It’s personal

Just what is functional medicine and why do some DOs gravitate to it?

Learn more about this growing practice of personalized medicine, often described as ‘root cause medicine.’

Aunna Herbst, DO, was in her early 30s when she decided to go to medical school. The former lifestyle and health coach had gotten into nutrition for personal reasons. But when her business became so successful that it grew too big, she decided to sell it.

Her love of biochemistry coupled with her natural affinity for healing led her to Oklahoma State University College of Osteopathic Medicine (OSU-COM).

“During residency training, I wondered how I was going to incorporate the two worlds of osteopathic medicine and nutrition,” says Dr. Herbst. “I pursued functional medicine as a means to bridge them.”

Dr. Herbst’s functional medicine pursuit was very successful and led to a gig helping the Cleveland Clinic get their fledgling Center for Functional Medicine started. Many of the holistic qualities of functional medicine align with those of osteopathic medicine, she notes.

Aunna Herbst, DO

What exactly is functional medicine?

If you’ve wondered about the specifics of functional medicine, you’re not alone.

According to the Institute for Functional Medicine (IFM), which is considered the gold standard of training in the field, “the functional medicine model is an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness.”

Functional medicine practitioners incorporate modalities such as nutrigenomics, which looks at an individual’s interaction between nutrients and their genes, pathophysiology and biochemistry to optimize function, says Dr. Herbst.

“Functional medicine is what A.T. Still must have envisioned osteopathic medicine to be,” she says. “It’s a truly holistic approach.”

After training at IFM, Dr. Herbst  set up practice in Grove, Oklahoma, and “natural medicine seekers began coming out of the closet” as her practice grew exponentially.

She became so well-regarded in the field that when the Cleveland Clinic decided to delve into the world of functional medicine, they invited Dr. Herbst to join them. Dr. Herbst helped the Cleveland Clinic develop and expand the Cleveland Clinic’s Center for Functional Medicine (CCCFM). She became the center’s second full-time physician in 2015 before becoming its operations director for a year. She has recently returned to private practice back home in Oklahoma.

Mark Hyman, MD, one of the pioneers in the field of functional medicine, explains in this video the difference between conventional medicine and functional medicine.
Christine Maren, DO

For Christine Maren, DO, functional medicine filled a void, both professionally and personally. Growing up in Boulder, Colorado, she had what she describes as a “holistically minded upbringing,” which is why she gravitated toward osteopathic medical school.

When she wasn’t getting answers to her own health problems through a conventional medical model, she went down the path of functional medicine as a patient first before becoming a practitioner.

“Functional medicine is a very individualized and personalized approach to medicine with a focus on root cause rather than symptomology,” says Dr. Maren. “I always think it should be called ‘root cause medicine.’ ”

FM takes time, engagement

While conventional medicine does a great job at treating acute and emergency medical situations, functional medicine is better suited toward chronic illness, says Dr. Maren.

“Most of my patients have seen conventional doctors and didn’t get effective treatment. They need someone to dig deeper and do a lot of investigative work,” she says.

At CCCFM, Dr. Herbst estimates that over 60 percent of the patients had a chronic illness and had exhausted all other treatment options. “They’d often come in with reams of medical records. They’d been to the likes of a Mayo Clinic and nobody could help them.”

Athletes, often professional, comprise another large group of patients at CCCFM, led there by a desire to optimize their health and prevent disease. “Mom and dad have dementia, and I don’t want it,” is typical of that group, says Dr. Herbst.

A third group of patients were not sure why they came there and were hoping for a quick fix. “Functional medicine is not a quick fix,” says Dr. Herbst. “It’s a process. It takes work and an active patient, or it won’t be successful.”

The rise of FM

Functional medicine is still a relatively fledgling field that is beginning to see explosive growth. The CCCFM, which opened in 2014, quickly outgrew its space and has since expanded into a prime 10,000-square-foot facility with more satellite locations being added, says Dr. Herbst.

Despite its popularity, functional medicine is often criticized for its use of clinical evidence rather than research-based evidence.

“At first, the Center was considered the two-headed stepchild for specialists at Cleveland Clinic,” says Dr. Herbst. “But the more grand rounds we made and the more progress we made with patients, the more they came around.”

A series of studies which include functional medicine approaches to asthma treatment, Type 2 diabetes and prostate cancer are currently underway at CCCFM.

“Our goal at CCCFM was to put functional medicine’s name out there,” says Dr. Herbst. “And really the only way to do that is through studies.”

A new model

Part of the allure of functional medicine, and why academic hospital-based centers like Cleveland Clinic are embracing it, is motivated in part by the shift in medical reimbursements toward outcomes instead of volume, according to an interview in Holistic Primary Care with Mark Hyman, MD, who along with Patrick Hanaway, MD, was instrumental in starting Cleveland Clinic’s CFM.

A report on outcomes of more than 4,200 patients treated at CCCFM found that CCCFM patients had greater clinical improvements and lower health care costs than patients receiving conventional care at Cleveland Clinic.

Part of the success of functional medicine is grounded in what might be considered an osteopathic approach to care: partnering with your patient and believing in the body’s innate ability to heal.

“What I loved about my DO training is the underlying philosophy that the body has an ability to heal itself,” says Dr. Maren.

In functional medicine, Dr. Maren says, “I found an entire tribe of people who were asking the same questions I was asking, which is why. And functional medicine helps me find answers to that for myself and also for my patients.”

13 comments

  1. “the functional medicine model is an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness.” It’s offensive to us other physicians to imply we don’t do this. Functional medicine physicians in my geographic area use non-FDA approved devices to diagnose things through the skin. They do dangerous IV vitamin infusions, and order tests and treat based off of the test results without seeming to understand what the test indicates such as reverse T3 that is normal but near the limit of normal with all other thyroid tests in normal range. Functional medicine doesn’t seem to be as science based as is claimed.

  2. As a physician with a back ground in biochemistry, I would be forceful to reject the tenants of functional medicine. This is not evidence based nor scientifically accurate. This makes DOs look like naturopaths. Quack, quack, quack.

  3. As a DO that experienced extensive clinical results while practicing first as a Chiropractor prior to Medical School, I knew that Holistic approaches ‘worked’. As time has passed – and with the development of many terrific laboratories (Genova Diagnotics, Metametrics, IgenX, Doctors Data, DiagnosTechs, Great Plains Laboratory, etc etc) Functional Medicine has a plethora of tools for us to evaluate our Patients with and determine functional losses and abnormal pathways and toxicities. I laugh when a conventional Doc scoffs at a diagnosis, as more often than not – I have more Laboratory evidence to support my approach than the ‘hunch’ they are operating upon.

    Functional Medicine is indeed a science based approach to Patient evaluation and treatment, and offers clues that have been missed / skipped over by traditional approaches and the dis / mis-information campaign employed by big pharma.

    I have been using Functional Medicine approaches since my days as a Chiropractor, while using Great Smokies Diagnostic Laboratory.

    There are numerous Chiropractors that have made their practice as Functional practitioners, a role better suited to a DO – and the Naturopathic Physicians are indeed capitalizing on this. If Osteopathy is to survive, embracing a more Holistic approach will be necessary – or the public will continue to aquire the viewpoint that a DO and an MD are essentially the same.

  4. Something I don’t understand is why Osteopathic physicians and the Osteopathic Profession as a whole continue to try to “reinvent” themselves as something special and different when we could just follow the true principles of traditional Osteopathy and provide Osteopathic Manipulation treatment as an effective adjunct to regular medical care. I have practiced such for 30 years and find so many patients being ignored for regular and common ailments that could be, in part or totally, treated with the traditional Osteopathic approach.

    We don’t need new procedures and newly named or renamed techniques- we have everything we need. It just takes time to teach it and use it the way Dr. Still and early Osteopathic physicians used it.

    It’s not rocket science or “Functional Medicine”- it’s Osteopathy.

    1. I love this and I applaud you for saying this! Thank you! The current structure of the osteopathic profession, as well as the future path that osteopathic profession is heading towards are both “MD-wanna-be”. We should celebrate and encourage our distinctiveness and the unique training we are already provided. DOs are already functional and holistic medicine if they stick to osteopathic tenants.

    2. Well said-if one practices medicine applying the FULL tools and philosophy of Osteopathic Medicine, you are seeking the root cause of illness, correcting the underlying issues and helping your patient heal!!

  5. As a former ophthalmologist who retrained for 3 years as a preceptor to become certified in Integrated Holistic Medicine, I am amused at the mostly uninformed comments of my colleagues. Holistic or Functional or Integrated Medicine is the application of diet, nutrition, herbs, oils, physical medicine and whatever else it takes to normalize the physiologic and biochemical functions of the body. There are tons and tons of research to support Functional medicine but it you don’t look for it you of course don’t know it is there.
    All my patients have a detailed Nutritional Assessment Questionnaire first. Their symptoms will target which organ[s] is not functioning best. Its all about regaining normal physiologic function by natural methods and not chemicals. Also Functional and Holistic Medicine are much better than traditional at managing chronic disease- we will always need acute care and surgical care. If you think traditional medicine is addressing obesity- you are wrong. All doctors should be trained to start some type of obesity treatment but even the PCPs ignore it for the most part. And, to ignore any healing modality even if it is ancient Chinese medicine, is not fully treating the patient. Mainstream medicine with which we include ourselves so we are equal to our MD colleagues is getting too dangerous- many drugs have side effects of cancer or death. Who needs that formulary. Keep an open mind and keep Osteopathy Holistic as promoted for long time but not practiced

    1. Training is self study through structured programs of various organizations. Most will lead to a certification exam. These are not give away exams, I failed first time on mine.
      The A4M has such a program but it it the most costly of the lot. The ABoIM has a fellowship online but is costly- then take the exam. Functional Medicine Institute used to and may still have a study program.
      In addition you need to spend some time in an actual clinic working with some qualified doctor to see their approach to patients.
      As doctors we talk about lifelong learning and retraining like this is part of lifelong learning.
      Every doctor should take the blood chemistry analysis from Dicken Weatherby, ND. He is expert in blood work analysis and how it relates back to disease, and most importantly, what the optimal values are instead of relying on the lab reference range which is pretty worthless. Yesterday I saw a patient lab from another clinic when patient brought it in. His TSH was 4.3, and not on any meds yet. Optimal is about 1.8 to 2.6. Keep studying and learning.

  6. My main gripe with functional medicine is the cost-worth. From what I understand, functional medicine is pretty much a “order as many tests as possible” approach, and yeah this approach might work for very specific populations (e.g. athletes, patients with very distinctive genetic metabolic issues) but not for the majority of the population. Most people can follow conventional dietary and exercise advice that has been around for years and see amazing results. It’s misleading to push patients towards functional medicine when they don’t really need it; this approach also costs the system way more money because of how many tests are ordered and associated one-on-one patient interactions with physicians. General dietary advice can be given by a health coach, brochure, or even personal trainer, all of which are much cheaper options.

    As a first year DO student, I also don’t like the associations that people are making, clumping and defining DOs as being more holistic than MDs or other providers. I don’t plan on practicing individualized functional medicine because it’s not cost effective. Yeah, I will individualize treatment based on osteopathic examinations, but osteopathy and functional medicine are not and should not be synonymous. The more the DO profession associates with arguably unsupported and pseudoscience the less credibility we hold. It’s the same argument that I’d make for forcibly learning ill-supported osteopathic manipulations.

    1. Daniel, I appreciate your posting and comment. It seems that you don’t know what you don’t know yet.
      Individualized functional medicine or holistic medicine is extremely effective. Would you rather be half cured for regular price or cured and well for a little more.
      Holistic may mean the body as a whole as the osteopathic concept describes, but, there is another definition that holistic includes using all the modalities needed and available.
      Western medicine denies the existence of an electromagnetic field around the body but we put pads on and get our EKG from the skin.
      As you master the present Traditional Mainstream medicine of the USA you will find that Ayurvedic and Chinese medicine have been around for about 5000 years, and have healed masses of people. Many surgical instruments used today have a design based in Ayurvedic medicine which included surgery even in ancient times.
      Don’t forget Biblical Frankincense- a tremendous antimicrobial, anti-inflammatory, analgesic herbal remedy that still works as well to day as many present day drugs with less toxicity and much less cost.
      Good luck in hour journey to becoming a masterful physician-knowing people and healing equally for best results.

    2. It is sad to see your final statement on be interraced to learn ill-supported manual treatments-why go to an OSTEOPATHIC SCHOOL? We help people every day who suffer from acute and chronic pain-from my student days through resident I treated hands on every day. with the opined crisis and so many people in pain hands on skllls are needed more than ever.

      The physical therapy profession is slowly working on research, bit if you do a good search – there is practically no research to support the majority of treatments and modalities used. IN Medicine most surgeries have no search to support their use-finally some are looking and-saying oh, we can treat some appendicitis without surgery and they do fine.
      Very little of what we do in medicine is suited to a double blind Medicine-including manual treatments, there is a growing body of research on OMT. Take some time to look up the work on the Cranial Rhythmic Impulse by Glonek and Nelson.

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