The belief that the functional medicine approach leads to better outcomes than standard care had little direct proof. Fortunately, a recent study published in October 2019 entitled “Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes” demonstrated better outcomes using functional medicine. (1) Before I get into discussing the study, I want to cover some essential background on how vital lifestyle modification (which is a crucial component of functional medicine) can be to improve one’s health and talk about functional medicine a bit.

Lifestyle choices for optimizing health are more important than perceived by the general population. The 2018 Physical Activity Guidelines Advisory Committee Scientific Report by the US Department of Health and Human Services states that regular physical activity has been specifically demonstrated to reduce the risk of cardiovascular disease, type 2 diabetes, metabolic syndrome, obesity, and certain types of cancer. Additionally, there is excellent evidence that regular physical activity is related to better brain health and cognition, as well as a reduction in anxiety and depression and lessening of stress. (2) Proper nutrition plays a critical part in eliminating or improving the outcomes in heart disease, diabetes, obesity, and cancer, and many other chronic illnesses. (3) Chronic sleep loss can lead to obesity, diabetes, high blood pressure, heart disease, anxiety, depression, and substance abuse. (4) Conversely, the biomarkers associated with cardiovascular, metabolic, and inflammatory disease risk improved with more sleep. (5)

The Institute of Functional Medicine defines the functional medicine model as “an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness. It requires a detailed understanding of each patient’s genetic, biochemical, and lifestyle factors and leverages that data to direct personalized treatment plans that lead to improved patient outcomes.” Functional medicine practitioners take into account the patient’s nutritional status, activity level, sleep patterns, anxiety level, etc., whereas conventional medicine centers on disease management through treating symptoms. Although virtually every physician agrees that regular physical activity, weight loss, adequate nutrition, and quitting smoking all result in health benefits, their business model does not allow the integration of these lifestyle modifications due to the short duration of the average visit, reliance on pharmaceuticals and lack of integrative care. (6)

The 2019 study mentioned at the beginning of this post used 7252 patients divided into one group that received standard care, and another that received a functional medicine model of treatment. They followed up at six months and again at twelve months after treatment. They used two scales to compare the groups; one for physical and one for mental symptoms. The Patient-Reported Outcome Measurement Information System (PROMIS), which is a questionnaire, was the basis of the baseline and follow-up symptomatology. The physical symptoms, known as Global Physical Health, at six months for the patients treated with functional medicine, had a significant improvement over those treated with conventional medicine. The mental symptoms, known as Global Mental Health, had similar results after six months as well. The physical symptoms of the functional medicine group continued to improve slightly at twelve months, whereas the Mental symptoms did not maintain as well at twelve months. The graph below shows the results quite nicely.

  The authors offer a few insights for the (not surprising) results seen in the study.

•     The functional medicine model uses a comprehensive approach that considers the patient’s history, physiologic status, genetics, lifestyle, and environment, which, when combined, contribute to superior results.

•       Addressing the nutritional, psychological, and social aspects of patients’ illnesses, which are components needed for the treatment of various chronic conditions, promotes long-term self-management.

•       Patients seeking functional medicine may have already had conventional treatment that they were disappointed in, which causes a greater motivation to change their lifestyle, nutrition, and behavior.

•       Patients become more active participants in their care due to better rapport with the clinicians involved in their care.

•        Scheduled long-term follow-ups may motivate the patients to maintain the conditions conducive to better overall health.

My patients that are willing to change generally have better and lasting results, so this study does not surprise me. Specifically, the patients that switch to more nutrient-dense diets devoid of processed carbohydrates, adequate sleep, and physical activity will generally have fewer, if any cavities, clench and grind their teeth less, and have little to no gum disease. A majority of these patients have expressed disappointment over previous treatments and the seemingly never-ending cycle of tooth decay and swollen gums, resulting in higher motivation to change their lifestyle, nutrition, and behavior. As they say, “if nothing changes, nothing changes.”

The missing piece of the health puzzle is usually lifestyle change. Those who use the functional medicine model understand this and try to help their patients help themselves. I tell all of my new patients that the two hours per year that they are receiving a cleaning and check-up leave 8758 hours that they are on their own. How can I prevent cavities and gum disease, given that I see my patients for preventive maintenance for .02% of the year? This blog is here to help those who want to help themselves. Hopefully, some of the information contained in my posts will resonate with a few people, and they can use it to become healthier.