 If you want to pump your body and expand your mind, there's only one place to go. Mind pump! With your hosts, Sal DeStefano, Adam Schaefer, and Justin Andrews. What's up, Mind Pump listeners? So me, Adam, and Justin had the amazing opportunity to sit down and have a great conversation with Chris Kresser. Now, for me personally, I have a special connection to Chris. Back when I started having gut issues and health issues, his articles were the ones that really directed me or really helped me, I should say, find the right direction to help myself. In the wellness world, Chris Kresser, he's among the best. His information is incredible. He's got some phenomenal books. He's a functional medicine practitioner. He looks at the entire body as one organism. In this episode, we have some great conversation with him. We ask him a lot of good questions. We talk a lot about the state of health in this country. We talk about diets and why we crave certain foods and everything from leaky gut syndrome to HPA axis dysfunction to adrenal fatigue. It's a really, really good episode. We have the experts in this realm. So you're going to love this episode. Now, you can find his information at chriscresser.com. That's Chris, C-H-R-I-S, chriser-k-r-e-s-s-e-r.com. He also has a book that's about to come out. Now, we were lucky enough to get an advanced copy of it. I'm already halfway through it. Brilliant book, one of my favorite books. The title of it is Unconventional Medicine. Join the revolution to reinvent healthcare, reverse chronic disease, and create a practice you love. It should be available either by the time this airs or within a few days. So go check it out. He also has a podcast, Revolution Health Radio. So without any further ado, here we are talking to Chris Kresser. Chris, I think I first heard about you. God, it's got to have been at least six or seven years ago, maybe longer. I had a client that I was working with who had just some strange issues with fatigue, just chronic fatigue, had issues with food. She was developing more and more issues with different foods that she would eat where she would get reactions like bloat or digestive issues or skin issues. And she talked about you and I looked you up and then I read, I think I read an article that you wrote about leaky gut syndrome and what that is. And we've talked a little bit about leaky gut syndrome to our audience. Maybe if you, if you wouldn't mind explaining that a little bit and what that is and how common that is, because I think since learning about it, I feel like it's far more common than people realize. Sure. Yeah, so our gut is basically, if you think about it, it's kind of interesting. Everything inside of our gut is technically outside of our body. Oh yeah. Yeah, it's weird to think about it because we think about it as inside. Explain that to me. Let's just throw it over. Here's how I imagine it like this. You have a donut and then there's a hole in the donut, right? Inside the donut would be in the donut. The hole is not in the donut because it's through. That's exactly right. And that's where your digestive system is. It's like a hollow tube that connects your mouth to your anus. I got it. I got it. And so anything that's in that tube is not really in your body yet. Wow, okay. Wow. She's shuttling through. Yeah. And that is helpful to think about it that way because then you start to understand one of the main purposes of the gut barrier, which is to keep things out of the body that shouldn't ever get in. You know, some things we put in our mouth that we're not supposed to absorb. That's why they come out the other end, right? But some things we need like nutrients and food. And so the gut is this barrier system that decides what gets in and what stays out. And so it should normally be permeable but only at the right time and for the right things. And leaky gut is what happens when it becomes inappropriately permeable. So it starts letting things in that should not get into the body in the first place. So these could be big protein molecules that haven't been broken down. They could be toxins from bacteria in the gut if there's like an imbalance of good and bad bacteria. And then when those things get into the bloodstream, they trigger an inflammatory response and all hell breaks loose. So it can cause everything from digestive symptoms clearly like you mentioned, but also skin breakouts and rashes because skin's the biggest organ in the body and inflammation will almost always affect it. So you've got kids with acne, adults with acne, eczema, psoriasis, all that stuff can be gut related. It can also cause depression and anxiety because there's a profound connection between the gut and the brain. So unfortunately most doctors, most people in the general public don't really know about this, the connection between the gut and all the rest of the body. It used to be, people used to laugh at leaky gut syndrome, just the term, like that's bullshit, it doesn't exist. But it seems like more and more people are now starting to accept that that's something that can happen. How far along is Western medicine in this regard? Are they acknowledging it at all or is it just right now in the study phase? Oh, well that's an interesting question because yeah, it's true. I mean, if you wanted to generate some serious eye rolling, or get yourself laughed out of a room 20 years ago, you'd go to a medical conference and start talking about leaky gut. It was like the realm of alternative quacks. And now if you go to PubMed, which is a big repository for scientific studies, and you search for intestinal permeability, so you have to use the very official sounding term, then you'll see thousands of studies, literally thousands of studies connecting intestinal permeability with everything from autoimmune disease to depression and schizophrenia. It's a legitimate condition that's being studied in peer-reviewed prestigious scientific journals. But whether that research has actually trickled down to the average primary care physician is a different question. And this is one of the biggest problems in medicine right now is there's at least a 20 to 30 year lag time it seems between like the cutting edge research and then what becomes the standard of practice. What are some of the main causes? Why are we having so many issues with our guts today? What's causing this? Well, in a nutshell, the answer would be the modern diet and lifestyle. So we human beings, just like all other organisms and animals in nature, we evolved in a certain environment and we're adapted to survive and thrive in that environment. And when you take us out of that environment and put us in a really different one, our genes can't change fast enough to adapt. And so we have things like processed and refined foods, big gulps and cheese doodles and all the crap that we eat today, that stuff will cause intestinal permeability. What is it, Chris, in those that are causing that? What is it? Sugar, refined flour, all of these things cause what we call dysbiosis. So it feeds potentially harmful microbes in our gut and allows them to proliferate. And then the toxins that those bacteria produce can cause that intestinal permeability. Is it because it's just like an overwhelming amount for the gut to handle at one shot? Is that what it is? Because we've refined it so much and we've processed it so much and it's just like this bomb going off in our gut? Yeah. I mean, to put it simply, if you think about what our ancestors ate, it was all real nutrient dense whole unrefined food. It was meat and fish, wild fruits and vegetables, some nuts and seeds and some starchy plants. And what these foods all share in common is they don't have a lot of easily accessible sugar in them. I mean, the fruit has some sugar, but it's locked up with fiber and there's a lot of water. And so when we eat these foods, our body knows what to do with them. When we eat the top six foods now in the American diet are grain-based desserts, bread, pizza, sugar-sweetened beverages like colas, alcohol and chicken dishes, but mostly fried chicken nuggets and KFC. Those six foods comprise the majority of what people eat. Wow. Yeah. The new food pyramid. The new food pyramid. Yeah. And you're saying that that is making us sick? Making us sick? That's weird. Isn't that crazy? I mean, who knew? So, I mean, it's kind of fun sometimes to think about the evolutionary adaptations we'd have to go through in order to thrive on those six foods being the part of our diet. I mean, they're totally depleted of the nutrients that we need, like the micronutrients, the vitamins, minerals, trace minerals. That's like fuel for the car. If we don't have that, we can still function, but we're not going to function very well. We're just putting diesel in a car that runs on gasoline. It'll still go, but it's not going to work well. And so, yeah, those foods, they have a lot of sugar that's readily available, and so that sugar feeds the microbes. Bacteria love sugar just as much as we do. And in fact, we know that those bacteria can actually cause us to crave sugar. They're actually kind of running the show when it comes to our cravings. So if we have more of these bacteria, they can make us crave that. Isn't that another controversial thing to say, too? Because some people, the whole craving thing is... I remember when we had Lane on the show, that was his big... I said, well, man, I get these cravings when I eat these foods, and you're, oh, we're careful with what you say when you say the word crave. Is that kind of like a gray area? Well, I mean, there's certainly plenty of research that shows that the gut microbiome affects our cravings because the chemicals that the bacteria produces affect our brain, and our brain is what determines our cravings for food. We have this system, the hypothalamus and other regions of the brain that basically determine what we seek out. And that's a survival mechanism that when we were living in... when we were hunter-gatherers, it was a survival advantage for us to seek out sweet and fatty foods because if we obtained those, we would survive. Pack it on. That's great. But when there's a 7-Eleven on every corner, and we can just walk down to the end of the corner and get a big gulp and all kinds of other stuff, that's where that hard-wire programming starts to work against us. There's also, when we did seek those things out, at some point, we have these natural systems where we'll actually get sick of a particular flavor. It's like a natural satiety signal. So if I were eating something sweet in nature, I could eat so much of it, but there'd be a certain point where I'd be like, I don't want to eat anymore. We've all experienced that. But when I introduce a new flavor to it, I kind of hijack that signal and I'll eat more. And what happens, a lot of times, this is what I talk about a lot on the show. This is the magical science behind McDonald's Fries and Ketchup, right? Exactly. And this is what I like to talk about on the podcast a lot of times is how food manufacturers of this process, because processed foods, really what they are, is just highly engineered foods. There's lots and lots of money and science that goes into figuring out the perfect texture, you know, crunch or whatever, the taste, the saltiness, the sweetness, the color, the smell, like all the factors that go into making a food desirable and then also overcoming your body's natural systems of satiety so that you eat more of them. It all goes into processed foods, whereas natural foods, you know, we evolve to kind of where our bodies will stop eating when they need to or crave them when they need to. Whereas with the processed food, that doesn't really happen too much. Yeah, there are a couple of good ways I like to talk about this that make it pretty clear for people. If you imagine two plates, on one plate, you've got a baked potato with no salt or butter, just steamed, plain baked potato. It's pretty hard to overeat that, right? You'd probably eat it if you're hungry, but you're not just going to keep eating once you're satiated. Then you imagine a plate with potato chips and it's pretty easy to imagine overeating those. You know, even once you're still full, you're still eating because it's hitting all of those reward signals that you just mentioned. Another example is that Rob Wolf likes to talk about. I know you guys have talked to him before. The porn industry. He loves to go that direction, right? There's that. That's not the one I had in mind. I know you guys have this book here on the table. It's on my mind. There was a video he actually links to. It was a contest where it was like, who could eat the most ice cream? I don't know if you guys have seen this. This guy's eating this just disgusting amount of ice cream. It was the kitchen sink work. It was like a full kitchen sink full. He's getting to the end and you can see him start to flag. He's getting green and it almost looks like he's going to throw up. How does he actually finish this? Orders a large order of fries. You got it. Salty, crunchy, totally different reward circuits. He eats the fries and then he's able to go back and finish the ice cream. So that variety is one of the most powerful signals for that food reward system. And this is one of the reasons why, if not the reason why, I think the whole watch your calories, watch your proteins, watch your fats, watch your carbohydrates model fails because it doesn't take these root systems into account at all. And so when you're sitting there trying to restrict yourself but you're not, you don't understand how these natural systems of satiety, hunger, reward systems work, then you're fighting it uphill battle. And then it's just your willpower versus your body's natural desires. And guess which one's going to win eventually. It's not going to be your willpower. I'll tell you. There are some phenomenal ways to put this into practice for losing weight. It's just that nobody will do them. So one is what we could just call the really boring diet. Sounds awesome. It's not going to be a best seller next year. I don't think so. The boring diet. The really boring diet that doesn't taste good. Oh, it seemed better. You eat like a few, you choose a few simple foods. You don't need a lot. You don't add a lot of seasonings. You don't add fat. So if you steam broccoli, you just have it alone without salt or fat on it. And then you have like a piece of meat or fish. It's just very simple. And then maybe even a starchy plant, like a potato or sweet potato with, you guys are salivating. I can see you loving it over there. I know you're all. Invigorated. No, I mean, if people ate that way, it would be very difficult to gain weight. And it'd be easy to lose weight. And there's the potato hack. Have you guys heard of this? No. Potato hack? No. It's actually one of the most successful strategies for rapid weight loss. You eat nothing but potatoes for, you know, three to five days. That's what people did. Not by choice. Yeah. Not by choice, exactly. And you don't put butter and, you know, olive oil and chives and sour cream and bacon bits on it. You just eat the potatoes. And you cook the potatoes. People are like, wait, isn't that going to tweak my blood sugar? You know, I'm all eating all these simple carbohydrates. You generally, you cook the potatoes in advance so you don't have to cook the potato every time you eat it. And when a potato is cooked and cooled, it forms a resistant starch. So this is a type of starch that's not digested by humans. So it doesn't impact your blood sugar the same way that eating a potato would normally. Oh, interesting. And it actually feeds your beneficial gut bacteria, which is one of the reasons it might be beneficial. But generally people can lose like a half a pound a day eating this diet. You just sold the hell out of that diet, by the way. And the reason it works is for exactly the reason you're talking about. It's almost impossible to eat more plain potatoes than you're actually hungry for. It totally short circuits that reward system and you eat only what you're hungry for and maybe not even that because you're so tired of potatoes. And you don't have to do it forever. You know, you just do it like there's different ways of doing it. Some people do three days a week and then the other four days they eat normally there's a variation called potatoes by day where people eat potatoes in the morning and at lunch. And then they have a normal dinner, you know, paleo type of dinner. And I'll tell you, it's one of the most effective way for people who will do it in my practice. These are the people who've tried everything else and it doesn't work. They're not usually just going to start with this. Is this easier for do you find in like having people fast as opposed to that? Often. I mean, it depends on the person, but. I would think so because you're getting something. You're getting something. You're eating. It may not be exactly what you want to eat. It's super easy from a time perspective. You just, you know, bake 10 potatoes on Sunday or whatever it's going to be for the week. And then you just eat the potatoes. So, I mean, like I said, I realize not everyone listening to this is going to go out and rush to do this. Not an ideal diet, but it's a good example. The point you're making very, very well made because I think the old paradigm of the hunter gatherer or how we used to eat was that we were constantly starving and that's why nobody ever, you know, that's why now we have food in front of us. So now we just overeat and I don't think that's necessarily true. I think it's the body. Not only did it evolve surviving with not having food, but it also had to evolve so that we didn't overeat when we did find food because every once in a while we would make a successful hunt or we would, you know, come upon a field of, you know, plants or whatever and overeating would have been just as dangerous as under eating. We could become sick. We could damage our guts. Even then we could cause problems, which would then affect our survivability. So these natural systems of satiety that we have, we still have them. We've just hijacked the fuck out of them. Yeah, extremely disconnected from ourselves. Totally disconnected. And the point you made about the bacteria driving our behavior, you know, it's funny when people laugh at that because really if you, first off, we probably have more bacteria cells than human cells in our body. We've evolved. We've co-evolved. It's a symbiotic relationship. We can't survive without each other for very long. So it only makes sense that our behavior is going to be influenced by our host, which outnumbers ourselves. But we've also got evidence of this. They've done functional MRI studies on people where they've mapped out their brain and how it's operating. Then they'll give them probiotics. And then the way their brain operates will kind of change a little bit after taking a particular type of, you know, strains of bacteria. We also know there's examples of, and I can't, there's a type of bacteria that rats and mice can pick up from, I believe, from cat feces if I'm not mistaken. And what this bacteria does is it makes the mice and rats seek out cat urine and be less afraid of cats. Almost as if it's like forcing the mouse or rat to get eaten by the cat to start the whole cycle over again. And so, and this is proven. This is proven. So to think that we're somehow immune from being influenced by our bacteria is absolutely ridiculous. I totally agree. I would point out, though, that even in nature, there are examples of people getting exposed to highly rewarding foods and that system being overrided or overridden. The Ache and Paraguay are like a hunter-gatherer people there. And they will go to extreme lengths to obtain honey. You know, they'll climb trees which they fall from and die. You know, they'll get stung by hundreds of bees. And then when they get the honey, they'll consume up to two liters at a time. Oh, shit. Leaders of honey. Just hoarding it. Can you imagine that? I mean, they don't have any conception of what's healthy or not healthy. They're not on the low carb diet. Oh, there's honey there. I'm in my cyclical keto phase, so I'm going to skip that. You're going to wait until Tuesday. No, they just eat it. It's there and it's available and they're going to eat it while they can. So even in nature, that's how powerful these reward signals are. And the difference is in nature, what do you have to do to get that honey? You've got to climb a 50 foot tree and risk falling and get stung by hundreds of bees. It's not like Amazon Prime, you know, it'll show up at your door in two days. I just came up with a new diet. This is what you do. If you have donuts or whatever in your house, set up some traps, put some bees in front of it and go through an obstacle course. Come in there and poke you with needles to simulate the bees. It'll be right up. And then on the other end, it's just potatoes. Yeah. It's like it's potatoes at the end. Oh, guarantee weight loss. Boring diet wins. So I'm reading a book called Subliminal right now and how much, Chris, do you think a lot of this stuff is driven from the hijacking and the processed foods and chemicals and how much of it do you think is driven from like behavioral, like from when we were children, like your mom or dad hitting an ice cream because, you know, you did something and rewarding you with foods and stuff. How much do you think, obviously they both play a role. How much do you think each? I think that probably depends on the person. It's really difficult to quantify an exact percentage in general. I mean, some people did learn in their childhood to use food as a way of suppressing difficult emotions or, you know, as a reward system or whatever. But, you know, for other people, that's not really that big of an issue and it's more just a question of these reward mechanisms that we've been talking about, which everybody is responsible to. I don't care who you are. And this is what happens when you take, you know, a hunter-gatherer group of people and you expose them to modern diet, they're not like, oh, I'm sorry, that's not on my, you know, my hunter-gatherer diet. They'll eat that stuff and they'll eat it liberally and they'll start to acquire all the diseases of civilization as they do that. So I tend to think these hard-wired biological mechanisms are primary for most of us and then you layer on top of that some of the stuff that you talked about and it makes it even worse. It's a shit storm. I felt like all the years that we've, thousands of clients that we've trained, the ones that really struggled with weight had the combination of both. Like if you were a hundred plus pounds overweight, it wasn't just you getting chemically hijacked, you also had some sort of attachment to food in a bad relationship and the combination ended up with this disaster. And genes do play a role. I mean, I often say genes run and environment pulls the trigger. Well, just keep in mind that you can pull the trigger a lot, but if it's not loaded, it's not going to make a difference. So genes do play a role. And I think it mostly determines like, I mean, we all know the person who just eats like crap and doesn't exercise and they're still, you know, lean and they don't have a problem. And then we know the person who does everything right and is still overweight. And that, you know, a lot of that comes down to genetic predisposition. That doesn't mean that you don't have responsibility or there's nothing that you can do about it. But it is worth pointing that out, you know. I also think it's important to note that fat gain is one symptom of it's one of many symptoms that can happen when it comes to, you know, poor, poor nutrition or, you know, bad lifestyle in that sense, because there's a big chunk of people who get diabetes or die from heart disease have or not overweight. Many of them are of normal weight. Or get autoimmune issues like psoriasis like myself, but never once struggled with weight my entire life. Autoimmune issues and it's kind of nobody really talks about, but that is an exploding epidemic in modern western societies. And that is the one thing that we have such a tough time treating with our, you know, western medicine, you know, strategies. I mean, one way I think about this is I have a pretty simple heuristic for talking about chronic disease. And it's just, if you think about like a math equation, you have genetic predisposition plus modern lifestyle equals chronic disease. I think it really is that simple. But the type of chronic disease you get is mediated by that genetic predisposition. So you take 100 people, 100 gatherers, let's say, you've never been exposed to the modern lifestyle, you expose them to it. They're not all going to develop the same problems. You know, 10 people will get psoriasis and eczema and skin problems. Another 10 people will get some different autoimmune disease. Another 10 people will develop Alzheimer's and dementia. Another, you know, 20 people will develop cardiovascular disease, metabolic problems. And this is, this is why we see this monopoly of conditions in our society. But what we don't emphasize what we get is that they all come back to that same equation of modern lifestyle plus genetic predisposition. Triggers are all the same. But they manifest differently and that's one of the biggest problems with conventional medicine. We see all these diseases like separate things were locked up in doing research to find drugs that will address the ultimate manifestation. We'll fix the skin problem or we'll alleviate depression or we'll lower the blood sugar or whatever. We're looking at it from the outside in and we should be looking at it from the inside out instead. So that's more functional medicine you're talking about. Could you like describe to our audience like, you know, what really is functional medicine and how are you addressing like these problems with the western way of doing it? Yeah, so, you know, our our healthcare system, I like to say it's not really healthcare. It's better we should probably call it sick care or disease management because what we typically do is we wait for people to get sick and then we try to, you know, give them relief from the symptoms by primarily using drugs, right? I mean, let's face it, the average visit with primary care practitioner now is 10 to 12 minutes. So, you know, after you get done saying hello and you know, with the pleasantries that leads probably 7 to 8 minutes to, there's no way in that period of time you're going to be doing anything other than, you know, prescribing a drug based on the symptoms that the patient has and that's what our healthcare system is. So, you go into the doctor you've got high blood pressure, what's going to happen? You're going to get blood pressure medication. You go on with high cholesterol, what's going to happen? Cholesterol. Cholesterol. And you say, doctor, how long am I going to take these medications? What are they going to, what's the answer? Forever. Right. That's it in a nutshell and, you know, don't get me wrong. Conventional medicine is amazing for acute emergency trauma situations. Like, you know, we were talking before I came. Like, if I get hit by a bus, take me to the hospital right away. You don't want acupuncture? No. I don't want acupuncture. I don't want functional medicine either in that situation. I want to go to the hospital and, you know, likewise like we're being, we can restore sites of the blind now or we can reattach limbs. I mean, this amazing stuff and things like modern sanitation and antibiotics and these things have incredible impacts on our quality of life and our lifespan. So I'm not denigrating that at all. But when it comes to chronic disease, which is by far the biggest challenge we face today, seven out of 10 deaths that happen are caused by chronic diseases, not accidents and trauma and emergency. So, functional medicine takes a different approach. We look at it and we say, okay, like I said before, you've got all these different chronic diseases, but what are the common mechanisms or pathologies that are leading to all of these symptoms? And so, those could be things like disrupted gut microbiome, which we've been talking about, or leaky gut. It could be things like blood sugar dysregulate, you know, high blood sugar, low blood sugar. They could be things like heavy metal toxicity. They could be things like stress, which, you know, some people call adrenal fatigue. We can talk more about it. Yeah, let's get into that because you were the first person because adrenal fatigue was his buzzword for a while in the wellness world. It still is. And it still is. And I remember when, and I know maybe we can get into the symptoms of what that is, but I remember learning about the symptoms and seeing it in my clients and working with them on that type of a model and helping them. But then I would have clients that were doctors and they'd say, what do you mean adrenal fatigue? If they got their hormones level checked, their adrenals are functioning just fine. And then I read an article by you where you were saying adrenal, that's the wrong thing to call it and you were calling it, you were talking about HPA axis dysfunction. So first off, can we talk about what are the symptoms of what we used to call adrenal fatigue and why is adrenal fatigue the wrong thing to call it? Yeah, I mean, so this is epidemic today and almost everybody I know has some level of it because we're just burning the candle at both ends, you know, and we can't get away with that without consequences. Wow, that's a strong statement. So you believe that like most of us are somewhat battling this. Yeah, I mean how many, I don't know, what do you think? I agree, we all agree. Yeah, I mean almost everyone I know has some issue, okay, so here the symptoms would be fatigue, could be waking up in the morning feeling unrefreshed, not getting quality restorative sleep, difficulty with exercise tolerance or recovery. So, you know, your improvement and your progress in the gym is starting to go back in the other direction. Could be, you know, low energy depression or anxiety, low libido issues, cold hands and feet. For women it's often a lack of menstrual cycle completely or changes in their menstrual cycle. I'm sure you guys have seen this a lot. Women who are training really intensely, not eating enough, they lose their periods well known in the training world. You know, there are many more but that's the basic constellation. And yeah, I mean so many people that I work with and just friends, family, people I know in my life are dealing with it at some level. You know, it might not be severe, but they're dealing with it in some way. And look, I mean adrenal fatigue is an okay term I think for the general public to use. It's certainly easier to remember and say than HPA axis dysfunction. Okay. And my point about this was mostly for practitioners and mostly around, like, look, if we want to build bridges with conventional practitioners and, you know, be taken seriously, we have to use terminology that is consistent with what we understand about the body today. And so adrenal fatigue, the sort of core idea was that what happens is over time when we when we burn the candle at both ends these glands that sit on top of our kidneys, the adrenal glands get exhausted. They get tired and they can't produce cortisol. Cortisol is one of the main stress hormones. And so over time the adrenals get tired they can't produce cortisol and that causes adrenal fatigue. And, you know, again in terms of people just trying to get a handle on this and figuring out how stress is contributing to their health problems, I think that's fine to talk about it that way. But the problem with it is that that's actually completely not what happens for most people. They'll get tested and they're like, well your cortisol levels are normal. I guess they don't have adrenal fatigue. Well, we talked about leaky gut being the main way to generate eye rolling amongst doctors, but now I would say adrenal fatigue. It's taking that top spot. Candida might be number 3 so we can talk about that. So, yeah, I mean it's true that stress has a big impact on this system called the HPA axis. Hypothalamus in our brain pituitary and then the adrenal glands. And this is a system that primarily governs our tolerance of stress and how we're impacted by it. The adrenals are just one part of that whole system. Most of it is actually in the brain. So it's the brain that mostly determines how our stress response. And the adrenal glands in some cases will be unable to produce cortisol, but that's actually pretty rare. There's no immune disease called Addison's disease which leads to inability to produce cortisol. But in many cases, when we end up testing patients who have so-called adrenal fatigue we see that they actually have high cortisol. Or maybe they're producing cortisol at the wrong, not in the right amount at the right time of day. So it's just that it's regulated. It's like low in the morning when it's supposed to be high. And high at night when it's supposed to be low and so that interferes with their sleep. And with production they have a problem with regulation. And the reason I think this is important to understand is that for one, a lot of times people go out and take supplements that raise their cortisol. Which is obviously not a good idea if their cortisol is high to begin with. The problem is that when you're in this state of HPA axis dysfunction or adrenal fatigue or whatever you want to call it you feel tired and fatigued and it feels good to take things that raise cortisol like caffeine or stimulants or whatever. So it is drinking coffee. It doesn't mean it's the best long-term solution. You get a temporary hit but then that can further exacerbate this syndrome. The other thing that's important to understand and I like the shift to HPA axis dysfunction maybe you guys can help me figure out a cooler name. I was thinking we can rebrand that somehow. HPA D HPA Yeah, we need a rebranding. Why can't it be more explain to me why can't it be just like cortisol regulation or the failure of that or the why can't it be because there's other hormones and things. When I teach practitioners I say you can name the specific dysfunction. So you do testing and you find if they have high cortisol you just call it high cortisol or you can call it hypercortisolism which is the fancier scientific term. If it really is low cortisol you can call it low cortisol but you should find out testing first or you can call it cortisol dysregulation or disrupted cortisol rhythm because it's a diurnal hormone it should be produced at high amounts in the morning and then drop during the day but the other point is that if you just look at it as a cortisol problem and this I think is what you were getting at you're missing the bigger picture and that's what I would often see with clinicians that would be like oh adrenal fatigue take these adoptogenic herbs take some adrenal glandulars and you're done but if we understand that it's a system a whole disorder that involves the brain and other parts of the body then we look at it in a bigger picture setting we know that there are four main triggers of dysfunction one only one of them is perceived stress that's what we think of when we think of stress work stress, financial stress relationship stress etc another trigger is blood sugar issues so let me just name all of them the third trigger is inflammation and the fourth trigger is circadian disruption so getting exposed to too much artificial light at night the wrong time, not enough during the day sitting in a room like this all day recording podcasts not getting out in the sun for example explains why you're so fucked up Justin I don't know what was wrong with me so this is an example I like to use in my patients let's say someone independently wealthy laying on a beach in Thailand so they've got no perceived stressors as we would typically think of them but they've got SIBO intestinal bacterial overgrowth inflammation in their body let's say they're eating a crappy diet and their blood sugar is high and let's say they're staying up with their iPad in bed late at night staring at the screen that person could have a seriously disrupted HPA axis even though they don't have any stress as we classically call it and the treatment for that person would not be to give them adaptogenic herbs and some liver pills or whatever it would be to fix the blood sugar fix the inflammation and help them with circadian entrainment well he's on the beach in Thailand so maybe this isn't the best example get off your iPad at night and make sure to go outside in the morning get some bright light hitting your eyeballs so we expand it a lot more and we think about more things when we put it in this bigger context I think the other thing that I read about was how because it's now well accepted and understood that we can have something like insulin resistance because we're constantly exposed to high levels of insulin that our body then becomes more and more resistant to it and in this case you could test someone for their insulin and be like you have normal insulin levels even though they display all the signs of low insulin because they're resistant to it does this happen with other hormones? it happens with cortisol this is actually one of the mechanisms most people and practitioners in my training course is cortisol resistance so when you have high levels of cortisol the body's going to do what it can to protect itself from excess cortisol and one of the mechanisms for that is making the cells resistant to it or decreasing the number of receptors on the cell for cortisol so either way you get a decrease in the effects of cortisol even though the circulating cortisol levels are still high so you can get a kind of paradoxical situation where you have the effects of low cortisol with higher circulating cortisol levels in that case in a situation like that how do you resensitize their body to cortisol? well the primary trigger for cortisol resistance is inflammation lower inflammation which is likely coming from the gut all the stuff we've been talking about come from poor diet poor sleep training or under training stress environmental toxins which are unfortunately a growing problem that there's not very much awareness of would you say that a body that's in balance with all of these things should be largely void of any chronic health issue is that the root message? actually I know people have a really hard time believing this because now chronic diseases are so common we think it's normal we think it's part of life there's a big difference between what's common and normal and everyone knows someone with chronic disease or maybe has one, one in two Americans now have chronic disease and one in four have multiple chronic diseases now over 25% of kids have chronic disease and that's up from just 13% in 1994 so we're not talking about a lot that's 25 years doubling of the incidence of chronic disease in kids so it's easy for us to be like chronic disease is just normal everybody has it but actually that's not true and if you look in hunter-gatherer contemporary hunter-gatherer cultures they don't have chronic diseases typically they suffer from, they have a lower lifespan on average but those averages don't take into consideration the lack of emergency medical care and the high rates of infant mortality and deaths from trauma and warfare and exposure to the elements exactly and anthropologists who have studied this have found that if that's considered and if people in those cultures survive those threats and if they have access to even the most rudimentary forms of medical care like walking for half a day to get to a rural medical clinic they live lifespans equivalent to our own in the west but the difference is they reach the ages that we reach without acquiring multiple chronic diseases they don't have heart disease they don't have diabetes they don't have obesity they don't typically get Alzheimer's or dementia you know they actually just live long healthy lives and typically die in their sleep I had my own experience where my body seemed to just rebel on me when I was 30 and this was after you know years you know I probably 15 years of abusing my body with supplements and diet you know overtraining because I was always into you know trying to build more muscle whatever and what happened to me was my all of a sudden I just had I thought I had like severe irritable bowel or even worse I couldn't you know I was losing weight it seemed like everything affected me and I did some food intolerance testing and this at this time first really got introduced to the topic of of leaky gut syndrome and the person who did my test said what you're probably gonna find is that a lot of the foods that we're gonna find that you're intolerant to a lot of the foods that you eat a lot of now and it didn't make sense to me then because I remember thinking like what are you talking about I've always eaten these foods these are things that I never had an issue with before why would I have an issue with them now and the way they explained it to me was because of the inflammatory response that I had caused through you know my lifestyle because my gut was you know permeable what it shouldn't it started recognizing these foods that I ate all the time as foreign invaders and it created antibodies and this is what this is literally what happened like I would I couldn't eat peanuts up until this point I eat peanuts every single day gluten was definitely an issue dairy was an issue but before that it was lactose so I knew I couldn't have lactose but if someone was lactose free I was fine well now it was all milk proteins I had developed antibodies against milk proteins egg whites because I ate lots of egg whites and it was just went down the list of all these foods that a spinach spinach was my vegetable that's what I every time I had to have a vegetable I'd have spinach and I developed an intolerance to spinach now through the years after identifying those things changing my lifestyle and having to you know gradually really learn my lesson a few more times I feel like I can have some of those foods again without having such a strong reaction so my question to you is can you once can you reverse some of these things is that what I'm experiencing what is the protocol for that yeah so you made a couple good points there that I want to highlight one is you know and this sometimes happens where I get a patient come in and we'll do the testing I'll say you're gluten tolerant it'll be like what are you talking about I eat you know bread and pizza all the time I don't have a problem with it and there's this phenomenon that we call masking and you know that's a more scientific term but I like to call it the dirty windshield effect because it's easier to understand so imagine you have a dirty windshield you get another speck of dirt on the windshield you're not really going to notice that additional speck of dirt right and that's like what's happening when someone's eating gluten on a daily basis so when they eat they feel crappy which is why they come to see me in the first place but they don't notice like a significant effect right after eating the gluten so you clean that windshield you clean the windshield so you go they put them on a gluten free diet for 60 days then they're like I think this is probably phony and then you know they miss it they go have bread and then they're just like sprinting to the bathroom just huge explosion and then they come to me and they say you caused me to have gluten intolerance you gave me gluten intolerance you know I have to explain the dirty windshield analogy because I think the body in its wisdom has mechanisms for protecting us against time it's trying to save you it's going to adapt you keep shoveling that shit in your mouth it's going to do what it can right and which you know is limited but it's something but then you take those out and it's like kind of like the proverbial sigh of relief the body lets down its defenses and then you put it you know then you put it back in it's like whoa you know yeah so that's an important phenomenon to point out so often people will actually become more sensitive right away for that reason I did initially yeah this has been years now I'm 30 so it's 8 years now of me doing this initially I would just have like a bread crumb or whatever and I'd have an issue now I can 8 years later now I can eat a bowl of pasta and I don't do it very often because if I push it then I'll have problems but if I do once or twice I notice a little bit but I seem to be okay so it's almost like I healed myself yeah so yeah I mean what happens there is the inflammatory response subsides the antibody production if there was mediated by that declines to zero or drops so low that you know there's some controversy in this in the world of immunology but typically you know once you start producing the antibodies to something the idea is you have these memory cells that will remember and that serves us very well if we get exposed to a virus like you know chickenpox when we're young then we get exposed to that later even 20 or 30 years later you have those cellular memory for those antibodies you can produce it and you won't get that virus again right you're not affected by it so with foods it's less clear how that's actually happening but I know from treating a lot of patients that generally after a period of time avoiding the problematic foods and after the gut barrier heals which that's probably what happened in your case is that just the reproduction of good healthy bacteria that's happening? Reproduction of healthy bacteria the sealing of the gut barrier so that it's not permeable and it's not letting these big food proteins into the bloodstream it's a thin barrier so it's almost like you've got like this scab and you've stopped rubbing the scab and you let it fully heal again when we're constantly you know eating this food that we have intolerance to it's like you're seeing there scratching at a scab which finally just let it be for a little while then it heals exactly and in that situation I mean those food proteins shouldn't be going into the that you were eating the only reason they were getting in is because you had a leaky gut that allowed those to get in and that's what triggers the immune response but if your gut barrier is sealed you know and you should be much better at able to tolerate it like you are and but you know as you said if you push it too much you start to go back in the other direction. Speaking of gluten what is it with gluten why is that a common intolerance why is it such a hot button and if somebody's perfectly healthy no inflammation whatever is gluten is gluten a problem for everybody that's JJ Spears he's hilarious is gluten a problem for everybody or just some people so I might differ a little bit from my colleagues in this I don't think there's strong evidence that gluten is a problem for everybody you know the most kind of liberal estimates I've seen for gluten intolerance which means people who are affected by gluten but don't actually have celiac disease are one in ten so that would still mean that nine in ten people could theoretically eat gluten without having an immune mediated response now does that mean that I think gluten should be part of everybody's healthy diet no because think about most of the foods that have gluten in them there are usually a lot of other reasons not to eat those foods they're generally nutrient poor pretty processed and refined like breads or cookies or crackers or things like that and they're generally not when we think about diet I think about it in terms of nutrient density you want to maximize the nutrient density of every bite of food you put in your mouth because that's what our bodies run on so if you're eating a lot of foods that are really depleted in nutrients that's not going to be good for you no matter if you tolerate gluten or not the other reason I think it's tricky is that all of us are kind of just unfortunately it's a constant battle to stay healthy in this world I mean there's so many threats whether we're talking about diet or lifestyle or environmental toxins etc that who knows who's going to become one of those one in ten people that starts reacting to gluten it's probably if you're concerned about that and you want to maximize your chances of staying healthy it's probably safer I feel like it's getting punched in the head it's like some people get knocked out right away when you get punched in the head and just because you didn't get knocked out doesn't mean it's probably a good idea to keep getting punched in the head isn't it kind of like that it could be like that I mean I think of things like in a spectrum you know like it's just a lot of people out there if they're eating a little bit of gluten in the context of diet that's overall healthy and nutrient dense and they're taking care of their sleep you know they're getting the right amount of exercise the right amount of sun exposure they're doing everything right that person's probably going to be fine but then you take someone who is eating processed and refined foods and gluten they've got a disrupted gut microbiome they have intestinal permeability they're not sleeping well they're you know all of those kinds of things that really describes a lot of people in our culture then I think the risks start to get high that something's going to go wrong I think it's also we also have to consider that in western societies gluten is just an everything and what I mean by that is if you go to like for example what country in the world do you think has some of the highest rates of rice intolerance right countries that eat a lot of rice like you go to Japan and having an intolerance of rice is much higher than you would find in other countries because of the chronic exposure I think we're just inflamed and gluten is in fucking everything it's not only in food that contains flour but it's added to foods that don't for you know it's for the texture or it's mouth feel or whatever they add gluten to sports drinks sometimes to make them taste a particular way or marinades and I found this all out the hard way when I was dealing with my gut issues is where I said you know they told me don't eat gluten so I said no problem and I was buying these marinated chicken breasts and I was eating them and I was having horrible reactions and finally someone said dude there's gluten in the marinade. That's fascinating I didn't know that. It's in everything and so this is why the common food look at the common intolerances that the most common ones right dairy you know nuts egg whites you know gluten I mean these are things that we just consume a lot of and if you understand that when you get inflamed when you if these things you know pass through the gut barrier your body creates antibodies against them. Gluten is probably going to be one of them because it's just it's literally in almost everything bombarding. Yeah there's a de-amidated gliadin which is a food additive can often be put in things without having the manufacturer actually having to say that there's gluten in it too so it's really tricky for patients who are super sensitive like you were at one point because you don't you know I mean I just tell those patients just don't buy processed refined foods because you never really know you know and if they have a reaction that is clear that's one way to know but the bigger problem is what about people who have a reaction that's not so viscerally clear. That's great let's go into that. Yeah so there's there's something called let's just stick with celiac for the time being but there's something called silent or atypical celiac disease and most people when they think of celiac they think of gut problems you know diarrhea gas bloating etc because that's the typical presentation of celiac but there are a lot of people who have celiac that don't have that and they the way it might manifest for them is in the brain so there might be attack that gluten related ataxia is a form of paralysis that's caused by gluten so this is how serious that it can be typically happens in children but it can happen in adults too. Gluten and celiac has been linked to all kinds of brain related disorders like depression even schizophrenia, anxiety to neurological problems like multiple sclerosis and Parkinson's and other issues. It can also manifest in the skin atopic dermatitis or eczema is one of the most common what they call extraintestinal meaning of the gut manifestations of celiac disease but all of this skin condition, psoriasis acne, acne rosacea can all be related to gluten intolerance so this is problematic because imagine somebody who is having has neurological issues and anxiety they're not going to think about that they go to the special doctor for that we have different doctors for different parts of the body then they go to the dermatologist and they go to that doctor and that doctor puts them on some medication for those symptoms then they go to the dermatologist and they say I've got the skin rash the dermatitis, doctor gives them some cream steroid cream for that and then they maybe go to their primary care doctor nobody's putting the pieces together and realizing that all of these symptoms in this patient are related to one food protein that if they remove from their diet can resolve all of these problems so that again, getting back to functional medicine that's the difference between functional medicine and conventional medicine conventional medicine is often playing whack-a-mole with symptoms and functional medicine we're asking the question what is it the root of this problem that's a huge paradigm shift although I think I hope because I feel like we're heading in that direction I just think we're probably another couple decades away from it Chris deals with it on a regular basis how much are you fighting western medicine how many things do you need to rebrand I'm going to need your help for sure I think it's both I think there's both really promising signs that ultimately I think functional medicine is just the fastest in the future I don't think that at some point it will even be a separate thing it's just going to at some point we're going to realize this is the way we have to approach chronic disease like the if you think about how our medical model evolved it's easy to understand how we got to where we are so in the year 1900 the top three causes of death were typhoid, tuberculosis and pneumonia the main reasons other people went to the doctor at that point were also acute they were like a gallbladder attack or appendicitis or broken bone so they would see one doctor they would get one treatment it might be the doctor removing the appendix or the gallbladder or setting the bone or might be later after antibiotics were developed there would be an antibiotic for the infection and that was it very straightforward the medical model frankly excels at that it excelled at that then and it excels at it now it's just getting better and better at that kind of intervention but chronic diseases are not at all straightforward in that way so the average person now has one or more chronic diseases they require multiple doctors they are seeing a doctor for every different part they might be taking multiple medications and they might be taking these treatments for the rest of their life so we have a medical model that evolved in the context where acute problems were the biggest issue and it's been kind of applied to this to our current challenge which is chronic disease by far it's the biggest challenge and it doesn't work it's like using a hammer to screw in a screw it kind of works keep banging that thing it'll get in there but it's not the right tool for the job it needs to evolve because we're solving a lot of those problems but now the main killers I just read a study heart disease is still number one cancer is catching up to it cancer is starting to kill actually you know what is number three little known fact here medical mess ups medical care not even mess ups we have a subset of it but even like medication that's prescribed appropriately it's not like the wrong medicine like the doctor made the dosing error or something it's the right medicine but it just happens to have death as a side effect so there's an editorial published in BMJ British Medical Journal in 2016 that counted up the deaths from what they call eatrogenic events so these are events caused by medical intervention of some type they could be errors but they might also just be the right thing done with unfortunate outcome and there was another analysis in 2000 that found the same thing and that analysis actually and this might be what you were thinking of they said that only 5 to 20% of the eatrogenic events are actually reported so that if all were reported it would actually be the number one cause of death our medicine is killing us so I mean one of the best examples of this is Alzheimer's disease so now you know it's growing on the list of top causes to death it's making a run for number one and I mean I don't know about you guys but that's terrifying if you think of like the worst way to die I think I'd rather get eaten by a shark for sure I'm a surfer and I'm like yeah send me out there you know it's time for me to go Gary the Great White go to Epica I would rather go out that way than get Alzheimer's disease and it's just devastating for not just the person who had it but the family members I mean we talked about HPA axis dysfunction before when researchers want to study that guess who they study caregivers of people with Alzheimer's cause it's recognized that they're like the people that are under the greatest most stressful thing you could do so if everybody I was just going to say 25 years of drug development for Alzheimer's using this conventional medicine approach of like the silver bullet what's the one thing the one drug that we can develop that will you know reverse this syndrome and that because that's the conventional approach is symptom suppression like we'll figure out a mechanism we'll develop a drug to target it and then that's how we'll do it failure after 25 years not a single drug can prevent the progression of Alzheimer's much less reverse it and you know there are researchers now I talk about one in my book Dr. Dale Bredesen who's been studying Alzheimer's his whole life as a bench scientist he's an MD but he was in a lab trying to find this silver bullet and he eventually figured out that that's not going to work and that's why because Alzheimer's like every other chronic disease is not caused by a deficiency of a drug you know that hasn't been developed yet heart disease is not caused by statin deficiency right it's caused by all of these numerous factors we've been talking about in our modern diet and lifestyle that can cause inflammation and all the other mechanisms that lead to Alzheimer's and so what he argues is we need we don't need a silver bullet we need silver buckshot which is a you know a good analogy we need a multi-pronged approach to addressing chronic disease that looks at the patient's diet looks at their lifestyle looks at their behavior and then starts looking at underlying mechanisms or pathologies that lead to all of these different syndromes and diseases and symptoms and that's how chronic disease has to be approached so I really do believe that eventually that's just how we will approach chronic disease don't call it functional medicine it will just be how we approach chronic disease and I think we'll get there either the hard way or the easy way knowing our history is probably the hard way I tend to believe that to be honest I will get there by just literally beating our heads into the wall you know one too many times where we finally realize that the approach that we're doing isn't working and that's bankrupting our government I mean that some statistics I've seen suggest we'll be completely solvent by the year 2035 because of rising healthcare expenditures and you know I'm glad you brought up Alzheimer's because it wasn't that long ago that Alzheimer's was considered a psychiatric disorder right but now we consider a physical disease because we can see that what's actually happening to the brain but the reason why I'm making this point is because we separate we tend to separate mental disorders from physical as if they're not connected and the reason why I'm talking about this is we have just recently we had a tragedy in Las Vegas we had someone just a lunatic just kill all these people and I was thinking about it this weekend and how you know there's a distinct difference between people who do something like that and your everyday crime where it's either because of poverty because they're stealing something or getting related or the black market for drugs here you have someone actually losing their mind so I went through and I actually did some research and I knew what I'd find but I wanted to see it for myself and we all know and it's widely accepted now the physical what's happening to our physical health and how bad it is and how bad it's getting you know people call it the obesity epidemic or the diabetes epidemic or just the chronic health epidemic but people are not talking about the mental health epidemic that is also right along with it right along with it you have as our physical health is declining so is our mental health to the point now where I forget but there's an incredible statistic in terms of the amount of people that are prescribed antipsychotics antidepressants ADHD medications anti anxiety medications all through the roof and they're all connected can we talk about that for a second how the connection between mental health and our mental health yeah that's a great question I mean it's true the World Health Organization I think saw some recent statistics that depression is increasing by 20% year over year and that it's predicted to become one of the most biggest health problems from a global perspective not just in the developed world but in the developing world as well and I mean and another mental health issues are really complex topic so I don't want to be too reductionistic here because it's true certainly our circumstances affect our mental health there's no doubt about that I think that's been firmly established and depression can often be situational and related to those circumstances we know that so I'm not going to dwell on that what I want to introduce here is something that's less well known which is that let's just take depression you know for many years the prevailing thinking was well initially it was the depression caused by serotonin deficiency that was never really believed by serious scientists that was a made up thing that made it easier to sell antidepressants because I think they discovered that these drugs increased circulating levels of serotonin and so then they came up with their afterwards which is how they got drug to like that and they drug companies hire marketing advertising agencies first before the scientists they get to marketing first and we go get our scientists and advertising agencies have come up with all kinds of new names for diseases they create the disease to create the demand for the drug that's how we got viagra viagra absolutely they created a drug to erectile ed it was for blood pressure and it kind of worked for blood pressure but oh shit people are getting boners market owners same thing with the stuff you put on your what is it called minoxidil or a lot of these were just marketing teams that came in and SSRIs like we have this drug that does this what can we do with it so yeah so it was like serotonin deficiency you've got low serotonin that's very easy to communicate you know and advertisements and people were walking around going yeah I've got low serotonin this drug it increases my serotonin great so only problem is I was not accurate and certainly depression can involve changes in brain chemistry neurotransmitter levels and things like that but still the question is why right is it just because of situational factors or there's some other things at play well there's a more current theory of what causes depression in many cases and it's called the technical term is the immune cytokine model of depression but the it's pretty easy to understand it's inflammation that generally starts in the gut and inflammation these inflammatory cytokines that's the chemical messengers get created in the gut they cross into the bloodstream they go up to the brain cross the blood brain barrier and they suppress the activity of the frontal cortex and that produces the symptoms which we refer to as depression so basically in many cases depression is a problem that starts in the gut and then affects the brain and this has been like people have been writing about the gut brain axis for a hundred years there were these MD scientists at Duke University in the 1930s that wrote a paper on the gut brain skin axis and they actually talked about how changes in the gut can lead to skin problems psoriasis, eczema and also depression and anxiety and they even talked about probiotics as a way of intervening to address these problems that was even before the term probiotics had been invented but they talked about a fermented milk beverage which is basically you know probiotic as a way for for intervening here so this has been known for a hundred years but it's only recently that's been kind of rediscovered because I think the whole depression and mental health field got so hijacked by the pharmaceutical field that we stopped actually thinking about what are some of the underlying causes that contribute to these problems. ADHD autism spectrum disorder there are now researchers in the U.S. and abroad who are looking at okay certainly we know that genetic predisposition is a big factor but the stratospheric rise in autism the latest figures I think are now one in 45 kids have autism so it used to be like one in like four thousand yeah exactly we're talking about a short period of time there's no way that genes can explain that it's impossible our genes cannot change that quickly yet we've never evolved and changed that fast it has to be environmental environmentally driven and so there are researchers who are now looking at this and there's a framework called the three hit paradigm I might not remember them exactly but it's basically genetic predisposition microbiome disruption and then environmental insults so you have poor diet environmental toxins all these things they affect the microbiome microbiome changes in such a way that it alters neurochemistry that then results in ADHD, OCD autism spectrum anxiety and all these problems that are so epidemic now in kids and I know there's got to be people right now that are going like wait a second how does that happen to a child who's born with autism so that now but I know we have studies that are linking what the mother the mother is passing down to the child and it most certainly could be coming from some of the habits that she had for her entire life and that's what's happening right yeah that's a really key point we see heritable traits as always being genetic but that's not necessarily true you inherit your initial imprint for your gut microbiome from your mom you know the the baby's microbiome or gut is relatively sterile they used to be thought that they had no bacteria in their gut in utero but now some recent research has suggested that actually bacteria can cross the placenta and there may be some initial seeding that happens while the baby's still in the womb but generally speaking even with this new research the primary kind of seeding of the microbiome if you think about it as a garden analogy the seeds are planted when the baby is coming through the birth canal and gets exposed to the bacteria to the point where when a baby is born by c-section there's actually movement now for doctors to swab the vaginal area of the mother and you know and apply it to the baby to give that exposure this is not like woo-woo stuff they're papers that have been written about this so what that means is it's not genetic but you're still inheriting that from your mother and if the mother we know that the mothers of autism have been studied and they have a lot of different characteristics so it's a combination of these genetic and environmental factors it's fascinating so here's something I'm going to throw you kind of a curve ball here I've been reading about so I have a family member with Crohn's and so very close to them and so I've done lots of my own reading and research on autoimmune disorders and diseases and there's this fascinating kind of sect and field of study where people with autoimmune diseases will self-administer like a parasite and that'll cause their symptoms to many times disappear what's going on there do you know what's going on there? I mean as much as we know I'm very familiar with the research and I actually did that myself so I have some personal experience there I don't know if you guys know anything about my history but I got into this work because I got extremely sick with a digestive illness when I was surfing in Indonesia in my early 20s and I got exposed to multiple parasites totally wrecked my gut and at one point I was diagnosed with IBD, Crohn's disease I don't think it was accurate now in retrospect but me being the geek that I am I wasn't going to do the steroids in the typical treatment and I was probably very early days in this you're referring to Helminthic therapy yeah there you go typically nematodes they're worms and they've been a part of mammalian evolution for something like 300 million years so in other words all mammals harbor helmets they have worms and typically it's not a problem we think of worms it's gross first of all especially if you go and look up pictures of some of these organisms I did yeah I'll turn you off to this idea real quick in most cases but generally there's even a theory and there's research behind this that suggests that our immune systems evolved in response to these organisms like this is so long ago in evolution that we're talking about pre-immune system as we even understand the immune system and there's some thinking that our immune system evolved in response to these organisms such that in a way our immune system can't function properly without them and so what happens is in the industrialized world we got sanitation and sanitation has saved immeasurable number of lives like it prevents so much acute infection so I'm not saying we should go back to an unsanitized environment all things have consequences and some of them are anticipated and hoped for and others are unanticipated and one of the unanticipated consequences of the increase in sanitation and the removal is the removal of these organisms from our guts and one way I like to explain it to people is if you're standing up and you have your hands out and you're facing someone and they have their hands out and you're leaning into them by a similar amount of weight you're going to balance neither one's going to fall down you're balancing each other out and this is how our immune systems were tuned in the presence of these organisms so these organisms exerted a kind of tuning effect where our immune system would push back a little bit and they're pushing back a little bit so we're in that state of dynamic balance what happens if you take away those organisms the immune system, that energy that was being directed at that low level pathogen that's there starts getting directed at something else what does it get directed at? our own tissue exactly or environmental antigens like dust, pollen bee stings it can show up as allergies it's just a hyperactive hypervigilant immune response because it doesn't have those those internal things that we had for so long and this is called the old friends hypothesis sometimes called the hygiene hypothesis as well because of the hygiene and sanitation being related to it but old friends refers to these worms which were our old friends in the sense that they tuned and regulated our immune system and so once this theory began to be developed then the obvious question was can we reintroduce these organisms and will that have the same impact and lots of research and clinical experience suggest that they can and people with allergies what happened with you? I've done it twice there's two ways that it's typically done one is with tricurus suis which is pig whipworm so it's a whipworm and it's one that typically colonizes pigs and the reason that they first selected this is that it can't colonize humans long term which means that when you swallow the whipworm it will stay in you for about a week and it will have its immune regulating effects but then you poop it out and it's gone it can never take up residence long term and so the thinking was that was safer to do that the problem was it doesn't have the same impact because it's not really a human so then they also start using human hookworm necatoramericanus and this can colonize the human host and it will stay in human but you know hookworm can be problematic but only with uncontrolled exposure so like let's say some you know a person living in a rural village in Africa is walking barefoot in through latrine kind of area and they are continually getting more and more hookworms and they can start developing anemia and other problems with parasites but if you have only a small population of hookworms maybe 25 hookworms then you can get the immune regulating benefits they don't multiply and just grow inside of you you just have that same 25 and they stay with you? they stay with you in theory if you take antibiotics in the endosol you can get rid of them so I did the trichorus Suisse first didn't really have much impact on me one way or another and then a little while later I did the hookworm it didn't really have much impact on me either other than being kind of weirded weirded out by the whole thing and having to go to Tijuana to do it because this is not legal you know and there are some legitimate ways to do it in Tijuana as you probably know there's medical tourism that happens there they have good doctors down there I don't recommend this to people without being under the supervision of someone who really knows what they're doing but in my case it didn't work simply because I don't think I ever had Crohn's disease and I had inflammation in the terminal ilium that was probably caused by the parasite infections that I had diagnosed as Crohn's disease however I've had lots of patients not lots I mean this is a pretty out there therapy but I can think of over 10 over the years that have done it and in some cases it's been absolutely miraculous we're talking about people who were facing removal of their colon because their inflammatory bowel disease was so bad who basically within you know three months period became almost symptom free without making any other changes wow what's the other one Sal that everyone's leaving the country to go do the stem cell stuff I don't know there's another procedure right now that you can't do in states that are you thinking of fecal transplant I don't think it's fecal stuff there's another one that we don't do here you know who did it was Dan Bilzerian I don't know I think that's legal here in the states there's stem cell here in the states it's not really that regulated at this point and there's some a lot of controversy about what you can and should use it for but it is legal it's about 10 grand a pop what do you know about it I don't have a lot of expertise in stem cell treatment but I know it's you know there are some indications that it actually has been studied for in peer review journals published you know particularly related to musculoskeletal complaints tissue regeneration and repair etc but it's being used in a much broader way in some clinics for just you know health optimization and life extension yes that's what I hear people yeah you know like looking younger I mean I know a couple of people who've done it and actually do look you know 5 or 10 years younger than they did before but there's I think there's some unanswered questions still about that so your experience with the parasites after you went surfing that's what got you to do what you're doing now or were you already yeah no I was not really contemplating a career in health care I was on a different track but I got so sick and really you know when I came back from my career system I was a pretty healthy kid and teenager athlete you know I've maybe gone to the doctor a handful of times and just for the usual stuff and then I came after that and I got sick I you know went to the doctor and the doctor prescribed some antibiotics and said oh it's probably just parasites it'll get better and then you know it took about 10 years for me to fully recover my health and learn just how poorly equipped the conventional medical system is for dealing with the kind of problems that I had that didn't fit into like a nice clean straight forward box and weren't amenable to just some drugs or medication and so I as I started to get better people around me started to ask what are you doing because they had seen how sick I was I mean I was taken to the curb I was completely down and now unable to work you know I was in my mid 20s I had no idea if I was even going to be able to like support myself and live a normal life and so it was pretty scary and then people around me as I started to get better were like wow how did this work what did you do and I started to share with them and then just over time realized that there was a lot that I had learned in that process that could be helpful to other people and I decided to go back to school and formalize that and then you know here I am well that's excellent yeah I'm glad that happened for you well I'm sad that I have I'm glad that you're here glad you got there I'm sick for a decade but it's helped me out you helped us gifts come in many many different ways of course and that's the way you got to look at it that's definitely the way I look at it I mean I wouldn't be here if I you know in this chair if that weren't the case what would you say one of the greatest I guess threat to our health in modern times right now what would you say is the one thing that we could if someone were to look at just one thing what would you say that would be well I would say chronic disease but I think you're asking as a cause yeah you know diet is the kind of it's still up there at the top but there's more awareness about that I would say actually sleep deprivation is probably when I look at the research on just about every condition and let's just talk about obesity so most people think of obesity they think of diet and exercise right as being the big triggers and certainly diet I think still is the primary trigger but exercise actually although it's important it's not sleep is probably number two a head of exercise in terms of the obesity epidemic and this is I think not really even that controversial now in the scientific world at least their studies have shown that I think eight nights of sleep deprivation can lead to an increase in calorie intake of over 500 calories a day which is equivalent to gaining 52 pounds in a year that's crazy and you know that's significant sleep deprivation that they're doing in an experimental setting so it wouldn't be likely that someone would have that every night in their life but if you take just even a lower level of that where someone is like we now know that 35% of Americans sleep less than six hours a night and that's up from just 2% in 1960 so that's a 15 fold increase in the number of people that are getting less than six hours a night of sleep in just the past you know 60, 50, 60 years 15 years ago I would have laughed if someone talked about sleep and walking sleep to sleep and then the two things I talk to more than anything else now is addressing sleep and then just moving because I feel like those two are probably the simplest things that people can address and look at in their life and start to make improvements we've totally had to change our tune with that in your profession if you look at this is where the ancestral perspective comes in so it's so helpful it's not that we need to return to the lifestyle of our ancestors but we can use differences in our modern lifestyle with our historical lifestyle to generate hypotheses about what might be screwing us up you know so we look at our ancestors we say oh they and contemporary hunter-gatherers most of them slept at least 78 hours a night like in the Zimane people in Bolivia who have been recently studied we can talk more about that it's really interesting there's not even a word for insomnia in their language the researchers were trying to ask them about insomnia but there was no word because they sleep and they sleep restfully and they sleep for 78 hours and so then we can start asking like okay well that's not happening now and does that make a big difference and then we can with movement we look at our ancestors we say and contemporary hunter-gatherers we say okay they walked an average of 10-12 thousand steps a day they didn't sit for long periods and yeah those lower level activities were punctuated by more intense activity like chasing prey or lifting something when they're building something sporadically exactly so now we're in a situation where you could meet the government recommended guidelines for exercise you can be completely sedentary but go to the gym for 3-5 days a week and exercise for 30 minutes a day you're meeting the government guidelines but still considered a sedentary you're still at a much higher risk of death than disease than if you are gardening walking or bicycling to work taking the stairs instead of the escalator and just doing what is called non-exercise physical activity so we make the case that when you look at the problems with modern lifestyle what forms of exercise directly combat though some of these modern problems one of the best forms of exercise is resistance training and the reason why I say that is because resistance training directly improves how your body responds to cortisol insulin and it also has an adaptive effect in the body where it causes you to your body wants to burn more calories which isn't necessarily a good or bad thing but in the context of modern lifestyle it is because you want to be able to have a metabolism that burns more calories with modern lifestyle which usually results in more calorie intake most people are in a caloric surplus so it's not a bad thing to do that and the other benefit of resistance training is just maintaining bone health as we age you probably heard the phrase break your hip, dive pneumonia fractures are a big deal in elderly population because they result in immobility and that immobility can cause pneumonia and other things that can kill you so it's no joke to maintain healthy bones as you get old and resistance training is one of the best ways to do that absolutely Chris where did where did the motivation for all this come I know we talked about what happened in your 20s but go all the way back to like high school what kind of kid were you like in high school were you a nerd were you always reading and studying I mean I was I did well in school you know I identified as an athlete you know I played basketball in high school I was a surfer all my life but I played basketball in high school and then what's gonna play in college UC Davis or Santa Clara actually not too far from here where I got recruited and then at the last minute I decided to I wouldn't have chosen either of those schools were it not for basketball and I didn't really want to go to either of those schools so at the last minute I decided to go to UC Berkeley which I did I was interested in and I was gonna try to walk on there but unfortunately Jason Kidd I was just gonna say you weren't you so we were on the same generation yeah I was a guard I was a guard and so Jay Kidd was playing my position I was like oh well thanks for trying maybe you'll get hurt I guess I'll give up basketball now and no I did play intramurals which was pretty competitive at Berkeley but I just kind of left that behind so I've always been driven by athletics and performance did you watch him play a lot were you I'm a diehard Jason Kidd fan I played basketball through high school I actually played against him there's a league called Slamming Jam remember that so I was on the Southern California All-Stars and he was on the Northern California All-Stars and my big claim to fame was that he only scored 40 on me because in high school he scored like 80 he was like 6'4 point guard who could like jump through the roof I mean in high school that was just bizarre you know and then I got really into martial arts when I was in high school I actually started with Muay Thai studied with Richard Bustillo and down in Losanto who is Bruce Lee's student at IMB Academy so I did that while I was in high school and then got into Bagua and some of the Chinese internal arts as I got older mellowed out you definitely are okay so now I gotta ask this you for sure are an athlete where do you see that athlete mentality of yours transfer over into the work that you do now yeah I mean what you do and what you put out there I'm super discipline I mean my wife jokes a lot with me like I'm really like when I I'm like a dog with a bone when I set my mind to something it's hard to get me off that track and I'm very disciplined and segmented with my time I schedule everything out I have no trouble sticking to routine and I'm definitely sense oriented so I've studied a lot of you know productivity enhancement time management like I'm always trying to up my game basically and perform at the highest level that I can I don't feel competitive in the sense of like oh this guy has got 2 million you know blog visits and I want to get 3 million I don't really approach it in that way so I think it's more just discipline that stems from a coach a father figure I mean did somebody implement that in you early on I mean my dad was a really high achiever and he was often my coach you know he coached a lot of our kid you know child before we got to higher level basketball teams and stuff like that and I always really appreciated his work ethic and the integrity with which he approached things um but I think of my parents had a lot to do with it they really said high expectations for us and we always had those for ourselves I have two brothers and they've been similar in there can you see now as an adult where some of those things have been a huge asset for you and then where they've also potentially hindered you as an adult absolutely in both cases I mean as I said I think I've been able to accomplish a lot because of my focus on performance and in all of the areas of my professional life where that's important but in some ways I mean the just going back a little bit into my early 20s and what happened there I was working in film and television actually in business and just working a lot a lot of hours I was driven and my life basically fell apart like I was young I was in my early 20s I had already bought a house I was on the fast track and but I was just pushing myself relentlessly and I got to the point where things just kind of fell apart and looking back it was a total blessing but at the time it didn't really feel like a blessing and but I knew intuitively that the path that I was on was not the best path and that it was going to end in destruction. Where did you make that connection was it the Indonesia thing? So no a bunch of things happened to me all at once which were kind of like a that I took as a sign so I had bought a video camera where I was going to start to make my own movies that was kind of one of my things and and so that camera got stolen my computer that had all the videos I had made crash and then my hard drive that I had back up crash lost all of that. My relationship I had a girlfriend at the time we broke up and you know kind of disintegrated I quit my job like everything just kind of fell apart and I was like wow I have nothing I was like no attachments and I'm just going to sell everything I own and go travel around the world for a year so I did that you know I got rid of everything I ran it out my house and then just took off and I went to Thailand first and I did a 30 day meditation retreat in the jungle above Chiang Mai which was like my way of like what's what's going on the dream way that I can like just sit there and stare at the ground for like 30 days and try to figure this out and so I was which had to been a hard transition from a guy who's like it like you said like a dog in a bone it was the hardest thing I've ever done in my life I bet no question like there's nothing that even comes remotely close to that first 30 day retreat and and then I stayed in Thailand for another few months and was continuing to study meditation and time massage which was also a total departure from what I'd been doing before and then I went to Indonesia and I was there for three months and that's when I got sick the first time but I continued to travel because I got better at first from the I took some antibiotics that I had in my medical kit and then from there I went to the Maldives which are these islands off the coast of India I went to South Africa, Madagascar Mauritius, Reunion Island and then back to Australia and then back home and by the time I got back I was a different person I bet you know it was just everything that I had planned for my life before and I think my parents had planned for me was just completely obliterated and that began this 10 year journey that I talked about before which was not just about recovering my health it was also about figuring out what I was going to do with my life and how I was going to apply my internal resources in a way that served me better and served other people and kind of like get off of this treadmill of like this life that I feel like I was expected to live in some way or I expected of myself and looking back on that it almost seems like the only way that I could have gotten off of that because of how much I said I'm like a dog with a bone was to be completely kind of destroyed you know rebuilt awesome movie better than point break as a wise, well traveled man now what do you I always say that your greatest strength is also your greatest weakness what do you still have to like catch yourself going back to old habits or things kind of resurfacing where you have to be I know that behavior I know that pattern do you have those for me it's definitely a tendency to lose sight or just get too intense you know and work too much I'm pretty good about maintaining work-life balance but I've come to realize that I'm like a sprinter more than a marathon runner so I can produce like really a lot in a short period of time but then I need a lot of time to just rest and integrate and recuperate and my tendency over the past several years has been to sort of measure my own time spent against other people like hey it's a 40 hour work week right that's just what everybody does so I should therefore be working 30 to 40 hours or 50 or 60 hours a week but what I've come to recognize is that that's not my rhythm and that's not the way that I function best and if I do that I suffer my health is now it's like the canary in the coal mine I can recognize that I'm off track by physical symptoms starting to return talk about that a little bit what do you start to notice when you I could so relate to what you're saying right now and it's taken me years to finally piecing this together now and a lot of that's having an incredible partner I've been with for over six years and she knows to just kind of let me do me and I know that I'm a little out of balance and out of whack and going full speed for maybe a week or two but then she also knows like okay I'm going to set book a trip for us to get away phones go off, computer gets shut down, we're by water up in the trees somewhere like that and helps me get reconnected and it's become extremely healthy for myself and my relationship with her and others what are some of the strategies or things that you do? Yeah I definitely do that I do regular digital detoxes you want to call them that like you said surfing is a big thing for me so like you know go to Nicaragua just post up on the beach somewhere and turn everything off and just surf all day my daughter is six now and she's getting into surfing so the last time we were down in Nicaragua we were surfing and you know taking some lessons I was getting them out there which was amazing I try to do that throughout the week too Sundays or like a Sabbath I don't check I turn off phones and computers don't do that at all I'm pretty disciplined about that in general even during the evenings I still meditate regularly I've been doing that now for 25 years and it feels like an absolute lifeline to me I think I would completely self destruct if I didn't do that and you know 45 minutes is my target and most days I get there but some you know if I'm traveling or something it's hard to do I'll just do what I can it could be 5 minutes or 25 minutes but that's been a bedrock for me and my wife also is really a good powerful advocate for me in that way she can recognize the early signs often before I do especially if I've got my head down I'm really focused on something spending time with my daughter is huge for me I've made that a priority and we have every Friday afternoon I take the afternoon off and I just we have what we call adventures so she's she's sick and so couple weekends ago we went out to Stinson Beach and just hung out and went surfing last weekend we went or last Friday we went to a pottery studio and painted some pottery and she had fun with that we'll go sometimes to parks we just do we went to the Children's Creativity Museum in San Francisco which is a great place for kids and I just spending time with her is if I apply the rocking chair test you guys know what this is so if I ever have any question about whether to commit to something or what it's relative level of importance is I do the rocking chair test where I imagine that I'm 100 years old sitting in my rocking chair looking back on my life and I think back on this question at that time and if I think for example what will I regret more not taking on this new work project or spending the time with your daughter on this weekend giving up my Friday adventures with Sylvie there's never been anything yet that has trumped that and led me to think that I would look back from my rocking chair and not say jeez I wish I wouldn't have spent so much time with my daughter the giving tree yeah I mean so and being with her it's like you know just being fully present turning off my phone not responding anything just being totally present with her is the best thing that I can do for her but it's also for me the irony too of all of this is doing these things and understanding these things you actually perform better also and I like to say that because we do have a lot of entrepreneurs that listen to our show and a lot of young kids who just want to grind it out and go crazy and you can do that but also recognize your body and balance will perform your body and mind in balance will perform far better than when they're out so understanding that and tweaking those things you're going to do better anyway it's like trading dimes for supporters I feel so passionate about that I'm glad you brought that up during the last three years I've tripled the size of my clinic more than tripled the size of my staff I'm running a training program for clinicians we've trained hundreds of clinicians I have blog podcasts I've written two books I'm not slowing down things are growing and building you probably have more rest days I work fewer hours over that period of time so I really challenged that idea I read an article in the New York Times a couple weeks ago I just wanted to throw something against the wall and I wrote an email to my people about this because it just drove me nuts it was about work culture in the Silicon Valley and about how you're looked at as a loser if you don't work 70 to 80 hour work weeks to the point where Soylent is making its way back exactly and there was a quote from an entrepreneur I won't say his name but some people know him where he said something like yeah I don't have any time for my kids I hardly ever see them but that's just the cost of being successful I just absolutely think that so angry it's hard for me to even express it and what is this guy doing he's making software that helps people visualize furniture in their home what so I wanted to send him the rocking chair test so imagine yourself in your rocking chair and you're going to look back and be like wow that software that help people visualize that coffee table in their living room I was a game changer my kids hate me I'm so glad I did that I also think it's just the false paradigm when people approach us when people approach us with fitness and they say I know you guys talk about being healthy all the time but I just want to look really good I just want to look aesthetic it's almost as if health and aesthetics are separate when in fact they're both one and the same and this is one of those things where you balance with yourself and that means sometimes you got to bust your ass too because you can also be out of balance in the other direction but being in balance both body and mind you're going to perform better and be able to produce more Chris will appreciate what motivated us to do what we're doing here which was what we saw there is a huge problem within the fitness community with programming and all the information that we're giving out there the beast mode the mentality of like you kill it you don't leave until you feel like you're going to die in a workout and that could not be further from the truth of what's really going to give you long term results sure that type of mentality might get you faster along in two weeks time but when you look at it like a year two years ten years of your life if you want overall health, long term, longevity that's not the approach at all and so when we first came out with our programs people just thought like this is too simple it's too basic, I don't understand there's only three days you're saying I have to be in the gym like yeah no shit, you ain't going to be in there seven days a week it's crazy where it's very similar the message that two and a half years later now we're getting emails from people like oh my god my body's responding like crazy I don't know I think there's some deep cultural roots with the whole periodanical work ethic thing there's nothing wrong with working it's the whole suffering that people equate to work well it's also not understanding the things that you're talking about here like periodicity and me also understanding different work styles like for me I figured out that I can accomplish a lot in a short period of time relative to maybe some other people not better or worse just the different tortoise versus the hare type of thing but in order to maintain productivity I need more rest and integration I used to think I went through periods of hypomania but really it's just I get super very passionate, very inspired and I'll put out incredible amounts of content in a very short period of time and ideas and whatever and then it's like I need time to recharge and let that so Chris moving forward you have a book that's about to come out let's talk about that for a second what would that be about so the book is called unconventional medicine and the premise of the book is chronic disease is the biggest challenge we face but our current system is hopeless at addressing it as we've talked about before it evolved during a time where acute problems were the biggest issue and now we're trying to apply those same solutions to chronic disease which just isn't working we have a system that's based on Band-Aids basically if you use an analogy you have a rock in your shoe and it's causing your foot to hurt you go into the conventional system you're going to get some ibuprofen and a diagnosis and a diagnosis of foot pain such a great analogy don't step so much it'll be a more scientific term for it it'll sound more official than just foot pain but of course it makes a lot more sense to just take your shoe off and dump out the rock and that's I propose a solution in the book that is focused around this approach of functional medicine getting to the root cause of the problem is one component it has three components the second one though is the ancestral diet and lifestyle we have to recognize that environment is the primary driver of chronic disease this is not just me making this up there are studies that show that 85% of disease risk comes down to environmental and behavioral factors so genes yes they play some role but it's really people making the wrong choices about their diet and lifestyle on a daily basis that's driving this and then the third thing is what I call a collaborative practice model so we need doctors we need doctors who are specialists who can do a colonoscopy specialized procedures who can do doctor type of stuff absolutely we need that but what we need arguably even more now is an army of what I call allied providers so these are health coaches nutritionists, trainers all kinds of people who can work intensively with folks on behavior and lifestyle changes because we talked about this before the average appointment time is 10 minutes with a primary care doctor there's no way if someone goes into the doctor and they've got multiple chronic problems going on they're presenting with new symptoms there's no way the doctor is even going to be able to figure that out much less to spend time with that person giving them the support they need to make meaningful changes that are going to last for a whole lifetime they might give them like as they're going out the door you know oh remember eat a healthy diet patients like on their way out first of all the doctor doesn't even know what that is because they've taken one nutrition class in college or in medical school if that and second of all if the patient just hears it as they're going out the door to go up to the front counter they're not going to take that seriously if 10 of the 10 minutes was spent talking about medication and then the last 10 seconds are spent on diet and lifestyle change they're not going to make a difference plus it's behavioral change I work with clients for years and sometimes it takes a year absolutely things start to happen change is hard okay I mean if it was easy we wouldn't have the problems that we have and yet I wasn't trained in behavior change as you know a practitioner I don't know no doctors are trained in it and but yet there's tons of evidence that supports all of these principles of behavior change to make it successful it's out there we know how to apply it but we just need to train people who can do that with like you know folks like yourself and a whole bunch of other people who can be in that capacity and work intensively with people to make these changes because that's going to have a far bigger impact in terms of preventing and reversing chronic disease then just research more research to find new drugs that's awesome it's funny because I trained a lot of doctors and I would tell them this like oh we got to look at and they say yeah no of course but I have patients who wouldn't even take the fucking pill they want to take the pills I give like they'll forget to take the medications and you want me to tell them to fix their diet yeah it's a systemic problem it's not the doctors fault anymore I mean it's their victims of the system more than anybody else well they're taught that way they're educated that way right taught that way there if they're practicing within an HMO type of framework they're often rewarded for seeing more patients and spending less time with patients you know that's efficiency and medical speak and many doctors know this and they want to do something about it but they don't know how within the current framework and system so there are actually some really interesting things happen this goes back to your question about you know are you seeing positive changes or are we going in the wrong direction there's a group called Iora Health in the Rocky Mountain area it's a primary care group and they basically approached some HMO some insurance companies and said give us your patients with diabetes or pre-diabetes we have this new approach that's really effective and we're gonna you know reverse we'll take your type 2 diabetics back to pre-diabetes or we'll take your pre-diabetics back to normal blood sugar and if we achieve our goals you pay us this much if we don't achieve our goals you don't pay us at all or you pay us less this is called capitated payments it's actually aligning incentives with performance which of course like happens in gyms and offices everywhere else other than healthcare right where you're rewarded for not performing that's a different topic but and then if they exceed their goals they get more money so what they do their approach which is really amazing and smart they just hire a huge number of health coaches all from the communities in which the people that they're serving they don't hire them based on expertise and nutrition this is a really interesting part they hire them based on their ability to form a connection with their patients if you had asked me as coaches, as people who've managed trainers that's the most important thing yeah so they don't care anything about their background in nutrition we can teach them not teach them not in like 2 weekends so what they do is they have like a speed dating hiring process where they sit them down they have conversation with them and they have like undercover observers in the room apparently they're like watching how they interact with each other so they make sure they're hiring people who can relate because that's what it comes down to the coaching relationship is about trust and the ability to empathize and connect with your client and so then they train them give them the nutritional information they need and then these people work really intensively with the clients they go to their house they do pantry clean outs they go shopping with them they basically hold their hand through every step of the process and they still see the doctor occasionally they get the blood test and if they need medication they get medication but it's had dramatic impact they're taking people as I said back from type 2 diabetes not only back to pre-diabetes but sometimes all the way back and they're just killing it and the levels are going to be what we need more of how cost efficient is it very efficient the cost of treating a patient with type 2 diabetes is $14,000 a year per patient per patient now people are getting diagnosed earlier and earlier kids now are getting diagnosed with type 2 diabetes imagine someone who's diagnosed at even 30 and because of our modern technology we can keep people alive for a really long time even if they're living a low quality of life so imagine that person spends 50 lives another 50 years until age 80 they're spending I mean that's well over half a million dollars to treat this one single patient so you want to talk about cost effectiveness you could spend $5,000 on coaching and functional medicine testing and still have some left over and if you prevent diabetes in that patient from progressing you've just saved the healthcare system half a million dollars for that one patient wow that's cool that's what I talk about in the book one of the common criticisms is like functional medicine is expensive diet and lifestyle it's all expensive and it's that's only because everything is subsidized in the insurance care if you go to the doctor and they give you this is what the conversation really should look like you'd be like you've got high cholesterol so you've got two options I can give you I can make diet and lifestyle recommendations but you're on your own when it comes to implementing that we have no support for you you're going to pay all those costs out of pocket and good luck or I can give you this drug and good news is that's totally subsidized by the healthcare you'll pay your $10 co-pay and your numbers will come down and the idea in that conversation is that those changes are equivalent they might lead to the same number on the paper in terms of the cholesterol level but they're not equivalent and they're not equal if the patient was paying a true cost of the drug and those costs were actually made clear it would be so much cheaper to do the diet and lifestyle intervention hire a coach to help them and even do some additional testing up front what other mechanisms might be contributing to the high cholesterol and address those and then save decades of subsidizing that person's medication it's just so ridiculous to me that we look at our healthcare system and we're like oh we got to fix our healthcare system it's the insurance programs or we need a single pair because it's so expensive and it's like nobody's talking about the elephant in the room which is we're getting sicker and this shit's going to keep getting more expensive and you can package it however you want some maybe a little better than others but at some point it's going to fucking bankrupt us we have to have our health that's exactly the point I make in the book I mean I could just take the words right out of my mouth it's like the debate on ACA versus ACHA that we just went through it matters it's important it affects people in real ways so I'm not saying that that's not important but I am saying that the problems that we have go much deeper than that and there is no scenario that anyone can come this is why it's so hard there's no scenario in which we can use insurance to pay for the growing burden of chronic disease as chronic disease increases it will bankrupt us I don't care if you have the Obamacare plan or the Trump plan or any other plan there's no scenario in which we can be spending as much as we're spending on you know to cover we're spending $3.2 trillion a year that comes down to that's $10,000 for every man, woman, and child in the US and there's no scenario in which we will be able to do that as the rates of chronic disease continue to increase so just think about diabetes again $14,000 a year just think of the impact of the average age of diagnosis going from 40 to 30 that's it game over for the whole healthcare system if you do the math on that you will quickly see how that takes the $3 trillion to $10 trillion and that's it bankrupt game over so it's really clear if you start thinking about this in a systematic way it's absolutely clear that the problem is chronic disease we have to figure out how to prevent and reverse chronic disease otherwise our whole society is going to fall apart it's not even just about healthcare it's about the effects of healthcare how about having a government that functions and isn't completely bankrupt so this is the motivation for this book for me I think in the whole healthcare debate it was so frustrating not to see that mention even once in popular media it's not in the conversation well I appreciate you writing this book I know people can pre-order it right now yeah I'm not sure when this is happening October 16th is pre-order it's unconventionalmedicinebook.com and then it comes out on November 7th and that will be on Amazon beautiful we'll definitely have a link in the show notes and everything to drive everyone over there for sure I really appreciate you coming on our show Chris your information online is a lot of what you wrote a lot of the stuff that I found that you wrote in your videos are the things that kind of pointed me in the direction that I am today so I want to thank you again for coming down great to finally meet you thanks very much to talk with you and keep up the great work I really believe that people like the work that you're doing as I said is arguably the most important work we need to do because you're on the front lines working with people in an intensive way to get their diet and lifestyle in order and that's going to have a bigger impact on anything else excellent thank you very much check it out go to YouTube subscribe to Mind Pump TV every single day also go to mindpumpmedia.com that's where you can find our 30 days of coaching and it's available for free thank you for listening to Mind Pump if your goal is to build and shape your body dramatically improve your health and energy and maximize your overall performance check out our discounted RGB Superbundle at mindpumpmedia.com the RGB Superbundle includes maps anabolic maps performance and maps aesthetic 9 months of phased expert exercise programming designed by Sal Adam and Justin to systematically transform the way your body looks, feels and 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