In Functional Medicine Is There Ever a Case for Just Treating Symptoms?

Over Christmas I told quite a few new people that I practice Functional Medicine. Every single one of them looked at me bewildered and their quizzical expressions begged further explanation. I eventually worked out that talking about it in terms of nutritional and lifestyle medicine was a good way to explain things. With a few people I did go into more detail - and in each case they led with the question, “Well, what can you treat then?”

As I explained to them - Functional Medicine isn’t about dealing with a specific illness or only applicable in certain conditions or cases. Functional Medicine is literally a different approach to ALL illness.

Instead of the Conventional Medicine approach of naming and taming symptoms, where diagnosis of symptoms and treatments to quell them are all that is required, Functional Medicine looks at all sickness from the deeper perspective of seeking to question why? As such, it is common to assert that Functional Medicine is attempting Root Cause Resolution, rather than just symptomatic relief.

In the scope of a Functional Medical practice, therefore, we aren't just attacking symptoms with medications (natural or otherwise). Instead, we are questioning: why is a symptom there? Why is the body breaking in that specific way? What is that symptom telling us about the functioning of the systems underneath? Why is the consequence those symptoms - and which ones are the lead dominos, which are red herrings and which are collateral damage? And for me, I'm always scoping out the extra-physiological 'stuff' to see if there are any deeper 'whys' behind a person’s physiological distress...

I spend all of my day asking these questions - and it is applicable to any illness. No matter what the label that conventional diagnoses would give to a symptom (or collection of symptoms) there are always deeper functional issues at play. Functional Medicine literally looks at the body as a set of interlinked systems and tries to work out where the links in the chain have gone awry to result in symptoms on the surface.

Functional Medicine vs. Conventional Medicine: A False Dichotomy

From this premise, it is easy to assume that everyone in Functional Medicine dismisses (and derides) everyone in Conventional Medicine because they aren't looking at the real causes of illness, they're just attacking symptoms with pills. In reality, those who work in Functional Medicine are more likely to have compassion for those on the frontline of our NHS - understaffed and without the resources, time or structures to think about illness in the Functional, “always ask why” kind of way. What we in Functional Medicine do is the longer job - and it takes time, patience and commitment from patients and practitioners alike.

I have heard it said that “If I get hit by a bus - take me to A&E. For everything else - Functional Medicine.”

I’m not quite this extreme in my views. If you follow me on my social media channels you will have seen that whilst I was trying to fight a cold myself over Christmas, as I felt my immune system simply failing to get on top of it I did, on this occasion (and for the first time in a decade) go to the GP and was prescribed antibiotics.

This is because the way I see medicine is simply about tools and tasks. Healing anyone is about using the right tool for the task at hand. In MOST cases, we actually require more than one tool. Functional Medicine has a vast array of tools - as does Conventional Medicine. The skill - and the art - of being in healthcare is choosing the right tool, for the right patient, at the right time.

So you won’t find evidence for Functional Medicine by tapping that search into PubMed. But nor will you find much if you type in Conventional Medicine either. This is because these are not two separate things that can be studied. Where isolated treatments or medicines are studied - the approach and the way of thinking behind each brand of healthcare is difficult to do randomised controlled trials on.

In this effort to point out the difference of approach that takes shape between Conventional and Functional Medicine it is common to believe that Conventional Medicine is all about symptom resolution - which drug will stop the symptoms that the patient is suffering with? - whereas Functional Medicine is more interested in finding (and fixing) the physiological root of the symptoms so they stop of their own accord... 

And yet, within Functional Medicine there are practitioners who recommend certain supplements to address the symptoms that a patient is experiencing. These are of derided for operating as a sort-of "green pharmacy", i.e. prescribing supposedly 'natural' remedies, but still looking at health through the lens of fixing symptoms with pills rather than addressing the root causes of illness.

A Word On the Importance of Root Cause Resolution

I am a fan of Root Cause Resolution, because I can never stand the idea of papering over cracks which will only recur at a later date. It does horrify me when some in Functional Medicine approach healthcare simply by acting as a ‘green pharmacy’, prescribing ‘natural’ alternatives to prescription medication without actually looking at what is creating any issues. And perhaps this is my Naturopathic training, but I really do believe in allowing the body to get on with doing its own thing, once the barriers that are preventing it from doing so are removed. This means that the default setting for a body is to be in balance and working effectively - and my job is to remove the roadblocks which prevent it from getting to that state.

Functional Medicine is just systems engineering for the human body - comprehending the workings of the complex physiological systems and how each of them interacts with and can affect the performance of each other system. Finding the weakest link in the chain of systems shows you where, and what, intervention needs to take place. However, there is always a danger when focusing so hard on Root Cause Resolution that we place too much emphasis on storyline or finding what originally created physical problems or will ultimately reverse the major issues, and too little focus on helping clients with their actual problems. In almost all cases, the problems that a patient is suffering from are the symptoms about which they are complaining. And this may or may not map exactly to whatever their 'root cause' happens to be.

The Perils Of Not Treating Symptoms

Let’s take a specific example: women with PCOS. This is hormonal dysregulation which manifests in several different ways and we can look into the precise ‘cause’ of each individual’s PCOS by taking a thorough case history and then running blood tests and other functional assessments.

For context, these symptoms include weight loss resistance, excess androgens which cause inappropriate hair growth and hair loss, anovulatory periods which can be painful, oily skin, acne and infertility.

Focusing on the root causes of PCOS often involves a look at blood sugar regulation, changes in diet, eliminations of certain foods and the restructuring of someone’s life to balance cortisol through managing stressors. It may also include treatments for gut infections or excess toxicity if present, both of which can affect hormones. We are mainly trying to re-regulate the body’s hormonal production and detoxification. A big focus is on stress regulation.

And all of these things can be a slow process that is very involved and takes time. None of these things are quick fixes which will immediately alter someone's symptom map.

Just look at the list of symptoms and you will note that a lot of them are extremely distressing. Hair growth, hair loss and acne seriously affect so many facets of confidence and mental wellbeing, as does the extra weight. Infertility is an emotional challenge which is unspeakably complex to contend with. And every one of these physical issues ADDS STRESS into the psyche of the patient.

Being stressed does not help us when trying to address one of the major issues within this picture - which is too much stress. All of which means that as a practitioner it is necessary for me to focus on at least some of the symptoms in order to address the root cause.

This isn’t just the case with PCOS: addressing the root causes in many patients with chronic health issues is a long game. In this situation, addressing some symptoms up front, even if that is done by using adaptogenic herbs for support - or even (sometimes) prescription medications which can help remove a layer of symptoms - is actually a choice I make in order to show my patients that improvement is possible. Having small, quick wins is what gives people the incentive to stick with any long haul journeys.

I also have patients for whom it is clear that their gut in the main source of their distress, symptoms and suffering... and yet they have barely any gut-based symptoms and cannot intellectually tie their symptoms to the food they eat. My job here is one of education and of providing evidence for the benefit of dietary alterations - but also it's about giving them actual 'stuff' which changes the way their body feels in order to encourage them that progress can be made.

My approach to healthcare is entirely patient-focused. It is about recognising what the major pain points are for my patients. This isn’t just about hunting for the root cause issue because I have to understand each person’s psyche enough to grasp what is truly going to matter to them in the short term so they feel better about themselves. Sometimes that even involves recommending something just for the placebo effect of allowing my clients to feel in control of their body and as if they are actively doing something to help themselves.

As far as I’m concerned, as a clinician it’s my job to know all of the tools in the toolkit - including conventional medicines and natural adaptogenic tonics etc. - and to use them as and when appropriate. I’ve always got one eye on the long game of true root cause resolution. But I am not averse to trimming some of the branches of the tree whilst simultaneously digging to uncover the roots.

When Root Cause Hunting Leads You Astray

And lastly, it is clear to me that sometime the phrase “Root Cause” can be misleading for patients and practitioners alike, because it implies that there is one focus and a 'magic bullet' or 'deep trigger' that we are going to find, fix and from which healing will flow. Functional Medicine is not as myopic as that, and whilst a lot of health is actually relatively simple, it is rarely linear or straightforward. Our recommendations within Functional Medicine might have a theme (of reducing inflammation, for example), but in truth we are thoroughly and comprehensively designing treatment strategies which support nutrient deficiencies whilst looking at gut treatment or rebalancing, improving detoxification, recommending lifestyle alterations to affect stress or toxicity burdens etc. etc.

In short, we’re never doing just ‘one thing’ addressing the ‘root cause’. A body expressing symptoms is a body in disarray and this often looks messy and demands multiple interventions at one time to effect healing change.

It is perhaps this multi-pronged approach which means that Functional Medicine is difficult to study as a single entity. We are not utilising drugs to alter one specific pathway - we are attempting mass-spectrum alterations to improve the whole physiology. Sometimes we use supplements to affect pathways, oftentimes we're throwing a lot of solutions into the mix at once to effect change - and from there we can scale back to identify the tools that really make the difference and tip the balance from 'failing' to 'healthy.

Inbuilt into Functional Medicine is complete comprehension of the irregular, non-linear and sometimes unpredictable response of human physiology to the life it goes through. Using holistic assessments, and remembering that the forces that affect one system will have an effect on the whole, as Functional Medicine practitioners we get the opportunity to help our clients find a way to untangle their health situations.

This will include baseline interventions to effect the greatest changes (Root Cause Resolution) but the most powerful strategies I have found are not just about root causes, nor are they focused on just minimising symptoms. I like to try and work from both ends of this spectrum - from the roots up whilst also trimming the branches. In this way, I find that patients stay with the process... and happily, the process also works.

If you're looking to find your Root Cause, or to understand your healthcare picture in more depth, please don't hesitate to contact me. I'd be delighted to bring some perspective to your issues and find a way to help you towards becoming as healthy as you can be by focusing on both causes and the symptoms you are dealing with.