What's the deal with functional medicine?

By Nina Chhabra on May 10, 2019

Dr. Anita Sadaty is a Board Certified Obstetrician-Gynecologist in private practice at Redefining Health Medical in Roslyn, New York.  She is an Attending Physician at North Shore University Hospital, Northwell Health System in New York and is an Assistant Clinical Professor at Hofstra Medical School in Long Island, New York.  She attended medical school at Cornell University Medical College graduating with honors as a member of Alpha Omega Alpha Society in 1994 and completed her residency and role as Chief Resident at North Shore University Hospital in 1998.

Nina: What is functional medicine?

Dr. Sadaty: Functional Medicine provides individualized, personalized medical care that focuses on discovering the underlying factors that cause illness and uncomfortable symptoms.   We look to understand the root cause of disease and then treat the cause in order to remove the symptoms as opposed to alleviating symptoms without addressing the underlying problems.

Nina: Okay, so what does that mean to you?

Dr. Sadaty: Functional Medicine is avoiding a Band-Aid approach where we ONLY are trying to reduce the symptoms someone experiences. We ask, what is creating the expression of your symptoms?  Symptoms on their own do not show us where the imbalance exists. Symptoms are just related to how a person is expressing certain genes. It is a much more satisfying approach to figure out why this person has a problem and get rid of the problem.  There are many different reasons why a patient presents with certain symptoms. Some common causes are related to intestinal issues, or excessive toxin exposure from the environment, or a vitamin deficiency.

The other thing that I like about functional medicine is that it sees the patient as a whole and not a collection of separate and distinct parts.   As a functional medicine practitioner, I don’t focus on the gut or the ovary or the uterus or the skin. I look at the whole interactive system.  

Nina: Can you give us an example of how functional medicine can be applied to a patient who is always feeling fatigued?

Dr. Sadaty: Fatigue is very broad description of how a person feels and can be related to many imbalances. The four biggest underlying causes related to fatigue are underlying inflammation, abnormal stress hormone chemistry, sugar insulin imbalance, and usually some nutrient imbalances. A good starting point to find out why a person is constantly fatigued is to start with a comprehensive blood panel. I look for deficiencies in vitamins and minerals. I also check for adrenal and sex hormone imbalance. I always check fasting glucose and sugar insulin imbalance. I also look for inflammatory markers in blood work as well as a basic comprehensive liver and kidney screen.  Checking thyroid hormones is also very important as well as screening for autoimmune markers.

These lab results are a great starting point to help guide me in helping the patient.  Another big component of functional medicine is to look at a patient from infancy to their current state.  Important questions to ask about their history are how much antibiotic exposure did they get as a child? What did they grow up eating? How was their birth mother’s diet while in utero? We also focus on current diet and sleep behavior. Another important focus is physical and emotional stressors in life, and how much the person is exercising or how much they are physically moving.

Nina: How are supplements and functional medicine related?

Dr. Sadaty: The belief in functional medicine is that nutrition is always first. It is the first line of change. Food is a medicine. How do we eliminate inflammation and toxicity in food, and how to we include anti-inflammatory foods? We can’t always get the nutrition we need from food alone, and that’s when supplements can help. When I use vitamins and supplements, I try to use them surgically and with great precision.  We use supplements to speed up the healing process. By using supplements, we bring some symptomatic relief with far fewer side effects compared to drugs. There is a role for symptom relief for both pharmaceutical medicines and supplements, but supplements have far fewer side effects compared to using vitamins, minerals, and botanicals. Supplements are also not as aggressive as prescription medications. Your body can process vitamins and herbs better. This is certainly not to say prescription medications don’t have a place in therapy. I frequently prescribe prescription medications in addition to supplements.

Nina: Are there any supplements you would recommend to all patients?

Dr. Sadaty: YES! In the Northeast, most patients should be on vitamin d supplementation. Another favorite of mine is magnesium. It speaks to the depletion in our food. I find lots of people are magnesium depleted because it is used for liver detoxification and is a major component of energy production. These are functions that are always going on in the body, 24/7. We all need magnesium.  It is also beneficial for sleep, so I recommend to my patients to take it close to bedtime.

Fish oil is another great supplement for most people.  In our North American diet, I find most people are deficient in omega 3’s. There is an actual blood test that can check an omega index to show you how deficient you are. The reason why omega 3’s are so important is because they are critical for arresting the inflammatory response in the body. The rise of autoimmune disease is related to a rise in inflammation. Once you start an inflammatory pathway, can increase your risk for autoimmune disorders.  Supplementing with omega 3 fatty acids such as EPA and DHA can stop this inflammatory process. Our body cannot produce this, so we must get it from diet. Sources of natural omegas are not always safe. Omega 3’s most come from fish, but fish carry toxicities as well.  The source of the fish in these supplements is equally important to look for.  You never want to buy this supplement in bulk. The extraction process for these supplements is of utmost importance. Check the company to see the source of omega 3’s, and check the extraction process. Cold extraction is usually best.

Nina: If a person has a “healthy” diet, should they still consider adding supplements?

Dr. Sadaty: Healthy means many different things to different people. A diet for one person might not be appropriate for another. It really depends on the person's underlying genetics. Let’s assume a patient has a balanced, fortified diet that is ideal for their body’s nutritional needs. One of the major issues I often find is that despite diet, many things going on in their life at any given moment can create the need for more vitamin and mineral support. Your body’s need for vitamin C and amino acids tremendously increases when under stress. A patient may also have intestinal absorption issues they may not be aware of, which could lead to a recommendation for additional supplementation. If you are exposed to toxicity or chemicals, you may need to increase supplements for detoxification support.

Another thing we overlook is the way food itself is grown.  Many people do not know that soil used to grow our fruits and vegetables are often depleted of certain nutrients, so there could be a need for supplementation.

Certain medications also leech vitamins out of your system. For instance, patients on metformin or oral contraceptive pills often need supplementation with B vitamins. Zinc and folate are two other elements that are depleted by prescription medications.

Nina: What are some options for supplements for patients who have difficulty sleeping?

Dr. Sadaty: CBD can be very beneficial.  There are also herbal blends patients can use, such as valerian root, lavender, and hops. Magnesium is another great option. I like magnesium glycinate as it is gentle on the stomach, as magnesium can sometimes cause diarrhea or loose stools. Glycine and L-theanine are great amino acids that promote sleep. GABA, or gamma-aminobutyric acid, is also very beneficial.  It helps by regulating neurotransmitters in the brain. Melatonin is also recommended for sleep, but I don’t go usually there at all, unless there is a melatonin deficiency. It is a hormone, so you want to use it appropriately and for a reasonable amount of time. If there’s cortisol imbalance and you have high cortisol at night, your melatonin is usually low. It can be a good short term solution to use melatonin for these situations until we find the reason for the imbalance.

Nina: What are your thoughts on probiotics? Do you think there is a gut-brain connection?

Dr. Sadaty: Absolutely! Probiotics in general have so much data regarding their benefits.  There is definitely no harm in using probiotics to try to improve digestive issues.  They can also help those with depression and anxiety. Probiotics can be helpful in promoting sleep.  They may provide benefit for those suffering from recurrent urinary tract infections, yeast infections, and sinus infections. Anyone with inflammatory bowel disease can be pro-inflammatory, and could benefit from incorporating probiotics. However, if you have irritable bowel disease, the strain you should stay away from is saccharomyces boulardii as this can trigger flares.  Using probiotics for small intestine bacterial overgrowth, also known as SIBO, can make things worse. This is when you have an overgrowth of bacteria in your small intestine. It can actually cause more bloating and discomfort.

Certain probiotics can cause diarrhea or constipation, because keep in mind, it is changing your natural biome. Everyone does respond differently. There may be some experimentation in picking a probiotic. You may have to do some trial and error until you find the right fit.

Nina: Where can I learn more about functional medicine?

Dr. Sadaty: For patients, a good place to start is listening to podcasts. I recommend Dr. Michael Ruscio and Chris Kresser’s podcasts. You can also search online for Dr. Mercola. He has a great website. If practitioners would like to learn more, I recommend the institute for functional medicine as a great place start.

Nina: How can a patient find a functional medicine specialist near me?

Dr. Sadaty: Look at The Institute for Functional Medicine website.   There is training involved to become a functional medicine specialist. One thing to be aware of when looking for a functional medicine practitioner is to look for credentialing.  Not all functional medicine practitioners are medical doctors. The title of functional medicine practitioner does not necessarily refer to which type of medical provider you are. It could be a nurse practitioner, acupuncturist, or nutritionist.  It does not necessarily mean you are seeing a medical doctor. If you are looking to find an allopathic medical doctor, look at credentialing. You can click the link here: https://www.ifm.org/find-a-practitioner/ to find a practitioner near you.

To make an appointment with Dr. Anita Sadaty, visit her website here, https://www.drsadaty.com/, or call 516-801-1313.