Many functional medicine doctors have taken to calling themselves “medical detectives.” It’s true, in a way, as learning functional medicine brings someone in contact with many ideas that are overlooked or dismissed in conventional medical training. After learning that conventional medicine doesn’t have the tools to help you feel better, it can be wonderful finally meeting a functional medicine doctor who is brimming with theories of why you may be sick.
The downside to the theories comes when your integrative doctor quickly recommends a huge number of tests so that they can investigate the root cause of why you are sick. You may be asked to spend thousands of dollars on testing, sometimes even before they’ve spoken to you or read your records.
I often wonder if this lab heavy approach comes from watching too many episodes of medical dramas, where the brilliant physician orders test after test and finally finds the answer why his patient is sick.
These shows work because in a TV fiction we’re okay with letting a lot of things slide. After all, It takes the fun out of it if we start asking questions like: Wait, isn’t that blood test falsely positive 40% of the time? Does that patient really need another spinal tap? How does some hospital lab have a test that has only been done in a research center? The big assumption we are willing to overlook while House does his detective work is that all of the tests generate meaningful results.
Unfortunately, back in the real world, not all tests are created equal. After practicing functional medicine for a decade, I can tell you with certainty that many tests in functional medicine rely on a whole lot of subjectivity, and others are just about as accurate as reading tea leaves or flipping tarot cards. Newer doesn’t always mean better. More expensive doesn’t mean more accurate. The truth is that too many detectives are using faulty decoder rings and cracked magnifying glasses.
So what do you do if the tests themselves are unreliable? How can you heal?
The answer is that we move right to treatment. You see, the best doctors are still detectives, but they make a different kind of list - a line up of the treatments that are most likely to help. Instead of wasting time theorizing about causes, speculating whether it is a chronic viral infection, or nutrient deficiency or genetic problem, they go right to the main suspects - the tried and true remedies that reduce symptoms. And the particularly savvy detective skips right to interrogation.
Here’s what I mean. Over the years, I’ve learned that many symptoms are the result of problems in a patient’s microbiome. So instead of ordering stool tests that may not be completely accurate, I want to bring the suspect in for questioning right away. As a result many patients' initial treatment plan will start with some combination of fasting, a low FODMAP diet, probiotics or even herbal therapies - all treatments that help kill off problematic bacteria and rebalance the microbiome. Most of the time they feel remarkably better in a short period of time. The suspect cracked under all that pressure and confessed. Case closed.
Other patients may come in complaining of feeling cold all the time, perhaps with fatigue and terrible brain fog. More often than not they’ve been given various combinations of thyroid hormone by previous doctors, but still have symptoms. Instead of ordering yet another round of unreliable thyroid markers, we simply deduce that the thyroid is not the culprit, and line up a more likely suspect. I observe that as a result of becoming chronically ill many people have slowly lost muscle and become deconditioned, and so I may ask my patient to start gentle resistance training perhaps 20 minutes of strength training twice a week. If I am correct that their cold intolerance is not the result of hypothyroidism but rather due to insufficient skeletal muscle then they will notice improvement. If something else was missed they will still feel cold. The treatment is the test.
A final example may be a diabetic patient who comes in with abnormalities in their blood sugar. When faced with this scenario many testing- first detectives will order a battery of tests and then use the bloodwork to justify a large variety of supplements, micronutrients like chromium or vanadium or other nutraceuticals like berberine and alpha lipoic acid - all of which have some evidence that they alter the body’s response to insulin. Unfortunately, these tools rarely work. The case has gone cold. However, with the knowledge that diets high in carbs and processed foods are the frequent criminals, in my office we bring these suspects straight to the interrogation cell for a round of a minimally processed, low carb or ketogenic diet.
One benefit of this approach is that if I am wrong, my patient still comes out ahead - in a few weeks their gut will be healthier or they will be stronger in a few weeks and better able to tackle what comes next. When a doctor who orders thousands of dollars of tests is wrong, then you waste your time and money. Unfortunately, I see many patients who have wasted years of their life chasing an incorrect theory due to misleading testing. They’ve been banging their head against the wall again and again trying to optimize thyroid labs, or trying to perfect their stool test. They deserve a different tactic.
“Probiotics and IBS” 2003-2020. 456 results
There is one last reason why it is so important to turn away from testing-first detective agencies. They have access to better evidence to help them make decisions. If you go to PUBMED, a medical literature database and enter “probiotics and IBS” over the last twenty years you get 456 studies. However, the terms “stool test and IBS” returns only 46, ten times fewer studies. Treatment-first detectives get to play with a stacked deck, they’re simply more likely to be able help you.
Using treatments as the test should be the standard of care. Rather than trying to guess why your TGFb1 is high, or what a grouping of organic acids mean, or if that marker on a stool test means anything or not treatments can be objectively tested. The simple approach of starting with the treatments that are most likely to work and moving down the list, (reserving testing for times where patients aren’t responding to treatments) a good detective can save you time and money.
If you are looking for a doctorthat can help you find the treatments that are most likely to help, then schedule an appointment today.