What Are Integrative & Functional Medicine?

Definitions & Descriptions

Integrative Medicine

Integrative Medicine is a combination of conventional medicine with complementary alternative medical treatments.

Integrative Medicine takes into account various healing traditions ranging for Traditional Chinese Medicine to Natural Medicine and Herbal Medicine. The underlying philosophy neither rejects conventional medicine nor uncritically accepts alternative therapies. It is inclusive of alternative medical traditions. Integrative Medicine encompasses a much larger realm than does Functional Medicine but it is not as doggedly adherent to published evidence as FM.

Functional Medicine

Functional Medicine is an evidence based systems biology approach to human health, functioning and disease.

Let’s unpack this definition. First, it is not the conventional model of determining a particular disease and applying the standard list of treatment modalities or options. FM recognizes that disease is a continuum not a simple point in time in a person’s history of health. It also recognizes an individual’s biological uniqueness and takes into account their personal health history, disease progression and treatment preferences. It is not simply naming a disease and then applying the accepted treatment. FM through the functional medicine matrix tries to discover the root cause of an individual’s condition and then to address the interconnected web of interactions and get to the cause of causes.

The biggest thing that separates Functional Medicine from other forms of medicine is its adherence to this systems biological approach as expressed in the functional medicine matrix.

Examples

Case Study: Diabetes

1. Conventional Medicine Approach

Diabetes is a disease entity defined by a random sugar over 200, three fasting sugars over 125 or a hemoglobin A1c of 6.5 or greater. Once one of these levels is reached, then the first line medication of metformin is started. Diet and lifestyle changes are recommended. If adequate control is not reached then second line meds are begun (i.e.- Januvia, Onglyza, Invokana, Jardiance). If these don’t result in control, then other medications and ultimately insulin is begun.

2. Integrative Medicine Approach

In addition to the above, herbals and supplements would be considered for treatment. Herbs like cinnamon or traditional remedies such as apple cider vinegar have been used to help with insulin resistance. Supplements such as berberine, alpha lipoic acid and curcumin are also used. Many diabetics have mineral deficiencies in B vitamins and magnesium as well as Vitamin D so these would be considered as treatment options. At times a cleansing type diet or a detox diet are implemented.

3. Functional Medicine Approach

Functional Medicine recognizes the above but also would include an individualized systems biology approach which would look vastly different for individuals based on their evaluation. As well in the Functional Medicine paradigm, based on the most recent medical literature, insulin resistance is a spectrum in which an A1c over 5.5 or fasting sugar over 100 are markers of insulin resistance and treatment would begin at this stage rather than wait until the A1c is at 6.5.

Diabetes is a part of a larger spectrum of diseases commonly called Metabolic Syndrome. For example, an individual may have detoxification issues resulting in systemic vascular inflammation and insulin resistance. Or another could have pancreatic or biliary insufficiency resulting in incomplete food digestion and inadequate nutritional absorption which can affect blood sugar regulation. Someone else could have an immunologic reaction with a certain food like gluten causing vascular inflammation and insulin resistance and a fourth person could have all the above. Function Medicine would address these.

Case Study: Fibromyalgia

1.Conventional Medicine Approach

Fibromyalgia is a pain disorder which also includes sleep disturbances as well as gastric and psychiatric symptoms. Treatment depends on the expression of these symptoms in the patient. Graded exercise has been shown to help with the fatigue and pain of Fibro. The sleep disturbances must be addressed and depending on the severity the patient may be given sleep meds, benzos (like Valium), or even atypical antipsychotics (like Seroquel). The pain syndrome is hard to address and many differing medication types are used whether SNRIs (i.e.- Cymbalta) or tricyclics (i.e.-amitriptyline) or nerve medications (i.e.-Lyrica or gabapentin). If none of the typical treatments work, then many times narcotics are implemented to treat the uncontrolled pain.

2. Integrative Medicine Approach.

Fibromyalgia is a syndrome and not necessarily a disease and for this reason the treatments are variable and layered. Light massage or myofascial release can benefit many individuals and acupuncture is a go to treatment in this arena as Fibro is seen as representing Chi stagnation. Homeopathics as well have been used for the symptoms of Fibro. Traditional healers will recommend clay baths for their detoxifying effects and biofeedback treatments can help with some of the psychiatric manifestations of Fibro. Many nutritional deficiencies are seen in these patients and a wide range of supplements can be helpful from 5 HTP, magnesium and minerals to vitamin d and Epsom salt baths.

3. Functional Medicine Approach.

In 2016 new research, out of the Massachusetts General Hospital at Harvard showed that Fibromyalgia is a brain based disorder market by inflammation in immune support cells in the brain (i.e.- microglial cells). This inflammatory cascade can begin in childhood via Major Adverse Childhood Events (MACE Events) or because of chronic low grade toxin exposure. Newer animal studies have shown chronic infection models associated with the development of Fibro (i.e.-chronic mono). Recent discoveries in mitochondrial energetics have found a link with mitochondrial toxins and fibro, this links heavy metals such as mercury as well as medications such as simvastatin with nerve damage and fibromyalgia. A Functional Medicine Matrix evaluation would take the patients personal story and symptoms and then line these up with the current most recent medical literature and attempt to discover the time line of events that led up to the initiation and propagation of the patient’s fibromyalgia. Then, like the layers of an onion, layer by layer a treatment strategy would be implemented, realizing that it could take 6–9 months before seeing significant improvements, even though for many improvements are seen in as little as 2–3 months.

Case Study: Chronic Pain

1. Conventional Medicine Approach

Chronic Pain is a diagnosis that has FDA approved treatments. Once the diagnosis is made, the approved treatments are applied in succession based on Randomized Controlled Trial data and the strength of evidence for the efficacy of the approved treatments.

i.e. Start with nerve pain medications or chronic narcotics for pain relief

2. Integrative Medicine Approach

Chronic Pain can be caused by many imbalances in a person’s body. These imbalances can be treated with conventional medications, acupuncture, dietary and nutritional support, herbals or manual therapies.

i.e. A patient may be treated with massage, chiropractic, ultrasound, transcutaneous electrical stimulation or natural herbal pain relievers.

3. Functional Medicine Approach

Chronic Pain is the final common pathway to multiple underlying dysregulations in a person’s inner connected web of biological systems. Through a comprehensive history and physical exam, the practitioner tries to determine which systems are involved and then in an organized fashion to begin to treat these issues. The systems treated can include: Structural, Detoxification, Communication, Assimilation, Defense and Repair, Transport, Energy and Personal Lifestyle Factors.

i.e. An evaluation may find that a person has chronic insomnia and depression coupled with systemic inflammation and toxicity resulting in multiple nutritional deficiencies, nerve damage and pain. The treatment would address all these systems—not just a singular system.

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