Functional medicine in Raleigh and the Triangle: what it is and how to choose

If you live in Raleigh, Durham, Chapel Hill or Cary and you have searched for "functional medicine," there is a good chance you are tired of hearing that your labs are normal while you still do not feel well. That is a fair reason to look for a different kind of visit. It is also a reason to be careful, because the name is used loosely and the offers vary a lot.

This guide explains what functional medicine is, how it differs from naturopathic care, what the research shows, what a first visit looks like, and what to ask before you book anything in the Triangle. It is written to help you choose, not to sell you a particular path.

What is functional medicine?

Functional medicine is an approach that looks for the underlying reasons a long-running health problem started. Cleveland Clinic's program lists genetics along with poor nutrition, stress, exposure to toxins, allergens and impaired gut health, and it plans changes in nutrition, exercise, sleep and mental and emotional health.¹ NCCIH notes that the term is used in more than one way, and different practices may use it differently.²

Cleveland Clinic, which runs a functional medicine center, describes it as a patient-centered, food-first approach to chronic disease. The program says it tries to answer the question "Why are you ill?" and then builds a plan that covers nutrition, exercise, sleep, and mental and emotional health.¹ The same page says the team collaborates with conventional medicine clinicians and does not replace them.¹

The National Center for Complementary and Integrative Health (NCCIH), part of the NIH, adds an important caution about the name. It says "functional medicine" sometimes means something similar to integrative health, which brings conventional and complementary approaches together in a coordinated way. It can also describe an approach that more closely resembles naturopathy.² So two practices that both say "functional medicine" may not do the same thing. That is the first thing to ask about.

How is functional medicine different from a naturopathic doctor?

Functional medicine is an approach. "Naturopathic doctor" is a training and a title. A naturopathic doctor completes graduate-level education at a naturopathic medical school, typically a four-year program at a school accredited by the Council on Naturopathic Medical Education.⁴

The Association of Accredited Naturopathic Medical Colleges (AANMC) describes four-year, doctoral-level programs. The first two years focus on the foundational biomedical and clinical sciences, and for at least the final two years students work in clinical settings under close supervision.⁹ Naturopathic care draws on dietary and lifestyle changes, stress reduction, and herbs and supplements, among other approaches.⁴

The overlap is real. Both a functional medicine practice and a naturopathic doctor will likely ask about your food, sleep, stress and daily life. The difference is that the first is a way of working and the second is a defined course of training. Because the term is used more than one way, the useful question is always the same: what is your training, and what will you actually do with me?

For a longer side-by-side, see naturopath vs functional medicine.

What does the research say about functional medicine?

The research is limited. One study from Cleveland Clinic is observational: it compared patients at its functional medicine center with matched patients at a Cleveland Clinic family health center, and a design like that cannot show that the approach caused any change.³

The study drew on 7,252 patients, and the 6-month comparison used 398 matched pairs. At 6 months, the functional medicine patients reported larger improvements in self-rated physical health than the matched comparison group: an average gain of 1.59 points versus 0.33 on a 0 to 100 scale, where the authors regard a change of 5 or more points as meaningful. At 12 months their improvement was similar to what it had been at 6 months, but the difference from the comparison group was not significant.³ The authors noted that patients who choose the functional medicine center may be more motivated to change, which could explain part of the result, and they said prospective studies are warranted to confirm the findings.³

What can you take from that? The group that chose this center rated their physical health somewhat higher at 6 months, and the study design cannot say why. It is not a reason to believe any practice that promises a result. Be most cautious with anyone who says one product does it all or who promises quick fixes. The FDA lists both among its tip-offs to health fraud.¹⁰

What happens at a first visit?

Expect a visit that starts with your history and your daily life. Cleveland Clinic and Duke Health both describe a questionnaire before the first visit, and a physical exam and lab tests where they are needed.¹⁶

Here is what two large organizations describe, so you have a reference point:

• Cleveland Clinic's functional medicine center. Clinicians gather your medical history and connect it to your context of living. They ask about lifestyle, family history and environmental exposures, and blood work may be drawn on the first day. The first appointment is a one-on-one visit with a clinician on the team.¹
• Duke Health's integrative medicine consultation. The visit lasts an hour and includes a comprehensive review of your health, after a detailed questionnaire. The provider asks about eating habits, sleep, daily stress, exposure to toxins and how active you are, does a physical exam, and orders labs or imaging when needed. You leave with a plan to share with your primary care doctor or to follow on your own.⁶

At Ecology of Health, the first step is a free 20-minute conversation, and the free Garden Check-in is a three-minute way to see which part of your daily life to look at first. If you want to know what a longer visit covers, read about a naturopathic consultation. Dr. Werness looks at five parts of daily life: Soil (food), Roots (stress), Rhythm (sleep and energy), Ground (time outside and movement) and Circle (the people around you). He works alongside your own doctor, never asks anyone to stop a medicine, and starts with one change, not ten.

What questions should you ask before booking in Raleigh?

Ask who will see you, what their training is, how they work with your doctor, what the visit costs and what is billed separately. NCCIH advises you to learn about a practitioner's education, training and certifications, to find out whether they are willing to work with your other health care providers, and to ask about their experience with your condition.⁵

Use this as a checklist when you call any practice in Raleigh, Durham, Chapel Hill or Cary:

1. What do you mean by functional medicine? The term has no single definition, so ask them to describe it in plain words.²
2. What is your training, and who will I see? Ask about education, training and certifications.⁵
3. Will you work with my own doctor? Ask whether they are willing to work together with your doctor.⁵
4. Have you worked with people who have my condition? Explain all your health conditions up front.⁵
5. What will the first visit include, how long is it, and what will it cost? Ask whether lab tests, follow-up visits and supplements are billed separately.
6. Which tests will you order, and why? A good answer connects each test to a question about you, not to a standard panel for everyone.
7. Do you sell supplements, and do you tell me to take them? Supplements are not reviewed by the FDA for safety and effectiveness before they are sold. "Natural" does not always mean "safe," and supplements can interact with medicines.⁸ Ask your doctor or pharmacist before you start one, especially if you take medicines.
8. Will you ever ask me to stop a medicine? The right answer is no. Any change to a prescribed medicine is a decision for the doctor who prescribed it.
9. What do you promise? Be wary of promised results, quick fixes, success stories offered in place of evidence and claims that one product does it all.¹⁰

If a practice cannot answer these questions plainly, that tells you something.

Is functional medicine covered by insurance?

Coverage varies, so do not assume it. NCCIH says not to assume your insurance will cover a complementary health practitioner's services, and to call your insurer to confirm, since plans differ and coverage may have restrictions.⁵

Some of the confusion comes from how practices bill. Duke Health, for example, says its integrative medicine consultations are considered specialty visits and are typically covered by insurance with a specialty copay, and that the service requires a current primary care doctor to partner with its providers.⁷ That is how one academic center describes its own consultations. It is not a rule for every practice in the Triangle.

Before you book anywhere, including with us, ask these questions: Is the visit billed to insurance, or is it a direct payment? Are lab tests and follow-ups billed separately? What are the fees for each? Write down the answers. You can ask Dr. Werness's office about fees and coverage on the free first conversation, and you do not owe anything for it.

How does a naturopathic doctor fit in Raleigh, Durham, Chapel Hill and Cary?

A naturopathic doctor can be the person who looks at the whole of your daily life with you, while your own doctor stays in charge of tests and medicines. NCCIH describes integrative health as bringing conventional and complementary approaches together in a coordinated way.²

That is how Dr. Werness works. He is a naturopathic doctor who trained at Bastyr University, and he has spent more than thirty years in natural medicine. He is based near Durham and works with people across the Triangle, including Raleigh, Chapel Hill and Cary, and by video. The goal is to find a few small, realistic changes you can keep.

You do not have to choose between a naturopathic doctor and your own doctor. If you are comparing options, you may also find these helpful: how to find a naturopath in Raleigh and nutritionist, dietitian or naturopathic doctor in Raleigh.

When should you see your own doctor first?

See your own doctor first if a symptom is new, severe, getting worse or has no clear cause. A wellness plan, functional or otherwise, should not stand in for a check on something that could be serious. NCCIH advises against using an unproven approach in place of conventional care or as a reason to delay seeing your provider.¹¹

Call your doctor if:

• You are tired all the time and it has gone on for more than a few days, it makes daily tasks hard, it started suddenly, or you cannot identify a clear cause.¹²
• You are losing weight without trying. Cleveland Clinic says to always see a healthcare provider if you lose weight without trying.¹³
• Something has changed that you cannot explain, and it is getting in the way of work, sleep or relationships.

Cleveland Clinic says to get immediate medical attention if fatigue comes with shortness of breath, or chest, arm or upper back pain, a heartbeat that is unusually fast, slow, pounding or irregular, a headache or vision changes, or abdominal pain.¹² In an emergency, call 911. It also lists thoughts of harming yourself or others among those signs.¹² If that is you, call 911, or call or text 988, the Suicide and Crisis Lifeline.

Share this article with your doctor if it helps. It is general education, not a replacement for your own doctor's advice.

Where to start

If you are unsure where to begin, take the free Garden Check-in. It asks seven plain questions, takes about three minutes and keeps your answers in your browser unless you choose to send them. If you would rather talk, you can book a free 20-minute conversation with Dr. Werness. Neither one asks you to stop anything you are doing or to change your medicines.