Functional Medicine Diagnosis and Treatment: Be Your Own Doctor

Posted 08/12/2012

Several previous health tips have mentioned the phrase “functional medicine” and I have a sneaking suspicion that many readers aren’t quite sure what it is, how it works, or how it differs from the conventional treatment you’ve likely been receiving all your life. Today, walk alongside me and try your hand at diagnosing digestive problems using a functional medicine approach.

As a quick review, there are two basic types of symptoms:

• Disease-based symptoms are caused by actual illness, such as the fever that accompanies an infection.
• Functional symptoms are caused by some aspect of your physiology not functioning quite right, such as your sex hormones being out of whack.

Out of 100 random patients who come to us with symptoms, just 5 to 10% are experiencing disease-based symptoms. The other 90 to 95% are having functional symptoms.

Importantly, functional symptoms, though often dismissed as harmless by conventional physicians, can be debilitating. Digestive symptoms alone from a functional disorder–severe heartburn, chronic bloating, stomach pain, unpredictable diarrhea and constipation–can make life miserable. The situation isn’t helped when your doctor says “Nothing to worry about. You’re fine,” or “You’ll just have to learn to live with it.” Or “Take this pill and you should feel better.”

Here’s an easy way to identify disease-based symptoms: they start at a certain point and get steadily worse + test results shift from negative to positive. This makes disease-based symptoms easier to diagnose with the passage of time. If you have a new symptom that’s getting worse and you’ve not been to a doctor, schedule an appointment with your health care practitioner muy pronto.

Conversely, functional symptoms come and go, often for years. They’re not dangerous but can be singularly annoying or even control the way you live your life. When confronted with patients who have symptoms that are clearly functional, conventional doctors prescribe medicine to relieve the symptoms, but rarely suggest significant lifestyle changes and virtually never recommend nutritional supplements as therapy.

Functional medicine physicians, on the other hand, work to get your physiology back in order, usually recommending a combination of lifestyle changes, supplements, and  occasionally hands-on therapy such as massage, chiropractic, or acupuncture. If you follow through with the suggestions, most of the time your body starts functioning smoothly again and your symptoms disappear.

Digestive problems: a functional work-up

With that background, let’s walk through a fairly typical functional medicine approach to a common group of symptoms. At the end of this health tip, you may feel qualified to say, “You know Dr. E, I could really do a lot of this myself.” And that’s why we’re here.

By the way, even if you’re symptom-free, digestion-wise, you might work through this, just to see how functional medicine is applied.

Background  Let’s assume your symptoms have been around for quite a while and your doctor shrugs when you mention your bloating, diarrhea, or heartburn, saying something like “Well, your gastroscopy was fine and so was your colonoscopy. Your gallbladder looked fine on ultrasound. Nothing’s wrong, so just keep taking your…”

The most common symptoms of digestive dysfunction are heartburn, burning or pain in the upper abdomen (usually before eating), indigestion within an hour of eating, bloating, and change in bowel movements (constipation, gas, diarrhea). There are also other symptoms, apparently unrelated to digestion, that often improve when digestive issues clear up, including fatigue, skin rashes, muscle aches, joint pain, and chronic sinus congestion. However, bloating seems to be symptom #1. If I established a national chain of medical offices called “Bloating Centers of America” I’d do very well indeed.

Functional medicine approach to symptoms  Now be your own doctor and sort out your digestive symptoms or those of a friend by applying a typical functional medicine framework.

Step 1: Find out if symptoms are caused by a food sensitivity  Generally called provocative testing because we’re trying to provoke your body into giving us an answer, this is easy–no blood tests, no probing any of your precious orifices. Also known more specifically as gastrointestinal detoxification or a food sensitivity elimination diet, for about three weeks you eliminate dairy, egg, corn, gluten, citrus, and soy, along with a few other commonly irritating foods (and foods containing chemicals, additives, and preservatives). Click here for instructions. You can speed the detoxifying process by using a product called UltraClear Sustain, which contains nutritional supplements that enhance liver and intestine detoxifying systems.

If you feel better (you see improvement in your digestive symptoms and any others), you’ll start reintroducing one food group every three days, in a clear attempt to “provoke” your symptoms, until you recognize the food culprit by the return of symptoms. Then, just avoid that food. Nothing terrible will happen if you give into a craving. Just don’t be surprised the next day when your digestion feels off.

In other words, your symptoms were not a disease, but rather a function of your dietary habits. Functional medicine–viola!

Step 2: Print out and complete this useful Functional Medicine Digestive Symptoms Questionnaire courtesy of Integrative Therapeutics, a supplement manufacturer specializing in products related to digestion. Now place it next to your computer so I can walk you through your results.

Finished? Okay, here we go:

Section A            Symptoms related to the initial phase of digestion (chewing, swallowing, food churning in your stomach and mixing with acid and enzymes). If most of your symptoms are in the A group, you could begin by eating more slowly and chewing your food more thoroughly. You’d be surprised by the number of people whose chronic indigestion occurs because they wolf down their meals. If this doesn’t help, consider a month-long trial of digestive enzymes and betaine hydrochloride–try one first, then the other–taken at the onset of each meal. These enhance the digestion that occurs in your stomach. (For more on these products, see the links in Treatment, below.)

Section B            Symptoms of gastric irritation or even a stomach ulcer. For these, you’d definitely not want to use betaine, which increases acid. For this group of symptoms, virtually anything that reduces acid should give you relief (from Maalox to Tagamet to Prevacid), but with symptoms like these you should see your doctor, likely undergo a gastroscopy, and get tested for the presence of the ulcer-causing bacterium Helicobacter pylori (H. Pylori).

Section C            Symptoms of inadequate digestive enzymes, especially those produced by the pancreas.  As we age, we produce smaller amounts of enzymes and the symptoms listed here can result. If your symptoms are clustered in this section, try a month of pancreatic enzymes with each meal and see if you improve. To confirm this diagnosis, I’d suggested one of the most commonly used tests in functional medicine, the Comprehensive Stool Digestive Analysis (aka the CDSA or “that poop test”). You collect a small amount of your waste from three separate bowel movements and send it directly to a lab. The results yield a vast amount of information about all your digestive processes and generally can show the region of your intestine that’s functioning poorly. This test also checks for imbalances of intestinal bacteria and the presence of parasites and candida (yeast).

Section D            Other symptoms occasionally associated with poor digestive function. Significant positive results in this group (such as blood in stool) may require that you have a colonoscopy, lab testing for food sensitivities, and/or undergo a trial period of strict changes in your eating habits.

Section E            Symptoms of the liver and gallbladder.  Again, lots of positive answers may indicate a need for further testing, such as the capacity of your liver to clear toxins (another functional test) and an ultrasound of your gallbladder (looking for gallstones).

Step 3: Six functional medicine principles for restoring digestive health  If you have no luck identifying a food culprit after completing the Step 1 self-test for hidden food sensitivities, here’s a plan to treat your digestive symptoms:

1. Optimize digestion by taking a high-potency digestive enzyme (such as Similase) with meals. If no improvement, enhance your stomach acid with Betaine.

2. However, if you have symptoms of heartburn, stomach burning, or irritation, avoid the Betaine and instead work to heal your stomach lining with Rhizinate (deglycyrrhizinated licorice) or aloe vera juice.

3. The lining of your small intestine is where you absorb food. Restore healthy intestinal mucosa using specific nutrients containing glutamine (an amino acid) and antioxidants (Permeability Factors, OxyPerm).

4. If your stool samples show parasites or candida, boost intestinal defense with parasite-killing herbs (Para-Gard), though you may also need an anti-candida or anti-parasite prescription drug.

5. Enhance your liver’s detoxification (Blue Heron, a fiber combination to absorb and eliminate toxins, plus Detoxication Factors).

6. Re-establish healthy bacteria (TheraBiotic, ProBiotic Pearls).

Here’s a brochure that expands on everything above.

I hope by now you can see the clear difference between conventional medicine’s approach to symptoms (symptom leads to diagnostic tests that, if negative, lead to prescription drug to suppress symptom) and functional medicine’s more complex exploration of your symptoms followed by tests of function, dietary changes, and supplements to improve function rather than suppress symptoms.

If you need a skilled hand with any actual digestive problems, call and schedule with me or my associate Casey Kelley, MD. Our nutritionists, Marla Feingold and Seanna Tully, are well-versed in functional therapies as well. If you live too far away for an office visit, Marla and Seanna can arrange phone consultations, but (sorry) we can’t bill insurance for phone services.

Be well,

David Edelberg, MD