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Applied Evidence
Functional medicine: Focusing on imbalances in core metabolic processes
Department of Community Health and Family Medicine (Drs. Orlando and Chang) and Department of Physical Medicine and Rehabilitation (Dr. Estores), University of Florida College of Medicine, Gainesville forlando@ufl.edu
The authors reported no potential conflict of interest relevant to this article.
Within the matrix, FM also recognizes 5 modifiable personal lifestyle factors: sleep and relaxation, exercise and movement, nutrition, stress, and relationships. When these lifestyle elements are influenced by specific predisposing factors (antecedents), discrete events precipitating illness (triggers), and ongoing physiologic processes (mediators), fundamental imbalances eventually result in the signs and symptoms characterizing diagnosable diseases.
The essence of the functional medicine therapeutic plan is a discussion of lifestyle changes, personal strengths, and potential adherence challenges.
The essence of the FM therapeutic plan is a discussion of lifestyle changes, personal strengths, and potential adherence challenges so the clinician can better offer assistive resources, which may include multidisciplinary referrals to personalized counselors such as a nutritionist, health coach, mind-body therapist, personal trainer, exercise physiologist, or physical therapist. While these professionals are not unique to FM, they are more frequently used by FM practitioners as part of the health care team.
Diagnostic testing through a different lens
A proposed solution to complex diseases recalcitrant to conventional moderntreatments is a systems biology approach to health care.10 Current laboratory testing such as liver enzymes, C-reactive protein (CRP), and leukocyte count provide some information on organ system homeostasis and molecular pathology, but even high-sensitivity CRP, which measures inflammation across the human system, is not adequate in cardiovascular disease (CVD) risk assessment.11 Genome-wide association studies suggest an association between biological pathways, genes, molecular markers, and QOL domains, and screening patients for cytokine markers may help provide prophylactic interventions to prevent QOL deterioration.12
With the purpose of being more systems-biology centric rather than disease centric,13 FM practitioners use tests to guide dietary recommendations and supplement selection, the evidence for which is found mostly in symptom-specific case series.14-16 Commonly used tests include MTHFR genotyping, comprehensive stool profiles, hormone and heavy metal panels, allergy panels, lactulose breath testing, micronutrient and advanced lipid panels, omega 3:6 ratios, and oxidative stress tests.
Some of these tests are performed by standard labs and are covered by insurance. Certain assays are primarily performed by specialized functional laboratories, such as comprehensive stool profiles, provoked heavy metal tests, non-IgE allergy panels, and oxidative stress tests. These laboratories also frequently offer direct-to-consumer orders. The latter situation raises a potential conflict of interest from supplement sales linked to laboratory testing and makes it imperative for health care professionals to understand the reliability and clinical utility of these tests in order to counsel patients accordingly.
