What is a Functional Cardiologist?

I am a functional cardiologist and I hate it.


Let me rephrase that. I hate the term functional cardiologist. And don’t get me started on holistic or integrative cardiologist. Those are even worse.


Why do we need a special term to say that a doctor wants to do more than put proverbial band-aids on symptoms? Why is it so unusual for a doctor to want to fix and reverse the underlying causes of disease? Why should that require a unique identifier?


And holistic? Does anyone believe that the heart exists in isolation and is not influenced by every other aspect of our health? I find it hard to believe that any doctor would admit they feel this way, yet all too often cardiologists act this way. 


How Cardiologists are Viewed


The best example is the perception of cardiologists as “plumbers,” using coronary stents to open blocked arteries.  If you are in the midst of having a heart attack (an acute myocardial infarction- AMI), you want a plumber.


An AMI is caused by a sudden and complete blockage of a coronary artery (one of the arteries that supplies the heart with needed blood flow), and interventional cardiologists can stop the heart attack by opening the blockage with angioplasty (balloons) and stents. For that, you want the best plumber you can get to unclog that vessel as quickly as possible.


But here is the problem. The hundreds of thousands of patients who undergo elective stenting for partial coronary blockages do not benefit in the way they think. Almost uniformly, patients believe stents reduce their risk of heart attacks. Yet, there have been at least 12 randomized trials involving over 5,000 subjects that have shown that stents do not reduce the risk of future heart attacks or the risk of dying.


Despite this, one study paradoxically showed that patients and physicians alike believe that stenting does prevent heart attacks and reduce the risk of dying.  How can our perception be so counter to what the literature shows?


It actually makes sense. We show patients the dramatic before-and-after pictures of the narrowed blood vessel and the miraculous post-stent result of the vessel now looking wide open. We usually don’t show them all the other plaque building up in the other arteries.


The Most Common Cause of Heart Attacks


It turns out, most heart attacks are the result of so-called vulnerable or unstable plaque. Unstable plaques have higher levels of inflammatory components and are more likely to rupture acutely, setting off a cascade of events that completely blocks the blood vessel. The problem is that on an angiogram pre-dating the attack, these plaques are barely recognizable and certainly not of concern.


That is difficult for many to understand. It isn’t the severe arterial narrowings that cause most heart attacks. Those cause chest discomfort (angina) from temporary reduced blood flow to the heart but rarely cause life-threatening heart attacks. The life-threatening heart attacks come from the 20%, 30%, and 40% narrowings that become unstable. What makes them unstable? Inflammation, oxidation, smoking, diabetes, and more.


Paradigm shifts take time, especially when the paradigm goes from a simple one (i.e. a blocked artery is the problem, therefore open it and the problem is solved) to a complex one. Coronary artery disease is a multi-factorial problem that can only be treated with a whole-body approach focusing on inflammation, blood sugar and insulin control, nutrition, exercise, stress management, and much more.


To complicate matters even further, we now have studies questioning if stents can help relieve chest pain any better than medical and lifestyle management. And this makes sense too. There may be one narrowing worse than the others, but by the time someone develops narrowings they also have endothelial dysfunction – impaired ability for the vessels to dilate and allow more blood flow when needed. If that is severe enough and widespread enough, it too can cause chest pain/angina. Once again, treating one blockage won’t solve that problem.


How to Treat Cardiovascular Disease


Looking at the data, it becomes clear that there is only one way to treat cardiovascular disease. Treating this disease requires a holistic, functional, integrative approach that considers the whole patient, the patient’s lifestyle, and every aspect of their health.


So where does cardiology stand? Are we plumbers? Or are we doctors? I am afraid of what the answer is for most cardiologists today. But I am hopeful that the trend is moving in the right direction. I am hopeful there will be a day when all cardiologists will be functional, integrative, holistic cardiologists.


Thanks for reading.

Bret Scher, MD FACC


18 thoughts on “What is a Functional Cardiologist?”

  1. Hey Bret 

    I second every word you wrote . You explained the situation with eloquence and grace . Many patients called me a holistic doc back in the 90s . I never wanted the label , I just wanted to be , and continue to strive to be , a  family doctor. 

    Bravo my friend, 

    Mike McEvoy 

  2. It's scary that most heart attacks are caused by unstable plaque and inflammatory components. I actually learned the other day that Kasin found in milk and meat can cause inflammation in the body. It sounds like I should definitely cut down on the amount of dairy and meat I eat. My father is very out of shape, and now I'm even more worried about his heart. What tips do you have for finding a great cardiologist to help him out?

    1. Hi Taylor. I would caution against eliminating any real food based on hearing it can cause inflammation. That is something that can be measured in each individual. Meat in particular has a bad rap for causing inflammation when in reality it is frequently what is eaten along with the meat. As for finding a great cardiologist for your father, that depends on where he lives. Alternatively,  you can look for an online coach who can help him through his medical journery and communicate with his doctors. I hope that  helps!

  3. This writing reinforces what I concluded in my recent journey. As a 62 year old, former smoker with mild chest pain and discomfort in my neck, I went for a physical. After referrals to pulmonologist and cardiologist, and multiple CTs, EKGs. an ECG, and a nuclear stress test I’m dismayed. Cholesterol was never tested or mentioned. CT showed significant cornary calcium around the heart. My 2nd cardiologist (the first one had no time for conversation at all) said my results were ‘atypical’, and implied inactionable. He prescribed aspirin and statin and a ” good American diet” and “let us know if it gets worse.” Needless to say I was left wanting. Currently looking for another opinion from a real Dr who gives a damn.

    1. I’m sorry for your awful experience, most anyone with serious health issues in this country would have a similar story to tell if they had the wits to.
      Hence the reason folks like our good Dr here should use his title proudly and loudly until it becomes the actual standard and therefore unnecessary; so that folks like us can know where to go for actual help.

      Be thankful for the perspectives your trials have brought you, and keep taking charge of your health.

  4. Thank you for that information. Until that day comes when all cardiologists practice holistic, functional, integrative medicine then we will have to continue to use those terms to differentiate the ones that do from the ones that don’t. I’ve seen three cardiologists and have yet to hear one mention diet or exercise or do blood work to check for deficiencies. What I’ve learned I’ve learned from reading books by cardiologists that practice integrative medicine. Unfortunately, where we live, only conventional cardiology is practiced.

  5. Bret,
    I eat as healthy as it gets, mostly vegan and mostly raw, no alcohol, no sugar, no gluten, no coffee. I walk, hike, do yoga. I take heart healthy supplements, even high C IVs AND still my BP is 150/95.
    Frustrated and out of options.

  6. Hello Dr. Scher. Thank you for this. I have been a cardiac patient since 2001 when I received my first stent. I am now at number 12. I had a heart attach in my hospital room three years ago immediately following the placement of two stents that failed, but no heart damage. I recently had another stent placed. This happens for me every two and a half to three years. My LDL is good and I am on a statin. MY HDL is 32. I am 5’6″, 141 pounds and I have been on the Keto diet for almost two years. I lost 25 pounds almost immediately on the Keto diet and my HDL went up from 32 to 48, and my triglycerides down from 78 to 38. Currently while still on the Keto diet my numbers have discouragingly returned to those of my previous Keto days. I am an avid cyclist and swimmer and practice yoga. My LP(a) is 181. A discouraged patient. Any advice? Bob Petite, Chicago

    1. Hi Bob,

      We’re sorry to hear about your experience and that you’ve been discouraged. Unfortunately, Dr. Scher is unable to give medical advice on his blog. If you would like a more detail devaluation and answer to your questions, you could always consider an individualized consult.

      We think it would make a huge difference! Best of luck.

      1. Hello very excited to have discovered your website. I’m currently looking for a new cardiologist that looks beyond just the heart. I have been diagnosed with a slight atrial flutter and have refused medications. Prior to that for many years I have been diagnosed with fibromyalgia/chronic fatigue syndrome. I am finding that I have a severe flareup of extreme fatigue, actually put me in bed for a day or two, after doing cardio workouts. I do not have the best practitioners and I’m afraid to go back to see the cardiologist because I’m sure they will just insist that I take a medication. As you probably know there’s not a lot of medical help with chronic fatigue and fibromyalgia. I wonder what your opinion is on this depleted state of experience the day after cardio workouts. Is this just a part of the chronic fatigue syndrome and I need to find the right medical care for that? Or… Is that a common response to having an atrial flutter. Another part of my dilemma is that I am on A rather low fixed income And so only see medical practitioners that are covered by insurance. So any light that you can shed on this dilemma would be greatly appreciated! I have really enjoyed discovering your website and reading lots of your articles and others responses. Thank you so very much!

        1. Hello Diana,

          Thank you for your question. This is an interesting topic that deserves a detailed analysis and explanation. We don’t feel the blog is an appropriate forum to provide you with the detailed response and advice you require. If you would like a more individualized approach and answer, please feel free to sign up for a one-on-one medical consultation with Dr. Scher. We know that your insurance most likely will not cover this, and we apologize for that, but this one appointment could be worth it to give you the clarity you need, especially since you’re not receiving it from your current practitioners.

          Apologies we can’t be of more help. This truly would require an individual approach and in-depth analysis. In the meantime, we’re glad you’ve been enjoying the blog and hope you continue to do so!

  7. My husband, at 65 and in apparent physical health, ideal weight, building contractor…had the Widowmaker on 2/15/2015. After his stent his Interventional heart doctor told him he was in great shape and that the rest of his heart looked great. He had a self paid CAC test 2 years ago that showed a score over 2000. His Dr. scolded me for taking him for that test and wouldn’t even address the test results. Some have suggested that the presence of the stent may have skewed the score but the scores were high for every artery. I desperately need to find a ‘functional’ cardiologist to assess his CAC score and prescribe the best diet for him. He is on all kinds of meds plus STATINS. Still building houses at 69.

  8. I wish more doctors, in general, had your perspective. I worked in the back office of a family practice clinic for 6 years. The owner/provider is convinced his patients don’t care about being educated on how lifestyle choices affect health and can actually reverse many conditions and only wanted a magic pill to”fix” them, so that’s how he practices medicine. He expects his patients to be noncompliant with lifestyle improvements so he doesn’t even bother trying. Add to that all the Meaningful Use, MACRA, HEDIS, etc, bullcrap that takes away from face-to-face patient care, I think a lot of medical providers have become jaded, disillusioned, and burned out and are just coasting through with the”quick fix’ — which is only a bandaid masking the symptoms instead of looking at and treating the actual root of the problem. I understand the point of your article and agree wholeheartedly. I wish there was a way for patients to distinguish between typical “conventional” medicine (which is typically behind modern research 15-20 years) providers and those that have a more functional approach. If I had the choice between a functional practitioner and a mainstream conventional practitioner, functional would win every time. Unfortunately, finding the right fit is trial and error.

    (Stepping off my soapbox now. )

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Bret Scher, MD FACC

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