New Textbook Explores
The Institute for Functional Medicine has
just published an 800-page, 37-chapter textbook crammed with useful
analysis and tools
care practitioners who want to deepen their understanding of health
and illness, and expand the ways they can help their patients. While
designed for practitioners, this book will also be extremely valuable
for consumers who want to delve deeply into causes and possible solutions
for their own lack of full health. The Textbook
of Functional Medicine is grounded in the
principle that health is more than the absence of disease. "Health is a positive vitality," one author writes. "We
recognize that wholeness signifies full function of the body-mind-spirit.
In this light, it is not extreme to expect to feel fully alive, vibrant,
and even joyful when healthy."
Functional medicine is a dynamic approach to assessing, preventing, and treating
complex chronic disease. Our conventional, acute illness model looks for specific
problems and treats those problems. Functional medicine looks at the complex
inter-related network of causes that eventually manifest as problems. It looks
at the relationship between diet, lifestyle, personal relationships, environment,
and genetic factors. The foundational principles of functional medicine rests
on the understanding that each human being is a unique genetic organism in
a unique environment and that a patient-centered medical system must take this
"It's clear to anyone who thinks about it, when you don't have
a diagnosable disease, that doesn't necessarily mean you're fine," says
David S. Jones, MD, president of the Institute for Functional Medicine. "We
don't want to limit ourselves to demonstrable problems. We want to go upstream
and ask as early as possible, what isn't functioning properly?"
Many of the authors are MDs, but others are chiropractors or naturopathic physicians.
Practitioners who come to the institute for training include MDs, chiropractors,
NDs, massage therapists, and acupuncturists. "We're one of the few institutes
that only requires that you be certified as a health care practitioner," Jones
says. "The issue is, are you willing to do the hard work needed to understand
functional mechanisms? If so, then you need to know how they function within
the limits of your certification."
Analytic Tools for Health care Practitioners
Every health care practitioner is trained
to use a patterned, logical approach when meeting new patients. "The problem with the conventional ‘history
and physical' is that it's so compressed," Jones says. "It's
like a closed accordion. The conventional intake process tries to reach a
diagnosis quickly and then offer treatment, usually through medications.
I loved this system when I first started using it – it was so elegant
and so clear. The only problem is that we now know it doesn't work for 80%
of patients, those with complex chronic illness."
Functional medicine uses a matrix of eight different aspects of functioning,
offering a systematic way to look deeply into the core clinical imbalances
that underlie various disease conditions. This functional review looks at the
- Environmental inputs such as diet, nutrients
(including air and water), and exercise
- Mind-body-Spirit imbalances
- Immune and
- Oxidation-reduction imbalances and mitochondropathy
absorptive, and microbiological imbalances
- Detoxification and
- Hormonal and neurotransmitter imbalances
imbalances from cellular membrane function to the musculoskeletal
The essence of the functional medicine
diagnostic process is to expand the accordion, so the practitioner
accepts more comprehensive
sources. The history should include the whole narrative:
when the patient felt well, when they stopped
and social environment
was at that time. "The underlying process that leads
one person to get diabetes may be quite different from
someone else who gets the same disease,
even though the diagnosis is the same," Jones says. "If
you really want to get to the underlying mechanism,
you have to expand the questions."
In the last section of the book, "Putting It All Together," the authors
show how conventional medicine would evaluate a patient, and then how functional
medicine would expand the areas of investigation. "In conventional medicine
you make a diagnosis, prescribe a treatment, and send the patient on their
way," says Jones. "But that is only part
of the job. The other part is to ask the question 'why'.
A diagnosis should be the beginning, not the
end of the journey."
Consumers Learn How to Analyze Their Own Health
While this book is primarily designed for health care practitioners, it will
also interest consumers who want to develop a sophisticated understanding
of their own health. It helps us all understand the many different layers
of functioning that go together to make up health or illness. It helps us
understand how much information could be available and what to look for when
seeking a health care practitioner. There are also checklists consumers can
use to evaluate their own situation, such as the checklist for environmental
sensitivity on page 777 and the life stress questionnaire on page 783.
The final section of the book demonstrates what can happen when a clinician
looks at all the possible factors influencing someone's health. On page 701,
there is an amazing story (originally reported in The Lancet)
of a 32-year-old woman with progressive muscular weakness and pain. A thorough
medical workup hadn't diagnosed her problem, and after two years, she was wheelchair-bound.
Then a more comprehensive investigation of her problem looked more broadly
for possible underlying causes, triggers, and mediators. It turned out she'd
had chronic Crohn's disease, treated by removing part of her colon. As a result,
she wasn't absorbing vitamin D, and that deficiency proved to be the cause
of her weakness and pain. Three weeks after starting appropriate replacement
therapy, she was able to walk without assistance.
That's just one example of the way a systematic investigation that covers environmental
inputs, genetic predispositions, and a wide range of potential imbalances can
uncover the reasons for a previously undiagnosed illness. This textbook is
a wonderful foundation for any health care practitioner who hopes to "expand
the accordion" to help patients experience deep, long-lasting healing.
Over time, as this volume influences many clinicians, we can hope it will help
shift the health care system towards a more rational, preventive approach to
Elaine Zablocki is the former editor of CHRF
News Files and Alternative
Medicine Business News.
At present, the Textbook of Functional Medicine is available only through the
Institute for Functional Medicine. The price is $189, and bulk pricing is
available for orders of ten or more. Students are eligible for a special
price, $149, with valid student ID at time of order. Libraries, schools and
nonprofit organizations may also be eligible for special pricing. For more
information, go to the website (www.functionalmedicine.org) or call (800)