Paul A. Goldberg, MPH,DC,DACBN,DCBCN
The Goldberg Clinic for Chronic Disease Reversal
Functional Medicine, a form of Alternative Medicine, has acquired increasing interest among medical practitioners looking to boost their incomes by taking advantage of the public’s concern with the failures and dangers of Conventional Medicine. Patients generally fail to understand, however, that Functional Medicine is simply another form of medicine, developed primarily by entrepreneurs in the supplement and related industries to increase the sale of products, services and seminars. Despite considerable hoopla, Functional Medicine is but a variation of conventional medical practice oriented to the medical treatment of disease as opposed to identifying and addressing causes.
In Conventional Medicine, patients are classified by symptoms or pathology and symptomatically treated with pharmaceutical agents, leaving causes untouched and the patient burdened with the toxic effects of the drugs employed. Functional Medicine retains the same template of disease treatments and adds additional treatments to those already being given, further burdening the body. Lip service is given to causal identification but in practice this rarely occurs due to their conventional medical understanding of what disease causation is.
Giving credit where credit is due, some Functional Medicine Literature shows considerable knowledge of Clinical Nutrition. I employed one of their textbooks, in University Clinical Nutrition and Gastroenterology Courses I taught for many years.
Their practitioners, however, are primarily Medical Physicians who know little to nothing regarding even Basic Nutrition let alone Advanced Clinical Nutrition other than salesmanship in vending supplements which is part of the Functional Medicine Curriculum. Clinical Nutrition is not part of their training or clinical experience and to simply tack it on after a seminar or two is comparable to a Medical Student becoming a General Surgeon after observing a couple operations.
In practice we repeatedly have patients come to us for assistance after failing to improve or having worsened in Functional Medicine Offices where the Physician has added alternative treatments to an array of pharmaceuticals including prescription hormones. Functional Medicine Practitioners trained in Medicine cherry pick a few applications pioneers in Clinical Nutrition and Hygiene developed over the past hundred years and add what looks like modernity but the outcome is Conventional Medicine mixed with Madison Avenue. If you mix poison with honey you simply get poisoned honey.
Seeking out root causes has been key to our practice of Bio-Hygiene™ for forty years combining Clinical Epidemiology, Hygiene, and Clinical Nutrition. Functional Medicine as an institution gives the notion of causality a nod but in practice their practitioners employ a non-causal based approach, which is part and parcel of the practice of Medicine.
This is to be expected. Years of Medical Training focused on treating symptoms cannot be changed by a few weekend seminars. The dynamics of medical practice do not allow the time to address causal factors with patients allotted six minutes per visit nor does the Medical Physician’s years of indoctrination orient them to do so. Whirling patients in and out of examination rooms destroys any possibility of a causal based practice, which takes considerable effort, patience and time.
Taking a causal oriented approach begins with the practitioners initial academic training and on their Clinical Experiences. Certainly hospital based practices run contrary to a causal based approach as is being involved in HMOs and PPOs where profit is measured in physician minutes expended. Clinical Epidemiology, Clinical Nutrition and Hygiene Essentials are bypassed as is the value of in-depth interviews, careful hands on physical examinations, thorough laboratory testing and tying the pieces together with the detective skills that thorough and early training and experience in clinical epidemiology and hygiene foster.
We find the absolute need to allot new patients one and a half hours of two doctor’s time for the first visit and a full hour for re-examinations. Even with that we often devote additional time as understanding the chronically ill patient whose case is complicated by years of pharmaceuticals and surgeries requires focusing on the person’s entire life. All the years of living that contributed to the patient’s constitution before they even saw us must be considered…not simply naming their current signs and symptoms and handing out drug prescriptions and/or a litany of supplements.
Why do Alternative /Functional Medicine Practitioners Fail To Employ A Causal Based Approach?
When Functional Medicine Physicians speak of addressing causes they are referring to their medical “diagnoses” which in truth represents symptoms. Common diagnoses from Functional Medical Practitioners purported to be causes are symptoms, including the following “diagnoses” frequently utilized:
Hypothyroidism- Tragically, thousands of women and men are unnecessarily placed on thyroid replacement therapy (TRT) each year. We have calculated that over 70% of the new female patients seen at our clinic are on Synthroid, Naturthroid or other Thyroid Replacement Therapy (TRT). That many (not all) of these patients had low thyroxin levels is true but this is insufficient reason to give them hormone replacement, which represents a serious threat to the function of the glandular system and constitutes a symptom-based approach. We also encounter patients with low thyroxin levels but rather then place them on TRT, which leads to glandular degeneration and destruction of the gland, we investigate what factors are causing the thyroid level to drop, what are the underlying causes. Often times it is due to hygienic factors such as lack of sleep, poor diet, emotional stress and sunlight deprivation. When these causal factors are addressed in a timely manner not only does the thyroid return to normal function (as opposed to progressive degeneration under the Functional Medicine Approach) but also the patient’s entire health picture vastly improves (see example of this in the video to the right). On the contrary, when Functional Medicine Practitioners throw TRT at a patient their issues compound, the thyroid gland degenerates and the causes of ill health and low hormonal output go untouched. To read more about this highly promoted yet tragic and widespread form of malpractice see http://www.goldbergclinic.com/blog/2014/10/21/sacrificing-womens-glandular-vitality
Yeast Overgrowth – Yeast (e.g. candida albicans) is a normal inhabitant of the body particularly the GI tract, normally staying in balance due to bacterial competition. Yeast overgrows due to medical prescriptions of steroids, antibiotics, hormones in the food supply, a high sugar diet, lowered resistance due to emotional stress, sleep deficiency, overwork and other lifestyle factors. Anything that runs the body down will fuel yeast overgrowth. These are the causes to be identified and addressed, not the yeast organism. The Alternative/Functional Medicine approach to name the yeast as the cause and “treat” the patient with anti-fungals such as Ketoconazole, Nystatin and the toxic drug Diflucan, known to cause liver damage is a pathway leading to disappointment and disaster.
We have had patients come to us “diagnosed” with “Candida” placed on Diflucan for months, even years by “Functional Medical Practitioners”, something even conventional practitioners would be loathe to do. Others place their “yeast patients” on an assortment of herbs and potions to “kill the yeast”. “Anti-yeast” diets are of value only if the problem stemmed from dietary issues, which often is not the case. Yeast is not the cause of ill health… factors that lower body resistance are and these are rarely addressed by the Functional Medicine Practitioner.
“Dysbiosis” – Much of the Public has an imbalanced intestinal environment due to an assortment of factors. The Alternative/Functional Medicine Practitioner labels the patient with “dysbiosis” and ‘treats” them with a hodge podge of enzymes, HCL stimulants, probiotics, herbal formulations and other nostrums unrelated to the etiological factors involved and thus the dysbiotic state in time generally worsens. This need not be the case when causes are addressed and the appropriate conditions for rejuvenation of the GI tract are provided.
Adrenal Fatigue – Most chronically ill patients are likely to have overtaxed adrenal glands. Prescription Drugs including steroids, negative emotions, loneliness, and a myriad of other factors that tax the entire body also stress the adrenals. The Functional / Alternative Practitioner administers herbs, cortisol, licorice, adrenal gland extracts, etc., to a body already overwhelmed. The patient did not develop the problem due to a licorice or adrenal gland extract deficiency. The causes of bodily fatigue must be identified and appropriate Bio-Hygienic steps employed to restore normalcy. Health cannot be restored by pills alone. http://www.goldbergclinic.com/blog/2016/8/31/adrenal-fatigue-a-common-but-misunderstood-condition
Gluten - Gluten as found in wheat and other grains have become a scapegoat to blame health problems on among many Functional/Alternative Practitioners. Some have even become “gluten specialists”. No need. Eliminate Gluten and after a few weeks look for improvement. Many improve simply because by eliminating gluten most junk foods are eliminated. That said, by blaming gluten alone we overlook the many other factors likely at play.
Small Bowel Overgrowth- A common condition treated by Functional Medicine Practitioners with antibiotics. Unfortunately the condition returns in most cases shortly afterwards. A thorough search for causal factors is important, as is understanding that Small Bowel Overgrowth is a symptom that can be related to many different causes. http://www.goldbergclinic.com/blog/2017/4/18/small-intestinal-bacterial-overgrowth-sibo
Vitamin D deficiency – We are a sun-deprived nation largely due to medical warnings to avoid sunlight. Ironically Medical Practitioners now write prescriptions for 50,000 units of Synthetic Vitamin D constituting at that level a drug, which carries risks of its own. The wise step is to obtain sunlight in a reasonable fashion something we assess patients for and train them to implement. Vitamin D is not a Vitamin but a hormone produced by the body in the presence of sunlight. “Vitamin D” Deficiency is a reflection of sunlight deprivation which disables the body from producing “Vitamin D” and deprives it of other benefits including protection from many forms of cancer which simply taking pills from the Functional Medicine Practitioner alone cannot provide.
Bio-Identical Hormone Replacement Therapy (HRT) -
Functional Medicine Practitioners know the public is eager for quick solutions to complex health issues. HRT fits the bill. Virtual instantaneous reversal of the aging process with no effort or so it appears. Entry way to the fountain of youth or so it seems. In response to issues such as hot flashes, moodiness, depression, low sex drive, impotence, fatigue, thinning bones and other signs of ill health out comes hormone creams and pills. All that glitters is not gold, however, as patients eventfully discover.
Standard Medical practitioners previously widely prescribed HRT in forms such as Premarin. This largely stopped after Epidemiological Studies revealed it was associated with significantly increased cardiovascular risk. Bioidenticals will in time we believe be found to present the same if not greater risks. Whether the hormone is derived from a pig or from soy or yam it is still a hormone. Pushing these hormones as being safe because they are plant derived is deceptive.
Hormone levels decline with age. This gradual reduction should occur with minimal discomfort in a healthy individual. When the person is in poor health existing symptoms are exacerbated as aging proceeds. Administering exogenous hormones ignores the underlying causes of symptoms. Taking Estrogen also increases the risk of estrogen-based cancers. The short-term relief some experience is soon outweighed by unpleasant side effects and new problems that are created.
Just as the Functional Medicine Practitioner pushes estrogen (and progesterone) for women it pushes testosterone for men often still in their thirties, forties and fifties. In good health these men will produce sufficient testosterone. Many healthy men in their sixties, seventies and even eighties still produce levels of testosterone sufficient to meet their needs without the dangers of taking it exogenously which includes testicular atrophy and potential prostate issues.
Low hormone levels are not a cause of poor health; they are a symptom of poor health. Underlying causes should be identified and addressed. In doing so we have seen patients attain healthy hormone levels for their ages and also achieve excellent health and vitality through an individualized program of healthy living that imbibing drugs can never accomplish. To see examples of this go to www.goldbergclinic.com. These before and after pictures represent women and men who have been Re-Created through individualized health care programs (without the use of hormones) focusing on causes rather than symptoms. For further information on the dangers of HRT go to: http://www.goldbergclinic.com/blog/2017/4/4/anti-aging-medicine-and-bio-identical-hormones-quick-fix-or-slippery-slope.
Diet Mania –Diet roulette has become common for both laypeople and Functional Medicine Practitioners. GAP diet, FodMap diet, Ketogenic Diet, Raw Food diet SCD diet, High Protein, High Carb, Low Carb, Low Protein, Makers Diet, Paleolithic diet etc., etc. the list is endless and the diets employed come and go, bandied about as the individual goes from one diet to the next experiencing frustration and disappointment. Dietary Factors are important but food intake must fit the individual and not the other way around. It is easy for the Functional Medical Practitioner to hand out diet sheets with whatever is in vogue at the moment as opposed to the time taking task of doing a detailed Nutritional Evaluation based on the individual. This involves looking at the full scope of nutrition i.e. not only food intake (diet) but factors involving digestion, absorption, assimilation, cellular excretion and elimination, a time consuming process that Medical Practices have neither the time, training or experience to delve into. http://www.goldbergclinic.com/blog/2017/7/26/diet-maniadiet-confusiondiet-frustration
Functional Medicine Practitioners confuse symptoms with causes. Addressing symptoms e.g. low hormone levels, gluten intolerance, dysbiosis, adrenal fatigue, yeast overgrowth and low hormone levels as if they were causal factors as opposed to symptoms of underlying causes leads to frustration and failure. In addition, treatment programs including hormone replacement therapies, anti-fungals, glandular supplements and ill fitted dietary schematics places the patient at risk of serious side effects and missing the opportunity to obtain good health by taking a causal based approach.
Bio-Hygiene evaluates patients physiologically, biochemically and bio-mechanically incorporating clinical epidemiology, nutritional biochemistry and thorough lifestyle analysis. It is aimed at uncovering functional disturbances and the reasons behind them. Functional and Standard lab analysis along with a detailed case history are employed to uncover causal factors and Clinical Nutrition and Hygienic Measures are utilized to address them. This is an effective pathway to reverse chronic disease avoiding any form of treatments or medicine although it requires considerable effort on the part of both patient and doctor. Patients sometimes enter our office thinking we are a Functional Medicine practice. They are mistaken. Bio-Hygiene™ is not any form of medicine.
I am well acquainted with Functional Medicine and have lectured Alternative / Functional Medicine Practitioners on topics involving autoimmune, gastrointestinal disorders and Clinical Nutrition. I was involved in the development of Functional Laboratory Testing Education over thirty years ago as a consultant to two major laboratories focusing on functional laboratory evaluation. If a practitioner understands laboratory procedures and their application in conjunction with the case history and physical examination, they can help uncover causes and monitor progress. Functional Medicine on the other hand, while employing many of the same laboratory tests we have long employed, uses them to implement treatments with drugs and supplements. This makes them fundamentally no different from standard medical practice.
For those with chronic illness the world of “Functional Medicine” can hold allure. The patient who suffered under Conventional Medical Practice seeks a saving grace. They fail to understand, however, that they are going from Dweedle Dee to Dweedle Dum with the same template being applied.
As a young man with Rheumatoid Disease in my 20’s I learned that Alternative Medicine in its varied forms (such as Functional Medicine today) was and is not fundamentally different from standard medical practice still treating symptoms unrelated to causes. Throwing supplements and additional drugs into the mix does not change its nature. Functional Medicine in essence is a marketing device to attract patients disillusioned with Conventional Medicine yet wishing to remain in a medical comfort zone.
There are today a plethora of Alternative Medicines in addition to “Functional Medicine” including:
- Anti-Aging Medicine
- Holistic Medicine
- Functional Medicine
- Naturopathic Medicine
- Complementary Medicine
- Integrative Medicine
All kinds of medicine presenting themselves as alternatives under the guise that they represent a better approach with their particular variety of medicine.
The Appeal of Alternative/Functional Medicine
Functional Medicine promotes itself as an improved or “complimentary” form of medicine. The jump from Conventional Medicine to Functional Medicine is a small jump allowing the patient to continue medical treatments, just different or additional ones. Beyond the hoopla and glitter, the various forms of Functional and Alternative Medicine are a facade based on the same faulty premise i.e. the naming of symptoms followed by “treatments” to address those symptoms. Call the plethora of alternative/functional medicine approaches by any name but a rose is still a rose, treatments are still treatments and the treatment of chronic disease vs. addressing disease causation are polar opposites. Causes of ill health need to be identified and addressed directly followed by the establishment of the right conditions for health renewal to evolve. Medical and Alternative Medical Treatments fail to accomplish this.
Use Our Medicine Rather Than Their Medicine!
Conventional Medicine initially viewed Alternative/Functional Medicine as a threat but has now chosen to assimilate it. Medical Giants e.g. The Cleveland and Mayo Clinics have opened departments of “Functional or Complimentary Medicine” leading a gullible public to believe they are in a place to get the best of both worlds when in fact they remain in the same world of treatments.
Patients are informed they have yeast overgrowth, the MTHFR Gene, Gluten intolerance, and other canned answers. “Diagnoses” are followed by prescribing herbs, supplements animal glandulars, parasite cleansers, detoxifiers, etc., Treatments and more treatments by “specialists” who received their education in weekend seminars. The Bioidentical Hormone craze is hawked, canned diet plans come and go and the individual jumps on board. Confusion and frustration follow.
Confusion is debilitating. I bear this in mind everyday working with patients bewildered by the avalanche of what they read on the Internet along with misinformation from Alternative Practitioners. Most patients I’ve worked with over the past four decades have taken a myriad of approaches prior to coming to us. Their “alterternative/functional medical” list of treatments often exceeds the long list of drugs they are taking.
The More The Merrier
The current trend is to employ both pharmaceutical agents and “Functional Medicine” treatments. The thinking is that the more approaches one takes i.e. a plethora of drugs accompanied by mountains of herbs, diets, probiotics, vitamins, chelation therapies, “bio-identical” hormones, ionic foot baths, anti-depressants, etc., the better the chance of recovery. The reality is to the contrary.
In plying the chronically ill patient with more toxic “alternative” treatments in addition to prescription drugs, the patient is driven further into illness and farther away from health. The result of the numerous “natural treatments” physicians dispense in order to warrant the “functional, alternative” titles” is that health issues are compounded. More treatments are not the answer. The correction of causal factors must be specific to the patient and not merely entail throwing a myriad of additional treatments at an already overburdened body.
Functional Medicine’s slippery slope presents two major inherent hazards:
- A medical physician is trained to treat disease with drugs. This is embedded into every physician’s psyche and it is improbable if not impossible for this treatment model to be drilled out. Likewise patients are indoctrinated in being medicated. It is therefore easy to add more medications under the guise of “alternative medicines” to the pharmaceuticals already prescribed.
Hippocrates the “Father of Medicine” did not emphasize medicines (let alone drugs) for the “treatment of disease.” The notion of giving potions for symptoms came later in the School of Asclepius, a competitive camp from which Conventional (Allopathic) Medicine evolved. Functional Medicine bears little resemblance to the Hippocratic School. Functional Medicine is driven by a symptom/treatment orientation regardless of how “holistic” the practitioner might profess to be as a result of a seminar sponsored by a supplement company they took on a cruise ship. New tests and alternative treatments are added to their pharmaceutical armory but the approach and results remain the same.
- To maintain Medical Licensure requires the practitioner to practice Conventional Medicine. To not follow medical protocol is to risk malpractice charges. The practitioner can add “alternative therapies”, “supplements”, “bio-identical hormones” etc., to their antibiotics, steroids, hormones, Synthroid, immunosuppressants and anti-depressants, but remains held to medical standards. The physician that gave pharmaceuticals as a standard practitioner still gives those pharmaceuticals as a “ functional medicine” practitioner but with yet more pills. The physician attends a weekend seminar on Bio-identical Hormones and on Monday advertises he or she is a Functional Medicine Practitioner to gain a competitive edge. Giving a probiotic along with an antibiotic or St. Johns Wort with Prozac or IV Chelation or Ozone Therapy or Ionic Foot Baths does nothing for the patient till at last as the disease becomes further ingrained and the patient fails to get well he says “I tried everything”.
Functional/Alternative Medical practitioners advocate a hodge podge of treatments. The difference between nature, hygiene and treatments is blurred in the public’s eyes. Physicians such as Television Personality “Dr. Oz” make careers of touting a plethora of “natural” potions and pills continuing to promote a treatment mentality.
What the chronically ill person needs is not “alternative medicine” but an alternative to medicine.
Functional Medicine and other forms of Alternative Medicine might prevent some from closing the door on hope but it also prevents them from returning to good health and taking control of their destiny. Alternative/Functional Medicine approaches take us down the same path of naming diseases and treating symptoms… a path going in the wrong direction.
The Goldberg Clinic For Chronic Disease Reversal
Causes Identified…Causes Addressed…Health Restored