From The Desk of Josh Gitalis

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I believe all practitioners are working with the best intentions to help their clients and patients resolve health challenges, prevent future ones, and ultimately improve overall quality of life. That being said, some are missing the mark, or making mistakes that are negatively impacting the results their clients and patients are getting. Understanding these five mistakes that functional medicine practitioners commonly make can serve as a guide to help you find an effective practitioner to work with.

Like any profession, the level of competency amongst practitioners varies greatly. An old joke illustrates this conundrum best. What do you call the guy who graduates at the bottom of his class from Medical School?” Answer: “Doctor”.

Unfortunately, we can’t ask practitioners for their report card, so it’s up to us to attempt to figure out who has the competency you’re looking for, and more so, who has the experience to best serve you.

In a recent report released by the Institute for Functional Medicine they found that on average, people have six diagnosis and over thirty symptoms. This isn’t something that can be addressed by one treatment (as we see with most allopathic interventions), or a slew of seemingly impressive testing. It is something that requires a comprehensive evaluation and multifaceted therapy regimen to address the root cause.

This is where a functional medicine practitioner can be helpful, as long as you choose the right one.

The following is a framework that will empower you to make informed decisions when choosing the right practitioner for your needs.

5 Mistakes Functional Medicine Practitioners Are Making 

1. Too Much Testing

When you go to the doctor for your annual check up, they will likely requisition some basic testing including a complete blood count, and possibly some others like TSH, blood sugar markers, serum ferritin, and vitamin B12, based on your specific history. These tests are mostly looking for end-stage imbalances.

For example, hemoglobin A1c (HbA1c), a marker of long-term (about 3 months) blood sugar levels, shows high readings after years of consuming high glycemic index and high glycemic load meals. Then one day, HbA1c comes back high, and you are declared as “pre-diabetic”.

There is a whole other world of testing called functional lab testing. With functional lab testing, practitioners are more interested in finding imbalances, rather than making a diagnoses. These tests can find imbalances years before symptoms appear. They often have the ability to detect issues where conventional lab testing falls short. For example, a blood fatty acids test can determine if someone is prone to inflammation, or even has silent inflammation. For a conventional lab test to detect this, inflammation would have to be pretty severe.

Yes, there is tremendous utility in these functional lab tests. However more testing and more results, doesn’t mean you are going to get better care and better results for your health.

An effective practitioner will first address the fundamentals. This is key, though often not as sexy as the fancy testing. Too often, people come to me with piles of test results, but have not addressed some key principles like practicing proper sleep hygiene, cleaning up their diet, integrating regular exercise or addressing stress levels.

Second, though test results can tell us a lot, they need to then be used to direct the protocol. Too many practitioners will give their clients the results, without taking effective action. This sounds surprising, but I’ll ask clients if they made any changes after doing this test or that one. The answer is often “no, my practitioner didn’t know what to do”, or “no, there wasn’t any follow-up after we received the results”, or “they just gave me some supplements”.  This is an unfortunate waste of time and money for all parties, and opportunity lost from good objective information.

Finally, when a proper history and evaluation is completed by the practitioner, they can often confidently determine imbalances without any testing. For example, if someone has a history of smoking, uses conventional cleaning products, doesn’t use clean skincare products, and eats non-organic food, why run a toxicity screen? They are surely going to have high levels of multiple chemicals, and a detoxification protocol would surely be beneficial.

[pullquote]”A functional lab test should only be run, if it’s going to change the clinical decisions.”[/pullquote]

Optimal Course Of Action: Before beginning a program with any practitioner, ask if they do any functional lab testing. If they do, ask them what determines if a test should be done, and how do they use the information gathered.

2. Lack of Follow-up

Habit modification is not easy. It’s simple, but not easy. The greatest changes come to those who have a solid foundation of the why behind the new habits they are adopting, coupled with repetition and refinement.

The job of a practitioner is to guide their clients on the path to change. To help get them back on track when they fall off, and troubleshoot issues with staying on track. This can’t be done with one session. The practitioner has to be accessible to the client for as many sessions as necessary to reach their health goals.

Consider the stages of change. They are pre-contemplation, contemplation, preparation, action maintenance, and transformation. Do you know how many people can successfully move through these stages from start to finish? It’s a mere 5%. Most people are going to cycle through these stages multiple times, and guidance is a key success factor through it all.

Optimal Course Of Action: Find out what kind of support you get as you’re going through the protocol. Is there a coach or practitoner that will follow up with or whom you can ask questions of? Is your practitioner available for serious concerns? Can you contact by phone or email? Must every follow-up be an in person appointment?  How long does it take to get an appointment or to hear back if you send an email? The answers to these questions should align with what you feel you need for success.

3. Doing the Right Things, But In The Wrong Order

I tell my students that you can do the rights things, but if you do them in the wrong order, you might not get the results you’re after.

Sometimes it is important to follow a specific sequence of treatments in order to both ensure the efficacy of your protocol, and to prevent any unwanted side-effects.

For example, if someone is about to undergo a detoxification protocol, and is experiencing constipation, they are setting themselves up for seriously uncomfortable side effects that may dissuade them from continuing. The bowel is one of the five channels of elimination. If it is not “open”, i.e. the person isn’t having regular bowel movements, then toxins that the body is trying to eliminate will go back into circulation. It’s analogous to vacuuming your home, without a vacuum bag in the machin– the dust just settles right back into your home.  Many people call this a “healing crisis”, but I just call it poor detox preparation.

Optimal Course Of Action: Find out if protocols are tailored to each individual. If a practitioner is doing a one-size-fits all type of protocol, then seek out someone else who understand personalization.

4. Relying  Too Heavily on Supplements

Supplements are powerful. In fact, I teach a whole course about their utility and how powerful they are as tools for healing.

That being said, I see people using them, and practitioners prescribing them, too often without addressing the root cause. In the field we often refer to this as carpet bombing — you know when you’re left taking a dozen supplements and aren’t quite sure why or what they’re for.

Consider someone who has spread their time too thin across all facets of their life. They are working long hours including weekends. They travel for work. They wake up early with an alarm to exercise. They drink coffee for energy. They forget to eat during the day because they’re so busy. They have one or more children at home they have to tend to. There are powerful nutrients and herbs that can support this stressed individual, however if they want to prevent a degradation of resilience leading to disease, they’re going to need to make major lifestyle changes. No supplement is going to replace the basic diet and lifestyle modifications that are essential if this person wishes to live and healthy, happy and long life.

Optimal Course Of Action: Find out from the practitioner how supplements are used and what their philosophy is on the topic. You want to find someone who understands that they are for the most part, temporary therapeutic tools. Optimally, they also don’t conveniently have stocked at full retail price every supplement being recommended. That might raise some alarm bells.

5. Failure To Address Diet

I recall a client who came to see me about her chronic yeast infections. She had been dealing with these for about twelve years. When I questioned her about what she had tried so far, she pulled out a pile of prescription pad scripts from her naturopath. As I read through them, I noticed that not once had there been any discussion about diet. It was supplement after supplement to try and kill off the yeast. My first step with her protocol was putting her on a strict anti-yeast diet, and after just one month she started to notice positive changes that she hadn’t been able to accomplish for twelve years.

Food can be a powerful healing tool, or, the cause of a disease. We eat daily for energy and sustenance, but food can also affect us in ways unrelated to their nutrient content. Our immune system can react to the food we eat inducing allergies or sensitivities. There are certain naturally occurring chemicals in food that people can be sensitive to like lectins, oxalates, phytates, goitrogens, and others. Processed foods often contain additives that can trigger a reaction, like sulphites and asthma, or food dyes and hyperactivity. Those with digestive imbalances such as small intestinal bacteria overgrowth (SIBO) might have issues with certain carbohydrates. Therefore diet must always be addressed for healing to occur.

Optimal Course Of Action: Inquire what the practitioner’s primary healing tools are. If diet modification is not one of the top three, then this is a red flag.

Important Questions To Ask Your Potential Practitioner

Here are a list of questions that you might want to ask a practitioner, before embarking in a therapeutic relationship. Feel free to use all of them or some of them.

  • Do you do functional lab testing, and if so, how do you decide when a test should be completed?
  • Once I begin working with you, how do I access you or a member of your team for questions along the way?
  • Do you create personalized protocols based on my unique needs, or do you have general programs you offer?
  • What areas do you address when working with clients (ie. diet, exercise, sleep, supplements)? And how do you determine the correct application of each?
  • Is it difficult to get an appointment with you once I have begun working with you?
  • What type of diet do you recommend?

My hope for you, is that if you seek out a practitioner to help you on your health journey, they can help you find what you are looking for.

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