Functional Medicine/ Naturopathy

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Functional medicine and naturopathy can be extremely helpful, but also, some aspects of functional medicine isn’t evidence-based 

The experience each of us have depends on the specific doctor and health situation we are trying to address.

I had a very positive experience with a naturopath. With functional medicine, I had a somewhat positive experience – the practitioner did help me, although later I understood that he had several red flags. I turned to these doctors when I was struggling with the onset of MCAS symptoms. None of the conventional doctors I saw knew how to help me, and I’m grateful that these two figured out some of my puzzle pieces and offered solutions that improved my quality of life.

I think that there’s some great practitioners within these fields, but there’s many more practitioners who are operating outside of the scope of their practice, relying on non-evidenced based practices, and charging exorbitant prices for unregulated supplements which they recommend based on useless lab tests. Beware of doctors who don’t have the knowledge that they claim to. This was the reasons I changed from my first doctor (functional medicine) to my second (a naturopath). I had a feeling something was off with him while we worked on my gut health, but when we moved onto hormone health, the red flags became really obvious. And while the first doctor did help me, I also think much of his success was just very expensive trial and error.

One major problem includes doctors working outside of their scope of practice

For example, some functional medicine doctors are chiropractors who take weekend courses in hormones or nutrition or the gut microbiome, then feel “qualified” to treat you for these problems. These doctors often look at the basics: gut/digestive health, hormones, nutrition, and major health-promoting habits (sleep, exercise, etc). Some questions you can ask is:

• What are their qualifications to treat X?
  • (for example, hormone problems, digestive problems).
• What kind of expertise do they have with X?
  
  
• Would it better to find an expert in X? 
  • (for example, endocrinologist or menopause specialist to talk about hormones, or a registered dietitian to talk about nutrition).

Have a dose of healthy skepticism and interview your doctor to see if they are right for you. For example, I had an appointment with a functional medicine doctor who believed methylation problems are at the root of all issues and wanted me to pay almost a thousand dollars (!) to analyze my DNA before she would be able to tell me how she thought that could help me. I declined and found another doctor who also wanted to look at my methylation, but she could tell me why in reference to my symptoms and she knew multiple free websites that I could upload my raw DNA excel file, which gave us useful info for free. Was the first doctor just going to put my DNA file into a bunch of free websites or ChatGPT and then charge me $1000 for it?!

Why do we turn to functional medicine or naturopathy?

Conventional medicine has done so much for us, from vaccines to lifesaving surgeries and medications. But for many of us with chronic conditions, it’s often a frustrating and even harmful system to navigate.

• Long wait times just to have a 10 minute appointment in which the doctor dismisses us or doesn’t actually address our concerns.
  
  
• Medications are often pushed on us without informed consent or with a disregard for the side effects that make us feel worse than our disease.
  
  
• The doctors can often only offer a vary narrow set of treatment which is based on pharmaceuticals or surgery, but not holistic or full body options.

What are some of the appeals of naturopathy and functional medicine?

• Longer appointment times with us, often 45-90 minutes.
  • We may finally feel heard and like someone cares about our health and is giving it the attention is deserves.
• It markets itself as “addressing root causes”.
  • (although in many cases it can’t treat/address contributing factors to illness anymore than conventional medicine can).
• Many practitioners recognize the value in a full body approach and will go through your diet and lifestyle to recommend more health promoting behaviors.

I personally saw my functional medicine doctor because I wanted to “address root causes” or find contributing factors that I could address for MCAS. I was seeing an allergist who specializes in MCAS, but he could only offer me mast cell stabilizers. At the time, I didn’t want to take those medications, so our appointments were a dead end.

If you’re considering working with a naturopath or functional medicine doctor, it’s important to have a healthy level of skepticism

And this isn’t just for naturopathy or functional medicine. I think it’s important to for any medical treatment we are receiving, from any type of doctor.

Don’t be afraid to:

• ask what evidence there is for different testing methods
  
  
• say “Let me look into it” and then do independent research before moving forward with tests or treatments
  
  
• say no if you think a test is too expensive
  • Is a similar test covered through your conventional doctor (gastrointestinal doctor, endocrinologist, primary care physician)?
• trust your gut and change the doctor if it just doesn’t feel right, even if you can’t put your finger on why you feel wary or uncomfortable

Be aware that there are some non-evidenced-based labs tests

Some doctors also really rely on the tests they do, and while testing is important, there are reliability issues with some popular functional medicine tests.

DUTCH test

Not only is it not covered by most insurance and can cost $400 or more depending on the practitioner, but the criticisms on the DUTCH test are that it’s unnecessary and even that the info is clinically meaningless for guiding HRT/MHT. Most of the same info can be gathered from blood tests with an endocrinologist or gynecologist for a fraction of the price.

From the North American Menopause Society (NAMS) position statement:

“Salivary and urine hormone testing to determine dosing are unreliable and not recommended.”

From the NAMs menonote on bioidentical hormone therapy:

“It is not necessary to check blood, urine, or saliva hormone levels to find the right [HRT/MHT] dose. During reproductive life, estrogen levels vary throughout the menstrual cycle and during each day, so there is no perfect hormone level for any [person].”

If you’re working with a doctor who wants you to get the DUTCH test, definitely:

• read unbiased reviews on it before buying the test
  • Here’s a helpful, independent review of the DUTCH test from Abby Langer, RD
• don’t be afraid to ask your doctor to explore using less expensive blood testing options with you. 

Microbiome and stool samples

While many doctors do a stool sample as a part of their diagnostic workup, it may not be necessary. It’s also vital to understand the limitations of a stool test. Unfortunately, some providers are using these tests for diagnostics in a way that they are not designed to be used.

A stool sample is just a snapshot of the bacteria in your stool, and this may not be reflective of the bacteria in your actual microbiome. That science is just not there yet, so be wary of the different claims that certain tests or practitioners make. Additionally, some tests show different levels of opportunistic bacteria, but just because it’s high doesn’t mean that it’s causing you a problem. Unfortunately, some providers lack nuance in understanding how to use these tests, which often leads to over treating. Providers should be analyzing the test within the clinical context:

• alongside any other tests the patient has done
  
  
• within the results of the overall stool test itself
  • (for example: are there multiple high levels of opportunistic bacteria?)
• among patient symptoms

Different stool tests can have pros and cons (in terms of what they look for, the method used, their reliability, etc). Some doctors use a combination of different stool tests because of this. Whether a doctor uses a stool test or not, they should be taking a close look at your symptoms as well as any other lab tests you’ve done to get a big picture of your gut health.

IGG food sensitivity tests

These are different than food allergy tests, which you would do with an allergist. Home food sensitivity tests, which are IGG tests, are often done by health coaches or naturopaths. They are kits that you do which supposedly tell you if you are sensitive to like a hundred different foods. Unfortunately these are not evidence based, and many organizations have recommended against using IGG testing to diagnose food allergies or intolerances.

Over reliance on testing

When using medical tests, it’s good to research into these questions:

• Are these tests really necessary?
  • Why do I need them? What is the point of them?
• Are they reliable/accurate and evidence based?
  
  
• What do unbiased reviews from people who don’t prescribe these tests say about them?
  
  
• Is it possible to obtain similar tests through a conventional doctor?
  • (which could allow them to be covered by insurance and to use a more reliable testing method to see similar results)

My first doctor, the functional medicine doctor, was all about the tests – we did tests, then his treatment protocol, then he wanted to repeat all the tests. Since they had already cost me over $800 the first time around, I said no, especially since many of my symptoms had improved. It then felt like he was lost on how to proceed with my treatment without the follow up tests. That was the final red flag, and that’s when I decided to change to another doctor.

My second doctor, the naturopath, was also a primary care physician* in the state of Washington (but not my primary care physician as a I live in another state). Looking at the tests I had already done, plus my current symptoms and the response I had on the other doctor’s treatment, she was able to make an ongoing treatment plan for me without me having to test and retest each time we needed to decide next steps. The only test she asked me to do was a stool sample specifically for giardia, because that pathogen was found on my first stool sample. Instead of me paying another $400 for a stool analysis, she told me to ask my primary care physician to prescribe it at the local lab for me, which cost me $8 with insurance. 

*A note on my naturopath also being a primary care physician: different states have different regulations on the scope of practice for naturopaths, from a broad scope of practice to not being able to practice at all.

Naturopathy and functional medicine can go hand-in-hand with conventional care 

My naturopath, vs the functional medicine doctor, was very open to me working with my local primary care to get tests and medications that were available to me within my insurance plan, which cut my costs immensely.

Sometimes a functional medicine doctor is able to give us a suspected diagnosis of something, like SIBO, thyroid problems, etc. This can be a huge turning point for us if none of the doctors we saw prior were able to give us any clues to what was going on with our bodies. If we are unsure of the care we are receiving with that doctor, or looking for care covered by our insurance, we can always switch to a conventional doctor, see both a conventional doctor and a naturopath/functional medicine provider, or search for doctor who is more specialized in our condition.

It’s recommended to inform your conventional doctor of any treatments you are doing with your alternative doctors.

The supplements industry is not nearly as regulated as prescription drugs are

Supplements can be very helpful with supporting certain aspects of our health. I know that some (not all) of the supplements I took for MCAS made a big difference. 

Your conventional doctor can often run blood tests to see if you are deficient in key vitamins and minerals.

Supplements may interfere with prescription medications you’re on, and additionally the supplements industry is not regulated nearly as much as prescription drugs are, so quality control for purity, strength, and ingredients of dietary supplements may be lacking with some companies.

Some functional medicine and naturopathic doctors make a 30-50% commission off some of supplements they prescribe! Others make their own supplement lines, which also brings up concerns about purity and ingredients. When the doctor makes money off the supplements they prescribe, that is a conflict of interest, and it’s hard to know if the patient really needs these supplements or not.

Even if the supplements are needed, they may be available for much cheaper by using different brands. For example, my functional medicine doctor had his own brand of own oral progesterone drops (RED FLAG!). They were very expensive, but they were helping me, so I continued buying them. When I changed to the naturopath, she told me to go see my primary care physician to get a prescription for a much stronger dose of regulated, FDA approved oral micronized progesterone, which was covered by my insurance, for a fraction of the price.

Many people regret having spent thousands of dollars on naturopathy or functional medicine that they could have spent other types of treatment

I do think naturopathy and functional medicine has its value, and like I’ve said, after I found the right provider, it very helpful for my MCAS. But considering how expensive naturopathy and functional medicine often is, some good questions to ask are:

• Is this the best option for me?
  • How do I know that it’s the best option?
• Would my symptoms be better addressed with another treatment, like excision surgeon or seeing a registered dietitian?
  
  
• Should I explore common co-conditions with conventional doctors instead, like PFT or SIBO? 

My functional medicine doctor also wanted to “check in” every two weeks, just for me to say “the current treatment is going well” and pay him $100 for that 15 minute check in! He was somewhat pushy, so it felt like I had to stand up to him, which was hard for me to do. Since he charged his patients per 15 minute time blocks, I found it helpful to organize myself beforehand, to go into the appointment with clarity. I made a PDF prior to each appointment with bullet points on my symptoms and responses to the treatment, and would email it to him prior to the appointment so that he could pull it up during our appointment and I wouldn’t not have to lose time to him taking notes – or be charged for it!