What is Functional Medicine?

Exploring Alternative Medical Care Options.

What is functional medicine, and is it right for you? If you’re exploring alternative medical care options, functional medicine is one system of care that you’ll at least want to look into. Monique Class, MS, APRN, BC is a board-certified family nurse practitioner and clinical nurse specialist in holistic health at Cleveland Clinic’s Center for Functional Medicine. In this Q&A, she helps to shed light on what functional medicine is and why it’s been growing in popularity over the past nearly 20 years. 

Peppermint Tea & Me: What is functional medicine?

Monique Class: Functional medicine is root cause medicine. I’m always looking for the cause to the symptomatology or to the diagnosis of the person sitting in front of me. In western medicine, ( I’m trained in both medicines), we’re trained to look for “What’s the diagnosis?” Give me this collection of symptoms and give me the diagnosis. in functional medicine, the training is, “What’s the root cause of these symptoms and this diagnosis?” What caused the dysfunction in the physiology? 

Another key thing is understanding that the body is made up of systems that communicate with each other. One system affects the other system. It’s understanding how different parts of the body influence other parts of the body and that it’s a network. Hormones influence the digestive system, and stress impacts the nervous system which impacts the digestive system and can be a root cause of many things. And long-term chronic stress turns on inflammation in the body that could turn on any inflammatory disease. So, it’s understanding how things are linked together and need to be unraveled. 

The third piece is that it’s patient-centered. It’s not protocol-driven. It’s individualized based on the patient. What is their belief system and what are they looking for? It’s looking at their story and their timeline in a useful way to see patterns and connections. We’re not trained to do that in western medicine. We’re trained to ask very specific questions to get very specific answers so we can get a diagnosis. We then give a protocol that everybody else with that diagnosis gets, so there’s no personalization of the medicine or deeper understanding of the human being. Functional medicine is understanding what gives our patients meaning and purpose and helping them make the right choices for their particular situation.

PTM: You can do all of that and still do all of the things that a conventional practitioner can do?

MC: Yes, and we do. Functional medicine includes conventional medicine. It’s not like you’re doing one or the other. Functional medicine expands on our knowledge base. It’s not throwing out conventional medicine. It’s embracing conventional medicine and then expanding it to look at other influences. We identify root causes and work with collaborative care teams to help change behavior. If you want to look at it this way, functional medicine is a panoramic view. What’s happening with traditional medicine is they’re looking at just that one snapshot, and they’re not looking at a panoramic view of things. 

PTM: You have certifications in imagery and meditation and mind- body medicine and yoga. What is imagery, and what is mind-body medicine?

MC: Mind-body medicine is really engaging the mind in the healing process and understanding how the mind influences the body and how the body influences the mind and getting people to understand that it’s all connected. it’s one big system. If you come in through the body, you’re influencing the mind. If you come in from the mind, you’re influencing the body. They’re intimately connected. It’s working with all of those dimensions and not just working with the body but engaging people’s mind.

Imaging is a way to get people in touch with the unconscious thoughts and images that are in their mind that drive choices one way or the other. It’s understanding what’s going through the mind stream and what the pictures are that people have attached to their thoughts. A lot of times, the images are all around negative things that are going to happen or past regrets that have happened, and people get stuck. You work with their images to help them create healing images that then drive the physiology. 

The research is there. One study had surgeons practice a specific surgery in their heads. They saw themselves doing it well with no complications. When you do that, you’re actually on a physical level. You’re priming those pathways and stimulating that neural plasticity for what you want to happen. For the surgeons who did that, their heart rate variability was more in coherence. They had less cortisol and were more focused. So that’s the end state imagery. It’s working with people to understand what their images are that they’re not even conscious of that are driving their fear and anxiety and then having them create new images. These new images begin to change thought patterns at the level of the mind and the unconscious mind.

 PTM: What is your general approach to using medication to treat illnesses or symptoms?

MC: I use it when I need to. It’s the wise use of medication in the right dose as a bridge, while you’re working on the lifestyle stuff. I’m looking to take them off medication once we get the rest of it, but I’m not afraid to use meds when I need to use meds. The conversation is, “We’re using this, we’re going to work on all this stuff and then we’re going to try to back down off of it.” If I don’t need it, I don’t go there first. Medication is a bridge. It’s not a permanent player if at all possible. 

PTM: Why did you decide to go into functional medicine?

MC: Functional Medicine was for me part of my larger vision of health. When I was looking at the way we were treating people in conventional medicine – both in the hospital and in the doctor’s office that I was working in – I felt like they weren’t getting better. We were just perpetuating a disease model. I wanted a model that worked higher upstream. A model that saw people as individuals and understood that the mind and the choices people make have a great influence on the body. If you work at the level of the mind and change the choices, you can reverse engineer complex chronic diseases. It’s very different than an attitude of “You’ve got this diagnosis, take this medication and see you later.” I wanted something more than that for myself and for my patients.

PTM: Do you ever find that patients or even other practitioners are skeptical of what you do?

MC: Not anymore. In the beginning, they didn’t understand what we were doing. Now, people are seeking us out. Functional medicine has really caught on among the lay public. People are finding us. We don’t have to advertise anymore. They’re coming to us because they want a functional medicine approach. We’re addressing them as human beings and finding out what’s meaningful to them and what they’re looking to achieve. We’re trying to help them with that in the gentlest way possible. 

PTM: Everything you’re describing sounds like it takes more than the 15 minutes allotted for conventional medicine. How does that work?

MC: We’re not in insurance anymore, but we did it for years. When we were in insurance, I would have people come back every two weeks for half an hour as we made needed lifestyle and behavior changes. Now, we are out of insurance, and we’re a fee for service. My first visit is about an hour and 15 minutes. Then we have follow-ups, and we work with coaches in our office to help coach people on behavior change. 

The model of utilizing collaborative care teams with coaches is used a lot. It’s focused on the care plan that the patient helps co-create with us as doctors based on their lab results, their symptoms, their individual stories and what their goals are. They then work with a team on these things and then loop back to me. It truly is a team approach. 

Important note about insurance and functional medicine

If you decide to work with a functional medicine provider, be sure and check with them on whether they accept insurance. If they don’t, and you’re planning to file your insurance yourself, check with your health insurance company about whether it covers the facility and type of program that you are considering. In addition, if you have a healthcare reimbursement account, you can also check to see if the services that you’re considering are covered by your plan.