Functional Medicine/ Naturopathy

Functional medicine isn’t really the rigorous evidence-based medicine that we believe it to be.

There are major problems with both functional medicine and naturopathy: that there is a general lack of evidenced based medicine, a reliance on unnecessary and even useless tests, unregulated supplements and hormones, etc. Not only might these practices be useless or expensive, they can also be delay true diagnosis or treatment, or even cause the patient harm.

I had a positive experience with naturopathy. With functional medicine, I had a somewhat positive experience – the practitioner did help me, although he had several red flags. I was struggling with the onset of MCAS symptoms at the time, and I’m not sure if I could have brought up my quality of life so quickly without these 2 doctors. However, my own personal, positive experience doesn’t negate the fact that overall there’s a lack of evidenced based practices within these fields. I do 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, shooting in the dark, and charging exorbitant prices for unregulated supplements which have been recommended based on useless lab tests. The experience each of us have depends on the doctor and health situation you are trying to address, because there are a lot of doctors out there who don’t have the knowledge that they claim to. This was one of the reasons I changed from my first doctor to my second. My first doctor had a bunch of red flags my second doctor didn’t have. And while the first doctor did help me, I also think much of his success was just trial and error, which wasted my time and money.

If you’re considering working with a naturopath or functional medicine doctor, it’s really important to know what red flags to look for, to trust your gut if something doesn’t feel right, and to have a healthy level of skepticism.

Don’t be afraid:

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

It’s definitely recommended to keep seeking conventional care for your symptoms as well and to inform your conventional doctor of any treatments you are doing with your alternative doctors.

Sometimes a functional medicine doctor is able to give us a suspected diagnosis of something, like SIBO, thyroid problems, etc, and that can be really helpful if none of the doctors we saw prior were able to give us any clues to what was going on with our bodies. But we can always take that information and then go find a conventional doctor for treatment as well, so don’t be afraid to quit any doctor you see if better or more affordable options are available.

One of the goals when working with these doctors should be to get off the supplement protocols and/or build healthful habits, etc, so that you no longer need to see them.

Once these 2 doctors got me oriented and up to a more stable place with my MCAS symptoms, within 6 months I was able to stop taking all the supplements, except for the oral progesterone, which I now have monitored and prescribed annually via my primary care physician. 

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 can be a frustrating and even harmful system to navigate. Long wait times just to have a 10 minute appointment in which the doctor dismisses us, doesn’t actually address our concerns, or pushes medications without informed consent or with a disregard for the side effects that make us feel worse than our disease. There may be poor treatment options, lack of understanding of my body and disease, and misogyny, racism, ableism, fatphobia, and other forms of discrimination that are rife in our medical system. This can lead to gaslighting, being told it’s “all in our heads” or anxiety, and medical trauma.

With naturophathy/FM, it’s really appealing that they spend longer appointment times with us, sometimes 45-90 minutes. We may finally feel heard and like someone cares about our health and is giving it the attention is deserves. It’s really alluring that naturopathy/FM 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 naturopaths and FM doctors will also comb through your diet/lifestyle and recommend more health promoting behaviors, such as better quality sleep, more nutritious diet, stress management techniques, etc. While some conventional doctors may mention these, the majority don’t have the training or the time to do so.

I personally saw my functional medicine doctor for MCAS symptoms, because I wanted to try to find contributing factors that I could address, and my allergist (who specializes in MCAS) could only offer me mast cell stabilizers which had a major side effect of fatigue. And after years of being fatigued to the core due to endometriosis, I didn’t want to take those, and our appointments were a dead end.

There are many 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 many 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. Most of the same info can be gathered from blood tests with an endocrinologist or gynecologist for a fraction of the price. And in fact, then North American Menopause Society (NAMS) has the following info in their position statements:

“Salivary and urine hormone testing to determine dosing are unreliable and not recommended.”(Source: NAMS position statement)

“It is not necessary to check blood, urine, or saliva hormone levels to find the right [HRT] 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].” (Source: NAMs menonote on bioidentical hormone therapy.)

If you’re working with a doctor who wants you to get the DUTCH test, definitely definitely read unbiased reviews on it before buying the test and don’t be afraid to ask your doctor to explore using the blood testing options with you. And if they won’t or can’t, this could be an indication that they are not fit to treat your hormones or that you may need to work with a different doctor for your HRT. Here’s a helpful, independent review of the DUTCH test from Abby Langer, RD.

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 (typically functional medicine doctors/naturopaths) 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 can show different levels of opportunistic bacteria on them, 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?), and 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 and 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, so many organizations have recommended against using IGG testing to diagnose food allergies or intolerances.

Other tests

I’m not familiar with all the tests that these types of practitioners do but there are so many, most of which are not evidenced based. When approaching a test, 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)

Over reliance on testing

My functional medicine doctor was all about the tests – we did tests, then did his treatment protocol, then he wanted to repeat all the tests. Since they had already cost me several hundred dollars the first time around, I said no, especially since many of my symptoms were now 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.

The naturopath I found was also a primary care physician* in the state of Washington (but not my primary care physician as a I live in another state). She used the tests I had, plus my current symptoms and the response I had on the other doctor’s treatment, to continue crafting a 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, and she said we needed to make sure it was fully gone. So instead of me paying another few hundred 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. 

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

*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.

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

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/ingredients. When the doctor makes money off the supplements they prescribe, it’s hard to know if the patient really needs these supplements or not. Even if the vitamins/supplements would be useful, they may be available for much cheaper by using different brands. For example, my functional medicine doctor had his own brand of herbal anti-microbials for gut health and he even sold his own oral progesterone drops (RED FLAGS!!). All of those were very expensive, and it took me a few months of struggling to pay for his treatment to realize that there were much cheaper anti-microbials available for “gut dysbiosis”/SIBO sold online which are commonly utilized for the same purpose. I also talked to my primary care physician to get a prescription for a much stronger dose of (regulated, FDA approved) oral progesterone, which was covered by my insurance, for a fraction of the price.

Supplements may help certain people with supporting certain aspects of their health, and your conventional doctor can often run blood tests to see if you are deficient in key vitamins and minerals.

I think a good goal with taking supplements is to get to a place where we don’t need them anymore, or where we need the least amount possible. When I was working with a naturopath when my mast cell activation was at its worst, I was on a couple of supplements she recommended, but the goal was to use them temporarily while I supported my body, and then within 6-12 months no longer need them.

Many people regret having spent thousands of dollars on naturopathy or functional medicine that they could have spent on excision surgery, a registered dietitian, SIBO treatment with a gastroenterologist, or other types of doctors/treatment.

In my own case, I can definitely see how several hundred dollars were wasted on supplements he prescribed that didn’t work, and tests and hormones that I could have gotten for much cheaper through my insurance with a conventional doctor.

My functional medicine doctor also wanted to “check in” every two weeks, just for me to say “the anti-microbials are going well” and get charged $100 to tell him that! Since that would cost me money, I told him that if I felt the treatment was going well, that I preferred to check in about 3/4 of the way into it with a focus on next steps. He was kind of pushy too, so it felt like I had to stand up to him, which was hard for me to do. After we finished my the antimicrobials, I ended up changing doctors to a naturopath who felt like a better fit for me and more understanding to my economic situation.

While a patient often gets a longer time with a functional medicine doctor or naturopath, in my experience 30-60 minutes can fly by and you haven’t even finished talking about everything you need to. It’s helpful to be very organized, go into the appointment with clarity on what you’re trying to address, and write down bullet points about your symptoms, responses to their protocol, etc, and email it to them prior to the appointment so that they can pull it up during and not have to lose time taking notes.

One major problems include 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 gut problems, 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). Is it better to find an actual expert in hormones, like an endocrinologist? Is it better to find a registered dietitian to talk about diet? It is better to work with a gastrointestinal doctor to talk about digestive health?

Have a dose of healthy skepticism and interview your doctor to see if they are right for you. What are their qualifications? What kind of expertise do they have in the issues you are looking to treat? For example, I had one appointment with a functional 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, and while the new doctor also wanted to look at my methalytion, she could tell me why in reference to my symptoms and she knew multiple free websites that I could upload my 23andMe DNA to, which gave us useful info for free.

Naturopathy can’t heal endometriosis.

Some doctors are misinformed and believe that they can cure or heal your endometriosis or that “balancing your hormones/body” will remove your endometriosis, but this is not the case. Endometriosis has no cure and the disease can still progress even if you become symptom free. Excision surgery is the gold standard treatment for endometriosis. We still don’t know the “root cause” of endometriosis (but genetics play a role and we are likely born with it), so if a doctor says they can treat the “root cause” of endometriosis, what that really shows is that they don’t know much about this disease at all.

I personally think functional medicine or naturopathy may be more helpful for certain conditions, and less helpful for others, but each patient experience will be different and of course depend on the doctor’s knowledge too.

I personally didn’t see my functional medicine doctor or naturopath for endometriosis symptoms, but rather for gut and hormone health directly related to mast cell activation syndrome.