Recently I was asked to do a newspaper interview about a best-selling book that discussed treatment of Hashimoto’s thyroiditis (low thyroid function caused by one’s own immune system). In the end I was not thrilled with the accuracy of the information provided in the article, nor with my role as what appeared to be the “stodgy Western-medicine physician.” In my own
practice I try very hard to work well with people who embrace both traditional (Western) and alternative (holistic, functional) approaches to treatment, and I try to accurately assess whether alternative therapies have merit in what they claim. I also share my opinions tactfully but honestly. It turns out that practitioners of what is called “functional medicine” and I often don’t agree about causes of illness or treatment approaches. I have many patients, though, who do like to see both types of practitioners. So, how should I approach this conflict? After some time of reflection, what I think is a helpful question came to mind. “What do I really like about
functional medicine?” Today I’d like to share my answers with you, along with some thoughts about how and why I practice the way that I do.
Practicing Western Medicine
Now, as we start, let me come clean. I am a full-fledged, Western medicine, allopathic physician. With this comes certain preferences and biases, which I fully admit and will even embrace. Here are just two:
- I like the scientific method. When I get an idea, I like to be able to design an experiment, take a measurement, and use it to test my hypothesis. Was I right? Let’s see what the data showed. In the same manner, if I am going to recommend something to my patients, ideally I’d like it to have both scientific evidence for effect and scientific
plausibility. More on these later.
- I adhere to the Hippocratic oath. The tenet “first do no harm” has importance. If I am going to recommend treatment, particularly with procedures, medication, or supplements, if there is not clear science showing benefit, I had better be confident it will not be harmful. This confidence can be especially hard to come by with supplements, which are not tested for or monitored for safety as stringently as medications. Numerous supplements, just like medications, have been removed from the market (remember ma huang?) when shown to be unsafe, and there have even been criminal cases of supplement makers continuing to knowingly supply unsafe products. This is not to say supplements are inherently bad, I am certain most are not harmful and some are beneficial, but rather that supplements are not inherently safe either.
The Benefits of Functional Medicine
Now with those caveats in mind, I’m going to shift gears entirely and tell you what I really like about functional medicine (and holistic medicine in general).
Functional Medicine pays attention to the mind-body connection. It turns out this is real, people. It is hard to be truly “well” if one is not physically, mentally, emotionally, and spiritually well. We need to pay attention to all these parts of ourselves and others.
Functional Medicine makes individual recommendations. It turns out when you listen to your patients, and pay attention to the mind-body connection, you can make very good individual recommendations. This is one of my favorite parts of being a doctor, trying to really understand what is best for my patient right now, in his or her circumstance. Yes, the guidelines might say there are 17 things I should recommend to you for treatment. But maybe your mother is sick in New York, you are traveling a lot to help with her care, and between that and trying to keep up at work and with your kids, there is no room for 2 interventions, let alone 17. So let’s focus on what’s critical for you right now, and put the rest on the back burner for another time.
Functional Medicine emphasizes prevention. I think Western Medicine has always paid attention to prevention as well, to a lesser degree, but treatment of existing conditions has always been brought to the front. It turns out that a little attention now to live a healthy lifestyle with proper food choices, exercise and sleep, to participate in recommended screening, to get vaccinated, etc., can prevent a lot of trouble down the road.
Functional Medicine promotes a healthy lifestyle. The values of our current society do not help us to be healthy, to be vital, to live at optimal health. We are stretched thin by work and family commitments, we are often sitting in front of a screen of some type and are not moving our bodies, we don’t get sufficient sleep, we don’t eat enough food that grew out of the ground, and we pay a price for this. Functional medicine emphasizes the importance of sound lifestyle choices as part of being healthy.
But is Functional Medicine Always the Best Treatment Option?
Well, after reading all that you might ask why I am not a functional medicine physician. Good question, and probably too long an answer for this post, but at the risk of drawing hate mail, let me give you two ideas as I wrap up:
Functional Medicine relies on anecdote. I mentioned I like the scientific method. I’ve heard a functional medicine physician say that we don’t always need to have randomized trials to show a medicine is effective, we can use “cutting edge science” to bring new ideas to patient care now. And if patients report feeling better, then it must be working well. I disagree. First, the power of placebo, just like the mind-body connection, is real. One study from the 50’s, perhaps the classic study on placebo effect, showed people
receiving a “sham” (that is, fake) operation for angina had a 35% improvement in their symptoms. Similarly, improvement after sham surgery for knee arthritis was more recently identified. So, if no one actually tries to measure if the intervention is helping, we might actually be doing harm. Wouldn’t we all believe that a drug that raises good cholesterol and lowers bad cholesterol should be beneficial? It turns out that a particular drug that does just that, Torcetrapib, was actually shown to increase mortality. If this drug had been released just based on the “early research” it would have been quite harmful to people who took it. We still need scientific studies.
Functional Medicine uses untested claims. In the name of using “cutting edge science” Functional Medicine crafts and adopts ideas before we know if they are beneficial, neutral, or even harmful. For example, there is a lot of circulating about what is proper treatment of Hashimoto’s thyroiditis (HT), including the idea that those with HT need to give up gluten. It’s true that some people with HT also have celiac disease, and those people do need stop gluten intake. However, in those with HT who do not have celiac disease (which is the vast majority of people with HT), there are no studies showing people with HT and low thyroid function can stop or reduce medication use by going gluten free. Additionally, I have found no studies that evaluated a gluten free diet in people with HT who do not have celiac disease (the few studies that ask whether a gluten-free diet influences the thyroid immune reaction in patients with celiac disease show conflicting results, some studies suggest thyroid autoantibody levels may decrease but other studies show progression of thyroid destruction or new cases of HT in those
who are on a gluten free diet). Whew! I hope that brief explanation makes some sense.
The bottom line for me? If you have celiac disease you need to be on a gluten-free diet. If you have HT, I want to see the study that shows benefit before I recommend you give up gluten.
So, Let Me Conclude
In this internet age, we have so much information available to us, just a click away. We have practitioners providing often conflicting advice about how to live, how to be healthy, and how to treat our afflictions. I hope you can find a doctor who listens to you, who pays attention to your body and your mind, who emphasizes prevention and a healthy lifestyle, and who knows you and gives you recommendations specific to your unique conditions and circumstances. I hope you find a doctor you can trust.