MEDICINE OUTSIDE THE BOX
inherently moves toward a one-size fits all approach . The LM handbook describes functional medicine as a practice focusing on the physiologic and biochemical functions of the body with attention to the balance of these processes and various hormonal and metabolic tests . Integrative medicine focuses on whole person needs using conventional , complementary and alternative approaches .
Lifestyle Medicine asserts a focus on treating the root cause of disease , reversing chronic illness and empowering patients to have a more active role in their health . Moving the emphasis away from pharmaceutical management of disease can help overcome the issue of nonadherence , which occurs in more than half of patients . Lifestyle Medicine makes very clear their emphasis on evidence-based approaches to managing and preventing chronic disease . The curriculum to prepare for the board exam includes nine landmark studies related to lifestyle approaches to disease . Physicians from many different specialties have sought certification in Lifestyle Medicine to develop skills in patient coaching , behavior change and treatment of underlying causes of disease . Another approach to patient care relying on treatment of the fundamental cause of disease is Functional Medicine ( FM ).
Functional Medicine
Functional medicine is a dynamic approach to assessing , preventing and treating complex diseases . It is defined as : A systems-biology-based model that empowers patients and practitioners to work together to achieve the highest expression of health by addressing the underlying causes of disease . Functional Medicine uses a unique operating system and personalized therapeutic interventions to support individuals in achieving optimal wellness .” 2
Functional medicine primarily focuses on a patient ’ s physiology and biochemistry to improve health . Each patient has unique influences that generate the development of disease and contribute to long term health . FM supports a patient-centered approach rather than disease-centered , encompassing all body systems and how they integrate and work together . Similarly to LM , FM focuses on a root cause analysis approach to preserving health – body systems decline well before the overt signs of chronic disease . Most treatments utilize nutrition , dietary changes , exercise , improving sleep and finding a sustainable healthy lifestyle .
Functional Medicine seeks to detect poor balance of body systems , declaring seven important biologic functions that can become unbalanced : assimilation , defense and repair , energy production , biotransformation , communication , transport and structural integrity . A patient may have a single imbalance ( inflammation ) that leads to multiple conditions ( heart disease , depression , arthritis , cancer , diabetes ); or a single condition ( obesity ) that stems from multiple imbalances ( inflammation , genetics / epigenetics , diet and exercise , mood disorders ). 2
For example , a common focus in patient care is the interaction of gastrointestinal health with the immune system , nutrient levels , brain function and overall well-being . Many symptoms and diagnoses can be corrected or significantly improved when identifying any GI sources of inflammation , maldigestion , dysbiosis and infection . FM and LM both present lectures on the philosophy of Food as Medicine . Patients crave exposure to knowledge of how they can help themselves through diet changes rather than adding on another medication to take for the rest of their lives .
A 2019 study in JAMA Network Open compared outcomes of patients in two Cleveland Clinic outpatient care centers : one functional medicine and one family health center . 3 Six-month outcomes favored FM in both mental ( Patient-reported outcome measurement information system ([ PROMIS ] Global Mental Health ) and physical ( PROMIS Global Physical Health ) well-being . At one year , patients in the FM clinic had persistent benefits in physical health and superior ( but not statistically significant ) scores in mental health . Specific cases can be very impressive : resolution of anti-thyroglobulin antibodies in Hashimoto ’ s , inflammatory bowel disease patients who can discontinue immunomodulators , improvement of interstitial cystitis and of course irritable bowel syndrome with dietary changes .
Five essential components form the structure of a FM approach to patient care : Eliciting the patient ’ s complete story , building an empowering partnership , addressing modifiable lifestyle factors , organizing within a systems biology framework and giving personalized recommendations to each patient . The personalized , individualized approach to care brings us to the most rapidly progressive of the three concepts , Precision Medicine ( PM ).
Precision Medicine
The Precision Medicine Initiative defines PM as “ an emerging approach for disease treatment and prevention that takes into account individual variability in genes , environment and lifestyle for each person .” 4 A guiding principle is , again , the idea that the same treatment might not be effective for all patients . Individualizing therapy can reduce the number needed to treat and raise the number needed to harm for various interventions . This contrasts sharply with most preventive medicine approaches , which target risk factors and have NNT in the hundreds .
A review by Ginsburg and Phillips includes several examples of precision medicine for cardiovascular and malignant disease . 5 If you find their article , check out Table 2 , a list of selected global precision medicine-implementation programs . Many of these larger
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