Chris Kresser: That’s a really great question, and there is a lot that I could say about this. From one perspective, functional medicine is kind of anti-niche, and what I mean by that is one of the main principles, as you know by now, of functional medicine is that resolving symptoms and diseases is about addressing the underlying pathologies. There’s kind of an inside joke in functional medicine, which is like we don’t care what the patient’s symptoms are. That doesn’t mean we don’t care in the sense that we’re not really genuinely trying to help them, but it means we don’t care in the sense that it’s not as important as it is in conventional medicine because in conventional medicine, treatment decisions are often made on the basis of symptoms without any investigation into what’s causing them in the first place. The examples I’ve often used are high cholesterol and high blood pressure. Those are symptoms of a deeper underlying problem, but if you have high blood pressure, the doctor is just going to give you a medication to lower it, and if you have high cholesterol, the doctor is going to give you a medication to lower that, and there’s not really any investigation into what causes those symptoms. Functional medicine is different. We are not really concerned as much with the ultimate manifestations. We’re concerned with the pathologies, and when we address the pathologies, those manifestations, a.k.a. symptoms, will resolve. So what we are really focused on in functional medicine is addressing all of those pathologies.
Getting back to the concept of a niche, in some ways, if you’re focusing on functional medicine, it doesn’t make sense to limit your practice to high cholesterol or hypothyroidism because that’s kind of focusing on it from a symptom-based perspective, which is more of a conventional paradigm model.
At the same time, having a niche makes certain things easier. Number one, you can develop expertise in a particular topic, and if you’re focusing on thyroid, that doesn’t mean you can’t still direct your attention to developing expertise in all of the pathologies that lead to thyroid hypofunction or hyperfunction. It also makes it easier to market your practice and grow it because you’re really just targeting one particular person, and that’s someone who has a thyroid problem, rather than all people with all chronic disease.
Ultimately, I think, it comes down to what you want, and I think this often gets left out of the picture. Personally, I’m a generalist. I’ve always been a generalist in my life. I have many different interests, and when I get interested in something, I dive very deeply into it and I become almost obsessed with it—for better or for worse! But then after a while, I tend to… maybe not lose interest in that, but I get interested in something else and I switch over to that. I always felt like the idea of just focusing on one thing, like thyroid or gut, would be really confining for me, and I don’t enjoy that in my personal life. It’s not naturally what I gravitate toward, and so I think when I did set up my practice and when I was originally working with Keith, we talked about niche, and I just approached it differently. I said what my niche really is going to be is helping people who haven’t been able to find help anywhere else. So, yes, that did take me down the road of treating people who are extremely difficult cases, and that may not be something that you want to do, but if I do have a niche, I would say that that’s it, and that kind of naturally happens as a result of me sharing my story and as a result of the kind of articles that I write and the podcasts that I make.