Not officially recognized as a medical specialty by health authorities, functional medicine is nonetheless often the subject of discussion. What does it involve? Why is this practice not officially recognized?
What is Functional Medicine?
According to its proponents, functional medicine seeks to heal the body by addressing the root causes of a disease, rather than simply masking its symptoms with medications. The following analogy is often used: conventional medicine acts like a firefighter who extinguishes the fire (the symptoms), while functional medicine aims to understand why the fire started. On the Institute for Functional Medicine (IFM) website in the United States, functional medicine is defined notably by the inclusion of ingestive therapies. Here, the idea is to bring together Western medical science – drugs, surgery, etc. – and complementary therapies.
However, functional medicine is not officially recognized as a medical specialty by health authorities, notably in France where neither the Medical Board nor the universities grant official diplomas in this discipline. But why this lack of recognition?
What complementary therapies?
The central therapy of functional medicine concerns therapeutic nutrition and micronutrition. This may involve temporarily removing certain foods from daily life, for example gluten, dairy products or products containing short-chain carbohydrates (FODMAPs). It can also involve taking supplements such as amino acids and omega-3 fatty acids, or even plant extracts like berberine.
Other complementary therapies fall within the scope of functional medicine. For example, mind‑body therapies such as medical hypnosis or mindfulness meditation, as well as manual and physical therapies like osteopathy, chiropractic, and other therapeutic massages. There is also the use of environmental medicine and detoxification, for instance through hepatic support protocols and coaching.
These different therapies have multiple goals, namely to reactivate cellular or mitochondrial functions, calm intestinal inflammation, stimulate immunity, reduce cortisol (the stress hormone) or regulate blood glucose. They may also aim to regulate the autonomic nervous system, ease digestive pains related to irritable bowel syndrome, or restore tissue mobility and optimize fluid circulation.
What criticisms are directed at this discipline?
The Institute for Functional Medicine (IFM) offers a certification program involving more than a hundred hours of continuing medical education. However, it should be noted that this program comes in two versions: medical and professional – without prescription of medications. The first can therefore concern doctors, nurses, dentists and pharmacists, while the second is more aimed at psychologists, nutritionists (and dietitians), physiotherapists (and osteopaths) and other naturopaths.
Conventional medicine relies on the scientific method known as Evidence-Based Medicine, i.e., evidence-based. Yet functional medicine lacks robust randomized controlled trials to validate the overall effectiveness of its protocols. There is also a risk of over-diagnosis and over-treatment – notably through the widespread use of biological tests not academically validated – which can lead to false positives and therefore to the overconsumption of dietary supplements.
Finally, the IFM and its non-degree private trainings allow various professionals to claim to be practitioners of functional medicine. Yet this totally falls within regulatory ambiguity, potentially exposing patients to financial abuses or to advice contrary to science.
