New Frontiers in Functional Medicine

Dr. Deanna Minich preaches: Eat a rainbow. Why? There are over 700 carotenoids found in plants – all bioactive, and generally pleotropic (ie: they do more than one thing in the body). We don’t need tons of any single carotenoid, and indeed – if anyone recalls the beta carotene smoker study from the early 2000’s, too much of a single compound could arguably be toxic. But variety is essential. And amazingly, certain groups of carotenoid colors favor certain organs. Think “orange for ovaries”; blue for brain and green for heart. Listen to my riveting conversation with Dr. Deanna Minich as she shares her own healing journey from endometriosis and how color, plant medicine and spirit converged…. carotenoid science to artist. Variety. ‘Bridging the gap between science, soul and art’ in medicine. And hear about the Scio and how you can test your food nutrient density in this cool, cutting edge, handheld device – and loads MORE! There are 25,000 plant phytonutrients that we are aware of, and probably many, many more that we are not. Listen to this revealing podcast with the incredible Dr. Deanna Minich, and be sure to comment, give a thumbs up, and share with a friend!

Non-alcoholic fatty liver disease is an urgent, often unrecognized concern. It’s the hepatic pandemic of the 21stcentury, and there is NO approved pharmaceutical therapy (the race is on, however…). Fortunately for us, there is MUCH we can do in functional medicine – indeed, our toolkit is powerfully effective in turning around NAFLD and even NASH – the next step progression. Listen to my conversation with my good friend and longtime colleague Dr. Robert Rountree (finally on NFFM!). Bob outlines the scope of the problem (did you know 80% of obese kids are at risk?) how to evaluate for it, and most importantly: what to do. This was such a content-dense discussion, I am most grateful Bob has made his full powerpoint deck available to you for download. Take a listen to the podcast, then circle back to the deck for all the specific details on what to do.

Dr. Joel Evans – you probably know him as long-time IFM faculty teaching in the Advanced Practice Hormone Module. He’s also donned a newish hat as KBMO’s Medical Director. Dr. Evans loves the FIT test for delayed hypersensitivities to foods, and states that the addition of complement fragment C3d to their test significantly reduced the incidence of false positive results found on standard IgG testing. Listen to our convo on the FIT test, how he’s using it in practice, who he uses the test on, and why its essential in preconception planning. Also: this just in! We’re the first to hear about his study using KBMO vs healthy diet on 100 individuals with IBS – get the outcome data here.

The centrality of gut health in overall health cannot be overstated, and for many years researchers and practitioners have encouraged probiotic use to promote gut health. But their recommendations have been based on early and inchoate research. Today, several decades after the emergence of gut health as the ground zero of overall health, science has been able to correlate specific bacterial strains with specific health outcomes—and one man has spent years anthologizing all that research and making it available to practitioners and patients. Dr. Jason Hawrelak is a scientist, educator, and naturopathic physician. He’s one of the leading experts in microbiota manipulation and the use of specific strains for specific conditions. He is also the creator of probioticsadvisor.com, where practitioners and patients can access information about specific bacterial strains. Check out my conversation with Dr Hawrelak on NFFM. I am thrilled to be introduced to his work (have referred folks to him already), and so appreciate his dedication to crunching the data for us clinicians on Probioticadvisor.com.

In my Tour de Force conversation with the brilliant Dr. Theoharis Theoharides, we covered all things mast cells, from “bench to bedside.” In case you have not yet encountered his work yet, he is one of the most highly decorated, well-published clinician researchers in the world. The focus of his life’s work has been on all things mast cells, and mast cell associated conditions. Given the meteoric rise in said conditions (and our improved understanding of the role of mast cells in most chronic diseases), as clinicians, we need to understand how to diagnose and treat. Buckle up for this podcast, and get your pen and pad ready – the depth and breadth of Dr. T’s knowledge requires careful listening. Give a listen, then give a thumbs up for this brilliant, generous clinician!

Some of our most popular podcasts have been with Dr. Corey Schuler: he’s down-to-earth, practical in his approach to patient care, and very evidence-informed. And today is no exception! Join me and Corey as he talks through his “4 Pillar” approach to treating anxiety and depression. He discusses the multifactorial biochemical underpinnings of both conditions, his assessment tools (including labs), treatment (for acute presentations, chronic and co-managing those on pharma) and expectations of outcome. You won’t find the usual arsenal of natural therapeutics in Corey’s approach – he rarely uses 5HTP or St. Johns Wort – rather, he starts with full functional medicine and drills down into his 4 Pillars to determine next steps. We chat on new research – I think you’ll be impressed – and citation links are in show notes – including a recent study on Theracumin for memory and mood. Give us a thumbs up, leave a comment, and let us know what you think! ~ DrKF

It’s not often that I get to spend an hour chatting with a busy clinician on pearls learned over years of practice. In today’s podcast, I’m talking with long time integrative medical clinician and anti-aging expert Lynne Mielke, MD about her approach to bioidentical hormones and why the Precision Analytical DUTCH is her preferred test for assessing HRT response. It’s her experience that the “gold standard” blood tests often lead to over-prescribing, and she commonly finds herself initiating tapers for those patients who come to her already on biHRT. Lynne also shares with us her journey to integrative medicine- as a psychiatrist, she faced the limitations of her training when her son was diagnosed with autism. As she puts it, she entered another world as she dove into integrative, biomedical treatments for autism decades ago: “Given the complexity of spectrum disorders, If you know how to treat them, you know integrative medicine.” From there, she leaped into anti-aging medicine, as parents of autistic children sought her care. Dr. Mielke discusses her transition into practicing integrative medicine, and what her clinic looks like today. ~DrKF

Dr. Mona Morstein has focused the bulk of her career on treating all types of diabetes (DM). In late 2017, she published the a superb 500+ page very well-referenced book on the topic, titled Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type 1 and Type 2 Diabetes. Despite written in layman language, clinicians will find it meaty enough to be useful in practice – I especially like the sections on DM complications. In our conversation, we look at the four main types of diabetes, discuss etiology and epidemiology of types 1 and 2. We discuss standard labs, including the limitations of A1C, and the utility of the GlycoMark test. Learn how she does a glucose/insulin tolerance test and specialty lab testing considerations in patient management, managing the microbiome, intestinal permeability, food sensitivities. Diets: Dr. M recommends a very low carbohydrate diet (VLCD), but we had a great sidebar convo on the paradox of VLCD and vegan macrobiotic diets demonstrating equally good outcome – learn why Dr. Morstein suspects that is. Toxins, particularly POPs, but also metals, play a huge role in ushering in diabetes – learn how she’s evaluating and treating. We discuss nutraceutical interventions, medications – what she’s using and why. Of course, no conversation on DM is complete without discussing the influence on lifestyle. An interesting point Mona makes is that the program of treatment must be doable and relatively stress-free. Please give this terrific podcast a thumbs up and share if you like it as much as I think you will, and as always, let me know your thoughts!

If you’ve listened to my podcasts, you surely know that I love what I do. And my podcast with Dr. Stephen Sinatra is no exception. One of my most inspiring conversations to date, Dr. Sinatra is, as you know, a pioneer in the field of integrative cardiology. Hear about his remarkable, very early transition to integrative cardiology, including pivotal encounters with patients and scientists that shaped his thinking; his gutsy, hospital grand rounds presentations on the use of CoQ10 for heart failure patients, and the story of my mom working as a cardiac nurse with him during his fellowship. While Sinatra doesn’t maintain an active medical practice anymore, he still goes into his office often “to see how my former heart failure patients are doing. I don’t charge them. I just want to check in” He talked about a 9 year old boy he saw with florid heart failure. That boy is 32 years old now, and doing great. He was involved in designing the treatment plan for the now oldest-living person with tetralogy of Fallot. What did he prescribe? The “fearsome foursome”: CoQ10, magnesium, ribose and carnitine. At 73 years old, the first heart failure patient he prescribed CoQ10 to (10mg TID!) is alive and well. We move through loads of research on nutrients (yes, we discussed K2) diets, fats and what we need to be doing for ourselves, our families and our patients. Update: Dr. Sinatra and I spent a chuck of time on the famous PREDIMED study, published in the New England Journal of Medicine in 2013. PREDIMED garnered much attention by validating the use of a Mediterranean diet supplemented with olive oil or mixed nuts for reducing incidence of cardiovascular disease in persons at high risk. Interestingly, the day we recorded, news broke that the PREDIMED was retracted. However, the study authors re-published the PREDIMED in NEJM June, 2018 with compromising data omitted. The findings remained similar to the original PREDIMED. Listen to Dr. Jeff Bland discuss the details.

Endotoxemia. A fundamental driver of chronic disease. What is it? And more importantly, what do we do to address it? In my podcast with Dr. Jill Carnahan this month, she unleashes a torrent of compelling science and clinical savvy on all things endotoxemia. From heart disease and diabetes to autoimmunity (genetic or acquired) and mast cell activation, Dr. Carnahan is clear that pathological intestinal permeability (she discusses testing, but at this point in her career believes most everyone who sees her with chronic disease has IP) drives inflammation by allowing excess microbial endotoxins- primarily as lipopolysaccharide (LPS)- to enter circulation. Focused on root cause functional medicine (toxins, diet, infection, genetics), she concurrently heals the gut to drop the inflammatory burden. A key intervention for Jill is sugar-free, GMO-free, serum-derived bovine immunoglobulin (SBI), and we spend quite a bit of time on why SBI is crucial. With 43 human trials behind it, if you are not using SBI yet, you’ll be compelled to start, I suspect. We also have a fun dialogue on the role of fatty acids and toll-like receptor activation, connected directly to LPS. Jill shares a handful of very compelling case vignettes AND talks candidly about how she set up an extremely successful functional medicine practice and positioned herself as an expert in the field. And let me know: will you be changing how you prescribe high fat diets based on the research we discuss?

Anxiety can get in the way of patients achieving their health goals—especially when a practitioner recommends significant lifestyle and nutrition changes. Patients may feel suffocated by the new regimen and then make changes for a while but revert back—or they may not make them at all. The Emotional Freedom Technique, also known as tapping, can help patients ease anxiety and better achieve their health goals. It can also help with the subjective experience of pain or be used in service of a specific health goal, like overcoming weight loss resistance. In this podcast, Dr. Fitzgerald talks to Jessica Ortner, author of The Tapping Solution for Weight Loss & Body Confidence, about how tapping could help patients in a functional-medicine clinic setting. And, together, they walk step-by-step through a round of tapping so listeners can hear how it’s done (and follow along).

After suffering through a lengthy Lyme infection himself (with classic presentation), which initially responded to antibiotics but didn’t resolve the infection, Dr. Darin Ingels went on a years-long quest to recover, returning to naturopathic principles and discovering essential less-used protocols. The results are in his book: The Lyme Solution: A 5-Part Plan to Fish the Inflammatory Autoimmune Response and Beat Lyme Disease (Penguin Random House), and he has been treating patients with Lyme and co-infections successfully since then. In this clinical pearl dense podcast, Dr. Ingels pulls from his experience as a clinical microbiologist by training, to share what he is doing today in practice – from labs that work and those that don’t, using immunotherapy, the association with mold allergy and mycotoxicity, to botanical protocols and when to use antibiotics. While he doesn’t use the word “functional,” it’s clear that his approach to Lyme embraces a full functional approach, and that addressing the whole person, and their environment, is essential to recovery.

Wow! What a great conversation with Dr. Valter Longo, director of USC’s Longevity Institute. It’s always exciting to talk to someone in the trenches of bench and clinical research, especially a rock-star like Valter Longo! You can hear my nerves as we begin ☺, yet there’s much to learn about Dr. Longo’s journey from a Blue Zone upbringing in Italy to music major to biochemisty major to leading expert in articulating the biochemical and genetic underpinnings of the aging process. Dr. Longo was a post-doc under Dr. Roy Walford – famous for his research on caloric restriction and longevity. While Walford’s work – famously the 2-year Biosphere study conducted on humans – yielded remarkable improvements in chronic diseases, there were many side effects. The limitations of the human Biosphere study prompted Dr. Longo to turn his attention to longevity in single-celled organisms (S. Cervascie, specifically), then animal studies, and most recently humans. Longo designed his short term fasting mimicking diet (FMD), which does away with the fallouts he observed in long term caloric restriction. We cover a lot of great material in this conversation – and Dr. Longo makes compelling points against the unfettered use of MCT and exogenous ketones. Take a listen and let me know what you think!

Yes, hemp & marijuana are major providers of cannabinoids, and in the FxMed space, we are extremely excited about this potent family of bioactive molecules. In particular, we are looking at CBD for indications ranging from pain to mood, inflammation, memory and more. Turns out the endocannabinoid system (ECS) extends body-wide, and similarly, phytocannabinoid sources extend far beyond hemp and marijuana. Listen to my conversation with Dr. Jacqueline Jacques, Senior VP with THORNE – and tour the ECS and the use of phytocannabinoids from hemp, rosemary, clove, black pepper and even hops, whose constituents have an “entourage” effect on the ECS, along with other commonly prescribed compounds including diindolylmethane, ginseng, echinacea. It strikes me as extremely logical we’d be thinking about using phytocannabanoids with most of our patients and ourselves – probably PCs are foundational interventions not dissimilar to the regularly prescribed essential fatty acids. We get the inside scoop on all this and more in New Frontiers! Take a listen and let me know what you think:

In my conversation with Mark Hyman on his new NYT best seller, Food: What the Heck Should I Eat?, we discuss the myriad challenges consumers face in figuring out the correct diet, but also, what WE as clinicians caring for patients – what do we prescribe? What do the data show? Are grains really verboten? Is dairy completely off-the-plate? What about meat? And fats/cholesterol and the APOE4 patient? Mark enlightens me to the new “regenerative agriculture” movement; going far beyond organic, regenerative agriculture regenerates the environment while providing good, clean food. Amazing, right? He also addresses the common price complaint. What is the cost of eating clean vs eating conventional? We also go behind the scenes to address the insidious agribusiness at the heart of US policy, and chat about Steven Savage’s recent take-down of Environmental Working Group’s Dirty Dozen Clean Fifteen lists. This was such a fun convo for me, and as always, Mark is doing great detective work getting to the heart of concerns around diet and the ecology of eating. Take a listen, I bet you’ll be as intrigued as I was.