Functional Medicine 101 + Introducing Dr. Alaina Gemelas

Functional Medicine is without a doubt the fastest growing medical specialty of the 21^st century. Public interest in it and public acceptance of it continues to please me. Every day I hear the sentence, “I made this appointment because I wanted a functional approach.” When I ask patients how they learned about it, the answer is a variation on “Dr. Google.”

We’ve been practicing functional medicine at WholeHealth Chicago for decades and many of our practitioners regularly attend professional meetings to learn the latest advances. While some mainstream MDs and DOs do use functional medicine tests and treatments, their numbers are small. The vast majority of conventional physicians are pretty clueless about it.

Thus I’m truly delighted that Alaina Gemelas, DC, a specialist in functional medicine, joins WholeHealth Chicago this week. Because Dr. Gemelas (the G is soft, like “gem,” her nickname) is a chiropractic physician who has chosen to concentrate on functional medicine, this seems like an ideal time for a quick review of how exactly functional medicine (FM) works.

Functional medicine, the basics
The FM model is a patient-centered, science-based approach that at its core is a collaboration between patient and practitioner to address the underlying causes of dysfunction and promote wellness.

FM practitioners focus on root causes rather than symptoms. They understand that dysfunction may have a variety of causes and that, as a result, FM treatment must be targeted to the individual, not the dysfunction.

Because FM tests can be ordered by any health care professional and treatment usually involves lifestyle changes and nutritional supplements rather than Big Pharma, functional tests are widely employed by chiropractors, naturopaths, nutritional counselors. Most FM practitioners are happy to remind you that correctly taken prescription medications, the fourth leading cause of death in the US, and are rarely needed when FM tests show abnormalities.

Let me make four important points about FM.

1–When you go to a doctor with symptoms, the odds are in your favor that the cause of those symptoms is dysfunction rather than an actual disease.
Functional symptoms are your body’s response to the situation in which you’ve placed it. The burning sensation in your chest that awakens you from sleep is not a heart attack or cancer of the esophagus, but rather the lasagna-chianti you were semi-consciously devouring while watching “Curb Your Enthusiasm.”

Your afternoon fatigue crash is likely not the first sign of serious illness, but rather a signal from your exhausted adrenal glands that there’s too much stress in your life.

Two major factors distinguish functional from disease-based symptoms:

• Functional symptoms come and go, depending on your situation (diet, stress level, time of month). Disease-based symptoms start at a fairly recognizable point and get worse, often quickly.
• With functional symptoms, common diagnostic tests return negative results. With disease-based symptoms, test results are positive and can help determine your diagnosis.

When you go to a conventional physician, it’s for reassurance that your symptoms aren’t being caused by disease. She’ll run some basic blood tests and if no disease is seen she’ll give you a prescription, mainly to relieve the symptoms. If there’s no disease, there’s virtually no inquiry to why your symptoms are occurring.

2–When you go to an FM physician, you’ll discover her goal is to uncover the “why” of your symptoms. To accomplish this, she’ll generally order a group of tests that determine how efficiently your body is functioning.

For example, let’s say you have a symptom like bloating. A conventional doc orders a couple of tests unrelated to digestion, like a blood count and cholesterol level, says everything looks fine, and tells you to take Prilosec.

An FM doc will suggest running tests such as these that specifically evaluate all aspects of how you digest and absorb food.

Other examples of common FM tests:

• A man with an afternoon exhaustion crash but otherwise normal tests receives an Adrenal Stress kit. He collects saliva throughout a 12-hour day that will be tested for levels of the stress hormones cortisol and DHEA.
• A generally healthy patient with concerns about a family history of heart disease or diabetes may receive a SpectraCell CardioMetabolic Profile, a package that summarizes the specifics of why she and her family may be at risk and, more importantly, what can be done in the way of prevention.
• A patient who knows she’s not functioning at 100% but has been told by her doctors “We know you’re tired/overweight/depressed/achy but we can’t find anything wrong with you” may be advised to have an Individual Optimal Nutritional Panel, in which 150 metabolic reactions going on inside her body are analyzed to look for nutrient deficiencies that need to be resolved in order to get her body running smoothly again.
• The patient who feels “toxic” or who suffers from multiple chemical and environmental sensitivities (and has been told there’s nothing wrong) may actually learn how her genetic make-up interferes with her body’s detoxification capacities with this test. Click through to read the really interesting information about potential food-based solutions.

These tests, which have been around for years, are unavailable at most medical centers like Northwestern or Rush. This is because physicians there are mostly unaware of them and the medical centers own their own labs and regard FM labs as competition. (Sadly, it’s always about the money.)

3–Interestingly, there’s nothing unusual about the individual tests in the profiles listed above. What an FM specialist knows is how the combination of tests can reveal the way in which a physiologic system (digestive, endocrine gland, detoxification, etc.) is functioning.

Quick example: A woman who knows her hormones are out of whack gets no benefit from a blood test that measures her hormones on the day of her appointment. Nor will receiving a prescription for birth control pills actually solve anything. But with an FM practitioner, she’ll receive a kit containing plastic vials and instructions to collect saliva specimens every three days for a month. Later, she’ll review with her doctor an entire single menstrual cycle. Click the link to see what her results might look like.

4—FM doctors at WholeHealth Chicago (Drs. Gemelis, Scott, Kelley, and myself) and clinical nutritionists Marla Feingold and Seanna Tully live and breathe FM.

As an internist, FM, which I started doing decades ago, completely changed my perspective on managing and resolving symptoms and preventing illness. Fortunately for us all, FM is part of the curriculum at all chiropractic and naturopathic colleges. Medical schools remain entrenched in the mid-20th century with two toolboxes: the prescription pad and the operating room.

Be well,
David Edelberg,  MD

PS:  Patients routinely ask if FM tests are covered by their health insurance. The answer is generally yes but never 100%. Depending on your policy, on average you’ll pay about 20% to 30% of a test’s cost. You’ll send a check or credit card number with your specimen and that will be your total cost. You won’t be responsible for anything your insurance company won’t cover. The term for this is “no billing of unpaid balance.”