Categories Expert Series

The State of Functional Medicine 2020: Insights From Dr. Adrienne Carmack

3X4’s new State of Functional Medicine series features interviews with a diverse range of active practitioners and established thought leaders to learn more about why they chose the field of functional medicine, what excites them most about their work, the most common misconceptions they hear from patients, and most importantly — how they see the field evolving in the years ahead as healthcare shifts to be more personalized, proactive, and preventative. 

Functional medicine practitioners play a key role in helping patients understand who they are so they can improve their quality of life which is what we’re all about here at 3X4. Our goal with this new series is to celebrate the work these practitioners are doing and inspire others to explore the exciting field of functional medicine.

The following is an interview we have recently had with Dr. Adrienne Carmack, Medical Director at Integrative Health Matters

Why did you decide to make functional medicine your focus?

Dr. Adrienne Carmack: As a urologist, I often saw patients with complex issues that were affected by their diets, lifestyles, and other medical conditions. Although the drugs and surgical options we have in urology these days are tremendous, there are many situations in which a more holistic approach is needed. Functional medicine gave me a way to help these patients.

As an example, a very common issue is overactive bladder. We have multiple pharmaceuticals developed for this, which do work very well but unfortunately also often have significant side effects—so much so that many of these drugs actually carry black box warnings from the FDA. I have found that helping patients with elimination diets and improving their bowel habits results in a cure of a significant number of cases of overactive bladder. Though this does not eliminate the need for medications or other treatments, it does minimize that need and allow many more patients to truly be well. The beauty of a functional medicine approach is that what works for one system undoubtedly also leads to health for other systems and thus a greater expectation of long-term wellness, while more reductionistic approaches often help just one symptom at the expense of others.

What excites you most about the field of functional medicine?

Dr. Adrienne Carmack: As the knowledge of genetics and the impact of the microbiome on health rises rapidly, I am more and more eager to see how much we can do with it. Currently, I love to use our biochemistry knowledge, such as by measuring the Kreb cycle and nutrient metabolites, to guide supplement choices and see quick recoveries in my patients. The early 20th century was such a boon for our understanding of nutrients and their impact on health, and yet that plays very little role in conventional medical practices. Getting back to this knowledge and incorporating it with our more modern technology and understanding truly yields better results with our patients in the short-term, as well as promoting longer-term health with fewer side effects from treatment. Advances in our understanding of genetics and the microbiome will undoubtedly add even further to this knowledge base and allow us to guide patients to the lives they are capable of experiencing, when the right foundations are in place.

What’s the most challenging part of your day to day work?

Dr. Adrienne Carmack:Financial limitations are clearly the most challenging part of functional medicine. In the United States, we haven’t yet found a way to incorporate a comprehensive look at diet, lifestyle, nutrient needs, genetics, gut health, and more into a patient’s care. This often leaves us making choices based on cost, even in those with great insurance. When I practiced in a conventional, insurance-based system, I had many frustrations. For example, when the new SGLT2 inhibitors became widely available, I often saw patients experiencing urinary symptoms from these medications. However, if I referred them for dietary counseling to help improve their diabetes so that they could stop the medications, the referral was often denied by insurance because they did not have end-stage complications of diabetes. And, further, another frustration is that the dietary counseling given in the conventional system unfortunately doesn’t keep up with the latest research and knowledge of how to best help patients, following the outdated food guide pyramid. As well, many now disproven myths, such as that egg consumption is a common contributor to high cholesterol, still persist despite countless data to the contrary.

What do patients most commonly get wrong about functional medicine?

Dr. Adrienne Carmack: Many patients and practitioners still view functional medicine through the reductionistic lens of more conventional medicine, ie, we make a diagnosis, we give you a pill, you get better. Functional medicine is fundamentally different in that it is about relationships, and thus a holistic view is needed. Functional medicine is about identifying who you are as a person, using multiple tools, and helping you uncover the sustainable practices that keep you at your prime. It is not simply using supplements instead of pharmaceuticals; in fact, it is not about avoiding pharmaceuticals or more conventional medicine at all. It is about restoring and maintaining health using all of the tools we have. Maintaining health often requires a readjustment of diet and lifestyle, and patients must remember that if they stop doing what they were doing when they felt well, they very well may feel poorly again. Functional medicine is an exploration of who you are and the balance you need to be well.

What has your experience been with offering genetic testing to patients?

Dr. Adrienne Carmack: Genetic testing is something I use routinely. I’ve used the free genomics reports out there, as well as paid ones. Of the free ones, I’ve found Pure Encapsulations Pure Genomics the easiest to use, and there are many actionable items on the report. I first run the genome through 23andMe, both to get the raw data for Pure Genomics and to see the patient’s APOE4 and celiac risk gene status (on 23andMe’s Health Report). I’ve also used paid tests such as Genomind, which have allowed actionable insight but have proven cost-prohibitive in a cash practice and are somewhat limited in their scope compared to 23andMe. Given that we don’t prescribe many pharmaceuticals in our practice, Pure Genomics run off of 23andMe data has been the most reliable, though we are constantly evaluating other products and eager to offer even more. Overall, my primary goal with genetics is to help patients know what practices they will likely need to continue to stay well beyond those we implement to resolve current health challenges.

How do you see the practice of functional medicine evolving in the years ahead?

Dr. Adrienne Carmack: The understanding of genomics and the microbiome hold great promise for solving issues we haven’t been able to solve before. I imagine that in the future, we may be able to highlight optimal diet and supplement regimens for patients from the very beginning, rather than running through elimination diets first. We will be able to better guide patients with chronic illnesses on potential therapeutic options. And, of course, we will better be able to guide prevention efforts and individualized plans for optimal wellness. I like to imagine a day when we will receive a genetics panel on a patient listing unique recommendations for their health, with custom meal plans and supplement packages. I also imagine the field of fecal microbial transplant will expand such that we will have the ability to customize a microbial load to inoculate a patient with what he or she needs to restore balance in the gastrointestinal and other systems. My great hope is that as more and more people experience wellness using functional medicine approaches, our entire culture will become healthier, and we will see far less of a chronic disease burden due to the commonly encouraged unhealthy practices in our society.

About Dr. Adrienne Carmack:

Dr. Adrienne Carmack, MD, IFMCP earned her MD with honors from the Texas A&M University College of Medicine in 2002. She trained in general surgery at Vanderbilt University Medical Center and completed her urology residency at Jackson Memorial Hospital and the University of Miami. After 15 years of urology training and practice, she became an Institute for Functional Medicine Certified Practitioner in 2017.

Soon after she entered private practice, she began to see patients with more complex, chronic problems; problems that didn’t show up at major university centers and that often weren’t effectively treated. Her search of the medical literature revealed that there were many well-researched integrative healthcare options that truly maximized the ability to honor Hippocrates’ guidance to “First do no harm.” This led her down a path of integrative medicine, which she has been studying ever since.