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Vitalism, Labs and the Art of Listening: A Deepo Dive with Dr. Brad Rachman (Part 1) — Transcript

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0:01[music]
0:03>> Hey everyone. Welcome to the Funk'tional
0:05Med Nation podcast. I'm your host, Dr.
0:07Steve Noseworthy. [music]
0:09The views and opinions of guests on this
0:11podcast are their own and may differ
0:13from my own. But as always, I try to be
0:15respectful of other people's opinions
0:17even when we might [music] disagree.
0:22Uh yes, so I started the podcast 2 maybe
0:253 years ago and [music] and really the
0:27intent was
0:29for me to have conversations with people
0:31that I wanted to ask questions of.
0:33>> Oh wow.
0:34>> And then um I I just kind of figured
0:36that if I have these questions, other
0:39people do as well. So, I feel like it's
0:41my role
0:42in the podcast to really just kind of
0:44sit in the stead of
0:46all the practitioners out there that are
0:48doing functional or integrated medicine
0:51uh that maybe don't know people that I
0:52might know or know someone who knows
0:55somebody else and
0:56um so that's it's been my great honor
0:58and privilege to talk with some pretty
1:00cool people and I count you among those
1:02because
1:03uh I still remember that first uh day
1:05that we met. The it was a seminar. I
1:07can't remember what seminar it was that
1:09I was teaching in North Carolina and and
1:11you paid me the kindest of compliments
1:14um at some point. So, I've been looking
1:15forward to this for a very long time.
1:17>> Thank you.
1:18>> Yeah. And me too. Yeah, so why don't we
1:21consider like we're already recording?
1:22So, let's just consider that we're
1:24rolling and um
1:26for those of you who are listening, this
1:28is Dr. Brad Rockman.
1:30And Brad, instead of me actually reading
1:32through
1:33the bio that you sent me, I'm going to
1:35have you introduce yourself if you don't
1:38mind. Um just take, you know, a minute
1:40or so and just kind of go through your
1:42qualifications cuz it's always
1:44you know, anybody who doesn't know you,
1:46their first question is why should I
1:47listen to this guy? And again, for those
1:50of you who are listening or watching,
1:51like you want to listen to this guy.
1:53He's been around for a while. He's got a
1:55rich background not just as a clinician,
1:58but as an educator, and he's
2:00uh worked in different sides of the
2:02functional medicine world, working with
2:04Genova Diagnostics. So, Dr. Brad Rodman,
2:07why don't you give us a little
2:09elevator pitch about who you are and
2:11what your background is.
2:12>> I am
2:14Thank you. And thanks for saying all of
2:15that. And
2:17um
2:18I'm just a curious guy, you know? And I
2:20was that prepare propellerhead kid, you
2:23know, who just was really interested in
2:24how the body worked,
2:26and how machines worked, and I was a
2:27maker. And when
2:30I became introduced to
2:33the I'm going to call it the alternative
2:35medicine space, because I got sick in um
2:38in college,
2:40which we'll talk about maybe a little
2:41later. And then I was introduced to
2:45uh
2:45>> [snorts]
2:46>> some more traditional uh Western ways of
2:49treating, and then also some
2:51alternative, and
2:53alternative to me at that point was
2:55meant anything that wasn't Western. And
2:57it would it thoroughly intrigued me. It
2:59it hit me on a visceral level, Steve. It
3:02was just so
3:04it was so organic, and it made sense,
3:07you know? That engineering mind of mine
3:08was like, I want to know why things
3:10work. I don't I don't want to
3:12put a Band-Aid on something.
3:13>> Yeah.
3:14>> And um
3:16uh after my after my primary training, I
3:19I went right into a deep dive into this
3:22kind of new burgeoning
3:24area back then, like that was in the in
3:27the mid to late '80s, which was like
3:29functional medicine. Like nobody even
3:31knew what that was. When I would
3:33when I would mention to patients, "Hey,
3:34you know, like there I'm pivoting a
3:36little bit here into this thing in this
3:37space called functional medicine."
3:40No one had a grasp of that.
3:41>> Yeah.
3:41>> And I had a joke that I used to say that
3:43like I guess it infers that everything
3:45else is dysfunctional.
3:47Um and
3:49in some ways um
3:51you know, there's a little bit there's a
3:52little bit of truth to that. And also it
3:56talks to something that
3:58makes sense to a lot of other people
4:00other than me, which is
4:02if we can figure out how to take away
4:05the noise, and if we can take away the
4:09blockages, the imbalances that are
4:10stopping people from expressing their
4:13their natural state, which I believed I
4:15really my cosmology has always been that
4:18we were designed
4:20by our maker to be well and to stay
4:21well. So, it it didn't take long, you
4:25know, I got my dog wanting to be in the
4:26podcast.
4:27>> [laughter]
4:28>> It didn't take long
4:30to
4:32you know, become you know, really
4:33established in this space. I I I I loved
4:36how laboratory
4:38medicine
4:40was my tea leaves, you know, it was the
4:41way that I could get you know, I mean
4:42people use um muscle testing and people
4:45use pulses and people use
4:48uh and and and and other systems, other
4:50other techniques and
4:53labs just like hit the science part of
4:55my brain really well.
4:56>> Yeah.
4:57>> And then I realized
4:58>> I have to say that I had a similar
4:59experience.
5:01Right? Just in terms of my first
5:02exposure to functional medicine
5:04uh was uh Datis Kharrazian teaching a
5:07blood chemistry course in Fort
5:09Lauderdale.
5:10>> Yeah.
5:10>> And it opened my eyes to a world I
5:12didn't even know existed at that point.
5:14And I'd been you know, I'd been in
5:16practice as a chiropractor for
5:18oh, probably 12 years or so at that
5:21point. And and to think
5:23you know, I just maybe just to kind of
5:25get outside of myself for a second, I I
5:27feel bad for clinicians who were so
5:30monolithic in their training
5:32and their practice and and all they see
5:34is what they know.
5:36Right? And to not have been exposed to
5:39functional medicine
5:41and to think that I could be another,
5:42you know, almost 20 years down the road
5:44in clinical practice and not not know
5:46what I know now.
5:48>> Right. I I wouldn't want to be that
5:50doctor. I really wouldn't want to be
5:51that doctor.
5:53>> It's a bias. Like we all have I I used
5:55to think that
5:57science in general proclaimed to be
5:59unbiased, but there's a lens, right?
6:01Through which we all use and
6:02>> Yeah.
6:04>> Uh
6:05I appreciate my lens got bigger.
6:07That that's all I can say. Like I my I'm
6:10so grateful that I was started out with
6:12a pretty big lens.
6:13>> Yeah.
6:14>> And um
6:15my colleagues started asking how I was
6:17doing what I was doing. I don't know if
6:18I was doing it well. You know, this is
6:20almost 40 years ago and I do not know.
6:23I mean, I do know that I wasn't great at
6:24it. I had a lot of enthusiasm for what I
6:26was doing and patients seemed to get
6:28better and I know that I
6:31you know, was not nearly as efficient as
6:33I am now and
6:35um
6:38and I also, you know,
6:40don't create as many symptoms and on my
6:42path
6:43to helping people to get better. You
6:45know, I think in the beginning I I
6:46created a lot of symptoms cuz I didn't
6:47understand some principle.
6:49>> Sure.
6:50>> Um which feels bad in retrospect, but I
6:52I do think in general there was more
6:54benefit than harm.
6:55But
6:57it it definitely turned into something
7:00where I became a mentor to a lot of
7:01individuals and
7:03I was welcomed into
7:07a
7:08very large um
7:10diagnostic medicine diagnostic
7:12laboratories, you know, provider at that
7:14point, which
7:16at that point was called Great Smokies
7:17Diagnostic Lab. This was way back, you
7:19know, in the in the late '80s and I was
7:23asked to kind of head up the
7:26uh the medical teaching part where we
7:29would train doctors because I was just
7:31good at doing that. I had been doing
7:33that for a while.
7:34And also head up research and
7:36development. So, like new tests. What
7:38what could we do that is going to that
7:39are going to help clinicians to diagnose
7:41things.
7:42And that was a big eye-opener. I I went
7:45from kind of private practice and maybe
7:48an office of a, you know, a few
7:50individuals that I led to a laboratory
7:54that was,
7:56you know, 300 employees and
7:59um held a
8:01really responsible position. I felt some
8:03days like a complete,
8:05>> [snorts]
8:05>> you know, impostor cuz like I had no
8:08skills, really. I had zero skills in
8:10management, but I'm a good learner and I
8:12wanted to be good at what I did and I
8:14wanted to understand how to serve
8:16practitioners at that level. And I
8:18learned a lot. I I would never, as hard
8:21as it was and difficult, I would never
8:24have given up my opportunity to learn
8:27all the different sides of a laboratory
8:28space.
8:29>> Yeah.
8:29>> And there's some really interesting
8:31insights that came out of that, which
8:32>> Yeah, and I would love to hear that. So,
8:33let me let me ask you to put a pin in
8:35that one because I want to I want to
8:37dedicate some time to talking about your
8:39experience with what we now know as
8:41Genova Diagnostics, but let's go back to
8:44the autoimmune disease. You said that
8:46you suffered some ill health and I think
8:48it was in your 20s. That was, you know,
8:50kind of your origin story that made you
8:52look outside of allopathic. If you can
8:55share whatever detail, you don't have to
8:57share tons, but what was going on and
8:59what was
9:00what was your frustration that led you
9:02to seek answers outside?
9:03>> In um I was in undergraduate school um
9:07for biomedical engineering and I started
9:10getting some really bad gut stuff.
9:12And I had never had that in my life and
9:14nothing was solving and of course I went
9:16through kind of the standard medical
9:18stuff there, which is essentially some
9:20medications to try to slow down
9:22motility, but it wasn't getting to the
9:24bottom of it and they couldn't find an
9:26infection. It was kind of at that point
9:29to them it seemed like a needle in a
9:30haystack and maybe not all that
9:32important. We didn't understand the
9:33biome. Um and
9:37it migrated,
9:38you know, through my clinical training
9:40until I was like a a year from
9:41graduating was in knee-deep in
9:43residency.
9:45Um, I bolted out of bed one morning and
9:48my spine just felt like it was crumbled.
9:50Like, I don't know how to describe it to
9:51people other than broken glass and it
9:53took a little while to untangle that
9:55there was an autoimmune problem
9:56occurring where
9:58um, it's called ankylosing spondylitis
10:00and for those that don't know it, it's
10:02similar to rheumatoid arthritis, but it
10:03doesn't affect the appendicular
10:06skeleton, affects the axial skeleton, it
10:07affects the spine. And you never see
10:10people's joints all gnarled up in their
10:11hands and then they can't bend those.
10:13Well, that's what happens to the spine.
10:15And then it's called bamboo spine
10:16disease because the natural progression
10:18of it is it, you know, the spine just
10:20[clears throat] instead of being these
10:21movable segments, a couple dozen movable
10:24segments, they all fuse together and
10:26literally on an x-ray we're taught like,
10:28as you know, it looks like a piece of
10:30bamboo cuz there's these bridge bones.
10:32What nobody ever tells you is that in
10:34the act of bridging these bones every
10:35night, the bones are kind of growing
10:37together with micro
10:40shards and then
10:42when I I remember just remember turning
10:43over in bed and just breaking my back,
10:45you know, all throughout the night. It
10:46was painful It was an extraordinary the
10:48probably the most painful thing I've
10:50ever experienced and it went on for a
10:52long time.
10:53And um
10:55I got to a rheumatologist who said,
10:56"Okay, well, here's the deal. You have
10:58you have a decision to make. You have
11:00two choices.
11:01Standing up or lying down." And I'm
11:04like, "I have no idea what you're
11:05talking about." And he said, "Well, do
11:07you want your spine to freeze in a more
11:09upright standing position or do you want
11:11it to freeze like where you're just
11:12lying down all the time?" And I'm like,
11:14"I got to get out of your office cuz
11:15this this is so bad."
11:17>> [laughter]
11:18>> None of those are my only two choices?
11:20>> I don't think you're helping me very
11:21much. I don't think I said that, but I
11:22did I did leave and
11:24um, it started my path, Steve, to like
11:27try to unpack
11:29something I I very, very, very little of
11:32the immune system and inflammation and
11:35something I credit um
11:38>> [clears throat]
11:38>> Dr. Crozan and you and others like these
11:41giants that I
11:43have stood on the shoulders of to
11:45understand this. Like I did There was
11:46nobody back then who really knew much
11:49about any of this. So it took some
11:51understanding and some digging and some
11:53research and I got [snorts]
11:55I got pretty far into trying to
11:58understand
11:59that this was not an issue where it was
12:02a real disease.
12:04Because
12:05even though I was oriented towards not
12:07thinking that the label mattered, it
12:09kind of stuck after a while.
12:11And what I came to understand was that
12:14this was a lack of regulation of my
12:16immune system. Like it was not behaving
12:18well.
12:19It was over responding and it was over
12:22reacting to things that I was unaware
12:24of.
12:25You know, I I really couldn't tease
12:27apart the cause and effect. I do
12:28understand it now.
12:30You know, gluten, certain environmental
12:32toxins like mold or just really still
12:34can They could light me up pretty good.
12:36Um but for the most part, it took a
12:39decade but I unwound the thing.
12:41Um I eventually met my wife who is a
12:45a [snorts] yoga therapist and massage
12:47therapist of incredible
12:50intuition and connection and she kind of
12:54finished off the layers of the cake to
12:57help me once I the inflammatory stage
13:00was kind of resolved for me. At least
13:01not It was put to bed. You like I was I
13:04was resolving inflammation better than I
13:05ever have. She got things moving again,
13:07all the stiff parts. So I think I still
13:09have a few few a few frozen segments in
13:11my spine and my spine doesn't look like
13:13everybody else's and my posture doesn't
13:15look like everybody else's but
13:17it's hardly anything I can't do and I
13:19don't hurt anymore.
13:20>> Yeah, and that's an interesting
13:22um
13:23comment about your spine doesn't look
13:25like everyone else's but your function
13:27is somewhat [snorts] preserved. Um
13:30And there was I just remember seeing
13:32one of the social media accounts that I
13:34follow was talking about a paper
13:36published recently. And this is, you
13:37know, probably more germane to those of
13:40us in this space that are our
13:41chiropractors and do manual type
13:43medicine, but you know, looking at
13:45studies where
13:46um
13:48you might have similar findings on
13:50X-ray, CT, or MRI of degenerative
13:53changes, disc lesions, herniations, and
13:55so on.
13:56And not You and I both know even we
13:59don't have to be functional medicine
14:00practitioners, but you and I both know
14:02that someone can have a really ugly
14:04looking X-ray and be pain-free
14:06and relatively mobile. And somebody else
14:09their spine might look absolutely
14:11pristine on an X-ray
14:13posturally as well as the you know, the
14:15integrity of the joints and they're in
14:17tremendous pain and disability.
14:20And uh it it but it it kind of teases
14:23around the idea of form and function and
14:26and how they're related. And those are,
14:28you know, just put those two labels out
14:29there and they're just very, very broad
14:32umbrellas that a whole bunch of other
14:33stuff fits up underneath.
14:35>> Yeah. And and you know, just to pivot on
14:38that cuz that so true.
14:40I don't think labs are that different.
14:43I think that when I have a new patient
14:46and I see a group of labs and they're
14:49rough. I mean, like, you know, I'm
14:51looking at optimal ranges and I'm
14:52looking at more traditional
14:55um standard ranges
14:57which I'd like to get into with you and
15:00you know, the patients are looking at it
15:02with me as we're reviewing it and of
15:04course they can be horrified because,
15:05you know,
15:06I create some reports with some good
15:08colors, you know, green's great and
15:10yellow's a little bit not great and then
15:11red's really and there's a whole red.
15:13And you could see that
15:15they're really troubled by like the fact
15:17is out of three dozen lab values, you
15:21know, two dozen of them are in the red,
15:22and I try to remind them that this is
15:25not their body breaking, but their body
15:27acting like Jenga. It's trying to adapt.
15:30Now, it may not be really good at
15:32adapting. You know, the body is going to
15:34try to get to that
15:35steady state, that homeostatic state.
15:37>> Yeah.
15:38>> But, most of what we see on labs are not
15:41necessarily cause.
15:43Somehow we think labs are magical.
15:45They're not. They're just like an x-ray.
15:46They're just like something else.
15:48There's a lot going on there, and a lot
15:50of it is effect, and I didn't get really
15:52good at figuring out what was cause and
15:54what was effect on the labs until maybe
15:57the last 10 years.
15:58>> Mhm.
15:59>> And then like some insight happened,
16:01which was like the ability to see labs.
16:04I mean, I think it's magical for me cuz
16:05I could just, as you can, just look at
16:07them and be like, I got it. Like, I
16:08understand your physiology now.
16:11Like that. And it seems a little like
16:13sorcery or magic to look at a lab and
16:17and to be able to do that, but it's
16:19it's a lens, right? That you can train
16:21yourself
16:22to be able to to look through.
16:24>> Yeah, we're we're getting dangerously
16:26close to talking about the topic that
16:29you chose for today cuz I gave you the
16:30choice of what to talk about, and that
16:31is vitalism. And I I think I'd like to
16:34put that at the end of the conversation.
16:36>> Yeah.
16:36>> Um I'm going to bring you back to
16:39your days with Genova. In fact, I'm I'm
16:41going to ask you some some very large
16:43picture questions first. Like
16:47cuz you've been involved in functional
16:49medicine very early on. Did you do your
16:52early training with Jeff Bland?
16:53>> I did.
16:54>> You did? Okay, so you were you were
16:56essentially there in the beginning. Even
16:58probably when the concepts and the
17:00principles of functional medicine were
17:02being formulated.
17:03>> Yes.
17:04>> Yeah. So,
17:06if you look back
17:08over the course of your career, and the
17:10and just the the industry of the
17:12profession, what do you think has
17:14changed from the beginning to now? And
17:17not necessarily just in your perception,
17:19but your observation of
17:21how we as a collective
17:23think about and apply functional
17:25medicine principles in practice.
17:28>> I think that
17:29a number of things have occurred.
17:31As with all things that are new,
17:34unusual,
17:36and disruptive,
17:38they're first looked at, you know, with
17:40this jaundiced eye, right? And nobody
17:44kind of begins to accept, "Hey, there's
17:45this thing in the labs called functional
17:47ranges and there's a thing in the body
17:49called function and the functions aren't
17:51these pathologic processes we think of
17:53like we think of like a real path
17:56process we both learned, you know, in
17:58training was like, "Okay, tissues break
17:59down." And we just think of things like
18:01necrosis and
18:03and we realize there's these other
18:05pathophysiologic processes like a
18:08detoxification imbalance
18:09>> Mhm.
18:10>> or a lack of immune regulation, right?
18:13Or endocrine disruption. So,
18:16that that world has gotten sufficiently
18:20large because, you know, when I
18:21>> [laughter]
18:21>> when I I remember going to my first um
18:25my first workshop with Jeff Bland and we
18:29just talked about kind of the gut and
18:31detoxification. Now, still those are
18:33really two great places to start when
18:34you think about it.
18:36>> And um you could probably wind up
18:38alleviating 80% of somebody's issues if
18:41you if you only had those two tools, but
18:44we've spun outward into an understanding
18:47of dysglycemia,
18:48the imbalance of blood sugar. We spun
18:50outward another circle to
18:52what happens in the mitochondria. We're
18:54getting into proteomics and epigenetics
18:56in a beautiful way. We're we're going
18:59outward in these ripples now to where
19:02and I'm sure there will be more. I mean,
19:04I'm just beginning to get into
19:05proteomics in a big way.
19:07>> Mhm.
19:07>> And that's just another ring. It's not
19:10another parallel universe. It's another
19:13way of understanding the body's
19:14expression. That toolbox is big.
19:17>> Yeah.
19:18>> You know, two tools and now
19:20ostensibly a dozen tools.
19:22>> Yeah.
19:22>> That's
19:24big. And not a tool, I don't mean, I
19:26think everyone's following, but I'm not
19:28like a tool to fix, but a tool to
19:29understand what could be going on with
19:32the body. That's changed.
19:34In the same way that something that was
19:35originally viewed as novel and maybe
19:38with a little bit of a jaundice eye, is
19:40now a little bit co-opted where I see
19:41functional medicine being used to
19:44describe alternative medicine,
19:46non-allopathic medicine.
19:48And nothing could be further from the
19:50truth because the real definition of it
19:52is not someone who offers hormone
19:54replacement therapy.
19:55>> Right.
19:56>> That could be part of it. You could
19:58absolutely need that.
19:59>> Yeah.
19:59>> And that could be a key linchpin in like
20:01somebody's whole thing.
20:04But it isn't the treatment tool. It's
20:08the understanding of the mechanics of
20:10what's going on inside.
20:12>> Yeah.
20:12>> What is lacking? What is being impaired?
20:14What is not What's stopping the
20:16expression of health?
20:17And I've seen functional medicine
20:20bend a little bit in that direction.
20:24You know, to where I don't think Jeff
20:25Bland even calls it functional medicine
20:26anymore. Like he's like expanded into
20:28the thing, which is personal
20:29>> Yeah, yeah, and I do think that I think
20:31the term functional medicine has been
20:33I don't know if the co-opted is the
20:35right word.
20:36>> Yeah, I think it's
20:36>> But I think I see
20:39I think I see similar trends. Like I
20:41think it's a it's a testament to
20:44the design of the human body that you
20:47referred to earlier.
20:49That you can spend your entire clinical
20:52practice career
20:54only doing detox and gut support and
20:57help an awful lot of people.
20:59>> Yeah.
20:59>> Right. But if all you do is
21:02you know, put someone on a
21:04XYZ protocol for gut and detox, is that
21:07really functional medicine? I would
21:08argue it's an aspect of that.
21:11Right? Because I I do think that
21:12functional medicine as I think you're
21:16implying, maybe stating explicitly,
21:19is this um it's a complex arena
21:22and we still yet only know a portion of
21:25it. We're still discovering more
21:28about human function and physiology and
21:30the intricacies of how everything is
21:32interconnected. And I I think that um
21:36what allows clinicians to be really
21:38successful in this space and and maybe
21:40by that I don't mean financially
21:42successful or you know, how many how
21:44many patients are you seeing in the run
21:46of a a day or a year. I mean successful
21:49in
21:51being able to help a large portion of
21:52people who walk through your door,
21:54including the complex complex cases. And
21:58I don't think that you can
22:00I don't think you can play in that
22:01sandbox of complexity
22:03if you don't understand
22:06at least to a nominal degree the
22:07complexity of physiology. Would you
22:09agree with that statement or how would
22:11you amend that?
22:13>> Uh
22:14I think that was beautifully said and I
22:16think that's absolutely to the point and
22:19if
22:20you know, you're a
22:22plumber and all you've got are a certain
22:24set of tools,
22:25there's going to be a lot you're going
22:26to encounter in a home that does not
22:29relate to that that you can't help. And
22:31you can try to tighten up the pipes, but
22:32you're not going to fix an electrical
22:34problem in the house.
22:35>> Sure.
22:36>> And um it isn't just about
22:40the
22:41toolbox of the plumber, but it's the
22:43orientation.
22:45I a plumber knows about water flow in
22:48and out of a house.
22:51But someone who really understands, you
22:53know, every element
22:56is a master because they can really come
22:58in and say, "Ah,
22:59that crack in the wall and that leak
23:02over there, they're related to a
23:03foundational issue.
23:05>> Yeah.
23:05>> But, let's get down to the root cause.
23:07Your foundation is you're losing this
23:08corner of your house. That's why your
23:10pipes are cracking, and that's why your
23:11walls are cracking, and that's why your
23:12electrical system goes in and out of
23:14your kitchen all the time. So, it's it's
23:17that broadness that that matters. It's
23:20the holding the biggest possible
23:22picture. And every time I thought in a
23:24workshop, "Okay, well, this is the This
23:26is the biggest possible picture anybody
23:28could ever have. Like, this is amazing."
23:29This new set of tools to diagnose and to
23:32understand, and more importantly, to
23:34to see a patient,
23:36something else expands a little bit
23:38more. So,
23:40I'm grateful for that, and in awe of
23:44how the body is fearfully and
23:45wonderfully made, and just as we're
23:47trying to characterize another way of
23:50how the body is we're trying to regulate
23:51itself, there's like there's more there.
23:54>> Yeah, I I like the idea of looking at
23:56lab results more as an indication of how
23:59the body is trying to make corrections,
24:02rather than this is a disease process.
24:04Or pathophysiology. And And maybe those
24:07lines get blurred somewhere along the
24:08way,
24:09right? Because I do think that um
24:12in an attempt to make corrections, if
24:14that process goes too far,
24:17and you don't have the
24:19um
24:20I know there's a technical word for it,
24:21and I'm I'm it's escaping me right now,
24:24but you don't have the the ability to
24:26rein in
24:28it like an extreme response. I think
24:30then you start bordering on to
24:31pathophysiology. And you know, maybe
24:34understanding the distinction between
24:35those two things is
24:37only hard-won through clinical
24:39experience.
24:40>> Right.
24:40>> Right. Seeing person after person that
24:42might be in that in that realm. I I'm
24:45I'm interested I want to ask you about
24:47your clinical model here in a second,
24:49but I want to go back to your time
24:52at Genova. What was it like
24:55cuz you said you were involved early on
24:57and part of your responsibility was
24:59deciding what tests to offer clinicians.
25:02And and I have
25:03I have said in seminars before
25:06cuz I think we're in
25:09we're in a different time and place from
25:11a diagnostic standpoint than say when
25:13you started in practice because there
25:14are a lot of
25:16uh in my opinion, there are a lot a lot
25:18of labs out there that offer tests that
25:21you can spend your own money or your
25:23you know, your patients' money on and
25:25get valid data
25:27that's not clinically relevant.
25:29>> Right.
25:30>> Because the way that I look at it is
25:32that um labs are businesses, they have
25:35to make a profit.
25:37And I wonder
25:39I wonder how much
25:41when labs are trying to decide what labs
25:43are going to offer to the marketplace
25:46how much of the conversation is driven
25:48about, well, what do clinicians need
25:51versus what can we sell?
25:53>> Right.
25:55>> What's your opinion on that?
25:57>> I I
25:59I think there is a perspective, at least
26:03during during
26:04you know, my tenure in that industry of
26:06both of those things going on and
26:10it was a little less nefarious than it
26:12sounds because there was a whole group
26:15of
26:17frontier tests they were coming out of
26:19research and that's where we found all
26:21this stuff. We would dig in the papers
26:22and like some brilliant guy or gal in
26:26University of Wakanuga, you know, wound
26:29up coming up with this really cool way
26:32of looking at lipids and they related to
26:34oxidative stress and more specifically
26:36to glutathione metabolism and then
26:37you're like
26:39God, that would be really good. Then the
26:41question is
26:42A, how do you
26:45bring that to market in an affordable
26:47way? And then you do that and you make
26:49that investment is anyone going to buy
26:51it? And they're going to buy it as a
26:53single test.
26:54So, there was in that in that area of
26:57functional medicine, there is this
26:58imperative to panelize.
27:01There's rarely one test that will ever
27:03be marketable and cost-effective.
27:07>> Mhm.
27:07>> Or it'd be $900 to run a single analyte.
27:09And some of that There are a few, you
27:11know, you can run an MTHFR test for
27:13methylation and get some really good
27:15value and you would be willing to pay a
27:17you know, $100 to $200 for that. But,
27:19for the most part,
27:22there's this mandate to panelize, which
27:24and by that, I just mean like find a
27:26bunch of things that work together and
27:28create a cardiovascular panel out of it
27:30that you that you can help a patient
27:32assess that.
27:34That became the financial mandate, which
27:37is like, well, how do you make it
27:38affordable, marketable, something that
27:41somebody will buy.
27:42And then there's a third category, which
27:44is like, how do you make it so the
27:45average clinician who may not want to go
27:47deep dive into all this lab stuff,
27:50that they can actually action something
27:51with a patient.
27:52>> Yeah.
27:53>> And it doesn't provide some
27:55limp data point, you know, which may be
27:58lit up, but they don't know what to do
27:59with that.
28:01Um
28:03I think I to be honest with myself, I
28:05think I was more valuable in many ways
28:09to Genova
28:11earlier in my tenure.
28:13I was there and interacted with that
28:15company
28:17in the in the one way or another over a
28:195-year tenure period.
28:22And I think I was more valuable in the
28:24beginning because I had more clinical
28:27feet on the street knowledge.
28:29And I was less valuable cuz I really
28:31didn't understand
28:32the process of how to do this, how to
28:35pull out of the literature something
28:36valuable that no one else is running,
28:38that they can't get at LabCorp or Quest
28:41or any of their other ABC labs out
28:43there.
28:44And
28:46you know, I got better in the
28:48in the element of the
28:51product and I think
28:53I helped to get my contribution was
28:55maybe to help the company to understand
28:57how to bring things to market in more
29:00limited panels that are really targeted
29:02and helpful.
29:04But it became clear at least in my last
29:062 years that I and I felt, you know, my
29:10mandate on on my clinical team
29:14we had lost touch with patients. And the
29:15thought was like we got to open up a
29:16clinic here in the lab, which they did.
29:19And everybody's got to start practicing
29:21again.
29:22You can't do what you're doing in the
29:25development of these tests and the
29:26support of these tests and the teaching
29:28of these tests unless you're using them
29:29with patients.
29:30>> I love that idea.
29:31>> And um
29:32>> I love that idea.
29:33>> Yeah, it was powerful and it was a
29:35>> Yeah, and you know, I would to all of
29:37that I would say maybe a couple of
29:38things. One is that
29:41um
29:41and you know, there are a lot of
29:43functional medicine labs. Uh and we can
29:45name names here. All right, we're
29:47independent. We're not uh not being
29:49driven by any financial interest with
29:51anybody.
29:52Um you know, Cyrex Labs for example.
29:56I would love to see them look at all of
29:58their arrays
30:00and look at every analyte on every array
30:03and look at how often it comes back
30:05positive or negative.
30:06And then drop off the things that really
30:09never show up as anything useful and add
30:11something else. Like, you know, go go
30:13back on almost to an overhaul of all the
30:15different panels that they offer just to
30:17make sure that every single thing there
30:19has a chance of catching something that
30:21might be clinically useful. And not just
30:23Cyrex, any any lab, any functional
30:25diagnostic lab that offers panels, I
30:27think, you know, should at some level or
30:29some time frame do that.
30:32>> I think the I think you're right. And
30:35someone that doesn't get a lot of
30:36attention in this space, but a real
30:38pioneer was Stephen Barrie. Stephen
30:40Barrie created
30:42the the stool test that is run 99% of
30:46the time in functional medicine.
30:48And he was the founder of this
30:51Genova. And
30:53and he he really understood
30:57that unless a test brought relevant
31:00information to the doctor-patient
31:02relationship that was actionable, it
31:04probably isn't worth having there.
31:06>> Yeah.
31:07>> And it wasn't an academic exercise. He
31:10was a really strong is a strong advocate
31:12for that.
31:13Um
31:14so
31:15>> I think I I think and you know, I'm just
31:17speaking off the top of my head now. I
31:19think there's probably
31:21two types of errors
31:23in decisions to
31:25have or not have things on a test panel.
31:27One is
31:29not including things that are relevant
31:32and actionable.
31:33And the other is information overload.
31:37Right? Data for the sake for the sake of
31:39data. Um because and and I don't know
31:41where I clued into this, but it seemed
31:42to me that there was
31:44a point when more
31:47companies started cropping up and
31:48competing in the diagnostic space
31:51that there seemed to be a shift towards
31:53information-laden
31:55or information-heavy reports.
31:58Maybe with the idea that more
32:00information is better and you and I know
32:02that that's not always true. Like
32:03sometimes more information
32:05particularly if it's not relevant or
32:07actionable just causes confusion.
32:10And and I'll point out some of the
32:12recent changes for example with the
32:14like
32:16Vibrant Wellness has their gut zoomer.
32:19And the amount of information and it's
32:21and it's not just Vibrant and not just
32:23that particular test, but
32:25I I find more often than not
32:27um thinking to myself number one, I wish
32:30labs would just be labs and stop trying
32:32to be clinicians. Don't put treatment or
32:35lifestyle or diet recommendations in
32:37your reports, that's my job.
32:39Right? And the other part is and and
32:42I'll use this as a specific example.
32:44When this is top of mind for me because
32:45I about 2 weeks ago I did a webinar for
32:49a couple of hundred docs down over in
32:50the UK sponsored by Apex Energetics,
32:53right? It was about the microbiome and
32:56mucosal immunity.
32:57And the slide deck that they wanted me
32:59to use was a couple of years old. So I
33:01wanted to refresh it and just add some
33:03new stuff and I came across a paper
33:06that
33:07looked at short-chain fatty acid
33:09production
33:11between
33:12two groups of people where they they
33:14measured baseline short-chain fatty
33:16acids and fiber intake in their diet.
33:18And they split the the two groups and
33:20all these people had low fiber intake.
33:23And one group
33:25increased their fiber to I think it was
33:2640 g per day for whatever their baseline
33:28was. The other kept their fiber intake
33:31at baseline
33:33but added in fermented foods.
33:36And at the end of the 10-week study they
33:38measured looked at their microbiome and
33:41they measured the short-chain fatty
33:42acids and the fermented foods
33:44outperformed
33:46the high-fiber diet in terms of
33:48diversity in the microbiome as well as
33:50control production of short-chain fatty
33:52acids and control of inflammatory
33:54chemicals. So that that's one thing.
33:57But you know, we see this trend
34:00in labs that do measure the microbiome
34:02to measure dozens and dozens and dozens
34:05and dozens of different species. Now we
34:07know
34:09as a result of the gut
34:11the the human microbiome project, we've
34:13identified almost 5,000 genetically
34:16individual species.
34:19But what I learned in prepping for this
34:21webinar was that
34:22roughly 70% of them have never been
34:25cultured. We don't even know what they
34:26do. We just know they're there.
34:28>> Right.
34:29>> And so we get a report from you know,
34:31any lab that looks at the microbiome
34:33particularly in detail, and there's
34:35literally nothing you can do with it
34:37clinically.
34:38>> Right. [laughter] Right.
34:39>> Right? There's nothing you can do.
34:41>> Right.
34:42>> And so, anyways, that that's a little
34:44bit of my my diatribe, but I I I like
34:46the perspective that you have, and it's
34:48it's comforting to know at least at some
34:50point in the history that somebody was
34:52asking the question, well, like, how can
34:54we help clinicians
34:56>> Yes.
34:56>> have more insight into clinic into into
34:59their you know, their clients' health
35:01and wellness rather than simply what can
35:03we sell in the market? Because you and I
35:05both know there are tests out there that
35:07none of us as clinicians should ever
35:09spend money on.
35:10>> Right.
35:11>> I'm not going to ask you to name them,
35:12but
35:14cuz I know you probably have your own
35:15list.
35:15>> with my patients all the time when they
35:17like bring when they bring [laughter]
35:18the test,
35:19I'm like, I can't use this. It's not
35:21helpful to me. And they're like, "Oh,
35:22but my last doctor thought this was
35:24going to tell me all the answers." I'm
35:25like, I they may know something I don't
35:27know. I don't I can't get any usefulness
35:29out of this.
35:30>> Yeah.
35:31Having said that, um
35:33what do you find utility in? Like if you
35:36you suggested earlier that
35:38labs are not the end all be all of being
35:40a functional medicine practitioner, and
35:42and yet
35:44it seems to me that just in common usage
35:46of the word, if somebody runs labs and
35:49provides supplements, they just call
35:51that functional medicine.
35:54Which I don't know. I don't know that I
35:56will qualify that as, but what are the
35:58tests that you feel
36:01are worth considering in most if not all
36:03cases? So, like, aside from just, you
36:05know, a good set of blood work, like,
36:08surveying foundational physiology. In
36:10terms of specialty labs, or maybe even
36:13let's call them specialty serum testing.
36:15What do you find yourself going to on a
36:18routine basis?
36:20What are the high-value ones?
36:21>> I think I'm going to surprise you and
36:23say that I think
36:25there [snorts] are standard reference
36:27lab tests that are not typically run
36:29that are in my essential toolbox and I
36:31go to this so much earlier than I used
36:35to. I used to go right for all the
36:36specialty tests.
36:38And this is not
36:41at all insinuating that when I have a
36:44difficult autoimmune case in front of
36:46me,
36:47I'm not right away trying to figure out
36:48what antibodies I'm looking at through
36:51the appropriate Cyrex test or the gut
36:53test, right? But
36:55there are some very high-level markers
36:57that I think are ignored.
36:59>> Let's start with those.
37:00>> And so
37:02complement C3, complement C4, complement
37:04C3a, complement C4a, completely ignored.
37:08And I love these complement proteins. In
37:10fact, I had the pleasure of talking to
37:14um one of the the
37:16medical physicians who
37:18was part of the development of
37:20complement C4a and I'm like, I can't
37:23believe like you you discovered that.
37:26He's like, well, yeah, you have to and
37:28then he went on to why and it seemed so
37:29obvious to him.
37:31Um these are markers that are part of
37:34the inflammatory cascade,
37:36but they more often than not are related
37:40to some form of stealth pathogen
37:43wreaking havoc and tissue injury in the
37:45body.
37:46Now, to me, to know that we're dealing
37:49with a stealth pathogen, now, I can't
37:51tell what it is. I don't know if I'm
37:52dealing with
37:53>> Right.
37:54>> cytomegalovirus, Epstein-Barr virus,
37:56coxsackie, I don't know what I'm dealing
37:57with, right?
37:59But I'm dealing with something in that
38:00arena
38:02as opposed to mold a toxin like mold
38:05toxin or a biome issue or a detox issue.
38:09Like our tissue's breaking down for that
38:11reason or another one.
38:14There's another follow-up marker to that
38:16which is the degree of tissue injury
38:18going on because I want to know
38:21if I'm being entrusted with a case,
38:23is my first aid in the beginning all
38:25about trying to just stop more tissues
38:28from breaking down? Because they're in
38:29this
38:30absolute swell
38:33of inflammation that is breaking down
38:35tissue, or did tissue break down in the
38:37past in this process, and they're just
38:40dealing with the struggle now that like
38:42something broke down. Thyroid broke
38:43down,
38:45other endocrine tissue broke down,
38:46muscle or connective tissue broke down.
38:49And I get a lot of value out of um
38:52MMP-9.
38:53>> Oh.
38:55>> Which is a really good indicator because
38:58it's secreted by neutrophils
39:00in a the expression of trying to break
39:03tissue down to try to solve
39:05>> Yeah, it's it's it's if I remember, it
39:06degrades the extracellular matrix.
39:08>> Yes.
39:09>> Yeah.
39:09>> It's like the body's beautiful response
39:11to saying, "Something so bad is
39:13happening here
39:15>> Yeah.
39:15>> that we want to break these tissues down
39:17to just get rid of them. Like they're
39:18worthless. They have They're not
39:19helpful. Let's just break it down.
39:21There's too much inflammation. They're
39:22not even They're not even functional
39:24tissue anymore."
39:26Um and another one in that same category
39:29is TGF-beta 1.
39:31>> Yeah.
39:32>> So, to me, like when I when I look at
39:34the cluster of those, that's super
39:36important.
39:38I rarely run any glucose panel that if
39:42I'm interested in glucose metabolism,
39:44and which I am with every single patient
39:46because
39:47to some degree it could be an issue, it
39:49is
39:50not helpful to me to just see fasting
39:53glucose that goes all over the place.
39:55Insulin is not helpful for me, either.
39:57>> Hm.
39:58>> Because it's
39:59>> I ask you why?
40:00>> It's variable.
40:02It varies significantly, but the
40:04equivalent of insulin over a longer
40:06period of time is C-peptide.
40:08>> True.
40:09>> I tag C-peptide, I tag fasting glucose,
40:11I could push those into
40:13a calculator developed at um Oxford at
40:16and and Cambridge
40:18HOMA calculator.
40:19>> Yeah. You had a pretty accurate
40:21indicator of, "Hey, am I dealing with a
40:23patient who's got
40:25things heading more toward the insulin
40:27resistance side?
40:29Where they're manufacturing a lot of
40:31insulin and their cells just aren't
40:33listening to that. Or are we in the
40:34reactive hypoglycemia side of things?"
40:37>> I want to ask you about that and and I
40:39don't want to derail this conversation
40:41cuz I love where it's going.
40:43But I over the years cuz I've been using
40:45the HOMA calculator for gosh, probably
40:4715 years, something like that.
40:50And a pattern that I notice very
40:52frequently
40:53are people who have what I call and I
40:56haven't been able to find any support
40:59for this in the literature, so this is
41:00just Steve's crazy brain trying to put
41:03clinical concepts together.
41:05I would call it insulin
41:06hypersensitivity.
41:08Where in in a client who's not a highly
41:11trained athlete cuz you would expect
41:13this pattern in someone who is highly
41:15trained and and very metabolically
41:17flexible and and fat adapted.
41:20I see people with
41:22insulin like HOMA scores, the percent S
41:25score
41:26well over 200%.
41:28Well over 200%. And for those of you
41:30listening, if you're not familiar,
41:33normal insulin sensitivity is 100%.
41:35There's a couple of ways you can model
41:36that with an index or with a percentage.
41:39But I see this a lot of times in your
41:40really severe
41:42reactive hypoglycemics who they don't
41:45handle low carb, they don't handle
41:47intermittent fasting, they try keto and
41:49it made them worse.
41:51You know, and and that picture is to me
41:53quite often associated with this very,
41:56very high insulin sensitivity. Is this a
41:58pattern that you've noticed?
42:00>> So often.
42:01>> Yeah.
42:02>> So often and it's often accompanied
42:06with a low triglyceride, which you would
42:07expect. Body's not storing fuel in the
42:10the
42:11It's often associated
42:13with a high
42:14morning cortisol level. Because whatever
42:18that fasting level is just got a whole
42:19lot worse first thing in the morning.
42:22And interestingly, it's associated with
42:24a low LDH.
42:25So, you know, the the further that LDH
42:28is below 140, the more times they're
42:30bonking and may not even know it during
42:32the day.
42:33>> Yeah.
42:33>> And if I could get like that group of
42:35markers,
42:37it it gives me everything. And I'll have
42:38patients like, "But my hemoglobin A1C is
42:41this, and I've worn a continuous glucose
42:43monitor." And I try to emphasize to them
42:45that there are so many
42:48backup power supply, energy supply, fuel
42:52supply mechanisms because the brain
42:54doesn't produce or store any fuel,
42:56excuse me. It just thinks it's the
42:58smartest person in the room, so it's
42:59going to regulate everything else. And
43:01whenever that blood sugar drops a little
43:03bit down, it will pump a bunch out of
43:05the a bunch of cortisol out of the
43:06adrenals and create, you know,
43:09gluconeogenesis from the liver. There's
43:12just stuff going on under the hood that
43:13makes those two things the if if I see
43:17really high or really low
43:20fasting blood sugars,
43:22I know the mechanism has failed. If I
43:24see a high hemoglobin A1C,
43:27I know the mechanism's failed. Like that
43:30that point for a long time, they're
43:31already caramelizing their body because
43:34of excess sugar. That's an end Those are
43:36end point markers to me
43:39as opposed to functional markers, which
43:41is the
43:41>> Like a process.
43:43>> the process markers I've been including
43:45the HOMA calculation, which is very
43:47functional. The LDH calculation, looking
43:50at triglycerides. These are
43:52These are really valuable to me. To see
43:55And I see that description that you were
43:57just just noting that clinical
44:00presentation
44:01in
44:03many perimenopausal women who are really
44:06transitioning poorly, and therefore in
44:08them I will see a pregnenolone level
44:10really low because that pregnenolone
44:12that mother hormone is being stolen to
44:15create all that cortisol to manage the
44:17blood sugar issue.
44:19Um
44:20and of course they could be
44:21extraordinarily lower marginal in
44:24estrogen, progesterone, and testosterone
44:26and DHEA, so
44:29and their GABA levels are typically
44:31depleted, you know, by the best tools I
44:33have to measure that which is kind of
44:35using a symptom survey, but it's really
44:38helpful for me
44:39to see that and you know, they they
44:42don't have
44:43the one neurotransmitter in their brain
44:46that is like regulating everything.
44:49Everything else is excited to worry and
44:50they're just off to the races in being
44:53you know, in this stress loop and they
44:55feel terrible. I mean, their body is
44:56just betraying apparently on so many
44:58levels, but
45:02>> All right, let's go back to the main the
45:03main thought was
45:05labs that you appreciate that are not
45:07commonly ordered in serum. So you you
45:10talked about complement tests. You
45:13talked about MMP-9.
45:15Uh then we kind of did this little
45:16sidebar off into dysglycemias which I
45:18think is helpful. What what else would
45:21you typically include in your
45:23I I'm assuming this is kind of like your
45:25initial evaluation when you're just
45:27engaging with a patient for the first
45:28time?
45:29>> Yes, and you know, I don't have as as as
45:33is the case with you
45:35every patient is like a snowflake to me.
45:37It's like I I love that part of what I
45:39do which is I view them uniquely. I
45:42don't have the Rackman panel that I
45:44check a box, but
45:46you know, when I just when I suspect
45:47tissue injury, when I suspect that we
45:50may be dealing with tissue breakdown or
45:53a a potential organism, I use this.
45:56When I suspect that there's a strong
45:58issue of of glucose dysregulation in one
46:01direction or another, I'd order that.
46:04I find often in immune dysregulation
46:06that glutathione depletion
46:08is central to that. Vitamin D, vitamin
46:11A,
46:12glutathione and what you just mentioned,
46:14which is short-chain fatty acids. So,
46:15I'm like
46:17I'm all I'm all about repeated vitamin
46:19D's and really targeting that toward a
46:22higher level in the beginning and then
46:25toward a more
46:26useful level afterwards, but I don't go
46:28by dosages. I'm going by lab values.
46:31>> Sure.
46:31>> I will run that test a dozen times till
46:32I dial somebody in.
46:34And I don't get a lot of value out of
46:37vitamin A testing, but I get a lot of
46:39value out of using vitamin A.
46:41>> What's your issue with vitamin A
46:43testing?
46:43>> The liver does some really weird things
46:45with it and it stores it, so you can
46:47measure vitamin A as low, but you give
46:49somebody vitamin A, it's not going to go
46:50up substantially. And then the liver's
46:53metabolizing it and all you're going to
46:54do is create a toxic liver. And then
46:56probably if [laughter] you're keep
46:57loading them up with more A for too long
46:59a period of time. But, even though it's
47:01like the third rail of what I do, like
47:03there are there are a few compounds that
47:05I recommend that I'm like, "Ooh, I
47:07really got to keep a close eye on this
47:09cuz it could really help and if I lose
47:11contact with it, it could go too high
47:14and hurt." Vitamin A is one of those. It
47:17can be extraordinarily helpful at high
47:19doses initially in care. And then if I
47:22don't tail out bring that back, I'm
47:23going to start to see the liver be
47:24unhappy.
47:26And glutathione is a really hard sucker
47:29to to measure because it is
47:32extraordinarily fragile molecule in the
47:35body. It just is it goes away. So, we
47:38have
47:39two surrogates in standard lab testing
47:41that I find very valuable for
47:43glutathione levels.
47:44One is GGT. Now, that's typically
47:47something that people think of as
47:48associated with liver function, but
47:51the the studies are pretty strong that
47:53if you have a GGT lower than
47:56you know, 17, you're 16 is kind of where
47:58I want them or or below, but if you have
48:00a GGT, excuse me, above that
48:03you're sucking up glutathione at an
48:05incredible rate and you don't have
48:06enough
48:07to process. We don't know whether that's
48:09a recycling issue or a substrate issue.
48:11Is there enough glutathione going in?
48:13Are they recycling glutathione, which is
48:15very fragile? And the other one that I
48:18use, um, is oxidized LDL. These are very
48:22good That's not the regular LDL, but you
48:24it's specifically the oxidized version.
48:27Um, you can If you Some labs will do an
48:30oxidized phospholipid test.
48:32I think I just think Quest will do it,
48:34but LabCorp won't, but
48:36you know, that's also a very valuable
48:38one, but these oxidized lipid markers
48:40are great because the body doesn't want
48:42oxidized lipids. So, it uses glutathione
48:45to satisfy those lipids and not and and
48:47reduce them and not make them dangerous
48:49in the body.
48:50>> So, you're you're using the ox LDL,
48:52um,
48:53I'm sure it's case specific, but in
48:55general as an indicator of glutathione
48:57sufficiency or uh, their antioxidant
49:00capacity in general as opposed to using
49:03it as part of a deeper cardiovascular
49:06workup. Which you would use it then as
49:08well, but there are other you And And
49:10this is something that I've been harping
49:12on for years and you know, teaching
49:13seminars is that
49:15we tend to pigeonhole markers as, you
49:17know, we learn it as this tells me this.
49:19Like GGT tells me about gallbladder,
49:22potential gallbladder issues. And I I'm
49:24with you. I've been using GGT as a as a
49:27proxy for glutathione for quite a while.
49:29And uh, I I haven't put a hard number on
49:31it. I typically look at the lab range
49:34and look at whether or not they're
49:35creeping into the upper third of the lab
49:38range. I kind of like the idea of having
49:41something that's a little bit more This
49:42is a hard line. Uh, so I'll have to play
49:45with that my own clients to see which I
49:47like better.
49:48But
49:50we silo we pigeonhole these lab markers
49:54and you know it's great to go to a
49:56functional blood chemistry analysis of
49:58course but you know for guys if you're
50:00new if you're listening and you're new
50:01to functional medicine
50:03there's more to learn than these basic
50:05courses and the basic courses might be
50:07overwhelming if you're coming from a
50:09background where you don't have any
50:10knowledge of diagnostics but you know
50:13when you master the basics this just
50:15really just kind of the beginning of
50:16your journey when it comes to
50:17diagnostics would you agree with that?
50:20>> 100% and and you know one little detour
50:23I wanted to take comes back to where you
50:25started today which is our our first
50:27meeting.
50:29I know exactly where it was in Charlotte
50:31North Carolina I know exactly the hotel
50:34room I know exactly what we were doing
50:36and I know the exactly the course which
50:38was the
50:40fundamentals of functional blood
50:42chemistry analysis and
50:44I know that because
50:46a colleague of mine Russell Sher who
50:48always gives me the best information
50:50about like who's out there teaching cool
50:51stuff.
50:52He said there's this guy named Datis
50:54Kharrazian and he's just like a complete
50:58propellerhead wizard about functional
51:00medicine and he has a perspective that
51:01other people don't have
51:03but he's he's so
51:06familiar with the information that it
51:08comes out really fast and and you may
51:12want to go find a place where his course
51:15that he has created is being taught by
51:18others somebody in his his faculty
51:21because it may be at a slower pace and
51:23and
51:25I found you I found I I was really not
51:28using Apex products I wasn't familiar
51:30with Datis's work I got into that room
51:33and it it was the same fundamental shift
51:35that I had
51:38sitting in that room the first time with
51:39Jeff Bland because not only were you
51:43presenting information
51:46that you know obviously
51:48Datis worked really hard to call out.
51:51But, you were making it so tangible and
51:55so accessible.
51:56And I think that was the compliment that
51:58I gave you. It's like it it when you're
52:00really a master at something, which you
52:02are, you are a master teacher. When
52:05you're a master,
52:06it it almost seems effortless.
52:09And to the learner, it seems effortless.
52:12And I had that experience where I was
52:15like, "Oh my god, like everything I
52:16thought I knew." And I had already been
52:18in the lab industry and out of the lab
52:19industry and I You would have You could
52:22have absolutely told me
52:24it before this, you know, "I don't know
52:26how much you're going to get out of a
52:28basic lab course on CBC and a CMP." And
52:31I would say to you, "Yeah, you're
52:32probably right, but I'm going to put my
52:33butt in the chair." I came out with
52:36principles that I still use today from
52:39you. So, I wanted to I on behalf of
52:40myself,
52:41because I'm an an enlightened
52:44teacher and doctor because of you, and
52:48your delivery and and sharing of your
52:50clinical insight about this work, and
52:53also because of De Tisse. Like I I was
52:55no way I would be doing what I'm doing
52:57right now.
52:58With with
52:58>> Yeah, I I I I feel the same way about De
53:00Tisse and and I um
53:02I feel a little uh
53:04what's the word? Embarrassed almost to
53:06be, you know, mentioned in the same
53:08sentence as Jeff Bland.
53:10Um but, I I appreciate it. I I really do
53:13and
53:14you know, I would I think I would hate
53:16to go back if if we had recorded,
53:18let's say the very first functional
53:20medicine seminar I ever taught or even
53:22the one where you and I met. I would
53:24probably not enjoy going back and
53:26listening to myself.
53:28Um because, you know, you evolve and and
53:30your
53:31your perspective on things changes. The
53:33lens through which you see human
53:35function
53:36uh widens. You start to consider other
53:38things. Um as we've been, you know,
53:41teasing around with these lab markers
53:43that you go to before you go to
53:44specialty test, but I I
53:47appreciate your kind words. Um I really
53:49do, truly.
53:51Thank you.
53:52So, back to back to the labs. Let's
53:54finish this off and move on to something
53:56else. Um we've been nattering on for
53:59almost an hour now and and I have more
54:00time if you have more time. We can keep
54:02this going as long as it makes sense. Um
54:05so, we were talking about
54:06you know, let's say atypical labs that
54:08you like to include on a frequent basis.
54:11It's a compliment. We talked about
54:13MMP-9, relevant blood sugar stuff.
54:16Um
54:19and what else? Oh, you're talking about
54:21glutathione was the last thing, some of
54:22the proxies. Is there anything else or
54:25or is that kind of your core
54:27additional deeper things that you like
54:29to look at?
54:30>> Into the immune system area, I do get
54:33value before I order specialized
54:35laboratory tests. I get
54:36value out of CD4 CD8 studies.
54:39>> Sure.
54:40>> Um they give me a little indication of a
54:43lot of indication of whether the immune
54:45system is in a relatively regulated
54:48state or whether it's dysregulated. And
54:50it will tell me somewhat of the
54:52direction it's dysregulated. Are we
54:53having some trouble regulating it or is
54:57it being thrown into an overly
54:59aggressive area? Is Is the normal seat
55:03belt in place for the immune system to
55:05function, but not to go crazy? Or is
55:08there something really crazy happening
55:09that the immune system is reacting to?
55:11So, I get that answer.
55:13And I
55:14although I I believe that a lot of
55:16practitioners looking for stealth
55:18infections, you know, we see an elevated
55:20MMP-9, C4A is up.
55:23TGF-beta-1 is up. We're like, "Okay,
55:25something is going on in the organism
55:27realm."
55:28I'm running strep tests
55:31um very frequently. Um I'm I'm looking
55:36at
55:37also besides Epstein Barr and the and
55:41the more clinically relevant marker that
55:43I find is the
55:46early
55:48EBV IgG. And although we would think
55:51that the an IgG marker is like maybe
55:53something in the back, it's not
55:55something in the back at 150.
55:57>> Yeah.
55:58>> Right. So, I get a lot of value from
55:59that. A lot of people order CMP, but
56:02there's some things I order regularly
56:04that
56:05I don't see a lot of other practitioners
56:07ordering more regularly. I order
56:09Chlamydia pneumoniae. It sounds like a
56:11STD, but it's not, you know, it's a
56:14a strongly transmitted cardiovascular
56:19It can it can be involved in other
56:21areas, but when I think about micro
56:22vascular problems, when I think about
56:24perfusion issues, when I think about
56:26hey, what's ripping up the endothelium,
56:28I'm I'm looking for the presence of
56:30that.
56:31And I will say for the gastrointestinal
56:33tract,
56:35most people aren't checking Coxsackie
56:37group B. And they're aware of this thing
56:40called hand, foot, mouth disease, which
56:41is Coxsackie A, but they're not tracking
56:44Coxsackie B and man, do I pick a bunch
56:47of that up? And I pick it up in these
56:48patients that have relatively normal
56:53biomes and they're just showing an
56:55inflammatory result on a on a stool
56:58analysis and maybe there's some
57:00inflammatory markers indicating
57:04that that the gut is lit up, but we're
57:07not really seeing SIBO and we're not
57:10really seeing dysbiosis.
57:12I I used to stop there and like, well,
57:15you know, it's just there and I never
57:17thought of vi- I what I would call viral
57:19dysbiosis.
57:21>> Yeah.
57:21>> And that's a weird word, right? Because
57:23there isn't a necessarily a normal viral
57:26biome.
57:27Like we're not supposed to have a bunch
57:28of viruses in our gut as we are
57:31bacteria.
57:32>> Yeah, and I and I I have the same
57:34experience and perspective. Another one
57:36that I might find in in the gut or I
57:39should say find in blood testing, but we
57:42connect it clinically to what's
57:43happening in the gut is adenovirus.
57:47And and interestingly,
57:49um at least from my perspective, and
57:50again, I I can only speak to what I see.
57:52I can't speak to what everyone else
57:54sees, but I tend to see with people who
57:56have these viral issues in the gut,
57:59they're very hypersensitive.
58:01Um and even to the point where sometimes
58:04drinking water
58:06can trigger their their gut
58:07symptomatology. Is that consistent with
58:10what you see as well?
58:11>> And and that tells me, yes, and it tells
58:13me that we are not dealing with this
58:18kind of superficial mechanism of there's
58:20an infection and then you get rid of the
58:21infection and you fix the problem, but
58:23that the gut is this
58:25extraordinarily neurological organism, a
58:29muscular organism, an immune or like
58:31there's there's no greater confluence of
58:34weird systems all together in one place
58:37than the gut. And when you put water in
58:40and you and and and that water shouldn't
58:43really trigger enzymes. It should not
58:45trigger gastrin to be produced or
58:48cholecystokinin. It shouldn't trigger
58:49any of that. Like it should be pretty
58:51neutral. And you're seeing the pure act
58:54of motility of peristalsis just light
58:56these people up and their immune systems
58:58are crazy.
58:59>> Yeah.
59:00>> Um
59:01it makes me think about viral issues in
59:03the gut all the time.
59:05>> Yeah.
59:05>> With your CD4 CD8 panels, do you break
59:08the CD4 down into T helper subsets or
59:11you happy with that surface level?
59:14>> for in my first pass through the
59:16reference laboratory. I can order that
59:18if I'm interested in it. Um but
59:21for the most part,
59:23no.
59:24>> I I this conversation begs a larger
59:27question as to like what what is your
59:29clinical model, right? Because we we
59:32talked earlier about how a lot of people
59:34in the functional medicine space, you
59:36know, they have baseline knowledge
59:38and they rely on that wonderful innate
59:42intelligence in the human body to fix
59:45things. All they're doing is changing
59:46simple inputs like a gut protocol and a
59:48detox.
59:50And and that's kind of like to me that's
59:52like
59:53maybe tier one
59:55applications of functional medicine
59:57principles.
59:59But as we both recognized, functional
1:00:01medicine is
1:00:03it's more complicated. It's a larger
1:00:04arena with more players.
1:00:07And the more you practice and the more
1:00:09you learn, the more
1:00:10you know, one day one consequence is the
1:00:12more you know, the more you know, you
1:00:13don't know, right? The smarter I get,
1:00:16the dumber I feel is usually how I I I
1:00:18phrase that.
1:00:20But what is the model that you're
1:00:21operating in? And I'm fascinated with
1:00:23models and I
1:00:25I probably mentioned this on a maybe the
1:00:27last podcast that I did in in the
1:00:29Funk'tional Medicine but
1:00:31every couple of years I try to sit back
1:00:33and ask myself what have I learned and
1:00:35what should I change in my thought
1:00:36process.
1:00:37And sometime last year I I spent some
1:00:40time
1:00:41you know, just creating a PowerPoint
1:00:42graphic that I've used in seminars to
1:00:45say, "Hey guys, this is for better or
1:00:47for worse, this is my current clinical
1:00:48model. This is
1:00:50for lack of a better way of saying it,
1:00:51Steve's brain on a slide."
1:00:55If you were to put words or to
1:00:59to verbally paint out your your clinical
1:01:02model, how where would you start and
1:01:05what's in the model?
1:01:07>> So,
1:01:09um
1:01:10that has really evolved a lot. Um and in
1:01:14the last 10 years
1:01:16I feel much better, stronger,
1:01:21and capable in the model I'm currently
1:01:23using and have refined. Prior to that, I
1:01:26would have called it a primary care
1:01:28model that I was shoehorning functional
1:01:30medicine into.
1:01:32Anybody that showed up
1:01:34to see me,
1:01:35to be with me, to have my expertise,
1:01:38I would I would welcome.
1:01:41Any case, any issue, any perspective the
1:01:43patient would have I I didn't even think
1:01:45about the cosmology from which they were
1:01:48coming and what their skill sets are and
1:01:50what their capabilities.
1:01:52And my model also
1:01:56was a little bit more hey
1:01:59let's figure out what's wrong with you,
1:02:00we'll put some things in place, and
1:02:03you know, want you schedule some period
1:02:05of time in the future and we can check
1:02:07in on labs and symptoms and that. It was
1:02:09loose.
1:02:10Um that model does not work for me,
1:02:13especially with complex cases.
1:02:16There there was not enough structure
1:02:18around it and nor was there enough of my
1:02:20heart and my head
1:02:21for those patients and
1:02:23those doctors practicing that model
1:02:25looking after a couple thousand patients
1:02:27at a time. Not all the time, but they're
1:02:29rotating in and out of that practice.
1:02:31That's the average for kind of a even an
1:02:33alternative or functional primary care
1:02:35practice.
1:02:37I made the the strong decision that
1:02:41I
1:02:42I'm just going to cap at
1:02:4550 brand new patients to me a year.
1:02:49And a total
1:02:52group of people that I was actively
1:02:54looking after at the range of about 300
1:02:57people.
1:02:58That's where that beyond that it was not
1:03:00comfortable because I didn't have the
1:03:02heart and head to keep contacts. We talk
1:03:05in AI now about contacts. Well, we're
1:03:07we're we're AI also, right? We're we're
1:03:10I, we're intelligence, right? And our
1:03:12intelligence can only hold a certain
1:03:13amount of contacts. And beyond that
1:03:15number,
1:03:16I can't really remember the granularity
1:03:19of what's going on with the patient and
1:03:20I need that.
1:03:22Um and I ask patients early on to let me
1:03:26know some things about their perspective
1:03:29of their life, their issues, their
1:03:33capabilities of addressing things. If
1:03:34there's stumbling blocks, I'm trying to
1:03:36understand
1:03:38if there's anything in their world
1:03:40before we even get started
1:03:42that could make it a stumbling block for
1:03:44them to get well.
1:03:46And I spend a lot of time
1:03:49trying to figure out if people are in
1:03:50the right place.
1:03:51>> Yeah.
1:03:52>> And if they're not in the right place,
1:03:54I don't hesitate right now to try to get
1:03:56them to the right place. I don't
1:03:58jettison them. I'm like, "Okay, this may
1:04:00be another good place for you, but it's
1:04:03I know it's not me."
1:04:04>> Mhm.
1:04:05>> Like this model either doesn't work
1:04:07because you don't have the time to
1:04:09dedicate toward it or you just lost your
1:04:11job and you may not be able to have the
1:04:12resources for some testing and
1:04:14supplements. You're just feeding your
1:04:15family right now and
1:04:17>> Yeah.
1:04:17>> nothing I say or do is going to change
1:04:19that. And once it changes,
1:04:20you know, there'll be some resources to
1:04:22put toward toward that.
1:04:24I'm really trying to understand if
1:04:27their cosmology matches mine. Has every
1:04:30doctor prior to them done them wrong?
1:04:33Are they are are they looking through a
1:04:35particular lens which I I can understand
1:04:38it cuz I did [laughter] it, which is if
1:04:40you don't feel good and you've seen a
1:04:41lot of people and they're all letting
1:04:42you down, you might then be looking for
1:04:44the next person to let you down.
1:04:46>> Yeah.
1:04:46>> And my guess is if you're doing that,
1:04:48that probably will happen.
1:04:49>> And I don't want to be part of the list,
1:04:50you know, I don't want to let somebody
1:04:51down.
1:04:52>> Yeah.
1:04:52>> So, I think I spend a lot of time
1:04:54figuring out if people are in the right
1:04:55place.
1:04:58And then I dig deeply into a small
1:05:00select group of people in their first
1:05:01year with me. Most cases that I work
1:05:03with have a complexity that takes a bit
1:05:06of time to unravel.
1:05:08And
1:05:09I also am working with individuals who
1:05:11have that arc mindset. They're like,
1:05:13"Okay, can you show me I could feel a
1:05:15little bit better?
1:05:17And if you can show me I feel a little
1:05:18better, I'm I'm okay for the longer ride
1:05:20if this is going to get me better."
1:05:24And that really serves me.
1:05:26Really serves my patients because
1:05:29I can be fully present, I'm my best.
1:05:32I know them. I am in constant
1:05:35communication with my patients. I'm not
1:05:37waiting for them to have a scheduled
1:05:39appointment with me. I'm in a
1:05:41synchronous conversation about their
1:05:43health with them via text and email. And
1:05:47we do have
1:05:48frequent scheduled consultations and
1:05:50progressive evaluations of small subsets
1:05:52of labs, but
1:05:55the process works for me. I don't think
1:05:56that would work for everybody, but it
1:05:58really
1:05:59works for me.
1:05:59>> and I and I had suggested when when you
1:06:02and I were texting back and forth, I
1:06:04suggested that maybe we could talk about
1:06:06the idea that as clinicians, we have to
1:06:10make a choice
1:06:12between volume and engagement.
1:06:15You you can't have both, right? Those
1:06:17are are at opposite ends of the
1:06:19spectrum. So, if you you know, like I
1:06:22think you and I practice in a similar
1:06:23fashion. I like to spend time with
1:06:25clients.
1:06:27I like to explain things to them. I like
1:06:29to be their partner, their cheerleader,
1:06:31their educator, their whatever. And so,
1:06:33it's not unusual for me to spend an
1:06:35hour, hour and a half, um just depending
1:06:38on what we're doing on on any given
1:06:40appointment. And so, you know, if I'm
1:06:41spending an hour with every person, I
1:06:43can't see 20 people in a day.
1:06:46But there are a lot of functional
1:06:47medicine clinics and like early on when
1:06:49I started doing this, I had joined a
1:06:51practice management group
1:06:53out in Texas. And you know, essentially
1:06:55their model was high volume,
1:06:58um low low cost programs essentially
1:07:01based around, you know, do some subtle
1:07:04dietary changes, um fix the gut, do a
1:07:07detox, and spend 20 minutes in follow-up
1:07:09consultation.
1:07:11And I discovered very quickly that was
1:07:12not for me.
1:07:14I just I don't like to operate. Now,
1:07:15that doesn't mean that again you can't
1:07:17help people in a high-volume
1:07:21a high-volume practice, but in a
1:07:23high-volume practice it necessitates
1:07:25pre-programming
1:07:28and a lack of personalization. And so
1:07:30there's this trade-off between
1:07:33you know, I and I really would encourage
1:07:35anyone listening [snorts] who's either
1:07:36new to functional medicine or just
1:07:37getting into it. And even if you're in
1:07:39functional medicine for a while, you're
1:07:41kind of in a mode of of just thinking
1:07:43about who you are and what you're doing,
1:07:45you have to figure out what kind of
1:07:46clinician you want to be and what kind
1:07:47of people you want to help.
1:07:49And if your goal is volume,
1:07:51then you have to be satisfied with
1:07:54low engagement,
1:07:56short visits, and pre-programmed
1:07:58approaches, which will work for many
1:08:01people as long as they're not beyond a
1:08:04certain point in that scale of
1:08:06complexity, because the more complex the
1:08:08case makes or becomes, the more it
1:08:11requires in terms of time and and
1:08:13investment and that high engagement.
1:08:16Yes.
1:08:18So, anyways, that was me offering my
1:08:20opinion.
1:08:20>> and I think I think that
1:08:23perspective matches mine.
1:08:25Um
1:08:26and I need to be
1:08:28When I share with patients, there are
1:08:29some there are some critical elements to
1:08:32care working.
1:08:34And most patients will focus initially
1:08:37on
1:08:38how much will something cost
1:08:41and do they have the money to pay for
1:08:42that?
1:08:43>> Yeah.
1:08:44>> And I try to remind them that the most
1:08:46expensive care is the one that doesn't
1:08:48work. Every dollar you spend is
1:08:49something that's not working for you.
1:08:51You're losing time and you're losing
1:08:52you're losing your money.
1:08:54Number [snorts] two,
1:08:56you know,
1:08:57the
1:08:59the ability to fully engage and to
1:09:02communicate well together is a two-way
1:09:04street. Everybody's got to be able to be
1:09:06present. Are we Do we remain committed
1:09:09through the diagnostic and treatment
1:09:11process? Do we remain good, clear, and
1:09:13kind communicators with each other, and
1:09:15do we keep that engagement? And
1:09:16everybody's engaged in the beginning.
1:09:18There's a lot of symptoms keeping them
1:09:20engaged.
1:09:20>> Oh, yeah.
1:09:21>> Really well, somebody needs to remain
1:09:23engaged with the goal, and the goal is
1:09:25not symptom reduction.
1:09:27>> Yeah.
1:09:27>> The goal is the restoration of the
1:09:29normal vitality that should be in their
1:09:32body.
1:09:33>> Which which brings up another level of
1:09:35conversation in terms of clinical model,
1:09:37because that I think the first iteration
1:09:39of that is
1:09:41you know, what test do I run, what
1:09:43metabolic processes am I interested in.
1:09:46Um
1:09:48but there's also a model that kind of
1:09:50supersedes that at at the 30,000-ft
1:09:53view, and that's how you progress
1:09:55somebody from
1:09:57I have active symptoms and problems,
1:10:01deficits in quality of life that I'm
1:10:03trying to fix.
1:10:05From that point all the way to
1:10:07um ensuring
1:10:09quality of life as someone ages, so
1:10:11longevity.
1:10:13Right? And that's something else I've
1:10:14been putting a lot of thought into for
1:10:16myself is how do I walk someone through
1:10:19the you know, journey. It's so overused,
1:10:21but it's so true. How do you walk
1:10:23someone through that journey of I'm
1:10:26initially presenting because I have XYZ
1:10:29complaints, problems. What diagnosis can
1:10:31we run to figure out what to do, what am
1:10:34I going to do, how do I do that, how do
1:10:36I troubleshoot problems along the way,
1:10:38and at what point in the conversation
1:10:40have I had enough progress and and
1:10:43demonstrated stability and resilience
1:10:45that I can start talking about my
1:10:46future?
1:10:48Because that initial phase is all
1:10:50reactive, here and now. But at some
1:10:52point, I think for you and I as
1:10:54clinicians,
1:10:56the best outcome we can ever hope for is
1:10:59to have someone age gracefully
1:11:01and either
1:11:03very very long time cycles delay
1:11:07sometimes the inevitable or maybe
1:11:09prevent them and someone just literally
1:11:11dies of old age.
1:11:13>> [laughter]
1:11:14>> It's just a time back.
1:11:15>> I used to defer that conversation.
1:11:19>> Me, too.
1:11:19>> And
1:11:20and I don't anymore. Um I create for
1:11:23every patient that I begin working with
1:11:25once we've done the full, you know,
1:11:27history and diagnostic workup, I create
1:11:30a document that's a health roadmap. It
1:11:33is about a 12 to 15 page document
1:11:36both graphically depicting and
1:11:38narratively depicting their entire
1:11:40timeline of what's gone on with them,
1:11:43where I think they are right now from a
1:11:46cause and effect point of view as a map,
1:11:48like what's cause and what's effect and
1:11:50all of the parts are on there, as well
1:11:52as the lines connecting it all. A Kanban
1:11:54chart showing the prioritization, what
1:11:56do we do first, second, and third in
1:11:58your care.
1:11:59And
1:12:01and I then also do a risk analysis with
1:12:06them, which is interestingly, you would
1:12:09think the most interesting thing to
1:12:11patients would be what's wrong with me
1:12:13and what's cause and effect because I
1:12:14promised them I'm going to provide that
1:12:17for them and I I love giving it to them
1:12:19cuz that's like the golden ring for me.
1:12:21>> Sure.
1:12:22>> Patients are so
1:12:24appropriately interested in the two
1:12:27lines I create. I do a 10-year risk
1:12:30analysis for them.
1:12:31Specific to them, based on what we know
1:12:34about you, there's a diversion path
1:12:36here.
1:12:37A,
1:12:38what happens to you and your
1:12:40capabilities in 10 years? What is your
1:12:42risk of losing your health span?
1:12:46Even though you're only 10 years older,
1:12:48your health span's gone.
1:12:50And in many patients cuz I'm working
1:12:52with
1:12:52very chronically ill patients,
1:12:55that that risk it does not surprise me
1:12:57to see them at a 70 80 90% risk of
1:13:01something serious like a showstopper for
1:13:03them. Stroke, heart attack, cancer, some
1:13:07endpoint, right?
1:13:09Within a 10-year period.
1:13:11And then the other fork of that, which
1:13:16is I do the analysis, which is if we do
1:13:18everything I'd like to do to reshape and
1:13:20restore vitality for you, what does your
1:13:23risk look like in 10 years? And for the
1:13:25most part, except in the worst of cases,
1:13:28it actually goes down significantly. So
1:13:30there And in the worst of cases, we can
1:13:33marginally keep them where they are and
1:13:35not make the risk go much higher than
1:13:38where they are right now.
1:13:39And we also do an analysis to determine
1:13:42like what's the window of opportunity.
1:13:45You know, is it 1 year? Do they have a
1:13:47year left to like spin this thing around
1:13:49before they've lost too much tissue, too
1:13:51much injury? It's just hard. Do we have
1:13:53a 3-year window? Do we have a 5-year
1:13:55window? That's really helpful because
1:13:58I then can pivot to ask a patient, "Do
1:14:01you want your health span to meet your
1:14:02life span?
1:14:04Do you want your brain span to meet your
1:14:06life span?"
1:14:07>> Mhm.
1:14:08>> And they they've never been asked that
1:14:10before. It was like the first dentist I
1:14:11ever went to that said, "Hey, do you
1:14:14want to keep your teeth your whole
1:14:15life?" And I'm like, "That is I just
1:14:17laughed. I thought this is the craziest
1:14:19Yes." And I'm like, "Well, he's like,
1:14:21well, you got to floss, you have to
1:14:22water pick, you got to do this and
1:14:23that." And then he went out through
1:14:24everything.
1:14:26When I ask patients, "Do you want your
1:14:28brain to be with you your whole life?"
1:14:32>> [snorts]
1:14:33>> That's a That's a big question for them
1:14:35that they don't really think about. And
1:14:37then it just takes about a pause, and
1:14:39they're really of course
1:14:41very enthusiastic about keeping that.
1:14:43>> And it really
1:14:45I'm sorry to interrupt, but that really
1:14:46shifts the frame of reference away from
1:14:49chasing symptoms to really the deep
1:14:53value propositions.
1:14:55>> Yes.
1:14:56>> So, how are you how are you calculating
1:14:58or modeling these these estimates? Are
1:15:01are these things like
1:15:02>> There are very few good
1:15:06um
1:15:07tools out there and what I began to do
1:15:12was cull
1:15:14research around longevity and the
1:15:19imbalance of certain systems systems and
1:15:22how they affect that longevity.
1:15:23>> Yeah.
1:15:24>> And my brain isn't big enough, so I
1:15:26stuck it into a
1:15:28model that I have continued to train and
1:15:32refine with I think I may be up to
1:15:36a few hundred studies now that inform
1:15:38that model. And
1:15:40I'm I'm using the big brain of
1:15:43artificial intelligence to just take all
1:15:45the lab values and pour it into that and
1:15:48come and create the assessment and
1:15:51um
1:15:52>> So, you're not you're not calculating
1:15:54>> for the for AI and that's one of them is
1:15:56like multivariate analysis. Based on all
1:15:58these things that we know and the things
1:16:00that are going on with you, what does it
1:16:02look like for you moving forward?
1:16:04>> Right. So, you're not you doing like a
1:16:05simple 10-year ASCVD calculation or an
1:16:10Intermountain risk score or something
1:16:12like that. So, you're you're training
1:16:13your own large language model
1:16:16um using data that's published in the
1:16:20medical literature and then feeding
1:16:22patient data into that.
1:16:24>> Yeah, and just to clarify
1:16:26the the the words in this space are
1:16:28typically important. I I don't have any
1:16:31skills in training a model, which is
1:16:32like that's like
1:16:35the way the model thinks. What I'm
1:16:36giving the model is a knowledge base.
1:16:40And it's trained already, which is
1:16:41great. And then all I have to do is
1:16:43harness that.
1:16:44>> Yeah.
1:16:45>> And I've created a different harness for
1:16:48how it pours its way through that data.
1:16:51And
1:16:52um hundreds of hours of
1:16:54training it to do that.
1:16:56>> How which AI platform are you using?
1:16:58>> Quad. I don't really use it more than
1:17:00that.
1:17:00Yeah.
1:17:01>> Yeah.
1:17:01>> And this is all this is coded stuff like
1:17:04I've deeply gotten into the ability to
1:17:06code
1:17:08because it just is able to
1:17:11allow me to ask it to do some hard logic
1:17:14and fuzzy logic things together.
1:17:17>> Yeah.
1:17:18It sounds like we might have to do a
1:17:19part two.
1:17:21>> [laughter]
1:17:22>> I would love that.
1:17:23>> Yeah, cuz I I I am um very I don't know
1:17:27I would put myself in a computer-savvy
1:17:30segment of the population. Um I love
1:17:33technology. I've I've used it my entire
1:17:35clinical practice and you know, we're in
1:17:37such an interesting time right now with
1:17:39AI. AI, but you know, along with as good
1:17:42as it is, there have to be so many
1:17:43caveats about be careful.
1:17:46You know, careful how you use it and and
1:17:48all that kind of stuff. So maybe maybe
1:17:49we can delay that to a another
1:17:51conversation.
1:17:53All right, so let's uh
1:17:55let's switch the conversation to the
1:17:56topic that it's taken almost an hour and
1:17:58a half to get to the main topic. Uh but
1:18:01this is this has been a wonderful
1:18:02conversation. I think I could sit with
1:18:04you and
1:18:05pick your brain for hours at a time for
1:18:07sure.
1:18:07>> Thanks.
1:18:08>> Um let's talk about vitalism. Let's
1:18:11start with um you defining that
1:18:14and then explain to me why you wanted to
1:18:16talk about it.
1:18:18>> It's such an unsexy topic in medicine
1:18:22because what what tends to get
1:18:27my attention and my patients' attention
1:18:29um is like, oh, this new substance came
1:18:32out that fixes this symptom.
1:18:35I mean I I will feel a dozen questions a
1:18:37week. I've read this article, I got this
1:18:39email, and like, can I will this fix the
1:18:42thing? Because they all the snake oil
1:18:45always says like it it gives a list of
1:18:4618,000 symptoms.
1:18:49The same thing with the labs. It's like
1:18:51you're going to use the lab for
1:18:52cardiovascular. You're going to
1:18:53configure something out with this. And I
1:18:55think
1:18:57it has taken me a really long time to
1:18:59not get entertained by the shiny objects
1:19:02of that.
1:19:04And to get into something more
1:19:07heart-centered,
1:19:09energetically, spiritually grounded in
1:19:11what I how I view the world, which is I
1:19:14really see
1:19:16for each of us like perfection unfolding
1:19:19in our personalities, in our
1:19:20relationships. We're all just learning,
1:19:22right? We're all just like kids still
1:19:24learning how to talk to each other and
1:19:25how to deal with feelings and how to
1:19:27deal with the world and unraveling
1:19:29business things and unraveling personal
1:19:32things, and we're all learning. And I
1:19:34think our our bodies are also on a
1:19:38trajectory if we let our bodies do that.
1:19:40I believe that there is inherently
1:19:45a miracle going on in our bodies where
1:19:47it is constantly
1:19:49self-correcting for us, and these
1:19:50symptoms are occurring
1:19:52either
1:19:54as the self-correction. Some symptoms
1:19:56represent the correction of the body.
1:19:59Or the correction's failed, and you got
1:20:02some some really serious things breaking
1:20:04down, and injury, and what you're
1:20:06feeling are tissues being injured or
1:20:07dying off.
1:20:08>> Right.
1:20:10>> And that perspective sounds
1:20:14like I a few people would argue with
1:20:15that.
1:20:17But it makes such a different
1:20:22outcome if that's your guiding principle
1:20:25as a clinician,
1:20:26as opposed to just agreeing with it.
1:20:29Because the The
1:20:30of hey, we've got to give the body
1:20:34everything it needs to be able to
1:20:37restore itself.
1:20:38And we've got to trust that the body can
1:20:40do this." is a different approach than
1:20:45"This organism is organism is present,
1:20:47we're going to kill it."
1:20:49>> Mhm.
1:20:49>> Uh this inflammation's there, we How do
1:20:51you quench that inflammation?
1:20:53>> Yeah, sometimes you don't want to.
1:20:56>> Right.
1:20:57>> Right.
1:20:58>> [laughter]
1:20:58>> So, to me it has gotten down to
1:21:01a
1:21:02a a fork in the road.
1:21:04Am
1:21:05Am I about doing or being? Am I a human
1:21:08doer or a human being? Am I a doctor
1:21:11doer or am I doctor being? Am I doing or
1:21:13allowing?
1:21:15And those are two very different
1:21:17principles because I can look at a
1:21:18woman's physiology going through
1:21:19perimenopause and think, "Science fair
1:21:21experiment. This one's low and this
1:21:23one's high, da da da da." And I'm going
1:21:24to whack them all this one down and this
1:21:26one will come up and I can I can do
1:21:28that. And I did that.
1:21:30And you could hold that together for a
1:21:33little while and [laughter] then you
1:21:34realize like you're a puppeteer, this is
1:21:36not going to work. Or you could figure
1:21:38out how to establish
1:21:40the normal balance that's supposed to be
1:21:42there.
1:21:43Take away the stuff, the inflammation or
1:21:45the gut issues or the confusion in the
1:21:48liver or the way that that estrogen
1:21:51recycling is occurring. Like take away
1:21:53the problem
1:21:55that is impairing the body from
1:21:57self-regulating itself and suddenly
1:21:58things become regulated and it'll hold a
1:22:00lot better.
1:22:01To me, vitalism is
1:22:04a
1:22:05undying appreciation for the notion
1:22:08uh that our role with the body is to be
1:22:11a steward. It's not to be the fixer.
1:22:13It's not to be the mechanism
1:22:16manipulator. I still think there's a
1:22:19role for surgery. I still think there's
1:22:20a role for medicine. I still think
1:22:21there's a
1:22:22role for doing in circumstances. I think
1:22:26I'm talking about the triage of
1:22:28what do I think is most important in my
1:22:30consideration of a patient? And when I'm
1:22:33in front of a patient who has had a
1:22:35sometimes a lifetime, literally a
1:22:36lifetime of impairment,
1:22:38I am looking through that functional
1:22:40lens, but I'm really looking through
1:22:42what in the world is going on here that
1:22:44what a a normally healthy body that
1:22:47should be regulating itself is not
1:22:48regulating itself in the form of the
1:22:51person in front of me right now. What is
1:22:53going on there? Like it's a denial of a
1:22:55birthright to me. Mhm. So, I feel
1:22:58even more committed and and enthusiastic
1:23:03and interested and curious about what is
1:23:06going on here with this person that is
1:23:08stopping something that should be there
1:23:09as opposed to I'm a master
1:23:11diagnostician. I'm going to come up with
1:23:13the right label and the label will lead
1:23:15me to a formulary of treatment and the
1:23:17formulary of treatment will lead to the
1:23:18patient's symptoms going away.
1:23:21Two very different approaches, two
1:23:22different biases.
1:23:25>> Yeah, and I think it it opens up to this
1:23:26idea that that has come out several
1:23:28times in conversation that just because
1:23:30a lab is abnormal doesn't mean you must
1:23:33do something about it. Just because a
1:23:34symptom is present doesn't mean you
1:23:36should do something to get rid of it. At
1:23:38least, you know, not in the short term.
1:23:41And so, vitalism, my understanding of
1:23:43like if we could offer a definition,
1:23:46might go something like
1:23:50um
1:23:53human we as humans we go beyond our
1:23:58our
1:23:58our structure and our physiology.
1:24:01Like we're not just biochemistry, for
1:24:03example. Like there is a
1:24:06a present governing intelligence in
1:24:09chiropractic we call it the innate
1:24:11intelligence.
1:24:12Again, maybe oriental medicine they call
1:24:14it chi.
1:24:15Um I think different healing different
1:24:17disciplines have different names for
1:24:20similar concepts, but this idea that
1:24:22there is
1:24:23a governing intelligence
1:24:26that has the capacity to adapt and maybe
1:24:29has
1:24:30aspects of stability and resilience
1:24:35that when that process goes wrong is
1:24:38when we end up with changes in quality
1:24:40of life and in symptom expression.
1:24:43But to your point, just because someone
1:24:45is expressing symptoms, it could very
1:24:48well be
1:24:49the attempt of this innate intelligence,
1:24:51this vital force
1:24:53to adapt to something.
1:24:55Right?
1:24:57>> That's how wellness works. It's symptoms
1:25:00lie. They lie all the time.
1:25:02>> [laughter]
1:25:02>> They don't tell us when there is a
1:25:03problem sometimes. There's plenty of
1:25:05people that have had a cancerous process
1:25:07going on or a cardiovascular issue for
1:25:10decades and then they get a symptom and
1:25:13they're like, "Oh, that just happened."
1:25:15Symptoms also lie in the other
1:25:16direction.
1:25:17>> Yeah.
1:25:18>> There's
1:25:18>> point. I don't I don't think I've
1:25:20appreciated that last point enough.
1:25:23>> They
1:25:24They They are the sometimes the
1:25:26indicator of a process going
1:25:30well that was asleep for a long time. If
1:25:33I
1:25:34you know, there are individuals who
1:25:36Mhm.
1:25:37I'll be at my my population's probably
1:25:39skewed a lot like yours where I'm seeing
1:25:40a lot of patients with like some wacky
1:25:43immune system stuff going on.
1:25:45>> Sure.
1:25:45>> I see a variety of of archetypes of
1:25:47that. One archetype is they are an
1:25:50inflamed mess because their body is
1:25:51struggling really hard to deal with
1:25:53this. They're either poorly regulating
1:25:55or they're exuberantly attacking. And
1:25:59that's one archetype, but I see just as
1:26:01much of the other archetype where the
1:26:03immune system has become fatigued and we
1:26:07call that immunosenescence, but like
1:26:09they can't get out of their own way
1:26:10immunologically.
1:26:12And
1:26:14this is an example
1:26:16symptomatically of someone who when we
1:26:20start to get the immune system going
1:26:21again, we will get some inflammation
1:26:23signals that we've not seen before.
1:26:25We I I I I thanks to you have have
1:26:29really seen huge benefit to the
1:26:31implementation of nosodes of homeopathic
1:26:35preparations that awaken the body's
1:26:36ability to know that there's an organism
1:26:39present. And um
1:26:41you know
1:26:42man, that can create some symptoms.
1:26:44>> Mhm.
1:26:45>> You know, I try to attenuate those
1:26:46symptoms and I try to
1:26:47help with that, but
1:26:50boy, you know, when you're awakening a
1:26:52sleeping tiger,
1:26:54>> Mhm.
1:26:54>> you can create some symptoms. And and
1:26:56I'm not the kind of person that does
1:26:58like the Lyme treatment where you stick
1:27:00a port in somebody and pump them full of
1:27:02drugs long enough or antibiotics and you
1:27:04know, and they're just miserable with
1:27:05their symptoms. I don't believe in that.
1:27:07I I I'm a inherently very compassionate
1:27:11human being.
1:27:12I don't I don't shy away from symptoms.
1:27:14I can hold a lot of space with my
1:27:16patients for symptoms and understanding
1:27:19that
1:27:21>> Mhm.
1:27:22>> they sometimes are absolutely necessary
1:27:25and we can attenuate them.
1:27:28>> Do you have preemptive conversations
1:27:30with people to that effect? Like listen,
1:27:32as as we go through this process, things
1:27:35are going to flare up and that's okay.
1:27:36>> Especially on immunosenescent patients,
1:27:38patients that their immune systems are
1:27:40asleep. When they wake up, they they I
1:27:43tell them it's like look, you you have
1:27:45the equivalent of a Ferrari body that's
1:27:47been up on blocks in your garage in the
1:27:50back, dusty. And when we start up that
1:27:53engine, it's going to rattle potentially
1:27:55and spurt and black smoke and we don't
1:27:58know what it's going to do. It's not
1:28:00going to start rolling out of your
1:28:01garage,
1:28:02you know, just work its way slowly up to
1:28:05120 miles an hour. It is going to be
1:28:08messy.
1:28:09>> Yeah.
1:28:09>> But we're we're going to work together
1:28:11and you're going to tell me what you're
1:28:11feeling and I will interpret that for
1:28:13you and then we're going to work to
1:28:15attenuate that where possible but also
1:28:17not become afraid of it because there's
1:28:18two layers here.
1:28:20There's the layer of the symptoms and
1:28:22there's the layer of the patient's
1:28:23expectation about that.
1:28:26There's this classic experiment where
1:28:27they took a bunch of college students in
1:28:29the 50s, separated them into two groups,
1:28:31they got them to do this terrible
1:28:32experiment cuz they probably promised
1:28:34them free pizza and they took one group
1:28:36and they put their hands on these
1:28:38electrodes where they zap 10,000 volts
1:28:40at a really low amperage. It makes a
1:28:42it's terrible feeling. Um but it's not
1:28:44going to hurt you and what they
1:28:47basically did was randomly shock them.
1:28:50And they told them, "Look, you can't
1:28:51have the pizza till you keep your hands
1:28:53on this through the entire experiment
1:28:54for an hour."
1:28:55They were a mess. Their cortisol is up,
1:28:58everything was messy. They were a mess,
1:29:00heart rate, all the all the things you
1:29:02would imagine in telemetry were off.
1:29:03They took a second group and said,
1:29:05"Every 90 seconds
1:29:07you will feel this."
1:29:09And although the first two created a
1:29:11little triggering response till they
1:29:12knew what to expect, once they knew what
1:29:15to expect,
1:29:16no cortisol increase, no heart rate
1:29:18increase, no blood pressure increase, no
1:29:20respiration increase, no perspiration,
1:29:22no sympathetic dominance from that for
1:29:24an entire hour.
1:29:25If we know what to expect with our body,
1:29:29we can handle a lot.
1:29:32It's that extra layer that becomes a
1:29:34problem.
1:29:35>> That's highly informative.
1:29:39Finally. And and like you know, I like
1:29:41stuff like that because it's got
1:29:42practical applications because aside
1:29:45from managing
1:29:48our patient's physiology,
1:29:51we have to manage the patient, too.
1:29:54Right? We have to create reasonable
1:29:56expectations and
1:29:59uh prep them for the journey, so to
1:30:01speak. And and I love the idea of having
1:30:03preemptive conversations. I I've said
1:30:06many times in seminars that I'm a huge
1:30:08fan of not looking like an idiot.
1:30:10>> [snorts]
1:30:11>> So, I would rather tell someone to
1:30:14expect something and have it not happen
1:30:17than not tell them to expect something
1:30:19that does and now, from that point
1:30:21forward, I look like I don't know what
1:30:22I'm doing and I'm just trying to explain
1:30:24away something that happened to them.
1:30:28And and I think so, are there any other
1:30:30things in your arsenal
1:30:32aside from say these
1:30:34preemptive type conversations that
1:30:36you've like to employ with your clients
1:30:38in the first phase where you guys are
1:30:40just getting to know each other?
1:30:43>> I don't know if you mean from a
1:30:47therapeutic point of view or from a
1:30:51information point of view, but I will
1:30:53say that
1:30:53>> could be both.
1:30:55>> From a therapeutic point of view, I
1:30:58think the world of using specialized
1:31:00pro-resolving mediators.
1:31:01>> Mhm.
1:31:02>> Because even a small amount
1:31:06of this substance or which we'll talk
1:31:08about for a while.
1:31:09Um
1:31:10can help a immune system which has been
1:31:15in an inflammatory dominant state
1:31:17regulate itself better. Most individuals
1:31:20are
1:31:22so depleted in
1:31:24what the body
1:31:26uses to biotransform
1:31:30omega-3 fatty acids into these
1:31:35substances, miracle substances that
1:31:36resolve inflammation, that if we give
1:31:39just a little bit of that to a patient,
1:31:41they're able to resolve these weird
1:31:43inflammatory instances so much better.
1:31:46And I don't mean like loading them up.
1:31:48But that stuff is powerful. It's really
1:31:50powerful.
1:31:52And
1:31:53whenever I think something we're going
1:31:55to do, be it slowly raising vitamin D
1:31:58levels, vitamin D is your where is a
1:32:00hormone mislabeled, you know, whatever
1:32:02it was 100 years ago, it's not a not a
1:32:04vitamin, it's not a Flintstone. It's the
1:32:06most powerful immune regulating hormone
1:32:08we have. Just bringing that up from a
1:32:10level of what some people would not
1:32:12consider to be low, at 30,
1:32:14I consider that very low. But, you bring
1:32:15that up to 30 to where I like to target
1:32:17my autoimmune patients at, 80 to 90,
1:32:21their immune system's turning back on
1:32:22again. They will have some inflammatory
1:32:24symptoms, they'll have immune expressive
1:32:26symptoms.
1:32:28And I'm adding just a small amount of
1:32:30pro-resolving SPMs, small specialized
1:32:32pro-resolving mediators, can make
1:32:35it can make all the difference in the
1:32:36world at dampening.
1:32:38Not alleviating, you know, it's not pain
1:32:40relief, it's not an anti-inflammatory
1:32:42the way we think about it.
1:32:43But, it can be extraordinarily helpful.
1:32:46And just helping patients to remember
1:32:49from a communication point of view
1:32:51that none of this is surprising me.
1:32:55Oh, and the doctors that I've trained,
1:32:58I share with them the most important
1:33:00words you can ever share if you really
1:33:01believe it,
1:33:03are I'm not surprised.
1:33:05Because
1:33:08if you really aren't surprised by what
1:33:10they're saying, please voice that to
1:33:13your patient, because it gives them the
1:33:14comfort like, I don't know why you're
1:33:16saying that.
1:33:18Thank goodness you're not surprised by
1:33:19this, cuz
1:33:20>> [laughter]
1:33:21>> somebody's at the switch here. You know,
1:33:23we see what's going on.
1:33:25Um, I will even
1:33:28when patients are describing
1:33:30a really weird series of symptoms to me,
1:33:33I will take a pause point and try to,
1:33:36before I even respond,
1:33:38understand how the different parts of
1:33:41their physiology connect to create that
1:33:43symptom.
1:33:44Then I will say, I'm not surprised.
1:33:47Here's what probably is happening right
1:33:49now. And when they hear, A, I'm not
1:33:52surprised, the person they're entrusting
1:33:53to guide them, and B,
1:33:56there's a reasonable explanation for
1:33:57what's going on here, and here's how we
1:33:59will know. We'll do this,
1:34:01wait this amount of time out or add
1:34:02this, and if in 3 days, 5 days, 12 days,
1:34:06we don't see a shift, we're going to do
1:34:07something else.
1:34:08>> Yeah.
1:34:09>> That's That's That's bank for
1:34:12>> I think people like they want they want
1:34:14to know that you have a plan, first of
1:34:16all.
1:34:17Um
1:34:18and this is why I love the functional
1:34:20medicine, especially a thought-out
1:34:22functional medicine approach, is because
1:34:25it is hierarchical, it is prioritized,
1:34:28and I love the idea that you implement a
1:34:31road map as you get started with your
1:34:33clients.
1:34:34To your point about saying I'm not
1:34:37surprised that I use a similar
1:34:39uh phrasing when I'm doing my new
1:34:42consults. Like certainly there are some
1:34:44consults where I'm like I'm not sure if
1:34:46I can help this person, and I will say
1:34:48that directly. Like I would like to try,
1:34:50but I don't know if I can.
1:34:52But I find myself more often than not
1:34:54saying to the people
1:34:56um
1:34:57towards the end of the consult
1:35:00like
1:35:00there's nothing you said that confuses
1:35:02me.
1:35:04And you can see people visibly have a
1:35:07reaction to that. Like they it's almost
1:35:10like they go, finally, someone's
1:35:12listening. Finally, someone thinks that
1:35:13they can help me. And I think those are
1:35:16are powerful techniques and tools, and
1:35:19you know, going back to what I was
1:35:20saying about managing the person
1:35:22and what I mean by that is their mindset
1:35:24and their expectations, because
1:35:26those are
1:35:28in some cases, their attitudes and
1:35:30expectations and their mindset is as
1:35:33powerful as anything we might prescribe
1:35:35from a supplementation standpoint.
1:35:38Right? You can give somebody
1:35:39You can craft the most
1:35:42beautiful functional medicine protocol
1:35:44the world has ever seen,
1:35:46but if it's with a person who's
1:35:49glass half empty, not glass half full,
1:35:51and everyone falls on the negative, and
1:35:53they're in a living situation where not
1:35:55only do they not believe they're going
1:35:56to get better, but they have someone
1:35:58speaking into their life saying, "You're
1:36:00never going to get better." Then, it
1:36:02doesn't matter that you have the best
1:36:03protocol ever.
1:36:05That's That's the power of that side of
1:36:07the equation.
1:36:09>> I think that's really well well said.
1:36:12And, you know, thinking about that from
1:36:14a physiological point of view,
1:36:17you really can't get well in a
1:36:18sympathetic dominant state. You can't
1:36:20get well if you are in feeling in
1:36:24danger.
1:36:26Even if you have symptoms, if you don't
1:36:28feel in danger, there's the room
1:36:30to get better.
1:36:31>> Sure.
1:36:31>> Which is why I implement with lots of of
1:36:34my patients
1:36:35whatever techniques I can think of to
1:36:37kind of short-circuit
1:36:39the fear response that triggers
1:36:40sympathetic dominance using polyvagal
1:36:43theory and lots of vagal toning
1:36:45exercises and Wim Hof breathing and some
1:36:49yoga poses and yoga breathing. Like,
1:36:51there's some really good techniques out
1:36:52there. Regular, you know, low-impact
1:36:56burst training. Like, these things
1:36:57definitely dampen the sympathetic
1:37:00response and and if it's matched to the
1:37:03to the patient,
1:37:04you know, beautifully, and that's
1:37:07really important because we want to not
1:37:08have that
1:37:09>> Yeah.
1:37:10>> play a huge role
1:37:11in this.
1:37:12>> Do you feel
1:37:15Do you feel that functional medicine has
1:37:17become too supplement-centric?
1:37:21Too diagnostic-centric?
1:37:24>> I think it's done both of those things.
1:37:27They're both and
1:37:29I have had patients um
1:37:31that have come to me and they're like,
1:37:33"Look, like, I know from talking to
1:37:36others that somebody referred you. Like,
1:37:38I really believe like you're the one
1:37:40that can help me figure this out. Um and
1:37:43I don't I don't think I can do a whole
1:37:45lot of testing. I don't think I can do a
1:37:47whole lot of supplementation. I can't
1:37:49tolerate it or I can't
1:37:51or I can't afford it. And the challenge
1:37:53of working with a patient like that has
1:37:55been so incredibly rewarding
1:37:57because
1:37:59without the tools of
1:38:01knowing what I'm dealing with as I'm
1:38:03used to
1:38:04and the tools of knowing how to treat
1:38:06something, which is what I'm used to
1:38:08using
1:38:09nutraceuticals to do that
1:38:11as well as lifestyle implementation.
1:38:14Uh the power of kind of barefoot
1:38:16medicine becomes obvious.
1:38:18Barefoot medicine was um you know, in in
1:38:21in the communist revolution and if those
1:38:23those people that listening don't don't
1:38:24remember, the communist revolution
1:38:26occurred and the whole health care
1:38:27system collapsed in China. They had I
1:38:30mean, nothing was there.
1:38:31So, what they did was they issued these
1:38:33books called the the barefoot medicine
1:38:37doctor's manual and they picked a person
1:38:39in each village and said, "You are now
1:38:41this. You are going to do this." And as
1:38:43a combination, almost all of Chinese
1:38:45medicine implementation. Acupuncture,
1:38:47acupressure, herbs, lifestyle practices.
1:38:51And that that ability to use barefoot
1:38:54medicine to
1:38:57to be able to change someone's
1:38:59physiology
1:39:00using your
1:39:03skill
1:39:04experience and intuition about what's
1:39:06going on with somebody
1:39:07and then using lifestyle principles
1:39:10outside of
1:39:13natural compounds that have been
1:39:15synthesized, refined
1:39:18made more concentrated.
1:39:20That's some of the more rewarding things
1:39:21I've done with patients.
1:39:25>> I'm I'm always excited
1:39:26>> have to say I was using some of the
1:39:27nutraceuticals and I would still prefer
1:39:29to do that, but it's really rewarding.
1:39:32>> I like I'm always excited in in
1:39:34someone's case progression when I can
1:39:36get them to start exercising.
1:39:39Or
1:39:40um and that's been a big one and and
1:39:42that was like I was kind of forced into
1:39:44it because I like you and everybody else
1:39:47I've gone through an evolution
1:39:50in my uh
1:39:51you know, my ability as a clinician. I
1:39:54I keep learning which is a wonderful
1:39:56thing about our industry. If you're open
1:39:58to it, every year you can be a better
1:40:00clinician.
1:40:01Um
1:40:02but I you know, I got to the point where
1:40:04I realized that I had become that style
1:40:08of functional medicine clinician who
1:40:10relied too much on the supplementation
1:40:12and paid too little attention to things
1:40:14like diet and lifestyle.
1:40:17And so I started intentionally like
1:40:20my first consult when someone says yes,
1:40:22they want to work with me. My first
1:40:24consult is a diet review.
1:40:26That's my very first thing before we
1:40:28even touch any supplements.
1:40:30And you know, this is just how I do it.
1:40:32It doesn't mean it's the right way or
1:40:34the best way to do it. It's just what
1:40:35seems to work for me.
1:40:38And then I always have the expectation
1:40:40of somebody if one of my clients is not
1:40:42exercising,
1:40:43uh I have the expectation that we will
1:40:45at some point be talking about using
1:40:48that as a therapeutic tool, not just a
1:40:50generic hey, let's just recognize that
1:40:52everybody should exercise, but as an
1:40:54intentional tool designed to move them
1:40:57further down the road. And then the
1:40:59challenge becomes how do you implement
1:41:00that with somebody who's
1:41:03you know, lost all of their exercise
1:41:04tolerance and maybe exercised in the
1:41:06past but had to stop because every time
1:41:08they exercise they get worse.
1:41:10And and that's
1:41:12you know, it can be challenging but it
1:41:13certainly can be done. But it's uh
1:41:15you know, for me it's really kind of
1:41:17opened my eyes to admit to myself
1:41:20I'm trying to do too much with
1:41:21supplements and I'm
1:41:23I'm leaving too much progress on the
1:41:24table because I'm not pulling on these
1:41:26very large levers of diet and lifestyle.
1:41:29And I'm not saying that this happened
1:41:30just in the last 6 months. Like this is
1:41:32an evolution that's been, you know,
1:41:33going for years and years and years now.
1:41:36Um
1:41:40Let me ask you a couple of
1:41:42let's say closing questions. And I
1:41:44really would love to have another
1:41:45session with you and talk about your
1:41:47>> love that.
1:41:47>> Yeah, your your programming and and your
1:41:50your risk assessment models.
1:41:53If you were If you were having a
1:41:55conversation with
1:41:57let's say someone who's been in practice
1:42:00for a while, any any of the health care
1:42:02disciplines,
1:42:03and they're just looking at functional
1:42:05medicine going, I I think I want to do
1:42:07it, but I'm not really sure.
1:42:10Say just tipping their toe. What advice
1:42:12would you give them
1:42:13about where to start
1:42:16or how to proceed
1:42:19becoming a functional medicine
1:42:20practitioner?
1:42:22>> I think that that is a really great
1:42:24question. And I'm and I'm and I'm and
1:42:26I'm faced with that. Like I receive that
1:42:28kind of conversation frequently.
1:42:31And my answer is usually the same, which
1:42:35is
1:42:36I think the quality of the information
1:42:41through the Kresser Institute is is so
1:42:45high and so much clearer, better, and
1:42:48more
1:42:49factually accurate than anywhere else. I
1:42:51start them there and I suggest
1:42:54not necessarily that they begin with the
1:42:57lab stuff.
1:42:59But if they could like take a stab at a
1:43:01real
1:43:03um multi-faceted issue. So I I direct
1:43:07them to the thyroid and Hashimoto's
1:43:10course because like you can hit the
1:43:12whole picture from that. You can hit
1:43:15labs and you can hit function and you
1:43:18can hit You really get a bigger sense of
1:43:22Oh my gosh, something that I used to
1:43:23think was a gland is a system.
1:43:26>> Yeah.
1:43:26>> It extends from the brain all the way to
1:43:28the mitochondria.
1:43:30>> Yeah.
1:43:30>> And you get it it it kind of like really
1:43:34messes with your mind if you're not
1:43:36programmed to think about that and
1:43:38it can give some tools that help
1:43:42people to help their patients right
1:43:43away.
1:43:45So, I like that one because yeah, it's a
1:43:47little bit of investment and probably
1:43:49it's a hard
1:43:51uplift
1:43:52to just like sit your butt in a seat and
1:43:55like get through that because you have
1:43:56to really be willing to stretch.
1:43:59But, if you're willing to do that, I
1:44:01think
1:44:02that is the best way to try it on and
1:44:04see if the model makes sense
1:44:07and if some of the principles, maybe
1:44:09just one
1:44:11could be used. Like just grab the
1:44:13thyroid conversion issue problem that
1:44:15that conversion of T4 into T3 and say,
1:44:17"Hey, in all the patients I've been
1:44:18working with that seem to have euthyroid
1:44:21sick syndrome, like I'm measuring TSH,
1:44:23it's maybe a little bit high, but the T4
1:44:26is normal and I don't know what else to
1:44:29look at in a patient. I'll send them to
1:44:31an endocrinologist, which is like the
1:44:32kiss of death in those instances." Um
1:44:35like what do I do with that? Oh, I'll
1:44:37order a free T3 with my free T4 and now
1:44:39I got a picture and oh, there may be an
1:44:42adrenal or liver thing going on here.
1:44:44That is just like
1:44:46I've added a simple lab with a simple
1:44:50response
1:44:51that could have some lifestyle things
1:44:53and maybe I add some adaptogens and
1:44:54suddenly you are practicing
1:44:56functional medicine. You are definitely
1:44:59practicing it.
1:45:01And that's not a that's not a huge lift.
1:45:03>> What what do you think is the value for
1:45:05people starting out having um
1:45:09call it a clinical model, call it call
1:45:11it a framework. Like for example, when
1:45:14um
1:45:15when we teach the blood chemistry course
1:45:18the one thing that I like to start with
1:45:20is what I'll call the hierarchy of
1:45:21physiology.
1:45:23You hinted at at this earlier, like
1:45:25looking at
1:45:26um anemias and blood sugar issues,
1:45:28things that can alter uh, energy supply,
1:45:32right? That has to be foundational cuz
1:45:34nothing happens without ATP, right?
1:45:37>> Right.
1:45:37>> And this was one thing that was
1:45:39>> Oxygen transport, like you right, all
1:45:42that.
1:45:42>> Yeah, this was one thing that for me
1:45:44when I was beginning,
1:45:46uh, just getting into it was really
1:45:48helpful because my mind is and I
1:45:51understand that not everyone thinks the
1:45:53way I do or you do. Uh, but my mind
1:45:56automatically likes to sort information
1:45:58into
1:46:00categories, subcategories, systems.
1:46:03And so when someone says to me, "Hey,
1:46:05let's look at some labs." I want to know
1:46:07what do I look at first and why.
1:46:10Right? And and you know, maybe to what I
1:46:13I asked you to answer, I I would add
1:46:16that anyone beginning
1:46:18I think you need to have a solid
1:46:19framework which is that bigger picture
1:46:23upon which you hang all your details.
1:46:26It's very easy to go to seminars in our
1:46:28space and get details that are difficult
1:46:31to put into practice because there's no
1:46:33larger framework
1:46:35to put that into position relative to
1:46:37other things that might be more
1:46:38fundamental.
1:46:40>> I agree.
1:46:41I couldn't agree more and because
1:46:44it's kind of like having the Christmas
1:46:46tree to hang the ornaments. Like we
1:46:47don't want to hang the ornaments in the
1:46:49air. There's no place to put on the
1:46:50ground, they're going to fall on the
1:46:51ground, right? You need the bowels and
1:46:53then you can kind of hang something that
1:46:55makes it, you know, have have meaning
1:46:57and substance and and and something
1:46:59that's enduring. I agree with you. That
1:47:01framework is
1:47:04I think it's critical and that probably
1:47:06would have made me a better practitioner
1:47:08earlier to have had the framework. It
1:47:09kind of got cobbled together over time
1:47:12and maybe I, you know, until you just
1:47:14mentioned it, it's something I might
1:47:16take for granted as a
1:47:19uh, something that I am unconsciously
1:47:22competent at. You know, there's that
1:47:23hierarchy of learning something. You're
1:47:26you're unconsciously incompetent when
1:47:28you start. You don't know what you don't
1:47:29know.
1:47:30>> Right.
1:47:30>> Then you become consciously incompetent.
1:47:33And and that's not the place I like
1:47:35clinicians to be when I'm training them.
1:47:37I don't want them to think, "Oh my gosh,
1:47:38there's all this and I don't know this."
1:47:41It it it it is a humbling place to be,
1:47:43but it's frustrating.
1:47:44>> It is.
1:47:44>> Then there's the consciously competent
1:47:46place. And you could get somebody there
1:47:48pretty quickly.
1:47:49>> Yeah.
1:47:50>> If if they're willing. And then then
1:47:52until you mentioned it, I think I've
1:47:54been you know, unconsciously competent
1:47:58of being able to just work through that
1:48:00framework when I'm working with the
1:48:01patient. And I would call it intuition.
1:48:03And I think there's some of that, but
1:48:05there's some experience and intuition
1:48:07and wisdom of doing this for a few
1:48:09decades where you kind of get that sense
1:48:12of that hierarchy of
1:48:14what should I do first, second, and
1:48:15third. And I I agree there's a
1:48:17prioritization that is absolutely
1:48:19critical.
1:48:20>> Yeah. Yeah, and and in in the words of
1:48:22Datis Kharrazian,
1:48:24you when you have a problem
1:48:27that's more fundamental than the problem
1:48:29you're focused on, you're not going to
1:48:30get better.
1:48:32>> [laughter]
1:48:32>> Right? He calls them deal breakers.
1:48:34Um
1:48:36Yeah. So and I think that that's a a
1:48:38good starting point. Well, why don't we
1:48:40why don't we close off this
1:48:43this episode and we'll plan on
1:48:45scheduling a second conversation because
1:48:48I think you've got a lot more
1:48:50that would be worth sharing to the
1:48:52FunkMed Nation audience. [music] So
1:48:55Dr. Brad Racman, I appreciate your time
1:48:57and your insight. It's it's always a
1:48:58pleasure and I wish that we were
1:49:00actually in in the same physical space
1:49:02more often. [music]
1:49:03Uh so I could shake your hands and put
1:49:05my arms around your neck.
1:49:06>> Thank you.
1:49:06>> Um it's good to see you.
1:49:08>> [music]
1:49:08>> Good to see you, Steve. Thank you so
1:49:09much.
1:49:10>> Thank you.
1:49:15>> [music]
1:49:24[music]
1:49:38>> Hey.

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