Almost half the Australian population is suffering from chronic health conditions, and the conventional acute healthcare model is failing to manage this crisis. Functional medicine is the answer; modern healthcare reimagined.
Functional medicine practitioners are perfectly positioned to solve our chronic health crisis. Functional medicine combines the best of integrative medicine and traditional medicine, to deliver a cutting edge, tailored approach to individuals with chronic health conditions. This article explains what functional medicine is, and how the functional medicine approach can reverse the trend of rising chronic health issues for good.
Functional medicine overview
- What healthcare looks like right now
- Reality bites - The state of health in the Australian population and failing healthcare
- Functional medicine - the antidote to the current health crisis
- The functional medicine approach - what is functional medicine?
- Evidence for functional medicine as the future of healthcare
- Who benefits from functional medicine?
- Why the future of healthcare is functional medicine
Izabella, a 38-year-old mother of three who works as a lawyer in Melbourne, stood in a doctor’s surgery for the fourth time that year. It was only early March and just three months since she received her diagnosis of Hashimoto’s Thyroiditis, after more than a year of unexplained tiredness, weight gain, and more recently, hair loss.
Izabella had seen an endocrinologist who prescribed the synthetic thyroid hormone levothyroxine. Izabella was told she’d need to be on for life. Also, after months of waiting, she’d even seen a gastroenterologist about IBS-type symptoms she’d been experiencing, and a neurologist to help with ongoing pain in her jaw and insomnia caused by it.
Her fourth appointment was with her GP to help her make sense of all the prescriptions each specialist had given her. Izabella also wanted to know whether there were things she could change in her diet or lifestyle and whether drugs were the only option, as she was worried about the side effects. Given the limited time in doctor’s appointments, the discussion was rushed, and she was given topline advice to eat a healthy diet, consider meditating to reduce her stress, and to come back if she did experience any other symptoms or side effects.
Izabella left the surgery feeling unsure of what steps to take with her diet, and generally alone with regards to what else she could do to improve her health. She intuitively knew there must be other things she could do and began losing faith in the healthcare system.
Izabella’s story is a common one. A recent study across eight countries including Australia, NZ, the UK and the US revealed that patients with at least one chronic health condition such as hypertension, heart disease, diabetes, arthritis, lung problems (COPD, asthma, emphysema), cancer or depression are mostly unhappy with the current healthcare system.
The majority of patients want a complete system improvement or overhaul. 57% of Australians surveyed said that fundamental changes were needed to improve the healthcare system, and 20% said it needed an entire rebuild.
Abroad in the US, 33% of patients surveyed said the system needed a complete rebuild, with 46% saying it needed fundamental changes.
The fragmented healthcare system has patients seeing multiple practitioners at multiple sites, increasing the risk of error and poor care coordination. Access to physicians for healthcare was also a barrier to proper care, with 53% of those surveyed in Australia having to wait more than a month to see a specialist.
More than half (58%) said they’d not been given a written healthcare plan to manage their health at home, and more than two-thirds (70%) haven’t been contacted after a visit to see how they’re doing.
The study concluded with some clear initiatives:
“Targeting the highest risk patients for outreach and follow-up care; building the evidence base for chronic care, especially for multiple conditions; and efforts to engage patients and communities with a population focus on prevention and health.”
The problem lies in how the health system has been built, outlined in the paper:
“Health systems initially designed to respond to acute, episodic illness increasingly care for patients with ongoing conditions, where the goals include preventing complications or deterioration rather than cure.”
Unfortunately, the healthcare system adopted almost the world over was designed to respond to acute illness, a framework that falls short in solving chronic conditions.
And it shows. Looking at statistics for the health of Australians, a large percentage of patients in the healthcare system are being treated for chronic health conditions, and the system is failing them.
Jabe Brown, founder and Functional Medicine Practitioner at Melbourne Functional Medicine succinctly explains how the healthcare system evolved, and why it's problematic for people with chronic health problems.
Reality bites - the state of health in the Australian population
A 2018 study showed that 47.3% of Australians have one or more of the following chronic health conditions:
- Back problems
- Chronic obstructive pulmonary disease (COPD)
- Diabetes mellitus
- Heart, stroke and vascular disease
- Kidney disease
- Mental and behavioural conditions
The same study found that more than two thirds (67%) of Australians aged 18 and over were overweight or obese, which predisposes them to chronic health issues like the above.
Even worse, looking at disease burden between 2014-16:
- 87% of deaths in 2016 were associated with eight chronic diseases (arthritis, asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental health conditions)
- Nearly 1 in 4 Australians are estimated to have two or more of these eight conditions
- Around 1 in 3 health problems managed in general practice was chronic
- 1 in 2 Australians reported having at least 1 of 8 chronic diseases
Functional medicine - the antidote to the current health crisis
In 1996, sparked by frustration within the failing healthcare system, a group of health experts including doctors, specialists, clinical laboratory specialists, health policymakers and researchers came together to develop an approach to healthcare that helped solve chronic illnesses. Using the latest scientific data, clinical tools and insights around chronic disease and health, functional medicine was born.
What is Functional Medicine?
Jabe Brown, the founder of Melbourne Functional Medicine, describes functional medicine as:
“Functional medicine is a way of thinking about human health and chronic disease. It’s about understanding the human body, and the relationships between everything that’s going on in a person. Through this lens, we can understand more about our patient’s health, and can tailor care to their individual needs, even treating things that don’t have a label or diagnosis. What’s so great about functional medicine is that it marries up the ideals of holistic healthcare with our modern understanding of how the body works, with the aim of resolving underlying health complaints. That’s the way healthcare should be done.”
Functional medicine employs the latest evidence base on understanding chronic health conditions and seeks to restore the function of systems and pathways to restore health. It does this by addressing imbalances in the body using diet and lifestyle interventions rather than prescribing medication.
Let’s break down how the functional medicine approach differs from the current healthcare system, and how it works in practice for patients with chronic health issues.
Key differences between conventional medicine and functional medicine
Functional medicine looks to address underlying causes and imbalances to resolve a health condition. These are largely modifiable elements such as diet, lifestyle and environmental factors that switch on genes and promote disease.
Perhaps the most important difference between functional medicine and conventional healthcare is the understanding that chronic diseases can be reversed, rather than simply managed.
Functional medicine practitioners take a ‘cause-based’ approach to chronic disease, by understanding how diet, lifestyle and environment factors interact with genetics and biology to bring about disease. Finding out what caused a person’s disease, and treating the cause, can help bring about resolution, or improve health outcomes.
In functional medicine, we use the analogy of a tree to convey our approach to healthcare and how it differs from the norm. The branches are the signs and symptoms of a health condition. The roots are the causes of health conditions and include the foundations of health such as nutrition, lifestyle and environment. Conventional care treats the leaves (symptoms or condition), whereas functional medicine treats the roots.
The current acute-care approach to diseases involves administering drugs to manage a condition or symptom, without looking at why a symptom or disease has occurred. Often the drug prescribed suppresses a pathway that can lead to bigger problems.
For example, statins reduce cholesterol by inhibiting a step in the pathway that produces cholesterol. As CoQ10, a critical antioxidant and cofactor involved in cellular energy production, stabilising cell membranes and regulating blood pressure, shares the same synthetic pathway as cholesterol, synthesis of CoQ10 is reduced. Hence common side effects are fatigue, as well as muscular pain. There is also an increased risk of developing Diabetes Mellitus by using statin therapy.
Treating high cholesterol by directly lowering levels is an outdated approach based on the latest research. Not only has it been found that most heart attack patients have normal levels of LDL cholesterol, but new insights also show that high cholesterol is often a symptom of other imbalances in the body, such as metabolic syndrome, intestinal permeability, changes in thyroid function, stress, underlying viral infections or environmental toxin exposure.
Conventional medicine asks ‘what is the best treatment for this disease?’. Functional medicine asks ‘why did this disease occur, and what underlying imbalances need resolving in order for the body to return to a state of health?’
Let’s use Izabella, our patient at the start of the article who had Hashimoto’s Thyroiditis, IBS, anxiety, pain and insomnia, as an example. In our clinic, her functional medicine practitioner would spend 4 hours in the first consult assessing her health from all angles.
Her practitioner wants to understand her health history, as well as dietary, lifestyle and environmental factors that may be contributing to her ailments. From there, some functional testing may be requested to understand what’s causing or contributing to Izabella’s health issues. Once her root cause, or causes, are identified, a personalised plan is created to help Izabella address those imbalances so her health can improve.
In 2015, Australians lost 4.8 million years of healthy life due to living with an illness (50.4%) or premature death (49.6%).
Root cause medicine is personalised, because the variables that contribute to a person's health is completely unique, and how an imbalance is expressed is too.
Using the example of obesity as shown in the chart below, there are many factors contributing to obesity. This chart also demonstrates how one imbalance can lead to a range of different health problems, depending on the person.
Inflammation is a cause or driver of many chronic health conditions, not only obesity but heart disease, depression, arthritis, cancer and diabetes.
Functional medicine recognises the interactions between the body and diet, lifestyle and environment, and how that contributes to the health of the individual.
“Perhaps surprisingly, more often than not the underlying explanation isn’t genetic. Rather, it has to do with the exposome: the food we eat, the water we drink, the air we breathe, even our social connections and the environment we live in.”
How we live, the food we eat, and the environment we live in have all drastically changed in recent generations, to something that is unrecognisable to our ancestors, and to our biology. As these factors directly influence our genetics, they have the ability to switch on genes that promote illness.
Many of these factors cause systemic inflammation that underlies all chronic disease, are implicated in the pandemic of obesity and the extraordinary rise in diabetes. Even what parents are exposed to around the time of their offspring's conception can negatively impact offspring, increasing their risk for cardiometabolic, immune and neurological conditions. Chronic diseases are, therefore ‘lifestyle diseases’.
38% of the total burden of disease could have been prevented by reducing exposure to risk factors: tobacco use, overweight & obesity, diet, high blood pressure, high blood plasma glucose including diabetes.
A functional medicine practitioner acknowledges that many factors cause or contribute to chronic diseases, such as diet, lifestyle and environment.
Only about 20% of how long the average person lives is dictated by our genes, whereas the other 80% is dictated by our lifestyle.
This is further supported by there being a little disease in certain populations that maintain a diet and lifestyle similar to our ancestors, such as the Okinawans in Japan, the Icarians in Greece and the Sardinians in Italy. These groups experience much lower incidences of chronic disease and live much longer than those in western civilisation. Beyond eating a diet that isn’t processed, people in these communities have a sense of purpose, are active, have a community - in stark contrast to the sedentary, disconnected lifestyle most people live in the west.
A review of discussing modifiable interventions with patients found that only 3.4% of encounters with a GP involve nutrition or weight counseling when it came to discussing improving cardiovascular health.
Therefore, the approach to restoring health focuses on the fundamentals of health, namely diet, stress reduction, sleep and exercise. All of these factors are personal modifiable factors that can make a big difference to one’s health.
Functional medicine practitioners use a range of clinical tools to identify what factors are contributing to a person’s poor health
One such tool is functional testing using some of the most advanced pathology laboratories in the world. Functional testing helps determine what imbalances in the body are contributing to a health condition. Functional tests include testing for:
- Nutrient status
- Genetic profiling
- Digestive health analysis (digestive function, microbiome assessment, parasitology)
- Hormonal imbalances
- Neurotransmitter imbalances
- Cardiometabolic profiling
- Inflammation markers
- Environmental toxin exposure
- Food sensitivity testing
Functional medicine practitioners will also assess the standard blood panel from a functional perspective rather than looking for a disease to detect underlying dysfunction.
The Melbourne Functional Medicine approach to health
CASE EXAMPLE: Chris
Chris, a business owner from Melbourne, had been experiencing chronic fatigue, brain fog, and painful joints for almost a year. He'd also been feeling especially tired when he ate certain foods. A thorough health history and some functional testing found that Chris was reacting badly to mould in his home, and that he was sensitive to wheat and corn which were staples in his diet. Once he eliminated his exposure to mould in his home, removed wheat and corn from his diet, and followed the protocol given by his practitioner, his energy returned, his thinking become clear, and his joint pain subsided.
Functional medicine focuses on disease prevention
“An ounce of prevention is worth a pound of cure”
Functional medicine recognises that health and disease are on a spectrum, that health is a dynamic state that can fluctuate, and that conditions can be reversed or prevented.
Functional medicine acknowledges that there is often a long period of declining health before a chronic disease occurs, from lifelong interactions of individuals with diet, environmental and lifestyle factors that can cause disease. Therefore, a functional medicine practitioner is trained to look for signs of dysfunction rather than a disease state and can recommend treatments to improve health and prevent disease.
The functional medicine approach recognises that health and disease exist on a spectrum. There is a lengthy period of declining function in one or more systems before disease occurs.
Functional medicine recognises the dynamic interplay between body systems and how they contribute to health or disease
Rather than compartmentalising body systems into specialists, a functional medicine practitioner has a broad understanding of how each system interacts with other systems. This ‘systems biology’ approach to health is one of the most significant breakthroughs in understanding the body and how disease occurs, with mounting evidence that continues to bring more light to understanding health and disease.
One of the most well-known examples of the interconnectivity of body systems is the neuroendocrine-immune system; the nervous, endocrine and immune systems are identified as a super system. Only by looking at the whole system and how it interacts, rather than looking at systems or pathways in isolation, can a complex health condition be understood.
Functional medicine practitioners translate the latest research to use in clinical practice
On average, in a conventional setting, a 15-17 year gap exists between scientific discovery and the implementation of those insights into clinical practice. The time lag exists because of the lengthy process of translating research into guidelines that inform general practice. In contrast, functional medicine practitioners directly access the latest research findings to continually evolve their understanding of diseases and get the best outcomes for their patients.
That positions functional medicine practitioners at the forefront of scientific understanding of chronic diseases and the latest, most innovative protocols for healing. While those in conventional healthcare may still believe that many chronic diseases are incurable, like with autoimmune conditions, functional medicine practitioners are interpreting the research and helping patients get well.
Functional medicine practitioners practice patient-centred care - recognising biochemical individuality vs disease-centred, ‘one size fits all’ approach
Rather than applying one protocol to many patients with the same condition, and functional medicine practitioner takes a more personalised, nuanced approach.
A functional medicine practitioner first asks: ‘Who is the person who has the disease, why was function lost, and how can we restore function?’ vs ‘What drug/treatment matches the disease?’.
Then, rather than asking what drug works for a disease, we ask “what will be right for Mark?”
A functional medicine practitioner will combine their clinical expertise with the best available current evidence, and the patient’s story to create a plan that’s truly personalised to the patient in front of them.
Each patient is entirely unique in their presentation of symptoms and their underlying factors that contribute to their health challenges. From their unique genetics, diet, lifestyle and environmental influences, each treatment plan is tailored to the individual. That means that two people with the same diagnosis may get a completely different treatment plan, targeting the root causes of their condition.
Let’s say that two people see a functional medicine practitioner with similar complaints - an autoimmune condition. After a comprehensive health assessment of both patients, the root cause and contributing factors or drivers determined are entirely unique. From there, a functional medicine practitioner will create a personalised plan to address each patient's root cause and drivers.
Watch Mark Hyman’s TEDMED talk on why functional medicine is the future of medicine.
Functional medicine is more economical over the long term
While the investment for functional medicine is much higher initially than conventional healthcare (and unfortunately isn't subsidised by Medicare), the investment is short term. That is because the aim is to resolve a person's health problem so that treatment finishes and they can maintain their health on their own.
In contrast, with conventional care, because the approach is to manage a condition rather than solve it, management treatment in the long term often requires additional treatments, including surgeries, so the cost of healthcare tends to increase over time. In addition, people with a chronic health condition see multiple practitioners and are often out of pocket for some specialists and tests not covered by Medicare or private health insurance.
On top of that, factoring in the years and decades of poor health that limits a person's life (including their careers), the other chronic health problems that arise alongside their main health complaint, premature death, plus the mental and emotional toll that takes from living with illness and the stress of ongoing treatment, the argument that the current healthcare system is value for money quickly crumbles.
Functional medicine engages patients in their own health journey
Another study exploring the gaps in the current medical system for those with chronic illnesses highlighted how in the current healthcare system, the role of the patient was mostly passive. As the medical system was set up to treat acute conditions, there was little need for doctors to develop patient self-management skills, or to track their patient’s health symptoms alongside their treatment plan. Unfortunately, most doctors and clinicians continue to practice in this way.
The study states:
Medical care then must assure that persons with chronic illness have the confidence and skills to manage their condition; the most appropriate treatments to assure optimal disease control and prevention of complications; a mutually understood care plan; and careful, continuous follow-up. Well-designed interactions between practice team and patient will be needed to complete the important clinical and behavioral work of modern chronic illness care.
Functional medicine recognises that a patient needs the support and guidance of a healthcare practitioner that engages them in their health journey to achieve optimal health.
A recent report listed ten rules for creating a higher-quality healthcare system. Of particular relevance to chronic care, these rules stress “continuous relationships with the care team, individualisation of care according to patients’ needs and values, care that anticipates patients’ needs, services based on evidence, and cooperation among clinicians.”. Like the report’s authors ponder: what would chronic illness care look like if these rules were in place?
The recommendations included closer interaction with the patient, with the goals being:
- elicit and review data concerning patients’ perspectives and other critical information about the course and management of the condition(s);
- help patients to set goals and solve problems for improved self-management;
- apply clinical and behavioural interventions that prevent complications and optimise disease control and patient well-being; And
- ensure continuous follow-up
That is why each patient who comes to our clinic is assigned a health coach alongside a functional medicine practitioner. Health coaches help patients set goals, learn self-management skills, give them ongoing support, and promote behaviour change that leads to lasting improvements to health.
An empowering relationship is developed between the practitioner, health coach and patient that encourages the patient to take ownership of their health and participate in their healing. Part of this approach includes increasing a patient’s ‘health literacy’ - understanding the factors that contribute to the health and being in tune with their bodies, rather than being disconnected from their bodies and playing a passive role in their treatment plan.
The evidence for functional medicine
Conventional medicine looks to randomised controlled trials as the best source evidence of whether an intervention is effective. Because functional medicine applies personalised interventions, rather than the same treatment to all people with the same condition, it is difficult to replicate in this type of study. However, cohort studies are now being done on the functional medicine approach with promising results.
A 28-week study in 2016 assessed the efficacy of a functional medicine approach to improving stress, energy, fatigue, digestive issues, and quality of life in middle-aged women. This study showed significant improvements in energy and overall health.
A more recent study on Functional Medicine reported significantly larger quality of life outcomes for patients with chronic health conditions such as autoimmunity, neurological conditions, hormonal disorders, cardiovascular conditions, digestive disorders and skin disorders than those treated conventionally.
Who benefits from functional medicine?
Functional medicine benefits those with long-standing health issues, whether diagnosed or undiagnosed. Functional medicine practitioners don’t necessarily need a diagnosis to work from, because they have an in-depth understanding of human biology, and how to interpret signs and symptoms. By taking a thorough health history, and using clinical tools like functional testing, they can help pinpoint potential root causes and other factors that need to be addressed.
Functional medicine can help with chronic conditions like:
- Asthma and allergies
- Autism and behavioural issues
- Autoimmunity (diagnosed and undiagnosed)
- Brain and mood disorders
- Cardiovascular disease
- Children’s health
- Chronic fatigue
- Chronic pain
- Digestive disorders (diagnosed and undiagnosed)
- Hormonal imbalances
- Metabolic Dysfunction
- Recurrent infections
- Skin conditions
- Thyroid disorders
- Women’s health (PMS, PCOS, Endometriosis)
Because of the holistic body systems approach, functional medicine can help people with a range of complex, unrelated symptoms that don't fit into a specific category or condition. In fact, many people coming to our clinic first tell us that they have a few things going on, and they're confused by who they need to see. Functional medicine can help by taking a 360 view of their health to determine what's going on their body, and why.
Other people who benefit from functional medicine are those who want to stay in good shape for the future, who want to prevent disease and increase longevity, or optimise their health now - whether professional athletes or biohackers.
Why the future of healthcare is functional medicine
While the conventional healthcare system has identified glaring problems with the state of care, the time it will take for the industry to change their approach, and retrain their doctors and clinicians to understand chronic diseases and the factors that contribute to it, will be at least 20 years away.
Functional medicine is here now, perfectly primed to care for patients and get them better again based on the latest clinical insights. So if you're after a personalised, collaborative and supportive approach perfectly designed to solve your chronic health problems, functional medicine is your best bet right now. Not only will it cost you less money in the long run, but you'll also live a higher quality, longer life. And you can't put a price on that.
The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.”
- Thomas Edison
Being unwell is frustrating and exhausting. Finding solutions and getting the right support can be too.
Our unique model of care - functional medicine combined with health coaching - was designed with you in mind. Find out how here.
About Melbourne Functional Medicine
Melbourne Functional Medicine is a functional medicine clinic serving people in Melbourne, Sydney, Brisbane and all across Australia via in-person consultations and telehealth. Our functional medicine practitioners Jabe Brown and Rebecca Hughes treat people with a range of health conditions, from digestive disorders, fatigue, cardiometabolic disorders, women's health conditions, thyroid disorders, autoimmunity, brain and mood, skin conditions and children's health.
Many of our patients have seen several practitioners, including integrative GPs, doctors and specialists, before coming to us. Our functional medicine practitioners enjoy taking on these seemingly unsolvable, tough, health cases because the functional medicine approach provides a comprehensive, thorough approach to an individual's health. To find out about some of the complex cases, our practitioners have helped to solve, see our testimonials page.
Our functional medicine practitioners use natural medicines such as nutrition and herbs alongside lifestyle interventions to heal the body, rather than drugs. However, they do work alongside integrative GPs, integrative doctors and specialists where an integrative approach is required.
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