Dr. Trevor Miller and Jessica Miller, RN work on foundational health. Their expertise cover a wide birth of topics giving them the unique ability to recoginze unuasual patterns. This allows them to be able to pick out issues that others have missed or that previous treatments have uncovered.
Are you thinking of using a functional medicine provider? Have you ever gone to a functional medicine provider and you’re starting to get results just to have the symptoms come back? Have you taken tons of pills or supplements to no avail? Have you treated one issue to have another pop-up? In this article, we will cover why these may have happened. Here are the six most common reasons for functional medicine failures.
The 1st issue
The most common problem with functional medicine treatment is that the treatment program needs to be in the correct order. In our years of practice, when we first started, we had the tests but needed the experience to know how to prioritize the phases of care. We discovered a framework for treating people and bringing them to a place where they can help themselves.
For example, if someone has leaky gut and detox issues, you can’t just go in and do detoxification. The patient has to be healthy enough to eliminate the toxins; otherwise, they get re-absorbed in the bowels as they sit there. This is not the typical five R program. The five Rs are there, but it is not just a gut program. Today’s patients seem to be a little more complicated. It is not unusual for a patient to come in with sleep issues, joint pain, arthritis, acid reflux, skin issues, anxiety, depression, or even multiple autoimmune diseases.
Where do you start with these patients? How do you prioritize what needs to be addressed first so you don’t give the patient multiple unnecessary supplements? Philosophically, we have a problem with pill for ill medicine.
In our practice, we have gone from letting the symptoms rule the roost to letting our testing help guide us on how to treat the patient. Here’s a brief video with Dr. Mark Hyman about “One Cause Many Symptoms and One Symptom Many Causes.” Now, our testing guides us through the phases of care. Most commonly, we start with stress and the neuroendocrine system. We begin with the neuroendocrine system because if the patient is depressed and has no energy, what is the likelihood that they will follow through? Also, if stress isn’t addressed, the symptoms will come right back once the therapy ceases.
If the G.I. track isn’t healed, infections addressed, and deficiencies treated, then when the therapy stops, the symptoms will immediately come back. If the body burden isn’t addressed, if one isn’t eliminating correctly, or if inflammation isn’t addressed, the symptoms will immediately return. So, it is essential to address the body’s systems in the correct order, allowing the body to be ready and heal. Foundational health for healing must be laid properly, like any foundation.
2nd issue
In our experience, the practitioner's training comes into play next. Right now, it is very trendy to say one is a functional medicine doctor or provider. But how did they come to be a functional medicine provider? Mentorship is indeed a valuable form of training. There’s also something to be said about the art of medicine being individualized, with some standardization and familiarity to breed patient trust. Meeting a set of standards builds proficiency, covering themselves legally and proving that providers know what they are doing. I am not trying to take away from someone else’s experience and style of practice.
Even though functional medicine is not cookie-cutter, giving yourself a framework to work off of guides patient care and increases favorable outcomes. The failure here is trying to avoid testing to save money in the short term. This leads to a lot of trial and error, which increases time and expense in the long term. Unfortunately, this is exacerbated because too many doctors don’t know what functional testing is, don’t know how to read the functional tests, or don’t know the functional ranges. Often, this type of failure isn’t because the practitioner isn’t any good; it is because their training and experience are incomplete, and their approach seems disorganized. This approach lends itself to the pill for an ill type of practice.
What we are seeing now is a lot of doctors calling themselves functional medicine practitioners. Still, they are doctors without any additional training besides a weekend course or two. This does a great disservice to the functional medicine community and doctors who have worked hard to create their systems. As any functional medicine practitioner can attest, you cannot learn this in a couple of weekends or even with a couple of seminars. It takes years to understand that you have to sit down with the patient, take time with the patient, and get to know the patient and what has brought them to this point.
The best way to avoid the pitfall of getting a practitioner who isn’t trained or certified is to check the Institute for Functional Medicine's website. Right now, they are the premier certification organization.
3rd issue
Pill for an ill practice, also known as “Whack-a-mole” treatment, is not too different from how I see conventional medicine practiced for chronic diseases. Let me give you some examples. They are somewhat rudimentary, but they make the point: 1) statins for cholesterol, 2) insulin or metformin for diabetes, 3) aspirin for headache, etc., but none of these get to the root cause. They are Band-Aids that help with the symptoms, but they do not address the “why” of how the illness happened or is happening. Managing the symptoms is usually where the treatment stops; typically, it is where people want it to stop. We, as patients, are under the impression that as long as there is no pain, then everything is all right. The issue with this is that something caused this symptom to happen. Migraines, high cholesterol, high blood pressure, tension, headaches, numbness, and tingling are not normal everyday pains that we should have. There is a reason they are happening, and if a person is willing to put in the effort, the underlying root cause can be found and remedied. These symptoms are not because your body lacks statins or metformin or acetaminophen. There is something more foundational at play.
What is required to figure out the cause of symptoms is to do testing and then start teasing out the triggers. It is natural and normal for our bodies to slow down over time, but our genetics do not usually allow for a global breakdown. Certain things can be uncovered during the testing that will enable us to see where the genetic weaknesses are. Then, we can support those processes, allowing the body to work more efficiently and to heal and feel good again. I liken it to a classic car; you cannot run the classic car hard all the time, but you can maintain it and see that it stays in good shape, and then you can run it hard when you need to. We, just like the car, need maintenance as we get older. This is where we get a choice. Start to dig in and figure out what is going on in ourselves, or use the litany of drugs that are available to us today to feel better without actually getting better. However, it seems like every time we try to take over a process for the body; the body gets weaker, or something else up becomes screwed up. If you genuinely want to be well, you have to get to the “why.” Suppose you address the “why” then you truly have hope, health, and happiness.
4th issue
Supplements are essential to functional medicine. However, supplements have several challenges: 1) scheduling and dosages, 3) fraud, and 4) overdependence. Let’s take these in order since supplements are some of the tools of the trade.
Scheduling and dosing go hand-in-hand. The body can only absorb so much at a time, so we like to use smaller doses throughout the day. This is how the body performs naturally; you don’t just wake up and all your hormones are there for the day. No, you wake up and get hit with cortisol; then you eat and get a little insulin; then your body does this wonderful orchestration timing of hormones and peptides that allows you to go about your daily business. If you supplement too much too soon, your body will excrete it out. If you do too little, your body doesn’t have enough to do what it needs. (Just as an aside, there is a subset of people that are chronically underdosing. We do believe in lifestyle and food-is-medicine approach. But if you think you’re getting enough nutrition from just whole organic foods, you may want to check this. If you want to go above and beyond the RDA, I recommend researching at the Linus Pauline Institute. They have adequate dosing of micronutrients in their database, and knowing what is adequate and what is toxic is essential). Supplements are needed to run the body optimally. The body seems to be about rhythm and balance.
Supplements also need to be trustworthy. So know your manufacturer, that they have good manufacturing procedures, and that they test their batches pre-and post-tableting. This helps keep fraud to a minimum and lets you know exactly what’s in the supplements. It is reasonable quality control. Here is an article on fraud in the supplement industry.
The last component of this category is over-dependence on supplementation. We will take the adage from my Iron Man days, beginning with “You can’t outrun a crappy diet.” Now let’s modify it to our current needs, “You can’t out-supplement a crappy lifestyle.” Unfortunately, we tend to depend too much on supplements and not enough on lifestyle. We want the convenience of a pill when it takes the effort of a run or food prep. The doctor's team needs to talk and address healthy lifestyles and habits. Those habits are what truly bring about the change and make them stick.
5th issue
Patient compliance is tricky. A lot of patients have issues once getting started. Patients must navigate five pillars to health: sleep, nutrition, movement, stress, and community. First, let’s address sleep. We all need good—not medicated, not induced—restful sleep. If someone isn’t getting sleep, they will have a lot of issues. Sleep affects every aspect of life—hormones, thyroid, gut, neurotransmitters, cognition, mood, and appetite. As a rule of thumb, people should get 8 hours of sleep plus or minus 30 minutes.
Next is nutrition. Nutrition is more than supplementation. Nutrition is eating good, healthy, nutrient-dense food that is not sprayed with chemicals and not highly genetically modified. We spend much time discussing nutrition and movement in our program. Again, like sleep, these are foundational tenets to having good, long-lasting health. Food is medicine, so practitioners need to encourage patients to eat well because they are worth it. Organic food is expensive, but you will pay for itself in health--you will either pay for it now at the grocery store or later with your health and with your pocketbook in the form of prescriptions. Go to farmers' markets, get to know your farmers, their practices, and then buy from the ones you trust.
Movement, although not necessarily gym time or scheduled exercise, is vital to our health and well-being. We are designed to move. Our eyes are in the front of our heads; we are predatory by nature, and since humans don’t have claws, fangs, or other built-in weapons, we were meant to run our food down. We are designed to move; if you aren’t moving, you are not maintaining your body, which will catch up with you. Movement can be a brisk walk 30 minutes a day. Go hiking. Go for a bike ride. Move and use your muscles, or you will lose them. The older you are, the more actively you have to maintain what you have. Things to think about with movement: balance, strength, muscle mass, muscle maintenance, and endurance. Please don’t make the mistake many people make by not prioritizing their fitness and exercise.
Stress is next. It doesn’t matter if it is financial, marital, physical, mental, etc., the body reacts the same. It will be hard to do anything for yourself if you feel bad, unmotivated, or disinterested. Stress causes fatigue, weight gain, disordered eating, leaky gut (intestinal hyperpermeability), thyroid issues, cholesterol issues, etc. Stress and learning to manage it is key. You also have to deal with cortisol and what is cortisol doing? Is it following the natural rhythm? Have you caused HPA axis dysregulation? There is a lot to stress and learning how to manage it.
6th issue
Finally, one of the most underestimated components is community. The people you surround yourself with determine a lot about you. Here’s a great article on the social determinants of health. Does your community, the people you spend time with, raise you up? Do they support you? Do they tear you down? It is best to surround yourself with the type of person that you want to be. Community is important because those people will pick you up, hold you accountable, and encourage you when needed.
Life happens. There are always going to be troubles and challenges. How are you going to handle them? There are times when money is tight; there are going to be times when you don’t feel well, and there are going to be times when things happen that are just out of your control. However, the accurate measure of a person is how they handle that. Do they fall off the wagon and get back on, or do they wallow around and self-pity? Life will always happen, and things will get in the way; you just can’t let it bother you.
Many controllable factors can hinder or even fail in functional medicine. However, functional medicine systems usually fail due to either the implementation or the protocol. I’ve been doing this for a long time, and functional medicine doesn’t fail; the practitioners or the patients fail functional medicine.
Read more from Dr. Trevor Miller and Jessica Miller, RN
Dr. Trevor Miller and Jessica Miller, RN, Integrated Health of Indiana
Dr Miller and Nurse Jessica have dedicated their professional lives to helping people live their best lives. Concentrating on healing from the inside out, they use a program to comprehensively address problems with hormones, foundational gut health, the micrbiome and mitochondrial health. Realizing that these are all tied together and addressing them as a whole leads to happier and healthier pateints.
