More and more new patients to the WholeHealth Chicago Network are asking for a “functional approach” to their longstanding undiagnosed symptoms. Many times these are digestive in origin (bloating, GERD, food intolerances), but other symptoms are vague: “fatigue”, “brain fog”, or just “feeling old”.
They’ve been reading about “Functional Medicine”, but when asked their primary care provider or the specialist they were referred it, they receive the routine, “I don’t know anything about that.” Well, rightly so. Functional Medicine was first introduced on the health care scene in the 1980’s by the Naturopaths (still not licensed in Illinois), certain Chiropractors (who had been battling the AMA for decades and was finally formulated into an actual new way of thinking about patients with unexplained symptoms by Jeffrey Bland, Ph.D and Joseph Pizzorno, N.D. (a Naturopath).
Dr. Bland founded the Institute of Functional Medicine in 1991 and over the past three decades, hundreds of health care professionals have taken dozens and dozens of courses both in person and online. Practitioners of Functional Medicine include Mark Hyman, M.D., David Perlmutter, M.D. and Frank Lipman, M.D. Well known patients include Gweneth Paltrow, Oprah and Bill Clinton.
The Cleveland Clinic now has its own Center of Functional Medicine so that slowly but surely functional and lifestyle medicine is entering the mainstream.
Now, let’s get started on diagnosing your digestive issues using a functional medicine approach.
You should be aware that when you see a doctor with a “symptom”, your concern is basically this, “Is this symptom a sign of an actual ‘disease,’ like something I need to worry about?”. For this ‘symptom’, your doctor will order some tests, most likely all of which will be ‘negative’, and she’ll reassure you not to worry. Of course, you might still have the symptom. So she’ll suggest taking something to ‘suppress’ the symptom (Tylenol, Nexium, etc.).
Specifically, in your digestive tract, disease-based symptoms when caused by actual illness, such as a pain in one area of your abdomen that has been getting steadily worse every week for the past month, tenderness in that area, accompanied by unexplained weight loss. These will be diagnosed by blood tests, scopings, scans, etc.
Functional symptoms in your digestive tract are caused by some aspect of your digestive process not functioning quite right, such as you’ve developed new food sensitivities, acquired an intestinal parasite, you’re experiencing new stressors in life, you are missing digestive enzymes or your sex hormones out of whack. Any of these “functional” problems can effect digestion.
None is ever tested by conventional physicians.
Out of 100 random patients who come to us with symptoms, just 5 to 10 percent are experiencing disease-based symptoms. The other 90 to 95 percent 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 separate disease-based symptoms from functional ones: disease symptoms start at a certain point in time 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. After all, how much can be accomplished in the fifteen minutes allotted for your appointment?
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 APPROACH
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 (“I look pregnant after a meal!”), 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 begins with a very detailed biographical history of your life by one of our Functional Medicine Practitioners. Questions you may never have been asked before, like your attitudes toward food throughout your life, your food cravings and intolerances, where you’ve travelled to, issues with your weight, how your period or your mood affects your symptoms, and what are your most significant food triggers of your symptoms.
We’ll review your previous tests and then suggest specific tests that are just generally not available in the so-called “major” medical centers.
These are the most frequently selected Functional Tests used for digestive symptoms. The costs are variable, usually around $250 each and not covered by insurance, but if you’ve got an FSA/HSA you can use it. Your practitioner will order the test(s) through Rupahealth.com which will email you an invoice. When you pay the invoice, the kit is FedExed to you.
Functional Medicine Digestive Test #1: Comprehensive Stool Digestive Analysis with Microbiome Analysis. You send three stool specimens to the lab and get a full report how well your entire digestive system is working, if you are digesting and absorbing your food, and if you have a healthy microbiome, free from parasites. Here’s a sample report.
Functional Medicine Test #2: Food Sensitivities. This information is from a blood draw. Food sensitivities are not the same as food allergies. Manifestations of sensitivities are generally digestive, sometimes two days after eating the culprit food and can induce systemic (joint pain, sinus congestion) by irritating the lining of your intestine (“leaky gut”). Allergy symptoms from food (which also can be tested, are more immediate, like hives from strawberries. Here’s a sample report.
Functional Medicine Test #3: Breath Test for Small Intestine Bacterial Overgrowth (SIBO). With this test, you receive a kit in the mail containing a liquid that will actually stimulate the bacteria in your small intestine to make more “bloat.” You’ll then (4 times) blow into a balloon, snap on a glass vacuum tubes, and mail what look like four empty glass tubes to the lab for gas analysis. They will be checking for methane and/or hydrogen and your practitioner will treat accordingly. Here’s a sample report.
For help with any of this, schedule at any of our centers.
Be well,
David Edelberg, MD