Defining evidence-based functional medicine

We are at an interesting crossroads for the future of functional medicine, said Jeffrey Bland, PhD, at the 2019 Institute for Functional Medicine Annual International Conference in San Antonio, Texas.

Heath is personal, and medicine is evolving to become more individualized through advances in medicine and in technology. While this concept of precision medicine aims to incorporate individual variability in genes, environment, and lifestyle, the emphasis is currently on profiling risk, according to a 2017 article in the Journal of the American Medical Association. The future of evidence-based precision medicine in the age of genomic diversity, Bland said, moves beyond population risk to understanding individual functional uniqueness. There is less emphasis on risk, and more emphasis on opportunity, he said.

But this idea poses many challenges, including designing randomized controlled trials. Bland says navigating around the limitations includes prospective cohort studies, retrospective cohort studies, pragmatic and large observational studies, case reports, and N-Of-One studies.

The key may be to look beyond evidence-based medicine, Bland said. What is needed is evidence-based medicine that supports interpersonal medicine, which is reflective of patient’s circumstances, capabilities, and preferences; recognized the clinician’s influence on patients and informal caregivers; and is anchored in longitudinal, multidirectional communication, broaching social and behavioral factors along with health sciences, Bland said, citing a 2018 paper in the New England Journal of Medicine.

Achieving this approach to medicine requires three steps:

1. Proper teaching and skill development
2. Measuring outcomes
3. Creating financial and nonfinancial incentives for its application

Evidence for functional medicine is hidden not too far beneath the surface, Bland said. A 2019 study in Scientific Reports found lifelong physical activity is associated with DNA methylation that potentially allows for increased insulin sensitivity and higher expression of genes in energy metabolism, myogenesis, contractile properties, and oxidative stress resistance in skeletal muscle of aged individuals. Another study found individuals following an Ayurvedic intervention experienced altered metabolomic profiles. And yet another study found meditation and vacation improved regulation of stress response, immune function, and amyloid beta metabolism.

There is a clear need for rigorous research evaluating wellness-enhancing interventions, Bland said. Encouraging motivated people participating in simple trials could align the interests of investigators and citizen scientists interested in wellness, he said.

“We are moving as a culture from a culture of populations to a culture of individuals,” said Bland. “We need both evidence and tools to support defining and understanding the uniqueness of people.”

Editor’s note: This article is part of Integrative Practitioner’s live coverage of the 2019 Institute for Functional Medicine Annual International Conference. For a full list of coverage, click here.