Is Dr Fionnula McHale the future of medical care? 'I make healthy people healthier with functional medicine'
Through a systems-based approach, Dr Fionnula McHale treats patients by assessing their lifestyle over a period of time, and getting to the root of the problem rather than prescribing a quick-fix. Could this be the future of our medical care?
Being healthy in the 21st century is not just about avoiding disease. While we clearly don't want to get sick, a healthy lifestyle also means the active pursuit of wellness. As defined by the World Health Organization, this is "a state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity".
We want to be our best-possible healthy selves and we're willing to do what we can to make that happen, whether that's through working at lowering our stress levels, being mindful or following particular dietary plans.
For Dr Fionnula McHale, whose Invigorate Clinic is based in Artane, Dublin, functional medicine is the healthiest way forward for a better way of living. It's a system-based approach, which looks at a patient's lifestyle and habits overall, and is guided by trying to prevent lifestyle-related chronic diseases. It is concerned with picking up early warning signs, as opposed to providing treatment for urgent medical conditions.
Considered to be an integrative method, functional medicine uses laboratory testing as well as careful assessment of a patient's history to work out what is causing his or her condition.
You wouldn't turn to a functional medicine if you've been struck down with pneumonia, for example. But if you're suffering from symptoms like low energy, anxiety disorders, stubborn body fat or poor sleep, and going through the typical medical channels hasn't provided any answers, functional medicine could be the answer for you.
"What I do is make healthy people healthier," Dr McHale says.
The Galway-native studied medicine at Trinity College Dublin, graduating in 2010, and went on to work in a variety of fields, including orthopaedic surgery, endocrinology and gastroenterology. Her interest in functional medicine developed because of personal health issues, which didn't respond to standard medical treatments.
"I just had to take my health into my own hands and through doing my own research, I came across functional medicine," she says.
"It was frustrating to be studying something [medicine] that isn't much help to what I wanted to be able to do. Medicine is more disease-focussed than wanting to make people healthier.
"I was always into nutrition and fitness, so functional medicine just tied in really well in terms of reducing the need for medication. Also, to be able to work with athletes and sports performance is also something I always wanted to do."
She applied the principles of functional medicine to her own lifestyle in college and found it brought a dramatic improvement to her wellbeing.
After studying with Institute of Functional Medicine, Dr McHale opened the Invigorate Clinic in 2012; her current client base has built up primarily through word-of-mouth and includes the mixed martial artist, Conor McGregor.
While functional medicine may not be familiar to many people yet - there are a handful of practitioners in Ireland - it has become increasingly popular in the US and UK.
"The general public don't know a lot about it, and maybe it's the younger generation who are coming across it a lot more and I guess taking health into their own hands, because they're becoming frustrated with the current medical system," Dr McHale says.
"They're becoming frustrated with going to the GP and just being put on a pile of medication and sitting there for 10 minutes without anyone figuring out what their problem is in the first place.
"Now, I completely understand how GP practices work and they're phenomenally busy and there are a lot of sick people. My practice is more for the person who is chronically unwell, as opposed to someone is acutely sick with an infection.
"Obviously, they can go to the GP and get an antibiotic and they're fine.
"My approach is that if someone has been to the GP five times with the same infection over the course of a year, I need to figure out why are they getting those infections."
There have been criticisms of functional medicine as being pseudo-scientific, something Dr McHale disagrees with.
"People are always going to have those comments about anything that's new or that's different. In the past, maybe it was a little bit all over the place. Now we have tests that back up everything that we do and access to all the diagnostic testing.
"I do follow-up tests, so if someone has a hormonal balance and I intervene with supplements and diets, I retest again and see improvements and markers. You can't argue with that," she says.
She also points to the fact this is individualised medicine.
"Research that's published is based on large groups of people, so it can often be hard to do research around functional medicine because every case is slightly different and every case has a different story and every person has a different genetic make up, so you have to rely a lot on individual case studies."
What functional medicine is all about is optimising health. "There are people who are walking around and their energy levels are six out of 10, and I make them a 10 out of 10, improving things like sleep, energy, bowel health, mood - all of those things you can always optimise," she says.
Optimum health, for her, means sleeping well, waking up and feeling good and generally being able to do all the things that you want to do, like being able to get up and go to the gym in the morning if you feel like it, and staying alert in work all day and not crashing at 3pm.
"Obviously, there's going to be a different definition for every person. If you're a person who comes to me with a low mood, optimising for them means getting them to feel a little bit happier," she says.
"Is it someone with anxiety and you want to get him or her to react more calmly in stressful situations? Or is it an athlete and optimises recovery so that they can train more?"
Her belief is that everybody can achieve optimum health and the only difference is how long it is going to take someone to get to that state of being.
"It's always a journey and it's not fast. I'm not going to give you a supplement and you'll feel great in two days, that's not going to happen. It takes time," she says, adding that most of her clients see improvements within three months, but it very much depends on the case and what she wants to achieve. There are different aspects to what she does, from working with athletes to optimise sports requirements.
She helps people who want to reduce body fat and increase lean muscle. She enables business executives to become 'corporate athletes' and helps them to improve cognitive function and, hence, function at their job at a much higher level. This is done by maximising things like sleep and energy and looking at their training and nutrition.
"You also have people with mood disorders - anxiety and depression being massive ones - and you can get great success with food, which is fantastic," she said.
"Then you'll have people with IBS (irritable bowel syndrome), and again, you can get great results with those clients, as well as women with hormonal disorders such as females with period irregularities, and skin disorders, a variety of those chronic conditions.
"Fatigue disorders are also common too."
An important part of the approach is going through a patient's timeline and medical history. "It's really figuring out where they're at, what their symptoms are and what brought them to me in the first place, and what I can do for them," she says.
"But it's also their story and their situation in context. What was going on at the time, when they were in school or in college? Were they bullied in college, did they take recreational drugs or was there a lot of stress and how did they cope with stress at the time? Were they on antibiotics at the time, did they have surgery? All these things lead up to where that patient is at the moment."
Medical details such as bowel habits, energy levels, sleep patterns and, for females, menstruation, also tells her a huge amount about the patient.
A key part of the process involves employing different testing methods, to determine what exactly is going on in a patient's body, something a standard GP test can't do, including genetics (costs for this particular testing can run up to €2,000), hormones, thyroid and more.
However, with functional medicine, there is no one-size-fits-all treatment.
"It's very much individualised," Dr McHale says. "Even if I do a test and I find the same results in two people, my approach in treating that patient may be completely different because I will have spent a lot of time with that patient trying to figure out their story, their personality, so I know what kind of strategy is going to work for them.
"Somebody might want a really rigid nutrition plan; someone else might just want a list of foods that they can eat and they put it together themselves. It's not just a 10-minute, 'Oh I have a cold so here's an antibiotic'."
Ideally, she'd like to bring the functional medicine message to a wider audience and is in the process of getting more staff at the clinic.
"I'd like to be able to reduce the fees [an initial consultation is €225 while testing fees are generally €250-€750] so that it is more accessible to people," she says. "And I'd love to educate more people about functional medicine. The clinic is one-on-one, but I'd like to give seminars and help a lot of people at the same time."
Dr McHale usually asks clients how do they feel most days, on a scale of one to 10. Most people usually say three out of 10.
"That's not normal," she points out. "People just have so much going on that maybe they just don't have time to stop and reflect, or other people around them are feeling the same.
"It's been said that you're the average of the five people you hang around with and that's very true. If everyone else around you is feeling awful, that becomes normal - everyone on my team is feeling wrecked, everyone is getting fatter - so that's normal.
"That's something I can relate to because I was really obese as a kid and that's what used to go through my head - 'Oh, it's fine because all my friends are fat as well'. Now, I can see from the other side where all of my friends are fit and healthy and I just accept that is just the people that I hang around with now.
"It comes back to mindset as well. Healthy people tend to have a more positive mindset and outlook on life."
Dr McHale's tips for better living
Awareness is key to how you feel. Try to understand what 'normal' is. Normal is Homer Simpson and nobody really wants to be Homer Simpson.
Making sure you get 8 hours sleep a day is always good. The quality of sleep is important and making sure you actually sleep through the night.
Eat more vegetables. Everyone needs more green vegetables: more broccoli, more cauliflower, more kale, watercress, rocket. If people could eat a hundred grams of those with every meal of the day, they'd probably do pretty well. Too much protein is bad and too much carbohydrate is bad but if there's one thing that nutritionists agree on, it's that we should eat more veg.
Get plenty of healthy fats in the form of avocados and nuts but don't go overboard.
Reduce the simple sugars. We all like a treat every now and again - I certainly do - but do everything in moderation and appropriate to your needs.
6 core principles of functional medicine
1. An understanding of the biochemical individuality of each human being, based on the concepts of
genetic and environmental uniqueness.
2. Awareness of the evidence that supports a patient-centered rather than a disease-centered approach to treatment.
3. Search for a dynamic balance in the internal & external body, mind, and spirit.
4. Interconnections of internal physiological factors.
5. Identification of health as a positive vitality, not merely the absence of disease, and emphasising those factors that encourage the enhancement of a vigorous physiology.
6. Promotion of organ reserve as the means to enhance the health span, not just the life span, of each patient.
Health & Living