But I Still Don’t Understand Functional Medicine

Updated: Sep 19, 2018

Functional Medicine has been around for a while but it is still new to many people. Naturally this leads to questions like what is it? what is involved? etc. Let’s answer those questions and more by delving deeper into what is involved by going through a case study.

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The Choice To Use Functional Medicine

This client was a female with a long history of Irritable Bowel Syndrome (IBS) and food allergies, specifically milk, that began after using powerful antibiotics in childhood. These issues persisted throughout childhood and early adulthood despite seeing several medical doctors. Approximately a decade ago, this client experienced the loss of her father. A few months later, one of her children had a major medical event and had to be air lifted to the hospital. This issue continued for several years without a diagnosis or plan which added stress for this client. Eventually, she began to have pain in her left arm. As she continued to deal with her child’s health issues and the loss of her father, the pain spread to cover her entire left side. She also continued to struggle with IBS and had alternating bouts of constipation and diarrhea.

She did see a different gastroenterologist regarding IBS. She was prescribed the antibiotic Rifaximin (aka Xifaxin) which has been shown to be effective for IBS. [1] She experienced significant reduction in IBS symptoms and was able to eat like a “normal” person. This lasted for approximately six months before the symptoms returned. Her gastroenterologist prescribed a different antibiotic but it was not effective in reducing any symptoms. She also went gluten free with her diet at this time and noticed a significant reduction in symptoms but would still experience alternating bouts of constipation and diarrhea.


As her pain worsened in her left arm and spread over her left side, she feared she may have Multiple Sclerosis. She saw a neurologist and had multiple MRIs on her brain and spinal cord. Luckily, no lesions were found and a diagnosis of Multiple Sclerosis could not be made. She also had blood work performed and was told that everything was normal.


The Problem With Lab Ranges

In working with this client, we were able to use the blood work that she had already performed. However, our findings were different. There were issues with several blood markers that indicated different forms of anemia. This was a significant finding since one of her chief complaints was fatigue and inability to concentrate. This finding also made sense given some of the medications she was taking are known to lead to deficiency of several B vitamins. A full thyroid panel was also ordered for this client. This showed that she had some issues with converting the inactive T4 hormone to the active T3 hormone, for more information click here.

How were these issues detected using the exact same results? Well, Functional Medicine uses a different range than Conventional Medicine. Conventional Medicine uses the reference range and considers this the “normal” range. How does the lab determine the “normal” range? Do they do specific testing or base it on research? The answer is…No! The range is determined by the people who are getting the tests performed in that specific lab. The range that is determined assumes that everyone who is having the test is healthy, but we know that is not accurate. After all, who is most likely to have blood work performed, a healthy person or someone who is sick? Then the range is determined by using a bell curve so that approximately 95% of the population falls into that range and is considered normal. You may have noticed that different labs have different reference ranges. This is because each lab has a different population coming in and being tested. These issues help to explain why these ranges can still be useful in diagnosing disease but do not perform well in regards to determining health.


Then what range does Functional Medicine use? Functional Medicine uses the functional range which is narrower than the reference range. The functional range does not diagnose any disease or condition. However, it does provide important information regarding your health and if certain areas are not working optimally. This allows you a chance to make changes and possibly prevent disease from developing in the first place.


Back To The Case Study

Let’s get back to the issue at hand. The client has pain on the left side of her body, gut issues, lack of energy, brain fog/difficulty concentrating, issues with T4 to T3 conversion, B vitamin deficiency/possible anemia and has significant life stressors. How did we address these issues? We focused on her as a whole. We did not attempt to give her a pill, supplement or medication, for each symptom.


In general, the primary aim of the treatment plan was to deal with stress. For this particular client, stress appeared to be the root cause of all of her issues. However, the stress came in many different forms. She had stress from the loss of her father, from her child’s illness, from her longstanding gut issues, and the list goes on and on. But how does stress lead to poor T4 to T3 conversion or B vitamin deficiency? Her longstanding gut issues contributed to some of this. Her gut was irritated/inflamed and she had alternating bouts of diarrhea and constipation. This shows that there are some issues with digestion and absorbing nutrients from food leading to increased allostatic load on her body. In essence, her gut issues were another stress for her body to contend with. The combination of poor digestion/absorption along with taking medications that can lead to vitamin deficiency helps to explain the B vitamin deficiency and possible anemia.

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Stress affects the Hypothalamic-Pituitary-Adrenal (HPA) Axis and has been discussed here. The HPA Axis can actually be extended to include the Thyroid and Testes/Ovaries. Therefore, if this axis is not working properly, it could lead to issues with the production of hormones or in this case, the conversion of hormones. It is also possible that the gut issues contributed to this issue. How? Thyroid hormones require iodine to be produced and selenium is required to convert T4 to T3. If there are issues with digestion and/or absorption, the body may not be able to obtain the nutrients it needs for these reactions (production and conversion) to take place.


So, exactly how did we address these issues? We focused on stress management and diet. I believe diet was the biggest issue for this client. She had to pay attention to everything she ate and how it made her feel. By doing so, she was able to identify a variety of foods that her body did not respond well to. It is interesting to note that some of the foods that were problematic for her are healthy foods. For example, many nightshades like tomatoes, potatoes, etc., were an issue. By identifying and reducing or eliminating these foods, she was able to decrease the overall stress on her body.

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She also began meditation and other stress management techniques. She used the headspace app for guided meditation. She was also involved with her local church and had a community around her. That community was key in providing her a safe place to be able to talk about and deal with the loss of her father and the uncertainty of her child’s health. In this way, she was able to respond to the stress in her life in an appropriate way instead of that stress manifesting itself as actual physical issues in her body.


She did begin to use some key supplements. This included a probiotic, digestive enzyme, adaptogen and B vitamin complex. The probiotic and digestive enzymes were used to address her specific gut issues. The adaptogen and B vitamin complex were used to address the B vitamin deficiency and allow her body to be able to adapt to stress in a healthier way.


Did It Work?

It did! We were able to work together to devise a specific plan to address her specific issues. She no longer has the same pain on the left side of her body. She has even been able to have a milkshake without getting sick despite her milk allergy. She also has more energy and is able to think more clearly. This has allowed her to spend more time with her family and to serve others through her local church.


This plan worked for this client. However, it might not work for you even if you are experiencing some of the same issues. This is because we are all unique and are affected differently by the issues we are facing. However, the same principles that were used in this case study can be useful in helping you deal with your own health issues. Find someone to work with that you trust to develop a partnership with you to obtain your optimal health.


Please go to my website, healthydesignfxmed.com, and sign up for a free 15 minute consultation to ask questions and see if we would work well together or dive right in and schedule your 60 minute Initial Evaluation. The Initial Evaluation and the free consultation can be performed in person or via phone/skype. I look forward to hearing from you and working together to accomplish your goals.


Disclaimer:

This article is for educational use only. Nothing contained in this article should be considered, or used as a substitute for, medical advice, diagnosis or treatment. This article does not constitute the practice of any medical, nursing or other professional health care advice, diagnosis or treatment. Always seek the advice of a physician or other qualified health care provider with any questions regarding personal health or medical conditions. Never disregard, avoid or delay in obtaining medical advice from your doctor or other qualified health care provider because of something you have read in this article. If you have or suspect that you have a medical problem or condition, you should contact a qualified health care professional immediately. If you are in the United States and are experiencing a medical emergency, you should dial 911 or call for emergency medical help on the nearest telephone.


References/Citations:

  1. http://www.nejm.org/doi/full/10.1056/NEJMoa1004409

  2. http://www.integrativepro.com/Resources/Integrative-Blog/2016/The-HPA-Axis

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