Who Is Speaking Our Language?
FUNCTIONAL MEDICINE
The Mainstream Arrival of Functional Medicine
Laurie Mueller
DC, CFMP
Discovering the underlying causation for dis-ease. Whole-body, inside-out health. Homeostasis. Providing the body with what it needs to function as designed. The body healing itself. Food as medicine. Natural approach to health. These concepts should sound familiar. Chiropractic has spoken this language since our inception in 1895.
For those of you who have not heard, there are new players speaking our language, and they are practitioners of what has been dubbed “functional medicine.” That title is a bit of a misnomer because functional medicine would actually be better termed a “functional approach” or “systems imbalance approach” to health care. MDs, DOs, NDs, DCs, and other professionals from around the world have caught on to this paradigm and are implementing it at warp speed. Expect to hear “functional medicine” from patients in your practice who have interest or questions. It is prudent that all DCs are able to respond as knowledgeable professionals and part of their patient’s healthcare team. It’s also important that we don’t get caught up in the semantics of the words “functional” or “medicine” and really understand what patients are referring to when it is mentioned.
How we decide to practice is, of course, up to each individual chiropractor and his or her scope of practice laws. Some DCs will choose to practice functional medicine in tandem with chiropractic practice. Others will choose
to send patients who want to pursue it to a functional medicine practitioner and co-care with them. With the depth and breadth of the functional medicine movement, it is important that chiropractic is not left behind. At its core, this mainstream movement to a functional approach for patient care is implementing the paradigm that our chiropractic colleges have been teaching from the beginning. All chiropractic practitioners should have cursory knowledge of what functional medicine is and understand the concept so that they can confidently and knowledgeably have professional conversations with patients as well as with practitioners who are implementing functional medicine in their practices.
With certificate programs from the Institute of Functional Medicine and Functional Medicine University, master’s degree programs in nutrition and functional medicine at colleges such as the University of Western States, and coverage by TV personalities such as Dr. Oz, this trend is here to stay. According to IFM, medical schools are even asking for specific functional medicine curricula to add to their core offerings.
In the medical realm, the renowned Cleveland Clinic in Ohio opened a dedicated Center for Functional Medicine in September 2014 under the leadership of Mark Hyman, MD. They reported that they had to move into a new, much larger space to meet patient demand in 2017.
http://www.crainscleveland.com/article/20180304/
news/15 3 73 6/former-cleveland-clinic-docs-self-fundnew-functional-medicine-practice
In an article from 2017, they reported that thousands of patients were on the clinic’s waiting list. Mark Hyman is a known advocate for “food being the best medicine.”
http: //ww w. modernhealthcare .com/article/20170123/ NEWS/170129982
A profound demand needs to be met as patients become more educated and want to try a different approach.
Functional Medicine Is Here to Stay and Patients Are Asking for it By Name
We can’t do it alone. It is not in our scope to prescribe drugs or help patients wean off them. However, all of us can assess physiologic function measurements, and many of us (in our states or countries of practice) can utilize lab testing and give advice on nutrition and lifestyle. At the most minimal level, members of our profession need to be literate on this subject for our patients, be able to have a professional discourse with them and other professionals, and be able to address the patient’s needs or refer them to others with an understanding of what they will encounter.
For those of us who do pursue certification to practice some elements of functional medicine, we certainly need to fully understand the implementation to do it safely and effectively, and we need to have the skills to co-care with medical doctors to handle the aspect of pharmaceuticals.
As part of this article, we want to walk through some basic terminology used to describe the major system imbalances that functional medicine practitioners look for in patients. Keep in mind there are exams, analysis, systems evaluations, labs, and other factors that direct practitioners to individual patient issues and proper care plans. Also, practitioners must recognize that most patients have a combination of imbalances at varying levels that interconnect and are prioritized and addressed according to relevance. Different organizations may name these imbalances slightly differently, but the concepts behind every area of imbalance are quite consistent. Here is a crash course synopsis to get us started.
Digestion/Assimilation
Digestion refers to how we break down food into nutritional building blocks and move food along the alimentary tract. Assimilation includes the ability to properly absorb nutritional components needed by the body so that they can be utilized by our target cells. Assimilation is also important in its role of blocking the absorption of harmful materials or with physiological damage that can lead to conditions such as leaky gut. Assimilation also includes the respiration process and the body ’ s air barrier integrity.
Energy
Energy is derived by catabolic pathways that break down organic compounds where the energy released can be captured for reuse. It is essential to life. ATP is required for most cellular functions, such as the synthesis of proteins, membranes like cell walls, cell movement,
and cellular division, to name a few. The mitochondria of our cells play a key role in production of energy and disruption of the electronic transport chain process are interrelated.
Transport
The cardiovascular system and our lymph network encompass an area we refer to as “transport.” These are the delivery systems of the body—highways for both the delivery of nutrients to cells and the removal of wastes, as well as a system to fight infection and carry other communications.
Messengers
Messengers include elements that deliver information or stimulate a reaction. Cells and tissues of the body require communication methods to share and respond to information appropriately to keep the body in balance. Communication happens with hormones from our endocrine system, neurotransmitters, and immune messengers, like cytokines. Our hormonal system and HPATG
axis (hypothalamic-pituitary-adrenalthyroid-gonadal axis) are a complex major component of this potential imbalance, and communication can be affected by a variety of factors that instigate changes in our microbiome and the process of steroidogenesis.
Defense
Defense and repair are focused on keeping pathogens out of the body. It includes barriers such as our skin and GI system and also includes our entire immune system. This imbalance includes areas of autoimmunity, GI imbalance, and diseases that affect barriers, such as diabetes and wound healing.
Biotransformation/Detox
Bodies engage in the process of biotransformation to create physical changes in molecules that we consume or are otherwise exposed to. It is particularly important in detoxification efforts because the body works to take toxic substances and break them down into metabolites that can
be more easily isolated or removed by the body via excretion. In some circles, this process is also known as purification.
Structural Integrity
Structure is a major determinant of function at all levels. As chiropractors, this one is near and dear to our hearts with our work with macro structures, such as the NMS system. However, from a systemsbiology approach, when we discuss structural integrity, we are just as importantly discussing microstructures, such as the health of our cellular and subcellular membranes. So not only are we looking at anatomy and biomechanics, but also at the molecular level because we are interested in the tiniest building blocks of the structural element, what can damage those structures, and how to support the structures for healthy function.
As a special note, our nervous system plays a major role in each of these potential imbalances and, of course, is of special interest to us in the chiropractic profession. As we look at these things, it is no surprise that our bodies are not made of static structures. All of our systems are dynamic, changing, and comprised of networks of tissues that are based on structure and functional biochemistry. We will explore more about the elements that affect our microcellular mechanisms, including concepts of epigenetics and nutrigenomics, as we feature more about functional medicine in future TAC articles.
Laurie Mueller, BA, DC, CFMP served in private practice in San Diego, California. She was the post-graduate director at Palmer College from 2000-2010; served as the ACC Post Graduate subcommittee chair for 6 years; andpeer reviewedfor the Research Agenda Conference. Dr Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions, LLC. She is a consultant, clinician, an educator and an expert in online educational pedagogy and is the founder ofwww.FxMedOnline. com.
