The Shadow of Functional Medicine

Where darkness meets hidden potential

Now let’s remember that to discuss the shadow of anything implies that there is also light. I start with this because I want you to know that I am not anti-functional medicine. I am for all forms of medicine when used in the appropriate situations. I think functional medicine has a lot to offer to the mainstream landscape of healthcare. I’ve seen it transform many lives for the better and in my own practice, functional lab testing has helped me identify key imbalances lurking in a patient’s unconscious. 

So I am not anti-functional medicine, but I am pro patient empowerment.

I am pro self healing.

I am pro treating people (not labs).

And most of all I am pro everyone knowing that humanity is the greatest technology for human healing and everything we need to heal is within us. 

The Hippocratic Oath is an ethical code that has managed to survive the ages, and while some medical schools have stopped incorporating it into graduation ceremonies arguing that it’s no longer relevant to modern day issues of medical ethics, I think it’s incredibly meaningful. One of the principles in the Hippocratic oath is to do not harm, and while I am not anti functional medicine, I have seen functional medicine do a lot of harm.

The purpose of this article is not to deter you from functional medicine, but to give you a perspective and knowledge for you to think critically about your care and set your expectations appropriately. Within every shadow is also unrealized potential, and in my how to piece of Friday I will teach you how to extract the hidden potential of functional medicine, while protecting yourself and staying empowered in the process.

For nearly a decade patients with poorly understood diagnoses entered my office with stacks of lab results and bags full of supplements they were taking. The labs had cost them thousands of dollars and the supplements were an ongoing expense ranging from $200-$500 a month. Not only were these patients coming to me because they didn’t feel any better, but they didn’t know why they were taking these supplements, if they were working, or when they were supposed to stop. The financial burden of their care had become an additional strain on the already unbearable stress of being unwell in America. These patients had been working with functional medicine providers, and the story was alway the same. They were fed up with mainstream healthcare (as we all should be), wanted to try something more “holistic” and found a functional medicine provider. The initial intake was lengthy, extensive lab work was done and then the provider recommended a long list of supplements to treat the abnormal lab values. In the months (or years) that followed, there were brief follow up visits (sometimes with a health coach) where supplement regiments were adjusted, diet and lifestyle changes were suggested and follow up labs were done. Overtime the supplement lists became grew and so did the monthly costs.

Now I’m not saying that there aren’t people out there benefiting from this style of care but I want you to know that it is not entirely benevolent. This approach can cause harm- especially to those suffering from mystery illness, unexplainable symptoms, and poorly understood diagnoses. I have seen functional medicine shine as an alternative to conventional primary care, for cardiovascular disease prevention, weight management, simple digestive complaints or common hormonal imbalances.

But if you have a chronic condition that you are very well informed about, a set of symptoms that even the top specialists can’t figure out, or a complex constellation of physical, mental and emotional and spiritual complaints, this style of care can be a big set back in your healing process. 

Here’s are a few reasons why …

1. Lab work is a great way to reveal patterns that we are not conscious of. It’s an essential asset to healing because the body does not lie. But what we do with lab work really matters.

Healing requires that you become conscious of the unconscious.

If this is new to you, please read any of the articles in my chakra series, starting with “The Healing Path of the Sacral Chakra” or check out the work of Carl Jung. Abnormal lab values can represent that which you are unconscious of. This is a great opportunity for healing but it requires that YOU become conscious- not just the provider. This means that YOU need to understand the results, what they mean, why they may be abnormal so YOU can consciously participate in the response.

When a provider looks through your labs, notes the abnormals and recommends a long list of supplements but doesn’t explain the why or encourage you to ask deeper questions about what it all means, you miss out on the opportunity to become conscious of the unconscious. You miss out on the opportunity to heal.

Often when clients come to me after working with functional medicine providers it sounds as if the providers were treating the labs exclusively, rather than supporting the patients in their healing endeavors. In my opinion, if someone’s lab values are improving but they don’t feel any better in a reasonable timeframe, we are off course. This is not the direction of healing. Becoming aware of what we’re unconscious of is critical to healing but so is remaining aware of what we’re consciously experiencing. This is the feedback we need to navigate the healing path. If the provider is more interested in optimizing lab values than your lived experience you will likely leave the visits feeling disappointed and disempowered because they are pleased with the results and progress but you don’t feel any better. This is not a therapeutic relationship and it creates a lot of confusion about whether the treatment plan is “working” because your definition of working is not the same as the providers. 

2. When it comes to your health, everything is connected. You would think functional medicine providers would understand this- and in theory I trust that they do. But in practice, they seem to forget because knowing that everything is connected should result in a more nuanced timing to when we order specific labs and which abnormals we treat first. When I see a new client, I spend as much time as I need during the intake to become very confident about where we need to start to move the needle on their experience the most as quickly as possible. After 15 years of practice I don’t need lab work for this. It’s part of the art of medicine and a skill that comes with experience. With that said, if I do need lab work to confirm my assessment, the only labs I request are the ones that are relevant. The reason is because if we order all the labs at once and discover ONE most likely cause of the client’s complaint, we want to tend to that first with the knowing that when we tend to that one thing, it impacts EVERYTHING else (including all the other lab results). When I say everything is connected, I mean it! 

Here’s a good example: a client was complaining of digestive issues, fatigue, hair loss and anxiety. Her functional medicine doctor ordered a complete blood count, comprehensive metabolic panel, nutrient levels, functional stool testing, adrenals and hormone panel, heavy metal testing, and more all at the same time. There were a bunch of suboptimal results including a pathogenic organism on the stool test. She was prescribed close to 10 supplements to address all the abnormals. Taking 10 supplements when the gut is not functioning optimally is rarely a good idea. And, it doesn’t make sense to treat the downstream effects of one thing before you’re addressed the primary thing- in this case the bug in the gut. But once you treat the primary thing, all those initial lab results are outdated so you need to repeat them. When she came to see me, I encouraged her to stop all the supplements except what she was taking to address the dysbiosis in her gut. I added additional support for her gut, and eventually all the other symptoms improved. When the gut is not well, it’s typical for nutrient absorption to be impaired- so rather than taking multiple pills to address those low nutrient levels, we simply treat the gut first. Ordering every lab that you can think of at once does not make healing more efficient, It makes it extremely confusing and costly and you wind up with a lot of irrelevant lab results. When you treat the underlying issue everything else is effected so it’s important to be thoughtful about what we test first and craft an intelligent sequence of care. This is part of the art of medicine.

3. Patients who have chronic, persistent symptoms are the real experts. In most cases these patients have been dismissed and poorly served by the conventional medical community. They don’t need more labs and supplements.

They need an empowering therapeutic encounter. They need to find meaning in their suffering.

What I find to be disempowering about functional medicine is there is so much emphasis on lab work and lab optimization that the patient is paralyzed without the provider’s lab access and ability to interpret the results. These patients need to remember that they have the ability to heal themselves without becoming enslaved by a supplement regiment. They need to remember that they are the experts in their experience and how they feel is more important than the follow up lab results.

4. Health anxiety is rampant! We are living at a time where people are lining up to get full body scans to screen for cancers.

I am all for preventative medicine but not when it feeds the stress and anxiety that raises your risks of pretty much every disease.

Of course my commentary here is not one size fits all and screening truly saves lives- but extensive functional lab panels are not basic screening tests, and often, people come to me freaking out because their magnesium is low, their cortisol is suboptimal, or their liver enzymes are a few points above normal and rather than taking the time to reassure them, their functional medicine provider focused on the risks and implications of these results and strongly encouraged a long list of supplements to start right away. Healthcare providers are busy and I understand the time constraints that prevent providers from providing proper education- but in many of these cases the anxiety created by non-critical abnormal lab values does more harm than the values themselves. 

5. Holistic care requires considering all of you and this includes the impact of the clinical approach on your physical, mental, emotional and spiritual health. I don’t see many functional medicine providers doing this. That doesn’t mean that there aren’t some great functional medicine providers out there practicing very holistically- but I’ve practiced in two major US cities, seen tens of thousands of patients and a large percentage of them (especially in NYC) came to me after working with functional medicine providers, so I think my observations hold some weight.

When you think you’re getting high touch holistic care (because that’s literally the marketing language that drew you in) and you actually get a ton of labs that you don’t understand, a high dose of anxiety about the results, a big out of pocket expense and a long list of supplements that you need to take indefinitely because no-one is asking the deeper question of WHY or crafting an individualized plan that centers YOU, you are right back where you started- in a failing healthcare system that disappoints and disempowers.

This is the shadow of functional medicine but there are ways to engage with it and stay empowered. There is tremendous hidden potential here if you have the right tools and perspective. There are things YOU can bring to any functional medicine encounter to ensure that you get the benefits, and that’s what I’m going to write about in this week’s how to series for paid subscribers. So stay tuned for part two on Friday!