Paul A. Goldberg, MPH,DC,DACBN,DCBCN
The Goldberg Clinic for Chronic Disease Reversal
Functional Medicine, another form of Alternative Medicine, has acquired increasing interest among medical practitioners looking to boost their incomes by taking advantage of the public’s legitimate concerns with the dangers of Conventional Medicine. Patients fail to understand, however, that Functional Medicine is yet another form of medicine developed largely 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 and/ or pathology and symptomatically treated with pharmaceutical agents, leaving causes untouched and the patient burdened with the toxic effects of the drugs employed or permanent damage from un-necessary surgeries. Functional Medicine retains the same template of treatments adding yet additional treatments to those being given, further burdening the body and complicating the patient’s health picture. Lip service is given to causal identification in theory but in practice this rarely occurs due to the practitioner’s conventional medical indoctrination of what disease causation is.
The notion of a Functional Approach to practice is sound. The problem is not taking a Functional Approach but rather a Functional Medical Approach. I employed a Functional (not Functional Medicine) Nutrition Text in some Clinical Nutrition and Gastroenterology University Courses I taught and found it well written. So called Functional Medical Practitioners, however, are at their core Medical Physicians who know very little regarding Basic and Clinical Nutrition other than salesmanship in vending supplements, combining them with a pharmaceutical approach. Oil and water do not mix, however. Clinical Nutrition is not part of medical training nor their clinical experience. To tack on some medical oriented nutrition courses after four to eight years of medical indoctrination by taking a seminar or two is comparable to a Medical Student becoming a Surgeon after spending an hour in the operating room.
In practice we regularly have patients come to us for assistance after worsening in Functional Medicine Offices where the Physician has simply added alternative treatments to an array of pharmaceuticals including prescription hormones. The medical practitioner simply cherry picks a few pseudo-natural approaches and morphs them into medical form. They borrow a bit from the work of pioneers in Clinical Nutrition and Hygiene developed over the past hundred years adding what appears to be modernity. Standard pharmaceuticals are inevitably part of the program. The outcome? Conventional Medicine combined 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 we have combined Clinical Epidemiology, Hygiene, and Clinical Nutrition in helping patients reverse chronic disease states. Functional Medicine as an institution gives the notion of causality a nod but in practice practitioners employ a non-causal based symptomatic approach.... part and parcel of the practice of Medicine.
Years of Medical Training/indoctrination 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 an average six to ten minutes per visit. Whirling patients in and out of examination rooms destroys the possibility of a causal based practice, which takes considerable effort, patience and time.
Taking a cause based approach begins with the practitioner’s initial academic training and Clinical Experience. 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 conducting 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. In theory some of these might be discussed in seminars but they are not employed in practices.
We find the absolute need to allow 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 based on a few minute visit and handing out drug prescriptions and/or a litany of supplements based on those symptoms.
Why do Alternative /Functional Medicine Practitioners Fail To Employ A Causal Based Approach?
When Functional Medicine Practitioners speak of addressing causes they are still referring to symptoms such as the following frequently utilized ones:
Hypothyroidism- Tragically, thousands of women and men are unnecessarily placed on thyroid replacement therapy (TRT) each year. We have found that over 70% of the new female patients seen at our clinic are on Synthroid, Naturthroid or other Thyroid Replacement Therapy (TRT). Some of these patients had low thyroxin levels but this is insufficient reason to administer hormone replacement, which represents a serious threat to the endocrine system and is a symptom-based approach. The question to be asked is why is a low level of thyroxin being secreted? We also encounter patients with low thyroxin levels but rather then place them on hormone replacement, which leads to glandular degeneration we investigate what factors are causing the low level, what are the underlying causes. Often times it is due to hygienic factors such as sleep deficiency, diet inadequacy, emotional stress, loneliness or sunlight deprivation. When these causal factors are addressed in a timely and thorough manner not only does the thyroid return to normal (as opposed to progressive degeneration under the Functional Medicine Approach) but the patient’s entire health picture also improves (see videos to the right). When the Functional Medicine Practitioner administers Thyroid Replacement Hormones, the thyroid degenerates and the causes of illness and resulting low hormonal output go untouched. To read more about this widespread form of malpractice see http://www.goldbergclinic.com/blog/2018/8/6/the-tragedy-of-thyroid-hormone-replacement.
Yeast Overgrowth – Yeast (e.g. candida albicans) is a normal bodily inhabitant particularly of the GI tract where it helps to maintain microbial balance. Yeast overgrows due to medical prescriptions of steroids, antibiotics, hormones, a high sugar diet, lowered resistance due to emotional stress, sleep deficiency, overwork and other imbalanced lifestyle factors. Anything that lowers resistance will fuel yeast overgrowth and therefore these are the causes to be identified and addressed. The Alternative/Functional Medicine approach to name the yeast as the cause and “treat” with anti-fungals such as Ketoconazole, Nystatin and the hepatoxic drug Diflucan, known to cause liver damage, is a pathway leading to disaster. We have had patients “diagnosed” with “Candida” placed on Diflucan for months, even years by Functional Medical Practitioners, something even most conventional practitioners would be loathe to do. Others place their “yeast patients” on assorted herbs and potions to “kill the yeast”. Yeast is not the cause of ill health…any and all factors that lower body resistance are and it is those specific factors that must be identified and addressed.
“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 causal factors involved. The dysbiotic state in time therefore worsens. This need not be the case when causes are identified and addressed and the appropriate conditions for rejuvenation of the GI tract are provided.
Adrenal Fatigue – Most chronically ill patients have overtaxed adrenal glands. Prescription Drugs e.g. steroids, negative emotions, overwork, lack of rest and a myriad of other factors that tax the entire body including the adrenals. The Functional / Alternative Practitioner administers herbs, licorice, adrenal gland extracts, etc., to a body already overwhelmed. The patient, however, did not develop the problem due to a licorice or adrenal gland extract deficiency. The causes of fatigue must be identified and appropriate Bio-Hygienic steps employed to bring about normalcy. Health cannot be restored by pills http://www.goldbergclinic.com/blog/2016/8/31/adrenal-fatigue-a-common-but-misunderstood-condition
Gluten - Gluten found in wheat and other grains has become a general scapegoat to blame health problems on among many Functional/Alternative Practitioners. Some have become “gluten specialists”. No need. Eliminate Gluten, which is a reasonable step to employ in any chronically ill patient and watch for improvement. Many patients 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. Most of the chronically ill patients we see eliminated gluten long before seeing us ago and noted little to no improvement as it was not a primary factor.
Small Bowel Overgrowth- A common symptom treated by Functional Medicine Practitioners with antibiotics and anti-bacterial herbs. For most patients the condition returns 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 a myriad of 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 and the indoor lifestyle of many Americans. Ironically Medical Practitioners now routinely write prescriptions for 50,000 units of Synthetic Vitamin D constituting a drug at that level with 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 a needed hormone as well as other benefits including protection from many forms of cancer. Taking pills from the Functional Medicine Practitioner is a poor and often risky substitute.
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 prescribed HRT in forms such as Premarin. This largely stopped after Epidemiological Studies revealed it was associated with significantly increased cardiovascular risk. Enter the so-called “Bio-Identicals”a mainstay of many Functional Medicine Practices. We predict these will 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 and foolish.
Hormone levels decline with age. This gradual reduction occurs with minimal discomfort in a healthy individual. When the person is in poor health, however, 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 including we believe an increased propensity to estrogen based cancers among females taking these largely estrogen based compounds.
Just as the Functional Medicine Practitioner pushes estrogen (and progesterone) for women it touted 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 included testicular atrophy and potential prostate issues.
Low hormone levels are not a cause of poor health; they are a symptom of poor health. In identifying and addressing causal factors 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. 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 some 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 consuming task of conducting a detailed Nutritional Evaluation on the individual. This involves looking at the full scope of nutrition i.e. not only the 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 such as low hormone levels, dysbiosis, adrenal fatigue, yeast overgrowth and low hormone levels as if they were causal factors as opposed to symptoms of underlying causes leads to failure. Treatment programs including hormone replacement therapies, anti-fungals, glandular supplements and ill fitted dietary schematics place the patient at risk of serious side effects and miss the opportunity to obtain health by taking a causal based, Bio-Hygienic, 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. It requires 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. Based in Hippocratic Principles it identifies, targets and addresses causal factors followed by establishing the right conditions to restore health.
The before/after pictures shown below are examples from our clinic illustrating what is possible with Bio-Hygiene™.
This concludes Part I of the article “The Facade of Functional Medicine”. To read Part II click here: http://www.goldbergclinic.com/blog/2018/12/28/part-ii-the-facade-of-functional-and-alternative-medicine.