicine can (and should) be practiced without any pharmaceutical medications.  True Functional Medicine will approach a hormone imbalance by attempting to find out what’s wrong underneath the surface, by asking the question: WHY are the hormones out of balance?

Truth #2: Functional Medicine is not HCG weight loss or any other fad diet.  HCG, whether in the form of the actual hormone or a homeopathic essence, is also allopathic.  This topic will most likely get its own post, because there’s more to say about this than is appropriate for the scope of this post.  For now, suffice it to say that HCG hormones are also allopathic and possibly harmful.  True Functional Medicine will ask: WHY is the person overweight in the first place?

Truth #3: Functional Medicine is not a quick fix.  While I’ve personally seen some miraculous results in just a few weeks using only true Functional Medicine and nothing else, it takes quite a while to normalize and regulate body chemistry, especially using non-pharmaceutical options.  Medications are meant to force the body’s chemistry to change quickly, and they are very good at what they do.  Natural medicine is very good at what it does, too, but its process is much slower.

Truth #4: Functional Medicine is not just glorified nutritional counseling.  It’s an entire lifestyle modification program.  Dietary modification and specific supplementation are indeed part of the major backbone, but there is much more to the story.  Since most of today’s chronic health problems developed from multiple genetic and environmental influences, the complete solution that delivers the best results utilizes multiple neuro-metabolic therapies based on genuine diagnostic lab test results.

Testing, testing: Lab testing and Functional Medicine

A Revolution in Advanced Clinical Nutrition…

A segment of Clinical Nutrition began to evolve considerably–quietly–about 30 years ago.  Now, it has bloomed into a full-fledged, legitimate medical subspecialty.  We now know much more about the mechanisms behind chronic disorders than we did even 10 years ago.  We also now realize that pharmaceutical medications, while necessary at times, don’t usually offer much in terms of resolution or long-term relief/improvement for these conditions.  Irregular blood sugar, autoimmune disorders, nutrient malabsorption, gastrointestinal microbes, inefficient liver detoxification, and adrenal fatigue don’t necessarily respond all that well to medications.

Since many of these disorders mimic each other (sometimes very closely), it can be difficult to determine exactly what’s going on using symptoms alone.  This can pose a problem, because if there is any hope in making progress or getting relief, the right treatment approach must be followed.

For example, let’s say Betty has fatigue.  The first remedy that come to mind might be caffeine pills.  It sounds logical; if she’s tired, the idea of a stimulant probably appeals to her.  If she doesn’t like the concept of chemical stimulants, she might opt for a more natural route; a naturopath or herbalist may suggest Ginseng or something similar.  Functional Medicine, on the other hand, asks why she is tired, and considers all the possibilities.  Fatigue is a common symptom, with many causes – maybe her adrenal glands aren’t producing enough cortisol.  Maybe her thyroid gland isn’t producing enough T4, or maybe she has a sluggish liver or gastrointestinal tract and can’t convert inactive thyroid hormone (T4) to active thyroid hormone her body can use (T3).  Maybe she’s got a lingering virus.  Maybe her energy is being diverted toward immune system activity because she has seasonal allergies.  Maybe her blood cells aren’t carrying enough oxygen.  Maybe she’s got candidiasis (overgrowth of candida albicans, a problematic yeast); maybe she’s fighting a bacterial infection.  Maybe she she has a food intolerance (these can make people profoundly drowsy).  Or maybe she has low blood sugar.

Each of these possibilities is a completely different problem.  Ten people with fatigue may all share the same symptom, but have completely different reasons for feeling the fatigue.  If the underlying reason isn’t investigated, and the person assumes they have adrenal fatigue when really they have a low thyroid, and they begin taking herbs that boost adrenal function, then they’ve missed the thyroid issue and they fail to correct the problem…and the problem remains.  This begins to illuminate the reason why lab testing is crucial.

As I mentioned before, when most doctors order lab testing, they tend to stick only with what insurance covers.  What you may not realize is that the testing insurance will cover is bare-bones, hardly scratching the surface of what’s actually going on.  Essentially, it’s a screening tool for basic disease and that’s really about it.  The limited tests that are ordered and the way in which the results are interpreted does not do much of anything to accurately assess someone’s actual baseline health.

This is not to “bash” the medical profession at all or paint some kind of “us versus them” polarized picture that illustrates that Functional Medicine is everything while conventional medicine has no place.  Indeed, some of those basic disease screenings can be highly appropriate and unquestionably warranted.  However, those basic screenings are sorely limited in their ability to comprehensively assess someone’s genuine health, wellbeing, and quality of life.  And that is where Functional Medicine has a chance to shine…

Functional Medicine doctors will order comprehensive testing that evaluates multiple areas of body chemistry and multiple important functions that are hardly ever touched on in hospitals or regular clinics.  When we order testing a patient has never had, we find things other doctors have never found.  A good Functional Medicine practitioner will evaluate (at minimum) several areas during routine testing:

  • Nutrient metabolism
  • Cellular energy production
  • Oxygen delivery
  • Inflammation markers
  • Organ and gland functions
  • Infection screening
  • Status of certain nutrients
  • Blood sugar consistency, long and short-term
  • Intestinal microbes, beneficial and hazardous
  • Adrenal stress
  • Central Nervous System state

Another important tenet of Functional Medicine pertains to how the lab testing is interpreted.  Most doctors simply scan the lab test results, looking for anything that the lab has “flagged” as abnormal.  In order for a result to show up as abnormal, it must fall outside of the “normal” or “reference” range.  These ranges are set based on statistics.  They vary by lab and even by region.  Look around you; you’re being compared to your neighbors, your friends, family, and co-workers.  How healthy are they?  I don’t know about you, but being “normal” compared to everyone else isn’t exactly reassuring.

What Functional Medicine doctors do is look closer at the lab test results.  They are familiar with what healthy ranges look like and where a person’s body chemistry should be.  These doctors will find literally a dozen or so dysfunctional/abnormal results that labs and conventionally-practicing doctors will flat-out miss.

Many Functional Medicine doctors take yet one more step further, to analyze patterns between these abnormal results, to attempt to find a common denominator, because often, various dysfunctions are related.  It is indeed entirely possible that a person may have multiple dysfunctional processes happening at once, and it’s also possible that multiple symptoms may stem from one underlying disorder.  Functional Medicine practitioners spend a tremendous amount of time behind the scenes pouring over lab test results and conducting any necessary research.

In short, the rabbit hole that is human physiology can go far deeper than expected; Functional Medicine is the only discipline to ever rise to the challenge.

How Functional Medicine works – the nuts & bolts

Practiced properly, true Functional Medicine orders a LOT of diagnostic testing because each test gives another piece of information, much like putting together a puzzle.  Basic testing only gives you part of the puzzle picture; you’re never really sure what the rest is supposed to say, and you’re forced to guess.  I don’t like putting my patients’ health at that kind of risk; it’s too important.  So the testing is non-negotiable – and why wouldn’t it be?  The human body is quite complex and there’s a lot to evaluate.

Actually, a good evaluation starts before testing is ordered:

  • Lifestyle habits
  • Dietary analysis
  • Trauma and illness history
  • Thorough symptom and metabolic questionnaires
  • Complete medical history
  • Vaccination schedule
  • Medication and supplement regimen
  • Cognitive evaluation
  • Motivation assessment

An important concept in Functional Medicine is that the testing conventional doctors order is not nearly enough.  It barely scratches the surface, because the current healthcare system is driven by insurance companies who do not see the merit in prevention; they are in the business of screening for advanced, established disease and then patching the symptoms with medication when they get further out of hand.

Once we uncover and identify dysfunctions, the doctor takes a secondary, supportive role in the patient’s care as the spotlight begins to shine on patient him- or herself.  The patient’s participation and initiative become crucial for a successful outcome.  He or she may be asked/required to do any of the following:

  • Dietary changes – short-term, long-term, or permanent
  • Specific supplementation – short-term, long-term, or lifelong
  • Specific exercises – these can include eye movements, walking, stretches, arm circles, strength training, interval training, or yoga positions
  • Homecare instructions – these can include doing math or art, reading, prayer or meditation, or utilizing the senses such as listening to music or smelling various scents
  • Other modalities and specialties – acupuncture, massage therapy, aromatherapy, talk therapy, thermography, colon hydrotherapy, homeopathy, physical therapy, brain-based therapy, conventional medical intervention, and more
  • Other lifestyle modifications – TV or computer limitations, activity modification, sleep-wake schedules, work environment, and others

It’s a challenge, and each person must decide for themselves whether or not they’re ready to take the plunge.  Commitment is key.  Motivation is key.  The effort is worth it; one of these days I’ll share some of my patients’ success stories–real cases (while protecting privacy), to demonstrate the power and miraculous relief that Functional Medicine can bring when conventional medicine, traditional alternative medicine, and self-treatment via the web have ALL failed.  It’s truly amazing!

What is Functional Medicine?

The short answer is, Functional Medicine is the future of medicine, if we are to get well and stay well as a society.  It’s the direction in which regular medicine should have gone.  It should be used as the primary method of treatment, especially in cases that are not acute, infectious, catastrophic, life-threatening, or other emergencies.

The long answer is, the definition of Functional Medicine largely depends on who you talk to.

  • The Institute of Functional Medicine, arguably the leader and Gold Standard of the field, describes a science-based, patient-centered form of healthcare that recognizes biochemical individuality and favors active prevention.
  • A talented colleague of mine defines Functional Medicine as a complete lifestyle-modification program that evaluates physiology using extensive diagnostic lab testing and then corrects any imbalances found by applying specific, individually unique combinations of neuro-metabolic therapies.
  • Another talented colleague of mine mentions looking at everything (hormone balance, nutrient metabolism, immune system, and a plethora of other categories) all at the same time, leaving no stone unturned

Functional Medicine really is “all that” – in terms of the explanations given above, as well as being Just That Cool.

When I explain it, Functional Medicine can take on a few different personas that all relate back to the same Big Idea.  Various descriptions are as follows…

  • A highly-advanced version of Clinical Nutrition, taken to another level as practiced by a doctor, that bases its herbal and nutritional plans on comprehensive lab testing
  • A third type of healthcare that is separate from both conventional and alternative medicine branches we’re already familiar with, that utilizes the best of both worlds
  • An emerging medical subspecialty that combines conventional testing and natural therapies
  • A logical, scientific alternative for those looking for natural or holistic healthcare, perfect for those who don’t know where to turn or who to trust.
  • A scientific-yet-holistic of looking at the functions of the body and how they are inter-connected, identifying dysfunctions in key areas using lab tests, and then correcting them with a comprehensive lifestyle modification plan.

That last one is my favorite (couldn’t you tell?)

Functional Medicine really shines with chronic, complex disorders, especially the degenerative and/or mysterious.  I can say it is definitely worth the effort, commitment, and investment!  Most Functional Medicine practitioners know firsthand; many of the best doctors got involved with the field because of their incredible experiences.

We’re a product of the choices we have made every day.  Every day we have another chance to stay on our current path or choose something different.  What are you waiting for? 🙂