New Frontiers in Functional Medicine

What a superb conversation with leading expert lipidologist and – importantly – clinician of 30+ years, Tom Dayspring, MD. In this tour-de-force conversation, we break down the essential cardiovascular risk laboratory analysis you need to be undertaking on all your patients. We spend a little extra time on Lp(a) and the coronary calcium score. Our conversation is practical; I was fervently taking notes through the entire recording, as I suspect you’ll be doing. I will likely bring Tom back for additional conversation, perhaps focusing on women’s cardiovascular health, so stay tuned! As with many of my podcasts, I chat with my guests before and after the recording. Tom and I discuss on the podcast whether we’re concerned about brain cholesterol deficits with an excessively lowered LDL. He unequivocally stated not; we synthesize all the cholesterol we need locally, including in the CNS. However, after the recording, he added that statins can cross the BBB and lower brain cholesterol. Serum desmosterol is an analyte that can readily be assessed that is a surrogate marker of brain cholesterol: consider this if needed. Enjoy this in-depth conversation, and be sure to leave New Frontiers a rating on iTunes or Stitcher or wherever you listen. It’s the best thing you can do to help share this valuable content and help put FxMed in front of more and more listeners! Thank you! ~DrKF

Globally, stress and anxiety levels have never been higher. According to one recent survey, a full 70% of Americans are stressed out, with a disproportionate impact on people of color. From worry about getting sick, to sick family members, to financial pressures, to homeschooling, the list of possible contributing factors is long. How do we care for our patients or clients in this climate? Victoria Albina, NP MPH is a family nurse practitioner in NYC – the COVID epicenter. She’s also a cognitive behavioral life coach and breathwork meditation facilitator. In short, she’s remarkably suited to walk us through tools to consider using with patients immediately. Victoria was an early adopter of using CBD for anxiety and has a wealth of knowledge around how to work with it for acute anxiety (regardless of how it presents: from insomnia to addictive “buffering” behavior). She also covers lifestyle interventions and key botanicals she’ll use concurrently when the need exists. And to top it off, Dr. Albina walks us through a lovely breathing exercise at the end of our conversation. It was one of the most grounding – and informative- podcasts I’ve done

Many of us in functional/integrative medicine have used organic acid testing for decades to identify nutrient, toxin, and genetic imbalances. I am proud that the lab I once worked in developed one of the original panels – still quite popular and in wide use today. Inspiration for organic acid testing came from inborn errors of metabolism research, where a handful of compounds are (still) measured in newborns to rule out severe genetic diseases. Flash forward to the “Omics” revolution: you know, the genome, the epigenome, exposome, microbiome, etc. We’re beyond the 42 organic acids of old, and moving closer to clinical metabolomics. For me, it's about time, to be honest. Metabolomics in the research setting has been happening for years, and today I talk with Betsy Redmond, PhD, on the ultimate metabolomic panel for clinicians and what that might look like: actionable, straightforward, and evidence-based. Perfect for the busy clinician, and satisfying for those who want a drill-down into the biochemistry. Thanks for listening, and please leave us a review wherever you listen to New Frontiers! ~DrKF

A nurse wakes in the night in profound anxiety, she can’t breathe, her first panic attack. Her husband is quarantined with COVID19; while she works the frontlines at a large hospital, witnessing what looks like the apocalypse. She begins a series of gentle, EFT Tapping exercises. After three brief rounds, she’s through the panic, able to once again relax. Nick Ortner is the CEO of The Tapping Solution, LLC, and my guest today on NFFM. Tapping is such a simple, elegant, immediate solution to the profound anxiety that comes with the out-of-control stress, fear and economic panic intrinsic in the COVID pandemic. With the Tapping Solution app (full access is available to healthcare providers for free), we can ground ourselves as needed. And for the data hounds among us (yes, that would be me); the app is tracking outcome. Over 1.5 million sessions have been conducted using the app. Regarding COVID19 specific exercises, Nick reports a couple of things: 1. Stress is at an all-time high 2. There is a daily average 45% reduction in the experience of stress after TAP exercises. You will enjoy this in-depth interview with Nick, and takeaway immediate tools to put to use for yourself and your patients. Let me know what you think, and please rate and review wherever you’re listening to New Frontiers.~DrKF

Dr. Alex Vasquez has been teaching clinicians, publishing articles, books, and also edits his own journal – for decades. If you know Alex, you know he’s a bright light – highly regarded in our field. You may also know he’s struggled with a “tough gut” for years; in fact, this is what brought him to integrative medicine. From our years teaching together, I know Dr. V is diligent – profoundly committed, actually – to trying/vetting/evolving integrative protocols for gut health (botanicals, diets, pharma, fiber combinations, gentle, aggressive), often receiving small measure of benefit. He’s used various protocols with his patients, case studies he often generously shares when teaching. But here’s the thing: when Dr. Vasquez says he experimented for a long time on himself, creating and tweaking, over and over, a fiber-centric product that resolved his gut issues, we shut up and listen, do we not? So that’s what this podcast is about: talking about a wonder product, designed primarily by Dr. Alex Vasquez, that will likely revolutionize our approach to treating tough guts (think refractory SIBO, dysbiosis, inflammation, permeability, etc). Furthermore, it looks like this program will balance metabolic irregularities and address weight loss resistance – all very exciting! I had a great conversation with Dr. Vasquez on the origin and design, and science behind this new intervention. I would LOVE to hear how you like it, what kind of results you’re getting, and if you decide to try it on your TOUGH gut patients. Listen and learn from Dr. V, and please share with your colleagues, and leave a review wherever you listen to New Frontiers. ~DrKF

Traditional Chinese Medicine (TCM) is used in all settings in China for COVID19, with preliminary outcome data very, very strong. Indeed, outcome data using TCM for prevention and treatment of SARS Cov1 was equally strong. Listen to one of the most important and timely conversations I’ve had to date on New Frontiers with Dr. John Chen, one of the world’s leading experts in TCM (with western pharma training). Framing TCM in language clear for the Western-trained clinician, and translating the early descriptive language, Dr. Chen (author of the seminal textbooks used in all the TCM training programs in the US) is actively following TCM in China, and shares his experience, insight, and observations with all of us. An incredible, and timely, conversation, worthy of your utmost attention. ~DrKF Dr. Chen, author of the seminal textbooks used in all the TCM training programs in the US is actively following TCM in China

We are all familiar with the Wahls Protocol. But how about the story behind the protocol? Did you know, for instance, that her director at U of Iowa (Terry is a clinician researcher) told her to write up herself as a case report? That was the first step. Her “N of 1”; then she wrote up a case series. Then she received a small grant and product for a slightly larger study. Then a million dollars. And now she’s heading into her largest study to date (yes, you will be able to refer patients). Listen to our New Frontiers conversation on how YOU as an FxMed clinician can contribute to the body of research demonstrating that: What. We. Do. Works. Terry and I also talk about behavioral change as THE MOST Important piece of the change journey. Hear how she supports it. This was by FAR one of my most treasured convos this year, and I appreciate you listening, commenting, giving us a 5-star review pretty please, and sharing with your colleagues! ~DrKF

Dr. Jocelyn Strand is the Director of Clinical Education at Bio-Botanical AND a great clinician herself. Prepare yourself: this is a very actionable podcast for clinicians using bioB. And for me, a huge pearl on refractory SIBO was unaddressed oral microbiome! In this episode of New Frontiers, learn how Dr. S addresses sibo using BB products. To test or not to test? And the underlying pathophysiology: tune in and listen to current thinking from a great clinician – she’s got to say and you’re going to learn a lot. Then, if you would be so kind, please leave us a rating and review wherever you listen to New Frontiers! I so appreciate your time and ears – thanks for listening! ~DrKF

This interview was, without doubt, one of the most moving for me. What Dr. Perlmutter and his son, Austin Perlmutter MD, have created is really nothing short of a revolution in returning us to our consciousness. It directly addresses one of the biggest elephants in the room – despite what we know to be good for us, good for others, good for the planet, why do we more often than not fall short of putting that knowledge into action? We. Are. Disconnected. As a people. As a world. Our prefrontal cortex allows us to engage in reflection, empathy and good decision making. However, when we lose the ability to engage our prefrontal cortex, we regress to a more primitive part of our brain – the amygdala – which fosters impulsivity, narcissism, and anger. It is virtually impossible to make the choices that we want to when our amygdala is in charge. And as we make those poorer choices – poor diet, less sleep, less exercise, more screen time – we reinforce our amygdala’s superior position. It’s a vicious cycle. In short, our modern world stacks the deck against us. And what can we do? Dr. Perlmutter gives us a unique lens through which to work with ourselves and our patients to start to support that prefrontal cortex connection. Tips to start to re-wire our neuronal circuitry in ways that will help us all make better choices. Be better people. ~DrKF

Dr. Jeff Gladd is a brilliant Fx/integrative physician who is PASSIONATE about all things Fx business. If there is ONE area I get more requests on, it’s business: setting up a practice, platform building, building a reputation, finding one’s focus and passion. Extra-clinic revenue streams. And mentorship: finding your tribe, building your collegial connection, moving off the island of medicine and into your tribe. With that in mind, Jeff – who is the CMO at Fullscript – and I have a tour-de-force convo on all of these topics. Learn about FS’s integrated EMR, our Clinic Immersion and Fx Residency programs, with top tips for building your brand. And so much more. Check out the shownotes for loads of links, references, downloads and more, and be sure to leave a review wherever you listen to New Frontiers! As always, thank you for listening!

As FxMed docs, we’re committed to working with the body’s own capacity for health. Dr. Josh Mitteldorf offers a contrarian strategy, one which he says is grounded in a new breed of evolutionary medicine. He tells us that diseases of old age are qualitatively different from the diseases we get when we’re younger, different because in old age, our bodies are part of the problem, not part of the solution. Aging, says Josh, is the body deliberately destroying itself (for the sake of the population), via inflammation and apoptosis and autoimmune diseases. In this interview, Josh and I find common ground talking about hormesis. In Josh’s theory, the fact that the body lives longer when stressed (e.g. caloric restriction) is proof that the body isn’t trying its hardest to stay young when it’s not stressed. It may sound like philosophy, but there are real consequences for the future of medicine. These are challenging ideas, so I’m eager to hear what you think, and be sure to leave a review wherever you listen to New Frontiers! Thank you! ~DrKF

A work horse laboratory in any functional medicine practice is stool testing. But really gleaning the best insight into our patient’s clinical picture can be tough. What do all of these commensal organisms really suggest? How do they correlate with the inflammatory findings? Of the bell weather bugs (like akkermansia) how can we increase levels? Is there ANY place for microscopy (O&P) and culture in today’s high throughput Omics world? You see where I’m headed. Even for the most seasoned FxMed clinician, a review of how to use these tests with an eye towards what to expect in new technology is essential. Disagreement with methods? Yes. Why? Zonulin Family Peptide – any utility? A great conversation with Dr. Michael Chapman of Genova Diagnostics. Thrilled with their commitment to in-house “data mining” and peer reviewed publication (IMO all of the Fx labs should be doing this). ~DrKF

Marvin Singh, MD is a practicing gastroenterologist with a focus in personalized lifestyle medicine. I met Marvin in 2017 when I was asked to submit a chapter to Oxford University Press Integrative Gastroenterology, 2nd Ed. Marvin has been coediting this behemoth with my IFM colleague Gerry Mullin, MD. (Full disclosure: very large props must go to Nikky Contractor, PhD for the heavy lifting on our chapter). Marvin’s evolution from a very traditional, academic gastroenterologist to integrative gastroenterologist to a cutting-the-edge personalized lifestyle medicine doctor (folded inside his own healing) is a story I think you’ll find interesting, and relatable. As we move through his story, I ping Dr. Singh on labs, interventions, books, all sorts of content – lots included, be sure not to miss this one. Brilliant guy, and I ‘d love to hear what you think! Be sure to rate, comment and review New Frontiers, wherever you listen to the podcast – I so appreciate you listening! ~DrKF

By far one of my most wide-ranging conversations on New Frontiers, Dr. Sara Gottfried and I set out to talk about her new book Brain, Body Diet and quickly headed north. Listen to our lively, personal, smart, heart-felt conversation as we dive into her experience using a continuous glucose monitor to address fairly severe nocturnal hypoglycemia, her thoughts on addictions and genetics, taming the dopamine-deprived COMTer, and lots of women’s health. You know that Sara is, of course, extraordinarily bright, but she’s also an open book in a lovely, inspiring way. For instance: How would a concussion, obtained through a dearth of self-care plus wine, lead to the Brain Body Diet? Besides the obvious connection, Sara describes a personal reckoning and rebirth that I can certainly relate to. If you are enjoying what you hear on NFFM, PLEASE leave a review wherever you’re accessing this podcast. ~DrKF

Take a second and think about this: what clinical presentation would prompt you to prescribe cognitive behavioral coaching, breathwork or meditation? Did GERD make your list? Along with gentle, but powerful botanicals and nutraceuticals (IT’s Motility Activator, DGL Chewables, Heartburn Advantage), these are cornerstone interventions for GERD in the practice of Victoria Albina, NP, MPH. Victoria operates from a patient empowerment position, believing that it’s essential for lasting change in a ubiquitous lifestyle condition such as GERD. We also cover epidemiology (30% incidence in the US), root causes, laboratory—and really interesting to me—the variable clinical presentations GERD can take. Finally, are PPIs .. safe? Victoria discusses a recent study that made the PR rounds. Take a listen, and be sure to like, comment and rate the podcast in iTunes, Spotify, or wherever you’re hearing my voice. Thank you! ~DrKF