Patrick Hanaway is a functional medicine family physician and educator. For more than 25 years, he has maintained a clinical practice with his wife, Dr. Lisa Lichtig, in Western North Carolina. He is board-certified in family medicine and is a Fellow of the American Academy of Family Practice, as well as the American College of Nutrition.

Hanaway served as chief medical officer at Genova Diagnostics for 10 years before becoming the chief medical education officer at The Institute for Functional Medicine (IFM) in 2013, where he oversaw the development and implementation of IFM programs worldwide. He has taught at the Institute since 2005 and has led the IFM Gastrointestinal (GI) Advanced Practice Module since its inception. In 2014, Hanaway helped establish the Cleveland Clinic Center for Functional Medicine, where he was the founding medical director and later research director. He was honored by IFM with the prestigious Linus Pauling Award in 2017 for his pioneering work.

Hanaway has been initiated as a Mara’akame (traditional healer) by the Huichol people of the Sierra Madres, in Mexico. He holds community fires, leads ceremonies and offers traditional healing sessions around the fire. He serves as the board chair of the Blue Deer Center, in the Catskill mountains of New York.

This month, Hanaway begins his newest role as chief medical officer of KnoWEwell, P.B.C., a digital community and marketplace that bridges the knowledge, access and insurance gaps to address the root causes of chronic disease. KnoWEwell owns Natural Awakenings Publishing Corporation, operator of the Natural Awakenings magazine franchise system.

 

Could you explain how the patient-doctor relationship differs in conventional versus functional medicine settings?

Functional medicine focuses on the individual, rather than a diagnosis, aiming to understand their life story in relation to wellness and illness. We seek to identify unique triggers and rebalance the imbalances, rather than just eliminating disease symptoms. The goal is to help the person be the healthiest they can be, in balance—body, mind and spirit—which is different than the conventional medical model that targets specific symptoms.

 

What advice can you provide for individuals that cannot afford or find a functional medicine doctor in their area?

We have a limited number of functional medicine practitioners. Because there’s such an interest for them, they charge higher prices because that’s the way that supply and demand works. In the setting of financial need, I recommend working with a functional medicine coach from the Integrative Nurse Coach Academy or the Functional Medicine Coaching Academy to initiate the basic lifestyle and behavior changes that are necessary to move toward health. Then they can help determine if there needs to be additional medical care, which might include specialty testing, supplements or targeted medication under the guidance of a functional medicine doctor. This would be a more economical approach to health improvement.

 

In your research, what did you discover about the outcomes and economic benefits of functional medicine?

Insurance companies are not so interested in better outcomes and decreasing costs because that’s not where they make their money. The incentives are such that the sicker a person is, the better the insurance companies do, which seems a little counterintuitive, but that’s how it works.

It has been my premise since I was in medical school in the mid-1980s that good care—whether we call it integrative, functional, holistic or regenerative—will lead to better outcomes and decreased costs. When I was at the Cleveland Clinic, we had the opportunity to look at patient-reported outcome measures across their entire healthcare system, and we were able to demonstrate that when compared to the conventional standard of care, functional medicine patients experienced improved outcomes. We published those results. Internally, we were also able to show about an 8 percent decrease in total cost year-over-year, but that was not able to be published because it involved proprietary data.

 

Can functional medicine emerge as the primary approach to healing chronic conditions?

I think we’re seeing a shift in primary care. People want what functional medicine offers in dealing with complex chronic disease. There are concepts of functional medicine around the gut microbiome and leaky gut that are being incorporated into more traditional Western medicine, and I’m glad these ideas that we’ve been talking about for 30 years are being integrated into standard medical care. But I believe that functional medicine and integrative medicine will continue to be on the cutting edge, bringing new ideas forward rather than dominating Western medicine.

 

How do you see the field of gut health evolving in the next few years?

The gut plays a central role in functional medicine, and we are deepening our understanding of the functionality of the microbiome, not just with gastrointestinal issues like irritable bowel syndrome, but also across all disease states, including cardiovascular, neurological and autoimmune diseases.

We’re recognizing, for example, that leakiness in the gut relates to leakiness in the blood-brain barrier and autoimmune diseases. With respect to the microbiome, we’re finding that it’s not so much which species are there, but rather what their functions are, with roles in healing, growth, energy production, thoughts, feelings, immune function and many more. The gut-brain connection is gaining attention. We’re learning that the 10,000-plus compounds produced by the gut microbiome affect the brain, influencing cognition, behavior, emotions and inflammation.

The way I see it, the gut serves as our biggest interface with the environment, processing 1,500 to 2,000 pounds of food annually, including macronutrients and micronutrients, which are transformed by the gut microbiome and then absorbed into the body. Our focus has shifted from studying specific gut microbes to understanding their functions. The goal is to optimize gut functions rather than viewing individual organisms or probiotics as solutions.

 

Is there a greater focus on food and lifestyle as opposed to probiotic supplements?

Exactly. Food, fiber, exercise, being in nature, even having pets—all of those things help to optimize the gut microbiome. At least half of our cells are bacteria. It’s about how we live in right relationship with the world. We feed our body with what we eat and what we’re exposed to, and doing that in a good way is how balance returns.

 

What do you love about teaching?

It’s the work that I love the most—even more than working with individuals—because I get the opportunity to share what I’ve learned so others can carry it forward. It’s also very humbling in the process because I’ve learned how little I know. I’ve also learned that there are no bad students, only poor teachers. If a student is not understanding something, it is my responsibility and my job to help them.

As a teacher, I work to understand something to a depth that I can simplify it, and that’s what I feel is part of my gift, as well as my passion. I want to get to a point of understanding an area where it becomes simple in my mind to be able to express and talk about it. It’s not about oversimplifying; it’s just being able to make it learnable so that somebody else can carry it forward.

It’s not lost on me that the word “doctor” comes from the Latin docere, which means “to teach”. We teach each other, and I can see farther because I stand on the shoulders of giants. I’ve had people who have taken the time to help me learn and understand in a deeper way, and there’s so much appreciation. So it’s actually necessary for me to “pay it forward”. That’s part of what my work in the world is, and I hope to continue to do that for a long time.

 

Sandra Yeyati is the national editor of Natural Awakenings. Look for part two of this conversation in our November issue.

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