The New Paradigm in Functional Medicine

How to improve functional medicine for better patient outcomes.

Functional medicine gets a lot of things right, but it also misses the mark in important ways that can cost patients extra money, and even worse, doesn’t get them better. In today’s podcast episode, I highlight the places functional medicine needs an upgrade, and share the clinical strategies that make functional medicine live up to it’s promise.

In This Episode

Episode Intro 00:00:08
Method of Analysis 00:05:32
Focus on What is Important … 00:11:43
Prioritizing the Information & Solving the Problem 00:18:13
Fear of Failing the Patient … 00:26:25
Questioning the Norm … 00:32:35
Chronic Misdiagnosis … 00:36:45
Episode Wrap-Up … 00:41:59

The New Paradigm in Functional Medicine -

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Hi everyone. Today. I have some exciting news and also some pretty juicy details regarding some of the shenanigans that occur in the Functional Medicine field. There is a lot going on in this podcast. So I’ll lead with a summary. There are a few things that we’ll discuss. The clinic has moved to Austin, Texas. The same telehealth services are available for anyone, anywhere, including people in California. So there will be no interference with care, our physical location has just moved. The clinic has expanded and hired two new doctors and a health coach and now has reduced wait times. We’ve done a massive overhaul of our systems to make everything from patient communication through patient checkout through data tracking, much easier and more seamless. I’m very excited to announce that we’re gearing up to start publishing research routinely through the clinic. That was part of the impetus behind the systems updates. To make data gathering en masse as easy as possible so that we could publish research without much rigmarole.

Then we’re going to go into an overview of some of the egregious actions Functional Medicine has taken. This is important because it helps the consumer have more skepticism regarding things like testing and the idea that we could help you if we just did more tests, which is true, maybe 20% of the time. We’ll also cover some keys to success in Functional Medicine. A reflection on what I have found to be the most effective way to analyze information from new patients and use that to create recommendations that really move the needle regarding their health. Then we’ll end with a round table discussion with the two new doctors at the clinic. So that’s kind of the summary of what we’re going to cover. I’m hoping this will be under an hour. Knowing how much hot air I tend to blow, probably not, but I will aim for less than an hour total on this. So let’s dig in.

Also, check out my video on The Truth about Functional Medicine.

➕ Full Podcast Transcript

Intro:

Welcome to Dr. Ruscio radio providing practical and science-based solutions to feeling your best. To stay up-to-date on the latest topics as well as all of our prior episodes, please make sure to subscribe in your podcast player. For weekly updates, DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hi everyone. Today. I have some exciting news and also some pretty juicy details regarding some of the shenanigans that occur in the Functional Medicine field. A lot is going on in this podcast. So I’ll lead with a summary. There are a few things that we’ll discuss. The clinic has moved to Austin, Texas. The same telehealth services are available for anyone, anywhere, including people in California. So there will be no interference with care, our physical location has just moved. The clinic has expanded and hired two new doctors and a health coach and now has reduced wait times. We’ve done a massive overhaul of our systems to make everything from patient communication through patient checkout through data tracking, much easier and more seamless. I’m very excited to announce that we’re gearing up to start publishing research routinely through the clinic. That was part of the impetus behind the systems updates. To make data gathering en masse as easy as possible so that we could publish research without much rigmarole.

DrMR:

Then we’re going to go into an overview of some of the egregious actions Functional Medicine has taken. This is important because it helps the consumer have more skepticism regarding things like testing and the idea that we could help you if we just did more tests, which is true, maybe 20% of the time. We’ll also cover some keys to success in Functional Medicine. A reflection on what I have found to be the most effective way to analyze information from new patients and use that to create recommendations that really move the needle regarding their health. Then we’ll end with a round table discussion with the two new doctors at the clinic. So that’s kind of the summary of what we’re going to cover. I’m hoping this will be under an hour. Knowing how much hot air I tend to blow, probably not, but I will aim for less than an hour total on this. So let’s dig in.

DrMR:

If you’ve been following the podcast or my work in general, you know how frustrated I get with the field of Functional Medicine. I always assume good intentions on the part of the doctors or the participants, but the field is in serious trouble, in my opinion. The good news here is there is a lot of room for improvement. The downside is that there is a lot of stuff that the healthcare consumer or the clinician has to protect themselves against. But the good news is that there’s a lot of room for improvement. The model I’ve been developing, it does seem to provide fairly substantial results. I don’t want to sound self-promotional or self-aggrandizing here. I wish it was not the case that patients come to see me after seeing three, four, five or six functional medicine providers and then we get them well. I wish that was not the case. So when I share these sorts of criticisms and anecdotes from my office, it’s not me trying to prop myself up. It’s a disappointment that people suffer for six months, a year, two years going through the wringer of Functional Medicine, and then we’re able to fix them. It’s not that I think we are doing things with some sort of magical protocol, it’s that I really feel that the education in this field is poor.

DrMR:

Even doctors who are doing their best and showing up and doing the training and executing whatever recommendations they’re learning, those are poor recommendations that need to be amended and updated. This is one of the things that I want to try to really showcase in part in this podcast. I want to share how we’ve been able to really help patients where other doctors haven’t and oftentimes in less time and with lower cost and also with improved psychological wellbeing. The psychological wellbeing is really important. If we order a bunch of tests that, as one example, are erroneous and fictitious, but the patient internalizes all those highs, lows and positives as actual problems that is a big detractor of wellbeing. If we then leverage that with a fear-based narrative on food, then we get even further entrenched in this detrimental psychological position.

Method of Analysis

DrMR:

I also say at the clinic or under our clinical model, because I want to be careful to not represent these things as being unique to me, one of the things I’m hoping to persuade our audience regarding is that it is totally okay to work with one of the other clinicians in the office instead of me, because these things are not unique to me. I have been working diligently over the past few years, to truly take these things out of my head and map them out. This has been evidenced by the fact that other doctors who follow our clinicians newsletter have submitted case studies back to us, and we’ve published them in our newsletter, applying these concepts and helping patients who are otherwise “tough cases”. So this is a model that is not dependent upon me. It is able to be replicated and executed by others.

DrMR:

In keeping with that, the system and the method of analysis can be taught and implemented by other clinicians. When I say systems, one of the things that I’ve found is quite helpful in learning and becoming a more astute Functional Medicine provider is data organization and tracking. I feel this is because when you have the appropriate organization of data, you can see trends, you can see cause and effect and you can learn. That’s how you can learn your way out of some of the very inappropriate practices that are currently occurring in Functional Medicine. This is exactly what happened with me. It was just having things organized well enough so that I could see what was working, what wasn’t working. One specific example of how that plays out is not treating too many things at one time so that you can actually learn what’s working, what’s not working.

DrMR:

Let’s go into some of the critical components of an effective clinician and an effective clinical system, the intake process, meaning the history and exam. I use the term exam loosely because physical examination, for most realms of at least functional medicine, GI and thyroid, aren’t really required. So it’s really more of a intensive history taking process. This is crucially important in creating the therapeutic hierarchy. We look at things like onset. Did the symptoms start upon living in a house with mold or had the complaints been present for years prior to this? This is one key thing that if you’re looking to champion mold as the cause of every disease, then when someone says, “I lived in a house that I think had mold”, the clinician may say its got to be mold. Let’s interrogate that a little bit further because we’re open to it but we’re also looking to disprove as equally as we’re trying to prove.

DrMR:

Were your symptoms occurring before living in the house? Yes. The symptoms started in 2014, I moved into the house in 2018. Then it is probably not mold unless there was a significant exacerbation of the symptoms upon moving into the residence that were resolved when moving away from the house or moving out of the house. Right? So these are all very important things in how we look at the initial case history data. Also, very important here, not wasting time on factors that do not help us solve the problem. As one example, I’ve criticized in the past spending 20 minutes on every facet of your childhood including breastfeeding or c-section birth. If you were or were not born by C-section or if you did, or did not have breastfeeding or an adequate breastfeeding window that doesn’t help us to treat you any differently.

DrMR:

All it does is just kind of further ensconce someone in the idea that, Oh my God, maybe my gut is broken. I’ll never be healthy. It also wastes the clinician’s time. Yes, we know that that may increase your risk for IBD, IBS, or autoimmune conditions, but that doesn’t help you treat the person differently. So these long, drawn out exams that go into copious detail on irrelevant history bits have been excised out of the intake process, and it really allows a clinician to focus in on what matters.

SponsoredResources:

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DrMR:

Keep in mind here as a side comment, clinicians have a limited amount of focus and short-term memory. So the more stuff you put into a clinician’s brain that is not essential in solving the problem of the patient’s ailments will actually reduce their ability to solve the problem. Having an extremely focused exam is conducive to better problem solving without any question. Now, there are items from the childhood that are relevant. As an example, emotional or physical trauma, right?

Focus on What is Important

DrMR:

These things could indicate unresolved trauma that may need therapy or limbic retraining. So there are things that matter because knowledge of them would change how we treat. If there is unresolved emotional trauma that leads to a clinical recommendation of therapy or limbic retraining. But if someone was not breastfed, there is no adult breastfeeding probiotic or other intervention that can replace that. So the onset is important. The prior diet and treatment history is also very important. What has been done correctly? What has not been done correctly and should be revisited? One common example that we find in the clinic is folks who have tried a single probiotic that didn’t help. Then when you dig in you find that they tried one probiotic from CVS for two weeks. It may have helped a little, but not enough to notice.

DrMR:

That’s vastly different from using the probiotic trio at a full clinical dose. So what we want to be careful to do is not take the “probiotics didn’t help me” statement and then throw all probiotics out the window. Alternatively, a patient may say “I’ve done three rounds of Rifaximin and two rounds of herbal antimicrobials, and I’ve never noticed any symptomatic difference”. That’s a bit stronger of an observation. That might tell us that, for this patient, anti-microbial therapy, which is normally a couple of steps up in the hierarchy now should be a position much lower in the hierarchy because we don’t seem to be having a good signal of benefit coming from that therapy. These are the things that really make the difference between the clinician creating an effective hierarchy for the individual or just meandering around with “well, we know Rifaximin is great for SIBO and your SIBO breath test is positive, so we’re going to treat you with Rifaximin”.

DrMR:

The patient is left with thinking didn’t you hear from the history that I’ve done Rifaximin three times and haven’t noticed any benefit? All these things come together and really lead to either a much more effective experience clinically or a much less effective experience clinically. Also, we look at symptoms. We make sure that our patients are giving us their symptoms and not their positive test results or diagnoses like SIBO, MTHFR and hyperthyroid. This is part of our intake process. Asking people to list their symptoms and we have a little asterisk footnote if applicable – MTHFR, SIBO, adrenal fatigue, hypothyroid. Those are not symptoms. Those are conditions. The reason why this is relevant is someone could come in and you’re trying to find out what their chief complaints or symptoms are and they tell you that they are worried about SIBO, hypothyroid, MTHFR, and adrenal fatigue.

DrMR:

You now have no useful information in terms of what the actual subjectives are. Do they have bloating? Do they have constipation? Do they have reflux? Are they having fatigue? Are the they having hard time sleeping? Are they having skin reactions? Going through the simple exercise of converting out of the language of conditions and into symptoms allows us to translate into actual subjectives and also get rid of these red herrings. People may be saying it’s SIBO, SIBO, SIBO, SIBO and in fact may not be SIBO at all. They may have never even had a SIBO breath test positive, but they read about it somewhere and a lot of the symptoms lined up. The result is the patient is saying SIBO, SIBO, SIBO and clinicians are assuming SIBO, SIBO, SIBO, and this whole thing just kind of runs away on you. No one takes the time to check if this is actually the case.

DrMR:

Hypothyroid is another example where this happens. Someone is diagnosed with hypothyroid, they see another doctor and that doctor assumes that the diagnosis was made correctly. Maybe they are not aware of the Lovatis paper, as one example, finding that 60% of the patients who had their ambiguous diagnosis re-evaluated were actually not hyperthyroid. Just in the intake process we are getting a ton of useful information. This is not an intake process that takes forever. We also take a diagnostic history. Using hypothyroidism as an example, that is one of the larger diagnoses to really make sure you vet out. Also lifestyle history. Has this person been damaged by Functional Medicine and need of correction of an overzealous or fear-based paradigm, meaning that you’re not as sick as you think you are. You can expand your diet. Might this person need limbic retraining? Are they sedentary and not sleeping enough (even if they don’t think it is that bad)? Maybe they are someone who says they go to bed usually between 1am – 1:30am. That’s not great from a circadian perspective.

DrMR:

So maybe this person’s chronic mid-day energy lul and loose bowels are due predominantly to a circadian dysrhythm and you look at their exercise and they’re not exercising. Maybe before we say your fatigue could be due to MTHFR and load them up on methyl folate, we should start with the low hanging fruit and the clearly much more clinically impactful intervention of getting your sleep rhythm where it should be. All of this is used to create a therapeutic hierarchy or a map that guides the clinician through the clinical process and as a hint for patients and doctors. Sorry to kind of pull back the rope here and reveal that the wizard of Oz is only a little short fellow pulling levers, but doctors don’t remember every detail about every case at three months or six months. This is why it’s essential to do the heavy analysis on the front end when all the data is fresh and in one’s working memory.

Prioritizing the Information & Solving the Problem

DrMR:

So now that you have all the information in your working memory, you can go to work on solving the problem and prioritize a list of objectives or a hierarchy. Various treatments can be used to address items in the hierarchy. This is really the algorithm. If there is a secret sauce, this is it. I’m sure there are patients out there who feel like when they follow up with their doctor, they spend 10 minutes just trying to give the doctor the information or that she needs to recollect all the contextual data to then make a choice. I’ve certainly had patients who have said that to me. That they have to remind their doctor of certain signs or symptoms and at 10 minutes into a session they feel they are just getting up to speed.

DrMR:

This does not happen at our office because we have all this information, coming back to the bit on the systems and data organization, right there at our command. I mean, we are not perfect. We’re not going to remember what was the name of your second dog, but the clinical information, the tests you’ve done prior, the treatments you’ve done prior, the diets you’ve done prior, what we’ve done together and what the response has been, what we think the next step should be based upon the history. All of that is mapped out on a dashboard. So the clinician can really steer the process effectively. Like I said before, we spend time pre and post each visit. Pre – reviewing that dashboard of data. Post – making sure we integrate all the findings from a given visit to amend and update that dashboard of data.

DrMR:

Again, if there is a secret sauce, this is really where it is. So the hierarchy is a kind of just alluded to adapt and evolve at each visit based upon response to treatment or changes in symptoms, which is huge. Lab testing also informs that, but we have to interpret many labs with a grain of salt and contextually. Also patient preference. A patient may not want to use a certain therapeutic. So we use a different therapeutic firstly and then position an unfavorable therapeutic until later in the hierarchy, given the patient preference. This may be the case with, let’s say, an antimicrobial therapy. Someone may be apprehensive about that. So they do the Elemental Diet first. Another component of this is not over-treating. This allows the clinician to see cause and effect.

DrMR:

This is really huge. Doing this allows you to know how to crack the patient’s code. What I mean by that is you can’t solve multiple variables at once. So when you’re looking at, or when you’re not over-treating, that means you’re also focusing more narrowly on one or two things at a time, and this allows you accurate and informative note-taking, which is very important. It allows you to see cause and effect and reduces costs because you’re vectoring less treatments at any one time. There’s also the issue of framing. People are being hurt by excessive testing. They think, as I said earlier, they have a number of things wrong with them that they don’t. This is often from lab tests. If I had a patient on a GI map, had a certain dysbiotic bacteria elevated and their integrative medical doctor told them when they did not respond to antibiotics, you should probably just start praying.

DrMR:

This person came in so damaged. They probably had a predilection toward fear, worry, anxiety, and train neuroticism combined with that. It just ranaway from there. So, you know, all these things kind of congeal together to create a really negative experience for patients. Framing really goes a long way. This can lead to, if done incorrectly, a destructive, double whammy. People learn to fear food. This would be a nocebo effect, meaning having a negative expectation and become dependent upon supplements, which is a placebo effect. This is incredibly destructive, right? If you’re expecting to have problems with foods and also anticipating a dependence upon supplements. This puts someone into a very damaging situation, existentially. One of the things I’m very proud of at our clinic is that we reverse this and I see these sorts of things like you just alluded to on a daily basis.

DrMR:

So I’m very proud to be offering this and championing this in a better direction. Again, I want to insert my repeat disclaimer that for those who may be doing this, I don’t think it’s anyone’s fault per se. I think there’s just been some overzealousness in education and a lack of nuance in some of the discussions. Which results in things like people being up in arms about gluten – gluten is so bad, it’s bad for everyone – type of mindset. However, the data don’t fully support that it. Yes, it is probably one of the more common allergens. But do we make a sweeping, absolutist claim? Probably shouldn’t. The utility of supplements, do they help out? Absolutely. Are they something that people should become dependent upon for the rest of their lives? Probably not. So there are grains of truth here or there, but I think the educational model, especially due to lab and supplement company funding and influence has gotten a little bit, well probably a lot a bit, ahead of itself.

DrMR:

It manifests negatively. I don’t think enough clinicians are aware of this, which is why I’m trying to sound the alarm from within, in a hopefully supportive way where we can all start moving in a better direction once we really identify this. I’m hoping that by my sounding the alarm bell here, people will figure this out more quickly because it took me years to figure this out. So, theoretically, if I had come across someone like myself, sounding the alarm bell on day one, I could have had this change and these updates made in my clinic within six months, rather than three to four years. So that’s really one of my underlying hopes here. The other piece that I am really pleased about regarding our clinical model is empowerment. When the doctor can see cause and effect, guess who else can too? The patient.

DrMR:

Now they know, Hey, if I do two days on Elemental Heal and then revisit low FODMAP with probiotics, when I’m flaring, I will likely be okay. This is great. Now they can make some modifications and are not dependent upon the doctor. Compare this to whoops, I’ve had a flare, it must be my SIBO again, darn this chronic condition, I better get scared and go back to the doctor, do another test, and then we can treat the labs. This is a much more disempowering narrative. Oh my God, I don’t know what to do, I’m going to have this condition forever. People get afraid when they get afraid they can’t think when they can’t think they can’t problem solve. This is all perpetuating the disempowerment. There is also evidence to back this up. A recent trial by Richard McCallum, who has been on the podcast before, published in the Journal of Neurogastroenterology and Motility concluded that SIBO retesting had no correlation to patient response to Rifaximin. So there may not be this large degree of need to do followup SIBO breath testing, something I’ve been saying for a while. Always open to exceptions this. I’m not saying that there’s irrefutable evidence, that this is the best path, but the point I’m trying to make is if every time someone has a resurgence of their symptoms, they think they have to report back to their doctor and do a SIBO breath retest, that’s good for the clinicians financially, but it’s not in the best interest of the patient.

Fear of Failing the Patient

DrMR:

So how did this get so bad? Well, in my opinion, it’s due to clinicians not being critical of what they’re taught. Following weekend seminars, lab sponsored presentations, supplement company recommendations. Again, I don’t think this is the clinician’s fault. I think the clinicians are assuming, well, there’s a presenter up there on stage, and they’re citing some science and they’re sharing some information. I’m going to assume that this is voracious information. I don’t think that we as a field, those participating in the educational seminars, have been critical enough or circumspect enough of the information that’s being shared with us. And I think this is one thing that the clinicians really had to start pushing back against. The gurus, the educators, the labs, the supplement companies and saying, I want more than just a few footnote references. I demand that you’re going to only use high-quality evidence to support your claims.

DrMR:

If you’re not, letting us know that this is speculative, and we should integrate this into our care models as such. Unfortunately what happens is that a few references are cherry plucked into the slides or and people don’t fact check. Like a study from seven mice in Asia. This is something where I will not name a name, but one of the largest weekend seminar/educational/ functional medicine/ supplement companies was notoriously bad at doing. How do I know? Well when I was a student I would go into the references of the manual and I would check them and I would be shocked when I found that none of this is actually in humans, except for maybe one or two things like vitamin D. All the other stuff is incredibly speculative. That was kind of the initial introduction, when I would say “let me just check”, because I was interested in the science, and I started thinking hmmm this is odd.

DrMR:

That was the inception of what later grew into this highly critical person you’re listening to now. As you peel back the curtain, you see that a lot of these things that sound so, so accurate and appealing, may not be. It’s easy to be drawn in when up on the slide deck they are showing all the patterns of hypothyroidism with all the clear pathways of how inflammation affects pituitary affects T4 affects conversion of T4 T3 and that this certain supplement can thwart that because it’s been shown to have an anti-inflammatory effect. The thing is, there’s not really any good data showing that that is actually how this stuff plays out in the real world. So the clinicians likely have not been circumspect enough when undergoing education. The other part that I think has led to how things have gotten so bad is not trusting that you can solve the problem with less, rather than more.

DrMR:

I completely understand there’s this fear because I felt this, this fear of failing a patient. There’s this instinct to do more. But the instinct to do more so as to ensure you help them has the opposite effect, it has worse results. I totally understand how someone can come in with an array of symptoms and you’re thinking, well, I’ve learned about how adrenal fatigue can cause this I’ve learned about how MTHFR can cause this I’ve learned about how poor conversion of T4 to T3 can cause these symptoms. So let’s just use all of these things because you don’t want to fail them. You’re thinking let’s just leave no stone unturned. Unfortunately that’s absolutely the opposite of what one should do. You end up obtaining worse results. Why? Because you can’t tell what’s helping and what’s not helping. Therefore you don’t learn over time and therefore you don’t become a better clinician over time. Therefore you keep just treating via the weekend seminar manual and not becoming a clinician who’s highly proficient in solving these problems. So the overtreatment model really seems to disempower clinicians and make them dependent upon a protocol based treatment method rather than an algorithm based treatment method. It really thwarts the ability of them to learn.

DrMR:

A more accurate way to say “if we’re not assessing, we’re guessing” would be “over assessing equals harm”. Part of this is because of the overtreatment and part of this is because many of the labs are not actually accurate. So how did I find my way back to kind of patient-centered care? Following the science, as we’ve discussed. That started with checking the references of the weekend seminar manual. SIBO and probiotics are a great example of this. There are some people I very much like and respect who still seem to have a hard time wrapping their mind around the over 18 clinical trials, finding that probiotics help with SIBO. That’s just one example. Hypothyroid. I mean, I think I’ve beaten our audience over the head with every example of how so much of the narrative regarding hypothyroid is just completely fallacious.

DrMR:

There’s a small kernel of truth in the messaging, but it’s just been way, way, way overstated, and really ends up hurting people. The same thing with gluten. So if you factor these things against the science, you see, Oh, some people clearly do feel better on T4 plus T3, but it’s not the majority. In fact, it’s not even close to the majority. We can still do this and have this as something that we use to help our patients, but we’re not going to start there. We’re also not going to go deeper and deeper into thyroid when there’s a gut issue occurring at the same time. We’re going to acknowledge that that might be driving the symptoms. We have the case studies to prove this, where this happens and when we do it the right way, we can rectify the situation.

Questioning the Norm

DrMR:

This kind of ties in with another facet, which is questioning the norms. It follows right from the above and this leads to treating patients differently. Part of that is the prioritization or the hierarchy or the algorithm like I’ve said, and also narrowing one’s focus. So this all kind of culminates in helping patients or being able to help patients who are not able to be helped previously. Part of this is not using invalid testing which also allows one to help patients for less money and in less time while improving their psychological wellbeing. What I’ll transfer over to here in a second is a video I recorded a few days ago, which I highly recommend you watch. We’ll make sure there are ample links for you to be able to access this in the podcast because the visual overlay substantiate everything that I say, but we’ll go over to that next.

DrMR:

You’ll see, as one example, one of the most popular stool test that was all the razzmatazz for a while, that I warned against for years, guess what they used to establish their normal ranges? They used dog poop. Dog poop was part of the data used to set the normative ranges for this stool test. So I’ll go over that specifically with visual evidence supporting every claim that I makes I’m excited for you guys to go through this here in a moment. Then after that, it’s only about a five minute video, I’ll be back in a round table discussion with the two new doctors at the clinic, which is now operating as the Austin Center for Functional Medicine. We’ll discuss a lot of these concepts, how they play out in clinical practice, things that they’ve learned from going from their conventional medical backgrounds to Functional Medicine training, and then finding their way over to my work and integrating into the clinic.

DrMR:

Just really grateful to have you guys listening to this because these things do make a sizable impact in one’s wellbeing. Erin Ryan, our podcast host, said something to me off air the other day, I don’t think she would mind me sharing this because she’s already shared something similar to this on the podcast, but she just said, you know, I just really want to thank you again. You changed my life when I came and I saw you at the clinic. She was not someone who was bereft of Functional Medicine care. She had seen many providers. But knowing that the care from the clinic literally had a life-changing impact on this person above and beyond what regular Functional Medicine did just reinvigorates the importance I see of this work. I am very grateful to have you guys listening to this because I’m really trying to champion the field into a better direction and champion this message.

DrMR:

So now we’ll go over to a video that illustrates some of the things we have to be very careful with regarding the field and some of the fairly egregious errors that have been made. Then we’ll be back with the two new doctors in the clinic and hash out some more of these concepts in Functional Medicine and how we can use the model to help people and not to harm people.

DrRuscioResources:

Hi guys, just a quick announcement. My clinic is now version 2.0. Wait times have been reduced as I’ve hired two new doctors and the health coach. We’ve enhanced our services with new systems to make the process even easier for our patients. The location has transferred to Austin, Texas, and the clinic has been renamed to the Austin Center for Functional Medicine, but we still offer the same telehealth services for people anywhere. If you’re in need of cost effective, practical and science-based care, please visit my clinic website, AustinFM.com.

Chronic Misdiagnosis

DrMR:

Hi, this is Dr. Ruscio. There could be a 60% chance your healthcare provider has misdiagnosed you. Sound hyperbolic? Unfortunately, there are several supports for this statement. Let’s look at one, a landmark paper was published in the prestigious journal Thyroid by Lovatis finding 60% of patients studied had been incorrectly diagnosed as hypothyroid. This same thyroid over-diagnosis problem has also been decried by Medscape. Additionally, our office has published numerous case studies of patients who have been incorrectly diagnosed as hypothyroid. So how is this rampant misdiagnosis possible? Well, when there is a kernel of truth in an otherwise incorrect statement, sometimes that’s all that is needed. An example of a kernel of truth: fatigue and depression can be caused by thyroid problems. But consider this, hypothyroidism affects 4.6% of the US population. Whereas IBS affects 10 to 15% and digestive problems more broadly affect as much as 40% of the US population. So gut problems are more common than thyroid problems.

DrMR:

We also know that IBS and gut problems can cause fatigue, depression, and anxiety. Quality research studies have demonstrated that fatigue, depression, and anxiety are improved by gut-tailored diets or by probiotics. So the more common cause of one’s symptoms, in this example, fatigue, depression, and anxiety, is often the gut. But isn’t your doctor aware of this and able to correctly diagnose your problem? Doesn’t he or she understand that gut problems could be three to 10 times more likely than thyroid? Sadly, no. We’ve already established that thyroid problems are overdiagnosed. Other research has found gut problems are underdiagnosed. Incorrect, and over-diagnosis of thyroid problems combined with underdiagnosis of gut problems equals a high likelihood of your doctor missing the right diagnosis. Again, our office has published numerous heartbreaking case studies of how damaging this incorrect diagnosis can be. One example, a famous thyroid doctor, who is literally on the cover of books, cost over a year of needless suffering force feeding a patient thyroid medication, even though she was feeling poorly on it.

DrMR:

She fit none of the diagnostic criteria. All the while this doctor overlooked the gut as the cause. When we addressed this and made the right diagnosis of her gut, she was better in two to three months. As if this all wasn’t bad enough, there is another problem. Some integrative, alternative or functional medicine labs are flat out lying to you. One example, a very popular stool test, literally used dog poop to help establish their normative ranges for humans. This is likely why they were subject to an FBI investigation, went bankrupt and insiders from this company said the science was flawed from the start. This was for a test I had warned against for years, but sadly many people still used it. And this is not the only case. A neurotransmitter testing lab pled guilty to falsifying lab ranges in order to sell more supplements. What do you think happens when your doctor runs several inaccurate tests? A massive bill, treating labs instead of the patient leading to poor results (not feeling better) and fear that you have a diagnosis that you do not.

DrMR:

This was exemplified by another case study from our office, a Functional Medicine doctor wanted $18,000 for a nine-month care plan. Thankfully, this patient came to see us for a second opinion, and we were able to help her in three months for a fraction of the cost. At our office, it is important us to help prevent this from happening to you. We assume doctors are well-intentioned, but these practices need to be called out because they cost so much patient suffering. What’s important us is that we make the right diagnosis. You feel better as soon as possible. We don’t waste your money. We don’t make you feel broken, afraid of food or dependent upon supplements. You feel educated, empowered, and that we have worked together as a team. Finally, it’s important to us to publish science, to help guide and reform the field. And yes, our doctors have been and continue to publish in peer-reviewed medical journals. Our clinical focus is minimally invasive and predominately natural solutions for gut health and the myriad of symptoms caused by problems in the gut, thyroid and the gut/thyroid connection, and diet and lifestyle for optimum well-being. There are additional areas we are cautiously examining and exploring with our patients. These include mold and mycotoxins, mast cell activation and metal toxicity. If you’re in need of assistance and improving your health, I hope you will contact our office.

Episode Wrap-Up

DrMR:

Hi everyone. So the roundtable, I’m going to delay until our next podcast. We ended up going for a good solid hour, and I’m very excited for you guys to listen to that round table, because it’s just our reaffirmation of these concepts, but seen through the eyes of other clinicians and also some very insightful reflections and pearls from these gentlemen. So I’m very excited for you to listen to that. It really has something to offer for everyone from the practicing clinician to the layperson, just trying to figure out how to get a better handle on their health and/or how to use Functional Medicine. So I’ll pin the podcast here for now, and then next podcast that releases we’ll have that round table with Dr. Joe and Dr. Rob.

DrMR:

Okay. We will talk to you guys soon.

Outro:

Thanks for listening to Dr. Ruscio radio today. Check us out on iTunes and leave a review. Visit Dr. Ruscio.com to ask a question for an upcoming podcast, post comments for today’s show and sign up to receive weekly updates.


Sponsored Resources

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Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!