Dr Mayoni Gooneratne debates the pros and cons of adding functional medicine approaches to your clinic offering
‘Functional medicine’ might be a term you’ve heard mentioned more and more over the last year or so. It is a branch of medicine that is truly on the cusp of breaking into the UK aesthetics arena. It refers to an approach that aims to understand and address the root causes of chronic disease.1
I often say to patients that allopathic medicine is like diagnosing what is wrong with a car engine by listening to the noise it makes, whilst a functional approach means we lift up the car bonnet and take a good look to see where the problems are. Personally, I’ve always offered this ‘cell-up’, whole person approach with our ‘BodyFit, MindFit SkinFit' model. I’ve found that this really started to grow in my practice following COVID-19, as people had a completely new perspective on health.
In my clinic, implementing this concept meant getting patients to consider positive choices around food, exercise, sleep, hormones and mental wellbeing, helping them to target the underlying causes of their problems rather than just the symptoms. However, I am concious that some people in the industry, and in medicine in general, are reluctant to accept the approach as a valid form of medicine, viewing those who practice it as charlatans.
In this article I will debate the use of functional medicine for benefiting our patients and discuss whether it should be implemented across aesthetic clinics in the UK.
Understanding functional medicine
Functional medicine is a concept that was born in the US during 1990 by biochemist Dr Jeffery Bland. It looks at the environment and the gastrointestinal, endocrine, and immune systems, considering how factors such as poor nutrition, stress, toxins, allergens, genetics and your microbiome are all triggering chronic illnesses. These factors impact on our mental, spiritual and physical wellbeing which all affect our health. The approach is not a series of specific treatment protocols, but is purely based on the individual.1
We also use a thorough understanding of the normal biochemical and physiological cellular processes that are occurring all the time to effectively help to support and rebalance that person’s health. It helps to emphasise the patient-practitioner partnership, empowering individuals to take an active role in their own health and wellbeing.
There has been much research done to evaluate the efficacy of functional medicine on chronic illness. For example, one study identified that implementing a palaeolithic diet plan had significant improvements in the fatigue and quality of life for multiple sclerosis patients, whilst another study evidenced statistically improved pain and physical health scores for arthritis patients after undergoing a functional health approach.2,3 A review also highlighted the benefits of the functional medicine approach in improving outcomes in patients with type 2 diabetes.4
I also think a really important application of functional medicine is in the optimisation of health. This is very different to diagnosing and treating disease which is what many of us are trained to do traditionally. We could be seeing the use of functional medicine as a way of improving and optimising population health too, which has huge socio-economic and political implications. This is why I have co-founded the British College of Functional Medicine.
It might be hard to see the link between this and aesthetic medicine, but I have found that a lot of the aesthetic concerns patients present to me with can be addressed or improved using functional medicine. This is because while our aesthetic treatments are great, I believe we really need a deeper understanding of what causes our patients to experience these problems in the first place.
For example, when I first started out as an aesthetic practitioner, I was often perplexed as to why some patients were refractory to our acne or rosacea protocols. However after learning about functional medicine, I understood that while skincare routines and devices can really improve these conditions, their overall health is what can have a real impact on their skin and form the underlying cause.
For example, many of my patients have rosacea especially now after COVID-19, and on further assessment and testing, we found high cortisol levels, disrupted sex hormones and evidence of a leaky gut – all central factors that contribute to chronic cellular inflammation. People who have acne also typically have some dysregulation in their gut, alongside the loss of the barrier integrity of their gut, they have may predispose them to certain skin conditions.6 Therefore I now advise them how to optimise their gut health through nutrition and cortisol rebalancing, which they implement alongside aesthetic options like skincare or peels. In my experience, this leaves them with truly incredible external results, as well as improving their overall internal health so they can live a longer and healthier life.
Despite having positive outcomes, functional medicine is something that has been widely debated in the medical industry over the years. In the 1980s, practitioners became almost vilified for implementing functional medicine. From my conversations with doctors, I know there were instances of practitioners being called up by the General Medical Council for not prescribing enough medicine, as they were instead suggesting lifestyle changes like going to a walking group or learning how to cook proper nutritional meals as solutions to help illness. This caused a fear in practitioners, as it seemed as though taking this approach would risk your career in medicine.
To a large extent, I think this is still the case now – it has been questioned whether functional medicine is real healthcare or a wellness ‘trend’.7 In 2014, the American Academy of Family Physicians banned continuing medical education credit for all programmes related to functional medicine.8 Other doctors have referred to it as being ‘the worst features of conventional medicine with a heapin’ helpin’ of quackery’.9 Indeed, there seems to be a long way to go in the acceptance of this form of medicine as legitimate.
It’s important to remember that training in functional medicine is not an easily affordable route to go down – the only training available for it at the moment is in the US, and it costs thousands of pounds as well as involving countless hours of learning. The fees of flying and staying there, on top of the actual training obviously aren’t feasible for a lot of practitioners and it would be unfair to demand this of people, although some training is now available online.
While it may not be practical for all clinics to have someone fully qualified in functional medicine, I believe it is of the utmost importance for all aesthetic practitioners to show awareness of the CONCEPT in their clinic. Attending talks, conferences and doing your own research can provide you with an understanding of the basics of functional medicine, as well as what to ask your patients in consultations and what to look out for to determine if they have the potential for chronic illness or disease.
If you personally do not have the right expertise and feel this is outside your scope of practice, then you should be able to recognise this and refer them to a practitioner who can help. By doing this, we can actually improve the results that the practitioner can give – we optimise their skin health from the inside out, meaning everything an aesthetic practitioner does in terms of filler, peels or botulinum toxin will have excellent outcomes.
While some are reluctant to accept it, functional medicine really is the future of aesthetics and we believe the health of the population as a whole, and to completely ignore it would be to fall behind the crowd.
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