Welcome to RIFM | Part 2:

Functional Medicine

What Is It?
How Does It Work?
Is It Right For Me?

Dr. Aaron Hartman

August 1, 2023

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    I routinely receive questions about functional medicine:

    What is Functional Medicine?
    How does it work?
    How long will it take to feel better?

    Ultimately, what people are asking is: Is functional medicine right for me? Is this going to be a good fit?

    These are important questions.

    In a previous article, I untangled “conventional,” “integrative,” and “functional” medicine. All three models are useful in a holistic model of care. In this article, I want to dive deeper into functional medicine. Functional medicine isn’t a loosey-goosey, less-strict kind of medicine. Not at all. I advocate functional medicine because it’s really great science. Functional medicine actually goes further than the current standard of care. Don’t be fooled by the pictures of trees; the diagrams used here are designed to simplify something that is quite complex.

    What Is Functional Medicine?

    Functional medicine is a systems biology approach focused on identifying and addressing the root cause of disease. It’s not a disease-based approach or a symptom-based approach. Rather, functional medicine drills progressively down from your symptoms on the surface to the root causes disrupting your health.

    The current standard of care in conventional medicine typically stops at signs & symptoms organized into organ systems diagnosis (e.g. cardiology, gastroenterology, urology) … then outsourced to specialists who typically don’t communicate with one another (and often don’t know how to communicate with one another because they only really understand their specialty). If you have a complex diagnosis or several separate diagnoses, then you probably have dealt with the frustration of trying to make sense of disconnected labs and prescriptions from independent specialists.

    Functional Medicine goes further.

    Together, we examine your past history, your family history, your health history, your genetics, your nutrition, your lifestyle, your physical health (past and present), your lab data, and even where you’ve lived — all the factors that make you … you. Then, we apply all of that data, along with the health information currently in the literature, to your individual situation.

    If that sounds like a lot; you’re right. In order to drill deeper through all of that data, Functional Medicine utilizes three primary toolsets:

    • The Functional Medicine Matrix
    • Lifestory Blocks (Antecedents, Mediators, & Triggers)
    • Foundations of Functional Medicine
    How Does Functional Medicine Work?

    The Functional Medicine Matrix

    Functional Medicine views the body’s overall function in light of seven fundamental systems. The Functional Medicine Matrix guides FM practitioners in organizing and prioritizing a patient’s health issues.

    Why does this matter?

    As this graphic below illustrates, a diagnosis can be the result of more than one cause. For example, depression can be caused by many different factors, including inflammation. Likewise, a cause such as inflammation may lead to a number of different diagnoses, including depression. The specific manifestation of each cause depends on your individual genes, environment, and lifestyle.

    The Functional Medicine Matrix acts like a web decoder, organizing your complex web of causes and conditions.


    Body Systems in the Functional Medicine Matrix

    The seven body systems in the functional medicine matrix are as follows:

    Interwoven Systems

    As an example of how these systems work together (and contribute to dysfunction), someone diagnosed with Chronic Fatigue Syndrome may not only have loss of energy and decreased exercise tolerance (Energy)—but also abnormal hormone levels and sleep/wake cycles (Communication) as well as digestive issues/gas/bloating (Assimilation) and recurrent injuries (Structural Integrity). Their brain fog, lack of ability to concentrate and quick mental fatigability (Energy + Communication) limits their ability to handle their everyday life.

    From a Functional Medicine approach I would attempt to see how all these systems are interrelated and in what order they became dysregulated. Only then can we attempt to ‘unwind’ these tangled systems.

    How Does Functional Medicine Work?

    Lifestory Blocks

    ATMs: Antecedents, Triggers, & Mediators

    Antecedents, Triggers, and MediatorsIn addition to the the Functional Medicine Matrix, I also take into account the your medical trajectory viewed through the lens of ATMs (Antecedents, Triggers & Mediators).

    • Antecedents

      What preceded the development of my patient’s thyroid disease leading up to her diagnosis?
      This could be poor diet, lifestyle, birth history, or even environmental factors.

    • Triggers

      Then, I attempt to discover the triggers that pushed her over the edge into autoimmunity. Was it an acute infection, one last bout of bronchitis/pneumonia, or even the car accident resulting in a concussion?

    • Mediators

      Finally, what event(s) are keeping the fire going? This could be poor sleep, chronic stress, work environment or even current/ongoing mold/lyme exposure.

    As you can see in this model, the complexity continues to develop as we weave web upon web to help uncover the root cause of an individual’s current health condition.

    How Does Functional Medicine Work?

    Foundations of Functional Medicine

    Foundations of Functional MedicineAs the word foundations implies, these five elements are critical (foundational) to understanding functional medicine. The foundations are used both to understand your condition(s) and to prescribe the treatment.

    After uncovering the antecedents, triggers, & mediators resulting in the current dysfunction—a combination of lifestyle & environmental factors interacting with a patient’s specific genetic predispositions—I work with my patient to progressively unwind specific lifestyle & environmental factors:

    • Nutrition

      It’s true: You are what you eat. I'm not going to delve into this much further here. this is a recurrent theme throughout this website and medical practice.

    • Exercise & Movement

      What is exercise and why is it important? Exercise is like a superfood, supplement, and mood enhancer all in one. It is a general performance enhancer, improving your hormone production and utilization. It improves digestion by increasing bowel motility and digestive enzyme production. It is the most effective antidepressant improving mood by 68%, beating the best medications currently on the market. It improves sleep, boosts your immune system, and helps with weight control. The better question to ask is, What does it not do or improve? Honestly, I do not know.

    • Sleep & Relaxation

      Sleep is a complex biologic process that we are just beginning to understand. In many ways, we still do not understand it, but at a minimum, we are learning all the bad things associated with disrupted sleep.

    • Stress

      Stress is the elephant in the room that people aren’t talking much about in the medical world today. We now know about so many ways that stress can affect our health. Unmanaged stress is associated with an increased incidence of cancer and heart disease. And did you also know that stress makes some medications less effective? It’s associated with anxiety, depression, and even severe episodes of COVID and long COVID. In our world today, it’s imperative that we manage our stress in order to reduce the risk of disease, improve our health span, and live longer and healthier lives.

    • Relationships

      We are social beings. As individuals, we find our greatest sense of worth and value in the context of community founded on relationships. Solitary confinement has long been a powerful tool used for punishment, and during the COVID-19 pandemic, we have seen a whole myriad of detrimental effects from social isolation. We were made to know and be known. Yet rarely is this topic brought up within health care.

    If you’re interested in learning more about the foundations of functional medicine, I recorded a podcast series: Foundations of Functional Medicine.

    Functional Medicine Takes Time

    Functional medicine takes a lot of cognitive and investigative work—not just by your doctor but by you as well. At times, it may feel like your FM practitioner is Sherlock Holmes or Dr. House. At other times, however, you are Sherlock Holmes and I merely play the role of Dr. Watson. I am a guide and support as you uncover your own health story.
    For this reason, instead of typical 10–12 minute office visit, my intake visit is two hours. The follow-up is 45–60 minutes, and additional follow-ups after that are generally 30–45 minutes.

    While using pharmaceuticals to address symptoms can sometimes be a quick solution, true healing usually takes much more time. My patients have to practice patience, trust the process, and take each step in turn. My most successful patients change their mindset from one of symptom resolution to that of addressing root causes and supporting the body in its natural ability to heal.


    Is Functional Medicine Right for You?

    If you’re looking for a whole-person approach, this is for you. If you’re trying to get to the root cause of your health issues, functional medicine is for you. If you’re willing to make hard changes to alter your health trajectory, this is for you. If you’re willing to change your diet, lifestyle, sleep patterns, stress management, even some toxic relationships, then this kind of medicine is for you.

    The fact that this kind of medicine takes more time and skill also usually means that it comes at a higher financial cost to the patient. This is largely because functional medicine is not recognized by the current healthcare insurance model that is focused on symptoms and diagnoses with surgical procedures and medication treatments. The current insurance-based model is not a root-cause approach, but a symptom and disease-based approach, which sometimes are complimentary but many times are diametrically opposed.

    Who is NOT a Good Fit for Functional Medicine?

    If you’re looking for a quick fix to your underlying symptoms and illness, functional medicine is not a good fit for you. There are no quick fixes in personalized medicine.

    If you’re someone who needs to be in control, you may find functional medicine challenging. You will have to move through uncertainty before arriving at clarity.

    If you feel the need to be in the driver’s seat, making medication decisions or higher treatment determinations, functional medicine is likely not a good fit. FM works best with a true doctor-patient relationship, where we come together and make decisions in a cooperative way. This key functional medicine doctor-patient relationship can’t be patriarchal on the side of the doctor, and it also can’t be dominated by the patient. Both sides need to listen to each other and work together to get to real health change.

    Functional medicine includes environmental medicine, toxicology, nutritional medicine, as well as the typical medical specialties all combined into one field of practice. A typical functional medicine physician, like myself, in addition to four years of college, four years of medical school, and three years of residency training, has an additional two years of certification training, and another 2–3 of fellowship training. There’s really no way to reproduce this kind of learning without actually going through the training.

    This kind of medicine is likely not for you if you’re not willing to move on from your past healthcare experiences. It takes work to move on from negative doctor experiences in the past, bad diagnoses, and difficult outcomes. Those patients who are willing to make the hard changes to move forward with a new health team have the best outcomes.

    Facing Medical Trauma

    One of the things I commonly see is a certain degree of medical trauma or other health-based trauma. About a quarter to a third of all patients that functional medicine practitioners see will have some kind of trauma, whether it is their own personal past trauma, the trauma from an illness, or the trauma from just dealing with the healthcare system. This is real, and I see it every day. Someone who is going to work with a functional medicine practitioner needs to be willing to work through this difficult, messy, dirty work and move forward. This is the route to true change in your health and your personal wellness.

    I covered a lot of ground in this article, but I noted at the outset that I routinely answer many of these questions. Chances are you had at least some of them. I hope this has been helpful and you are armed with more knowledge as you pursue the best standard of care to address your health.

    Always remember: You were made for health.

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