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“You should really try going gluten-free.”
My friend, a pharmacist, offered that suggestion after I was complaining about my worsening heartburn. My heartburn had gotten so bad that I saw a gastroenterologist. As part of my work-up, the doctor had included a test for Celiac disease, which can lead to a variety of digestive problems related to eating gluten-containing food. Fortunately, I did not have it.
I asked my friend why going gluten-free would help. She told me that, after having gone gluten-free herself for several weeks, she felt better in a number of ways: more energy, fewer headaches and an improved mood. She then went on to inform me about functional medicine.
My friend directed me to one of the leading proponents, Dr. Mark Hyman, who has written several books that have appeared on the New York Times best-sellers list. Most of his published work touches on the integral role of proper food and dietary supplements in treating chronic conditions and how they can improve overall wellness. He is a convincing speaker and has produced a number of videos available online.
Hyman and other practitioners of functional medicine claim that the difference between functional medicine and traditional medicine are as follows:
■ Traditional medicine is siloed into specialties (cardiology, neurology, gastroenterology, etc.) without focusing on treating the patient as a whole.
■ Traditional medicine treats symptoms rather than focusing on what the underlying cause is of those symptoms.
■ Functional medicine focuses on patients as individuals, and the treatments are tailored to each individual: Two people may come in with the same complaints but be given completely different treatment regimens.
Looking at that list, and listening to Hyman, I would concur with several of his suppositions: Traditional medicine is specialized, and a patient can be bounced from specialist to specialist when seeking care. Physicians do base treatments on symptoms, but are on the look out for underlying diseases associated with those symptoms. And, yes, clinical guidelines can lead to what appears as cookbook medicine.
But what’s lacking in the field of functional medicine is scientific validation. Why does going gluten-free make someone feel better? Why do licorice supplements alleviate certain digestive disorders? The counterargument may be that, because functional medicine treats each individual differently, aggregated outcome data is hard to develop. I find this to be a bit of a dodge. Without rigorous scientific analysis, medicine is no better than alchemy or dousing.
A better argument is that traditional medicine is not as scientific as doctors like to think. And I wholeheartedly agree. Unfortunately, several doctors (this one included) practice medicine based on what they learned. Often, the amount of scientific data on why certain things are done is minimal to none: I perform a surgery a certain way because that was how I was taught. My colleague does it a different way because she was taught by someone else. The goal of physicians, however, should be to utilize evidence-based practices when they are available. I have modified my own practice based on such recommendations, and will continue to do so.
For example, I do my best to limit prescribing antibiotics because a capricious use of antibiotics is ineffective and can lead to untoward outcomes. This may lead to a disagreement with some patients, but these tough conversations are part of the job.
One thing that functional medicine proponents seem to be grasping onto is the large dissatisfaction that patients have with traditional medicine. Google “headache” or “chronic abdominal pain” and look at the patient discussion boards. You will find scores of patients who are still suffering despite undergoing CT scans, MRIs, lab studies, etc. One will also find people who see opportunities for comfort by trying to go “gluten-free” or “detoxing.” There is a gap here that physicians need to address.
Functional medicine practitioners need to be open to scientific inquiry if they are to avoid the charge of hucksterism, and those of us practicing traditional medicine need to acknowledge that we need to do a better job at treating chronic conditions or risk losing our patients.