The Cleveland Clinic and WholeHealth Chicago

I know, I know. It’s presumptuous of me to mention Cleveland Clinic in  the same line, much less on the same page, as WholeHealth Chicago, though we do have significant attributes in common, as you’ll see today.

This research article, which appeared last week on the JAMA website, links the two of us in ways we never expected, though it didn’t surprise us. Naturally, we were pleased and delighted. But surprised, no.

In a summary sentence (all research papers open with one):

In this study of 7,252 patients, 1,595 cared for at the Cleveland Clinic’s Center for Functional Medicine and 5,657 by the Cleveland Clinic’s family health center, those following the functional medicine path exhibited significantly greater improvements in health and well-being than those treated conventionally.

This is a real stunner of an outcome.

It means that just about everything well-intentioned primary care physicians have been taught in medical school, during residency, and out in the field has been wrong, especially when it comes to those patient beset by chronic illnesses.

Comparing the two models
With conventional medicine (CM), let’s say you have some chronic symptoms or a diagnosed condition–high blood pressure or Crohn’s disease or chronic fatigue. A CM physician seeing you as a new patient will begin by asking the main reason for your visit (doctors call this the chief complaint). The doctor expects you to say no more than a few words, like “I’m having headaches,” before starting a detailed exploration of the headache. “When did it start? What brings it on?” and so forth. This so-called History of Present Illness can be accomplished in about ten minutes.

It’s worth noting that this disease-centered interview is the way CM has always been taught.

In response to your answers, the CM physician will run some basic tests, give you one or more prescription drugs, and possibly refer you to a specialist, who will probably recommend still more prescription drugs. Just about every depressed patient gets an antidepressant. People with high blood pressure, diabetes, and autoimmune diseases also are prescribed drugs as a matter of course. Most primary care doctors work with the same 20 or so meds, prescribing them repeatedly.

If you ask your CM doctor “Why do I have this condition?” her response will usually be a shrug of the shoulders, a “We don’t know,” and a few seconds later “I’m prescribing this…and this…and, oh yes, this too.”

With functional medicine (FM), your initial health background interview is far different, averaging 60 to 70 minutes and including an exploration of your life story. When I’m with a new patient who has a headache, I begin by asking, “Please don’t tell me anything about your headache yet. Tell me about yourself. Your childhood–happy? Healthy? Dysfunctional?”

Your personal biography, often in unexpected ways, has a real bearing on your health. Medical intuitive Carolyn Myss said it all when she said “Your biography becomes your biology.” After hearing her say this 30 years ago, I never practiced medicine the same way again.

The goal of your conversation with a FM practitioner is to ferret out root causes for your “dis-ease.” Just why are you having headaches, why are your intestines inflamed, or why are you tired all the time? What exactly has gone wrong?

There’s rarely a single cause. Your illness may be a combination of an unhealthful eating pattern that includes nutritional deficiencies, a flaw in your digestion, environmental toxins you can’t dispose of, physical inactivity, and/or emotional stress.

FM tests look at entire systems in your body and how they’re working together (or aren’t): your genetics, how you digest and absorb food, how you eliminate toxins, and how your hormones work. The goal is to reverse illness, promote health, and optimize function.

Treatment revolves around lifestyle changes, including moving your body and using food and nutritional supplements as medicine. Your FM practitioner is not only a diagnostician, but also a health coach (often an annoyingly persistent one).

FM practitioners may have different initials after their names, but all take extensive coursework before certification and all approach the human body as a dynamic system. In addition to MDs and DOs, many practitioners are DCs (doctors of chiropractic), NDs (naturopathic doctors), NPs (nurse practitioners), or CNNs (certified clinical nutritionists).

At WholeHealth Chicago, for example, Dr. Scott is a naturopathic doctor and Dr. Gemelas is a chiropractic physician who expanded her studies to functional medicine while in school. Katie McManigal and Wendy Ploegstra are nurse practitioners who have taken post-graduate work in FM.

In a FM environment, you’ll also be likely to work with a clinical nutritionist and possibly one or more integrative practitioners, such as specialists in Chinese medicine or homeopathy.

WholeHealth Chicago has been the Midwest’s largest center for functional medicine for nearly 25 years. Our FM practitioners include Neeti Sharma, MD, Alaina Gemelas, DC, Cliff Maurer, DC, Caley Scott, ND, Katie McManigal, FNP, Wendy Ploegstra, ANP/FNP, and Olivia Wagner, RDN, IFNCP. They are about as knowledgeable a group as you can find anywhere, and at WholeHealth Chicago they’re supported by an equally skilled circle of practitioners that includes everyone you see at this link.

What did the Cleveland Clinic study actually show?
–All patients from both the conventional medicine and functional medicine groups were given extensive questionnaires that measured physical, mental, and social health. The results produced two summary scores: GPH (Global     Physical Health) and GMH (Global Mental Health). Higher scores meant a better health-related quality of life. The tests could be repeated periodically to track improvement or lack thereof. The investigators chose to test at baseline (before any treatment) and then repeat the tests at six and 12 months.
–The average age of the enrollees was 54. 65% were female and 86% were white. Annual income of the group treated with FM was $59,000 versus $72,000 for those treated by CM.
–Conditions treated ran the gamut of those encountered in any medical office: diabetes, depression, high blood pressure, low energy, digestion issues, chronic pain, etc.
–At the end of six and 12 months, both the GPH and GMH of patients being treated by the functional medicine team was significantly better than the patient scores of those treated by the conventional medicine team. Functional medicine GPH/GMH scores went up while the conventional medicine GPH/GMH remained flat.

How did the functional medicine team accomplish this?
As I touched on above, there are several ways FM differs from CM.

–Far more time is spent during each FM patient visit, with the physician and patient remaining partners and encouraged to keep in touch with each other.
–FM addresses chronic disease by delivering what’s called “precision medicine.” This means collecting data and organizing it in such a way that the practitioner gets a clearer understanding of the patient’s biological processes, which can be mapped to create a picture of  human disease.

Let me clarify with an example: A typical FM test, the GI Effects by Genova, measures more than 20 parameters of digestion and absorption and the microbiome and tests for intestinal parasites and yeast (candida). In reviewing the results, a FM practitioner might recommend a different way of eating, digestive enzymes, prebiotics and probiotics, and herbal antiparasitic supplements, all with the goal of improving not only her patient’s digestion and absorption of food, but also overall health and well-being through better nutrition.

–FM looks “upstream” from the patient’s presentation of symptoms. This means a meticulous examination of the complex web of a patient’s biographical history, genetics, lifestyle, and environment and how these contribute to her physical and mental status.
–Armed with this data, the FM practitioner has the opportunity to develop patient-specific management strategies. Without such data, the CM physician is stuck with a “one-size-fits-all” approach.
–One undeniable fact: patients who seek out FM are generally  highly motivated to get well. Some patients have chronic illnesses, have exhausted all their other treatment options with CM, and are now willing to make significant lifestyle and nutritional changes.

Cleveland Clinic functional medicine video
OK, now stop reading and please (please!) watch Cleveland Clinic’s masterful video on the urgent need for patients with chronic conditions to choose FM. Click here to view the video, which includes actual patients telling their stories of healing with functional medicine.

Let me close with a bit of irony. The website quackwatch.com, run   by retired psychiatrist Stephen Barrett, MD, is a platform that apparently exists to trash virtually any form of alternative medicine. When Wikipedia was just getting started, quackwatch raced to the head of the line to write almost all the alternative medicine entries, from acupuncture onward.

Here’s the entry on Functional Medicine, written in quackwatch’s easily recognizable style. Think about the veracity of the text as you consider this week’s JAMA study. Will Dr Barrett go after Cleveland Clinic next?

Be well,
David Edelberg, MD