Introduction

Functional medicine can appear to be a kind of utopia solution to the impersonalized and dismissive one-pill-one-disease approach of conventional medicine. However, functional medicine is an evolving field that is far from being a panacea.

Even with the most cutting-edge tests and programs, some patients still aren’t fully restored to their optimal health. Providers may struggle with coaching and ensuring patient compliance on many tests and protocols. It can take months to years before someone feels better, and there is not one objective test to confirm an overall improvement in their health. 

Metabolomic tests, such as organic acids and blood nutrition tests, have long been a part of functional medicine. However, with hundreds of markers tested, these tests can be a tsunami of information without one unified formal protocol to decide what to do with it. Most practitioners and patients tend to look for specific deficiencies or infection and use a supplement for each issue, which can easily become overwhelming. 

In this article, we cover where functional medicine falls short of its own ideals, and how metabolomics should be an indispensable tool in any functional medicine doctor’s toolbox. 

Where does functional medicine fall short?

Before we discuss how functional medicine falls short of its own ideals, let’s first talk about what’s ideal. 

According to the Institute of Functional Medicine, the functional medicine approach is defined as:

“A systems biology-based approach that focuses on identifying and addressing the root cause of disease. Each symptom or differential diagnosis may be one of many that contribute to an individual’s illness.”

Instead of diagnosing specific diseases and treating only the disease with pills or procedures, functional medicine doctors treat the whole person. They educate and coach patients on addressing the root causes with food, exercise, gut health, mindsets, and more.

Millions of patients have reversed their conditions with functional medicine. Functional medicine especially shines where conventional medicine falls short:

• Chronic lifestyle-related cardiovascular and metabolic problems
• Some hormonal and lifestyle-related fertility issues, especially women’s health
• Energy problems like chronic fatigue
• Inflammatory conditions like autoimmune disorders, allergies, and chronic pain
• Brain and mental health disorders 

Although these all sound great, functional medicine is far from perfect. It’s possible for a patient to commit their dollars and faithfully do everything recommended to them and not achieve their desired health goals. Let’s talk about where the problems are.

Problems with functional medicine

Introducing many things at the same time

It’s common for functional medicine doctors to require the following up front:

• 4 - 5 tests, ranging from $200 - $1,000 each
• Major dietary changes and lifestyle overhauls, such as a restrictive diet
• Introducing complex supplement protocols involving dozens of supplements 

The cost of seeing a functional medicine doctor, excluding the doctor’s fees, can run in the tens of thousands of dollars. Most health insurers don’t cover it. Many people with chronic issues simply cannot afford it.

In many cases, if the patient is fully compliant with the protocol, they can achieve great results. But even if that’s the case, it’s hard to tell which changes delivered the most benefits and which to continue in the long term. More importantly, these fully-compliant patients are rather rare. 

Statistically, among patients with chronic illnesses who are prescribed medications, only about 50% take them as prescribed [1]. These same patients would benefit the most from functional medicine, but they would also struggle with the tsunami of changes they’d have to make.

Many functional medicine practitioners choose to practice more conservatively. They may recommend only a few simple changes at a time and skip the tests, at least at first. Some doctors in this camp believe it’s more effective to first calm down the nervous system before diving into all the fancier tests and supplements. While this can be the better approach for many patients, it will take longer for them to fully reap the benefits of functional medicine.

Overly focusing on a few concepts, often missing the forest for the trees

A lot of the health industry runs on hype. One year it’s gluten, then it’s gut healing, then it’s detox, keto, mold, methylation, or hormones.

The human brain is susceptible to bias, including among health professionals [2]. Functional medicine doctors are no exception, and they can be overly focused on a few of these concepts. For example, a patient could spend thousands of dollars on gut panels, elimination diets, and supplements without feeling much improvement if their main problems were actually mold and traumas. 

When a practitioner learns something new, they may feel like it applies to every patient.

It takes a very centered and skilled practitioner to integrate all the pieces of information to recommend the right courses of action. Eventually, patients who aren’t seeing results can become demotivated and go seek another practitioner. 

Many practitioners end up specializing in the category they have the most success with, such as heavy metals, hormonal issues, or gut health. 

Lack of an objective way to tell which needles are moving, and by how much

Functional medicine seeks to look at the whole person and deliver personalized programs, since everyone is different. This means objectively measuring progress becomes even more difficult. Most providers use comprehensive intake forms that have the patient quantify their symptoms and history. Some of these intake forms can take up to 5 hours to complete! This can be especially challenging for patients with fatigue or brain fog. 

Many functional medicine tests, such as the four-point cortisol tests, hair tissue mineral analysis, and food sensitivity tests, are not diagnostic. It’s possible for someone’s test results to appear worse even though they’re making progress.

The gut infection tests can be more clear-cut, but they aren’t always. Many of these microbes are very resistant to antimicrobials, requiring aggressive protocols to kill them. For example, some parasites can hide from the tests or reinfect a susceptible host. They can go undetected in a test once, but then reappear in a later test. 

The journey of being a functional medicine patient and working on your own health can be long, costly, and arduous. It can take from six months to years, making numerous changes, going through many ups and downs. It takes a very skilled practitioner to correctly interpret all of these questionnaires and tests for their patient. It takes even more skills to keep them on track and motivated to continue. 

How Theriome Aristotle Metabolomics and Artificial Intelligence Can Solve the Biggest Problems in Functional Medicine

Objective and unbiased measurements for baseline and progress

The solution to human biases is data, especially objective feedback from each intervention.

Data (from the right tests) don’t lie as long as you have a comprehensive and balanced dataset, but it can get overwhelming fast. 

The good news is you don’t have to rely on your own brain to comprehend all of it and deduce what’s best for your patients. Let the (clinically-educated) computer do it for you.

After testing 126 metabolites covering 68% of metabolic pathways, along with a comprehensive intake form, Theriome uses artificial intelligence trained on the available clinical literature with respect to each metabolite. The algorithm then deduces objective scores in each health system, estimates disease risks, and provides recommendations. To determine the best courses of action, we use Digital Twinning to simulate various possible outcomes if the individual has gone through any combination of those changes.

This can help overcome human biases and ensure that you don’t miss the forest for the trees.

Obviously, computers cannot fully replace human brains and intuition, so your patient will always need your clinical insights. However, Theriome’s objective tests and algorithms will ensure that your assessments are unbiased and reveal any blind spots you may have.

Recommend the most impactful changes, including the basics

Some functional medicine patients experience limited progress despite running tests and following several protocols.

Fortunately, this is very much avoidable. Theriome Aristotle uses Digital Twinning taking into account the patient’s history, symptoms, and health goals, along with their test results. It simulates over 100 iterations to create the most effective wellness protocols. 

These protocols address the basics like dietary changes and exercise, along with a few supplements. This feature shortcuts years of trial and error, and thousands of dollars in ineffective interventions, to help the patients get their results as quickly as possible and stay motivated.

Additionally, if a detected dysfunction can lead to disease, the Aristotle test also extrapolates disease risk based on the presence or absence of collections of disease-associated metabolites. In these cases, the doctor can recommend additional disease specific tests or preventive interventions.

Conclusion

Functional medicine is a significant upgrade from conventional medicine—It can revolutionize healthcare and deliver groundbreaking clinical outcomes by addressing the root causes. However, it is not without problems. Like any field of health, functional medicine is not free of bias, which can cause the doctors to miss the forest for the trees. There is also no standardized and objective way to measure progress or wellness status. As a result, patient noncompliance and lack of motivation to stick to the protocol can also keep them from reaping the most benefits. 

Theriome Aristotle and our suite of omic tests, together with artificial intelligence, can help overcome many of these issues. It’s one simple blood spot test that provides a comprehensive overview of the patient’s biochemistry, wellness status, and health risks. In addition, by using Digital Twinning, you save time and money with AI-simulated recommendations based on their history, metabolomics, and the clinical literature. Therefore, Theriome’s Aristotle should be a tool in any functional medicine doctor’s toolbox.

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1 Brown, M. T. and Bussell, J. K. (2011) Medication adherence: WHO cares? Mayo Clin. Proc., Elsevier BV 86, 304–314 

2 Featherston, R., Downie, L. E., Vogel, A. P. and Galvin, K. L. (2020) Decision making biases in the allied health professions: A systematic scoping review. PLoS One, Public Library of Science (PLoS) 15, e0240716