What Is Functional Medicine?


For most patients faced with medical issues, the first step in seeking treatment is a visit to any regular or specialty doctor, surgeon, or medical professional who treats symptoms, diseases, and other health issues using science-based, modern practices such as drugs, radiation, or surgery. But sometimes, even when seeking such help, a patient can find themselves facing chronic illness, the diagnosis for which can seem to fall outside of the purview of standard medical care. Test results are normal. There are no signs of obvious causation. “There’s nothing wrong with you,” or “We just can’t figure it out,” patients are told.

A recent study by ARNet (Autoimmune Research Network) surveyed around 23,000 patients and found that it takes an average of 4.5 years to achieve a diagnosis and an average of four different physicians, which points to a growing number of individuals — especially among women and women of color—facing chronic or “invisible diseases” oftentimes related to autoimmune issues. As such, these patients are having to rethink medical treatment that exists on the outskirts of allopathic, or traditional, standardized health care models.

One such practice is “functional medicine,” a treatment program that seems to be catching on with some promise: A 2019 global study of more than 7,200 patients published in the Journal of the American Medical Association found functional medicine might have the ability to improve health in patients. But what is “functional medicine” exactly? And what’s the difference between a functional medicine doctor and other, more obvious physicians like an integrative doctor or primary care doctor? Let’s dive in.


What is functional medicine?

As it turns out, the term “functional medicine” is kind of self-explanatory. “Functional medicine, in brief, is all about understanding and optimizing how the body functions,” he says Joel Evans, an OB-GYN and the founder and director of the Center for Functional Medicine in Stamford, Connecticut. “Initially, what we do is determine how and why illness occurs, which is because of problems with function, and then we restore health by addressing the root causes of disease that are personalized and specific to each person.”

“Functional medicine is great when people have symptoms that they can’t identify through conventional medicine,” Evans continues. “Many of us in the field say our best cases are when people have had an exhaustive medical workup and their doctor says they can’t find a reason for their symptoms. That’s when and where we shine.”

Susie Ellis, chairman and CEO of the Global Wellness Institute, who recently led a symposium on functional medicine in Bangkok, Thailand, describes it as a “bridge between medicine and wellness.” Ellis says the functional medicine approach to care can make patients feel more empowered about their sense of well-being. “People are going online, and they’re learning more,” she says. “They’re not at the whim or mercy of what their medical doctor tells them.”

Why explore functional medicine?

According to the CDC, 70 percent of all US deaths are from largely preventable chronic diseases like type 2 diabetes, high blood pressure, and high cholesterol. Evans says the majority of people who gravitate toward functional medicine want to find a way to address these issues without medication and its residual side effects. He also says people tend to turn to functional medicine out of frustration when they have a constellation of symptoms their primary care doctor can’t seem to piece together into a diagnosis.

In this Covid era, people with underlying conditions such as these are at higher risk for more severe illness. Functional medicine purports to help patients heal from these types of conditions, largely through diet and lifestyle modification. “The pandemic was a springboard that gave functional medicine a lot of momentum,” Ellis says.

Functional medicine is great when people have symptoms that they cannot identify through conventional medicine.

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Is functional medicine a rebrand of alternative, complementary, or holistic medicine?

The short answer is sort of. The term “functional medicine” seems nebulous because it refers to an approach to treating patients rather than the modality of treatment itself. This is why you’ll find an array of practitioners, including medical doctors, chiropractors, acupuncturists, naturopaths, and others, who refer to themselves as functional medicine doctors.

“I can use, and we teach how to use, a functional medicine approach to almost any illness,” says Evans. Adjacent to the Center for Functional Medicine, the Institute for Functional Medicine offers licensed health-care practitioners the opportunity to apply to enroll in coursework that results in a certification. He says he trains all sorts of specialists, listing emergency room specialists, surgeons, oncologists, endocrinologists, and cardiologists among them. “Every specialty is represented in our trainings because the approach is suitable, no matter what the disease is,” he adds.

Though functional medicine’s origins date back to 1990, when Dr. Jeffrey Bland founded the Institute for Functional Medicine along with his wife, Susan, the practice has endured its share of skepticism. Look up “functional medicine” on Wikipedia — which is written by volunteers not employees, mind you — and you’ll find liberal use of damning adjectives and a claim it’s simply a rebrand of complementary and alternative medicine.

Yet Western medicine is notoriously slow to embrace alternative medical methodologies. (Ellis confirms the American Medical Association doesn’t recognize functional medicine — they were contacted for this article but did not respond to a request for an interview.) Take acupuncture, for instance, which falls under the “alternative” umbrella. Though the practice is Eastern and ancient, there’s now plenty of well-established scientific evidence that supports its efficacy for chronic pain, musculoskeletal issues, nausea, and a host of other ailments.

So, what does a visit with a functional medicine practitioner look like?

Evans says functional medicine practitioners are trained to look at the body in a different way than primary care doctors. “We have our own language,” he says, describing the three things he looks for during intakes: antecedents, or a predisposition for or an increased risk of a particular health issue, like genetics or environmental factors; triggers, which are what brings on symptoms; and mediators, meaning anything that produces or perpetuates symptoms or damages tissues of the body, including behaviors.

“We try to identify what we call the ATMs, then we look at personal lifestyle factors that might be contributing to their issues, like sleep and relaxation, exercise and movement, nutrition, stress, and relationships.” During the intake, the practitioner tries to identify if there are ATM imbalances, then references something Evans refers to as “The Matrix,” or seven nodes of the body including hormones, digestion, and immune response, to identify the root cause of their health issues and determine a plan to address them, ideally before these issues cause bigger health problems.

One primary differentiator between a functional medicine intake and a primary care intake is that functional medicine practitioners tend to do lengthy intakes — often an hour to two hours — allowing them to dig deeper into a patient’s background than the speedy 15-minute-per-patient model most primary care physicians are restricted to.

“There is that extensive getting to know the background and understanding the whole you,” says Ellis. “That’s a big difference. It takes time to discover root causes. Lifestyle changes take time to coach and implement. A lot of it is also based on compensation models. A primary physician is not as inclined. They’re not going to be making a lot of money spending a lot of time with one person and then giving them advice about exercise, nutrition, and stress reduction.”

Another key difference is that functional medicine practitioners may prescribe supplements for issues where medical doctors are often more likely to prescribe medication. Depending on the individual, the efficacy and side effects from either can vary, and therein lies the gray area we all have to wade across.

side view of young woman standing at home

Functional medicine, in brief, is all about understanding and optimizing how the body functions.

Javier Sánchez Mingorance / EyeEmGetty Images

Do medical doctors recognize the benefits of the functional medicine approach?

Judging from the symposium she held, Ellis says medical professionals around the world have been “overwhelmingly positive” about the approach of functional medicine. “There were 33 medical doctors on the stage; they were all pro-functional medicine. They didn’t all call themselves functional medicine doctors, but they understand the idea of ​​functional medicine being patient-centric, being root cause-oriented, and being lifestyle-oriented.”

Functional medicine is gradually being integrated into some hospitals as well. The Cleveland Clinic, a well-respected nonprofit academic medical center in Ohio, opened its Center for Functional Medicine back in 2014. Dr. elizabeth bradley, medical director of the center, says the response was enthusiastic and immediate. “We had interest from patients from all over the country and even internationally. It was clear right away that people were interested in this type of personalized care,” says Bradley. “There were many patients looking to dive deeper into their health issues beyond treating just the symptoms.”

Following the functional medicine edict of looking at the underlying causes of disease and focusing on the whole person rather than treating isolated symptoms, providers at the Cleveland Clinic take an extensive medical history, including issues like poor nutrition, stress, toxins, allergens, and genetics , offering individual appointments, which are 60 minutes long, followed by nutrition counseling and health coaching.

Bradley says they’ve had so much interest that when they first opened, they couldn’t keep up with the demand for individual appointments. Now they offer a program called “Functioning for Life,” which allows patients to share appointments every week for 10 weeks and, theoretically, support one another.

What does the future of functional medicine look like?

Like with the Cleveland Clinic, Ellis says she sees a day in the future when functional and traditional Western medicine can exist side by side. But for patients looking to explore functional medicine right now, one barrier can be cost, as many individual functional medicine practitioners don’t accept insurance.

When asked about this pain point, Evans says his center and institute is consulting with “big umbrella institutions,” like VA hospitals and nonprofits, to make functional medicine practitioners more accessible and affordable for more people. Also, like the Cleveland Clinic, the Center for Functional Medicine offers shared medical appointments — like group therapy but intake for your medical issues — stating there’s data (from the Cleveland Clinic) that supports how this type of diagnostic groupthink helps facilitate better outcomes at a lower cost of delivering care.

When it comes to health — be it the experience or business of — knowledge is power in every sense of the word. Though it’s been around for more than 30 years, functional medicine is still considered very new, and in the world of medicine, it can take decades of longitudinal studies to prove the efficacy of a medicine or a practice. But in the meantime, it’s our prerogative to empower ourselves with research.


Vivian Manning-Schaffel is a multifaceted storyteller whose work has been featured in The Cut, NBC News Better, Time Out New York, Medium, and The Week. Follow her on Twitter @soapboxdirty.

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