 So we're going to talk about another, fixing another part of the environment. We've talked about the payer environment. We're going to be talking a little bit now about environmental medicine. Keep your tweets coming in. We've had a couple on hashtag Functional Forum. We're going to have a panel here in a minute. So I'm going to get everyone's tweets from people who are watching at home, and we'll deliver it to the panel. So the next speaker is another bolder native. I think you're going to see that she got a little bit mad too, right? She got a little bit mad when she realized that health care, the way that she had learned to practice it, was not helping out with the things that her patients were dealing with. So please give a warm, bolder welcome to Dr. Jill Carnahan. August 6th, I was hiking just down the road at Sanita's, my favorite weekend event. And I was walking up the left side. They call it the goat trail. And I started getting short of breath. I don't know if any of you remember August 6th, but if you remember this headline, we had the worst air quality in the entire world. I moved to Denver. One of the reasons I moved here was I loved to ski. And the second reason was I loved the crisp, low humidity air and the great air quality. And I don't know if any of you were outside the day. I obviously did not look at the weather forecast, and I did not take that into account, because by the time I was halfway up, normally I could do that whole loop in about 90 minutes, I had to turn around because I was so short of breath. And you saw the picture before, I was, fortunately, I loved to bio-hacking in my fridge. I had nebulized glutathione in NAC, so I went home and pulled out my nebulizer for the first time ever. And what's funny about that picture before is it's actually upside down, because I didn't know how to use it. So it wasn't puffy. And it was like, there's no smoke coming out. I'm like, what is wrong with this thing? And I did it for over an hour, and the juice was still in there. And it took me, you know, calling a friend to realize that I had to turn it the other way to get the nebulized treatment, so so much for really knowing how to do a nebulizer. But I learned, and this headline then came out the next day, and they said that day, being outside for an hour, was the equivalent of smoking two cigarettes. So air quality, big issue. What is in welfare? Smoke, I actually wrote an article about this recently because what's happening is our patients' labs, I'm seeing TGF beta, MMP9, all kinds of abnormalities from the wildfire smoke, the kinds of things that I would have used to seeing only from a massive mold exposure. So this is epidemic, and you can see the list there. This stuff is really toxic. If your practitioner is listening live, I'm sure many of you are nodding your heads because you've seen this pandemic, and you've seen how the air quality also affects people's susceptibility to COVID, right? If you look at some of the maps, some of the air quality meters and the rates of COVID, there's definitely correlations to air quality as well. So this is a big deal. Our air quality is suffering. And then massive amounts of flame retardants are being dumped in the environment. Now as a mold expert, this is fascinating to me because if you read this, one of the things that these flame retardants are doing, they're causing these small ponds affecting water quality, and they hinder this dilutional effect, and we're getting algae blooms, which if any of you out there know about mold-related illness, there are other biotoxins besides just mold that can cause the same illness, and one of them is algae blooms. And if you've been watching the news, you've noticed algae blooms are on the rise. Could it be partially related to this massive increase in wildfires and the use of flame retardants? Who knows. And the air quality matters because did you know it's linked not only to brain cancer rates, but Alzheimer's disease and many, many other medical things that we're seeing in epidemic proportions. And that's just the air. Look about our water. And I just grabbed this in two seconds on the internet, but you can find thousands of other headlines just like these about our water quality supply. And you know, I always say, it's interesting. Look at this one. US scientists actually laughed at this. High amounts of toxic rubber glove chemicals in fast food. Well, first of all, we probably shouldn't be consuming fast food, but second of all, if we are, we're getting toxic rubber metabolites in the fast food. So our air supply, our water supply, our food supplies we heard from Robin this morning is massively being affected. And here we are in our offices as functional medicine or integrative medical doctors giving out supplements for changing diets and all of these things. But sometimes we forget the basics. And tonight I want to just give back to the basics because you can be an expert in prescribing NAC and glutathione and sulfoethanes, et cetera, et cetera. And these things are important granted. But like all of our speakers tonight, if we don't get to the root cause, which is back to the basics, clean air, clean water and clean food, we've lost the battle. There's no amount of supplements or great diet that will change an environmental insult that's causing illness in our patients. So that's what I want to take just a few minutes to talk to you about tonight. So just a little background, I love environmental medicine because it really does matter and make a difference in our patients' lives. And I always like to talk about the toxic load because that's really the elephant in the room and it's exponentially increasing because our environment is becoming more and more toxic. We're all now swimming in toxic soup. We're getting it, like we said, as I showed you with the headlines in our air, in our water, and in our food supply. So what contributes to total toxic load? I like to divide it into two categories of endotoxins and exotoxins. The exotoxins are the things that come from the outside. So those are things like chemicals, pesticides, stalates, parabens, glyphosate, which we saw that shocking map this morning that was from five years ago and is only getting worse. Things like mold in the environment, heterocyclic amines, et cetera, et cetera. And then there is the endotoxemia, the endotoxins. These are things that come from inside. And these are just as bad, things like LPS, the bacterial coating on the microbiome components that when it leaks across the membrane in a leaky gut causes massive damage in the immune system. We know LPS endotoxemia is one of the number one causes of cancer, diabetes, obesity, heart disease, and even things like depression, anxiety, and insomnia. It's epidemic, and this all starts in the gut. Acetylaldehyde, it's a similar byproduct of formaldehyde, and it's a byproduct that's made when you have overgrowth of fungal elements in your gut. You know that hungover feeling? That's acetylaldehyde too, because when you drink alcohol, the byproduct of a hangover that causes those symptoms is acetylaldehyde. So did you know there's actually something called, in fact, last time I was in E-town, I talked about auto brewery syndrome. Did anybody remember that? It was a funny story about a guy who kept getting drunk, but he didn't have any alcohol, and the police pulled him over, tested a positive blood alcohol content, and he swore he was not drinking. But when they took him in to observe him in the ER and they had him abstained from alcohol, which he insisted he wasn't drinking, they measured again a blood alcohol content after a meal of beer and pizza. And it was because his own gut was causing fermentation and creating alcohol in his blood, which raised the limit in his bloodstream to above the legal limit. Now what's funny is after I gave that talk and it was live online, some of my patients and fans found it. And would you believe I got calls for DUIs? They said, hey, Dr. Carnahan, can you help me? I thought this was a great excuse. So I just put this slide here, I'm not gonna read these, but as your eyes gloss over the different symptoms, we all have many of these symptoms. And this is so common, the epidemic of all of the mood disorders and gut disturbances and skin issues like acne and even menstrual irregularities or male hormone decrease. All of these are related to our environmental toxicity. And I bet many of you in the room can either relate to these or you know many of your patients that have these common symptoms. So as I'm working on my book and documentary, I recently interviewed my grandmother who's my only living grandparent in that generation. And I found a fascinating story that I wanted to just share briefly with you tonight because this isn't even just our culture today, but it goes back generations for me. And for me it was a big aha because it also reintegrated my desire to deal with environmental toxicity and the importance of it because of how it affected my grandparents. So this is a photo of my grandmother on the right, the older daughter there. Right here is my grandmother. She had a younger sister, a younger brother and a very younger sister here. And this is my great grandparents. They grew up on a farm and my great-grandfather was farming until my grandmother was about 14 when he bought a dealership in town in Washington, Illinois. And his last name was Essex who we call this the Essex Chevrolet Company. He moved his entire family above the auto body shop right here into this apartment on the second floor. So my grandmother at the age of 14 moved in there with her younger siblings. Now you might know where I'm going with this because they lived above an auto body shop with diesel fuel. And I'm literally talking to my grandmother, no one in my family had ever put this together before and I'm saying, grandma you mean you lived, oh yeah, my mother, my great-grandmother. She would always have these headaches and migraines and she was super chemically sensitive. She could barely drink water. I'm just shocked, I'm listening to her tell this story. Well the rest of the story is as I went through my family history. My great-grandfather died of liver failure. My great-grandmother died of liver cancer. My grandmother's brother died of metastatic cancer to the liver. My grandmother's younger sister died of metastatic melanoma to the liver. And the other sibling died of lung cancer metastatic to the liver. So this was just the story just this year that I found out about my family. The generations back and a massive environmental toxin probably benzene and lead from the diesel fuels and it affected almost every one of them. My grandmother's still living but guess what? She was 14, she was working in the office so she was not in the home for most of the time as she told me. And then she married at age 15 or 16, she married very young so she was taken by my grandfather and they went off, this is my grandmother and grandfather in their Chevrolets from the dealership. And they went off and got married so she was saved from some of the toxic effects and she just turned 90 and she's still going strong. But this really matters and again to me it just drove home the passion I have about teaching on environmental medicine because this is my family. So let's dive into just a little bit of basic principles of detox because I wanna leave you with a little practical information. Okay so basic principles of detox, we have optimizing elimination and excretion. We have the phase one and phase two of the liver which I'm gonna talk to you about some very important nutrients that all of us are using. Mitochondrile function is key because the mitochondrial are inadvertently affected by toxins and often energy production is down and fatigue is probably one of the number one symptoms of environmental toxicity. And then the liver transformational detox. So as you can see here, busy slide, all I wanna bring to home tonight is just that there's phase one and phase two of liver detox. And when we're treating this we use the nutrients that support those phases. So phase one you need B vitamins, you need folic acid, you need glutathione, and phase two you need methionine, you need sulforphanes. The interesting thing about phase one and phase two is when you have an environmental toxin and it's biotransformed by the liver, you take that toxin and put it through phase one and into an intermediate and then that intermediate is taken into phase two and excreted into the bile acids and the bile is stored in your gallbladder and then that bile is excreted into the gut. Now what we call the enterohepatic circulation which is how our bile is reabsorbed. It's actually incredibly efficient, about 95% efficient. And this is one of the reasons with mold toxicity and a lot of our toxic problems. We use binders because if we don't actually go in there with an electrostatic charge particle like clay or charcoal and grab onto that bile acid, it'll just do a merry-go-round in the gut and be 95% effectively reabsorbed so that you remain toxic. Now the interesting thing about this is this intermediate which is hidden by the red line there. That thing I said comes in between phase one and phase two. It's actually more toxic than the original toxin. Which means if you drink coffee which up regulates phase one, cytochromes, or you push phase one without supporting phase two which requires leafy greens and sulforaphanes and a lot more intensive support, then you get stuck in the middle and you get a lot more toxic. This is just a slide kind of a take home kind of thing. I won't read these all but these are some of my favorite detox nutrients that cover all the cycles. One of the really important ones you'll see on there is sulforaphanes which is from broccoli sprouts. That particularly supports that phase two so you don't get stuck in the middle. Glutathione, methylated B vitamins, SAME, glycine, glutamine, et cetera. And one reason we use vitamin C, glycine, glutamine and NAC or those are all precursors to our master detoxifier, which is glutathione. And then the gut. Let's not forget the gut. One of my other favorite organs. So critical is the gut and detoxification and we must support this with collagogue herbs. These are things that cause the secretion of bile acids. Things like probiotics. I'm especially fond of spore based probiotics but there's many other types. Bovine immune globulins and even things like coffee enemas. Yes, I'm an MD and I do talk about coffee enemas. My story there is I went to Switzerland and I was with, I was like by decades the youngest one there. I took two groups, one in 2018 and one in 2019 to the former Paracelsus Clinic. It's now called the Swiss Mountain Clinic for a one week liver and gallbladder detox. Sounds like a great vacation, doesn't it? So I went there with this group and what happened was I guess older retired people are the ones that have the money and the time to go to Switzerland to deliver gallbladder detox because the average age was about 95. And so I was amongst these elderly people and they were all just running around taking hikes up the mountain, doing their detox, drinking their bitters and I was like, what in the world? If I was back home in Boulder and I'm treating like 30s and 40s and 50 year olds, they would all get really sick during this detox. So what's the difference? And one of the things they incorporated into their program was daily coffee enemas and colon hydrotherapy once per week. And I realized there was a power there. So I came back to the States and started talking about coffee enemas and now that's one of my claims to fame but I'll tell you what, it really does enhance the gut detox because by doing that enteropathic stimulation in the colonic receptors you increase production of glutathione by about 600%. So it's a great way to support detox. So back to the basis, like I said, we're gonna kind of finalize this detox segment on clean air, clean water, and clean food. This is just a picture of me in my office amongst one of my five Austin air filters. I think we have literally the cleanest air in Boulder inside my office and this filter actually filters out micron particle sizes that would filter out the COVID virus. And I will tell you this interesting factoid in the 18 months since the pandemic started because we're an essential medical office that entire time I have had my full staff working in person at the office and not one of us has gotten sick. So go figure, we actually practice what we preach. Clean water, just drinking clean spring water filtered and leaving out the plastic bottles. And then clean food as Robin set us up so nicely this is absolutely essential, organic, non-GMO, pesticide free, local whenever possible, grow your own whenever possible but food is so core to what we do and there's no amount of supplements that can outdo a poor diet. Now I wanna end, like I said, Robin just could not have set me up better for this because I wanna end with my own story. This is the farm where I grew up in central Illinois. And I'm so proud of my family because after what I'm about to tell you my brother took this seriously and he switched his entire 10,000 plus acres that they farm over to 100% non-GMO and they're bit by bit by bit switching over to organic. And if any of you know farming in central Illinois that is unheard of, especially with the big agribusiness that's happening. This is the actual homestead and the bins of the farmhouse where I was born and grew up. And this is my dad and my brothers and I and Jamie, this is before my youngest brother was born. So there's us on the farm. So my story began in relation to toxicity in 2001 when I was in medical school, 25 years old, prime of my life pursuing my dream of becoming a physician. And I found a lump in my breast. Now I wasn't too worried because 25-year-olds don't get sick, do they? But at the insistence of my friends and family, I went and I got ultrasound and mammogram and I remember sitting with a radiologist as a medical student, everything's a learning opportunity. So I sat beside him in the dark room and looked at the images of my own breast. And I saw the fear in his eye as he looked at me and said, Jill, if you were 55 years old, this is highly suspicious for ductal carcinoma, also known as breast cancer. And I knew what he meant. And I'm very intuitive and I also knew what the fear in his eyes meant. But still I had hope until I got the biopsy and I got the call from Dr. Smith and her voice cracked over the phone. And you know those times in your life when your world changes, many of us, pandemic times, many of us when the World Trade Towers went down, many of us, all of these types of experiences, maybe someone you love passed away and you get the phone call. I'll never forget the chair was sitting in the color of the wallpaper every single detail about that day when Dr. Smith called me and said, Jill, you have aggressive breast cancer. The cells in the cancer are growing very fast, very rapidly. This is extremely life-threatening and you are in for the battle of your life. And I was 25. I grew up on a farm where we drank water from a well where atrazine is still legal in the U.S. and it's banned everywhere else, where when I was 35, 10 years after my diagnosis, I finally looked up online, I Googled atrazine and about fell off my chair. The brightest, hottest spot, kind of like that Glyphosate map that you saw earlier from James, was Wright's Mac Deb on top of the farm I grew up on in Central Illinois. Atrazine is a known endocrine disruptor that causes ambiguous genitalian frogs from the Silent Spring, if any of you read or heard that book or movie. And as I studied, because my question was why, I lived well, I ate well, I didn't do harmful things to my body. But I have no doubt that maybe even in utero, my mother was exposed to endocrine harming chemicals and I was born with very poor detox genetics and that cancer cell probably started to grow at age 10. And by 25, it was an aggressive tumor that I battled my life against. So this matters. And I'm here today with such a passion about environmental toxicity and about our farms and our farmers. It's funny, because I did not plan to talk about farmers and their plight, but Robin set it up so beautifully because this is where it starts, guys. It starts in our communities, on our land, on our soils, our water supply, our clean air, our clean water, and our clean food. And I'll tell you what, if you don't start to care right now, you won't have a choice in five or 10 or 20 years because of rates of cancer and autoimmunity, neurodegenerative disease, Alzheimer's disease, they're gonna, I don't care how many functional doctors are out there, our system will be broken and overwhelmed and we will not be able to go back. So it matters. This was me when I lost all my hair and I battled my life with three drug chemotherapy that completely destroyed my gut, led to a diagnosis one year later of Crohn's disease. Both of them I've overcome through functional medicine and living well and completely cured of both of them. But this matters. This matters. Our clean air, our clean water, and our clean food. And I just wanna leave you with this thought so it isn't too depressing. You know, the things we go through, they make us who we are. And every one of you in this audience has a reason or purpose for what you do. And it drives us, most of the time, it involves a story of difficulty or suffering, something that transitioned or changed your life. I remember back in medical school, I was the crazy one. I started an integrative medical club at Lay Old and I brought in massage therapists and chiropractors. And my colleagues thought I was crazy. And you know what happened? Every couple of months I get a call from one of my colleagues, or of text. And they say, Jill, my husband, he's really sick. And I don't know what to do. We weren't taught this in medical school. Do you have any ideas? Or could you see him? The world knows that our system is broken. Physicians, even in conventional medicine, know that they don't have the answers. And even we know, as functional integrative physicians, we don't have all the answers. But at least we know where to look. And it starts with clean air, clean water, and clean food. Thank you. Thank you, Jill. Thank you so much. Why don't you stay up here? Let's bring on the chairs because we're gonna have the panel now. That was super, super powerful and super grateful for you sharing your story and so much value there. We've got some questions coming in via Twitter. I might call on a few of you in the audience for some questions here. So you're gonna have, why don't we bring up Dr. Tusek and we'll bring up Dr. Chris Shea here as well. And yeah, let's get you guys mic'd up. All right. So Jill, actually, I wanna just start with you because I didn't know actually that you were from Peoria, Illinois until last month when I met Jeff Robbins, or I hung out with Jeff Robbins. And he thinks that his meetup or his community in Peoria, Illinois was like the first one in the country and you were there too. And I just wanted to ask you, as far as like getting people, getting helping doctors to come to this new realization of what's needed, what sort of confidence does it create to have this sort of community where you can meet with others who are doing it differently? Well, like I said, back in medical school, I felt like the only one. I felt like I was crazy. And yet I knew inside I was doing the right thing. So I think the collaboration of doctors getting together is giving us empowerment to go forward, knowing that we're supported because otherwise we're all islands, we're all aliens. But the truth is there's more out there than not. There's more docs that are being, they're lacking the tools that they need and they're looking for answers. And you can see that with all the educational programs. They're bursting at the seams. Yeah. Dr. Shade, you're hosting the crew down here before the pandemic. You had in your new offices down in Louisville, you had 100 practitioners there. Why did you decide to get involved in helping organize the practitioner community? Well, that's where I got my start in all of this. It was the original, what were they called? The Colorado Functional Medicine Meetings? Yes, and we have one of the organizers of the original Colorado Functional Medicine Meetings. John Scott and Cheryl Gray. And I had started my company originally just all I wanted to do was measure mercury levels and people doing metal chelation challenges. And got myself really sick doing that. And I was watching all these meetings. I would come every month and I would see these wonderful people lecturing and I was watching Bob Roundtree speak and Nigel Plummer speak. And I say that I was going through the dark night of my biochemical soul as I was trying to use key laters to overcome basic deficiencies I was having in my detoxification system. And just getting sicker and sicker till I had this vision that I had to change how I was trying to do this. And in my case, it was going from trying to push things through the kidney to try to make my liver work better, make my GI work better, make my microbiome work better. And it was just in that space that all of Quicksilver Scientific and all that we do, all that we make and all that we push in creating protocols for trying to line up people's detox at their immunity, that was all born out of that. And it was born out of that collaborative environment and just being able to watch all those things and talk to each other and support each other. And one of the worst things that happened during COVID was the loss of that face-to-face community and the divisiveness and the derision and the division of our community into do we vax? Do we not vax? You're bad, you're bad. And everybody quietly sitting back not talking to each other, not fertilizing each other with the ideas that it takes to get through a crisis like this. And so I'm so glad to see us all sitting in a room together, unafraid together and sharing our energies and our love together. Thank you, Chris. Yeah, I appreciate that. So, David, I want to ask you because, you know, these guys are sort of deep down the rabbit hole, right? Practicing very, you know, deep detoxification, deep functional medicine. But you're delivering, you know, functional medicine light, should we say, inside cloud medical. So for doctors who are watching this who, you know, don't want to go so deep into that care, what does detoxification look like in the cloud medical protocol? Kind of detox for everyone. Well, I mean, I pay so much homage to both of these amazing humans who have taught me a ton over the years. And, you know, my journey kind of started with the other functional medicine societies like A4M and IFM and, you know, even as a medical student back in the old days, we had ACAM and the American Academy of Environmental Medicine. And so I started going to all of these conferences and, you know, slowly but surely implementing those strategies into very conventional mainstream primary care. And, you know, learning about different types of supplements and, you know, protocols and processes. So I think that if we look at, you know, the way that we approach our bodies with, we typically start with the five pillars of health of my practice, which is hydration, nutrition, exercise, sleep and stress reduction. And we say, if you're a dehydrated, pop-tar dating sedentary, insomniac stress ball, things are probably not gonna go very well and you're not gonna feel great. And so supporting our patients along all of those angles, you know, on the body, certainly the nutrition and the, you know, the source of where we get our clean water, you know, I think is really, really important because if you detoxify tap water with all kinds of filters and everything, you're also pulling out the really nutritive minerals that are in there. And so, you know, how do we replenish those things? We are very fortunate that we live at the foot of all of these amazing springs so we can actually drink fairly clean spring water. And, you know, certainly there's a time and a role for the wonderful supplements that Dr. Shade's company makes and many others. Awesome, right. I wanna have a question here. Dr. Carlton Lewis, MD, I don't know where you are in the world, but you tweeted in this question. This is for Dr. Khanhann, but maybe anyone can pipe in after you first, Jill. What do you suggest for patients who can't tolerate sulforaphane or cruciferous vegetables to support phase two detoxification? So food, food is medicine, right? So leafy greens are great sources of a lot of the other, and vegetables in general. And I'm assuming if they can't tolerate, they may have SIBO, which is a problem with FOD mounts, but there's lots of other things, including starting with leafy greens. Could I just throw something in there? Sometimes, you know, I have a lot of very sulfur intolerant people, and so the crucifers, the garlic, the onions. When I first got into detox, it was all with the worst of the worst. So everybody was a limey, a moldy, autistic, and you had a lot of sulfur intolerant people there. And in fact, the strongest phase two detox stuff are also the most toxic on a sulfur level, so sulfuraphane. So we'd often have the mused polyphenols, which are not quite as strong for a regulation of phase two but they're much better tolerated. And often in the early stages, we'd say stay away from all of, now it's certain kind of sulfur. So crucifers and alliums, those are really toxic solfers. Ironically, you have about 20 times more sulfur in a piece of chicken breast or meat, but those are not so reactive. And so staying away from those food groups in the beginning and going with polyphenols like green teas, pine bark extracts, some of the ayurvedic things like kerataki and malaki can be a lot better tolerated. All right, well, let's have some questions here in the audience. So if you wanna ask a question, put your hand up, I'll come around and give you the mic and you can ask a question to this amazing panel. I see Cheryl here, I'm gonna pick on you because Cheryl Gray runs the Environmental Health Symposium, really awesome conference. If you wanna go back into the Functional Forum archives in April, 2017, I think we made a show about your conference with the late great Walter Crinian. So do you have a question? So my question really is, is that there's so much talk about functional medicine, but really environmental medicine is at the core. So for people looking to start an environmental medicine, what do you recommend? Great question. All right, what do you guys recommend? Well, you mentioned quite a few of the organizations, but I still think some of the best. EHS is a great one, Cheryl. ACAM is still out there. IFM is one of the leaders in the basics. A4M I feel like has more cutting edge programs and I'm on faculty for all of them, so we can, but any of those are great sources of education. I think one of the interesting, I don't know if it's a distinction, but if you look to Dr. Tusek, there's a function on primary care, there's focus on primary care and then there's interventional care. Like, so primary care, how are we gonna set up our basic health and then interventional, I've got a problem now. And with this problem, I have to go and I'll have to do this round of detoxes, I have to do some, maybe some peptide injections, HBOT, some sort of thing like that. So I think as we go, we'll sort of differentiate those two. And the same person can be doing both of those, but how do we lay down basic care and then how do we integrate light detoxes into that versus a strong environmental, like, you're sick now, we gotta figure out what's in you and we have to start getting that out. Yeah, a couple of things I wanna share on that, just from my experience as well is that one, doctor's office is starting with a group detox for their patients as a way to introduce patients to the concept has been a really easy way to introduce it to patients in the office and many companies have tools for that, but one other thing I wanna share is that, telemedicine has evened out at 38 times its level since before the pandemic. And ultimately, when you do telemedicine, you have an entrance into someone's home pretty much, like, unless they're doing their call at work. And if all medicine is environmental medicine, the majority of time people are spending in their home. And one of the things that we've seen in our virtual groups is, you know, people say, well, look, I'm mainly eating salads and that kind of stuff. We're like, okay, let's go and look at the fridge. Like, let's go and take me over to the fridge and let's have a look. And ultimately, I think there's something really powerful about telemedicine in seeing patients where they actually live, where they spend the majority of their time. And I've heard from so many clinicians who have shared that it's been an interesting window rather than having someone in their office where they're just really disconnected from their home. That's been an interesting side effect, should we say, of this growth in telemedicine. All right, you got a question? I do. Thank you guys for being here. This is so nice. Pharmacogenomic testing, are you testing for SNPs and which ones? And then if you're testing, which testing companies are you using? Jill. Gosh, there's a ton out there. Intellect's DNA is my new favorite. I think it's the most powerful tool right now. But there's so many other, you know, Bob Miller's company has a great platform that a lot of docs are using. And there's a lot of other side companies that have little, you know, the DNA company, Intellect's DNA, the Bob Miller platform. And honestly, they all have the same things. So for me, it's which platform is gonna give the physician the best interpretation and the best data? Because as you guys know, if you're doing this, it's completely freaking overwhelming the reports. You get 50 pages or more or hundreds. And there's no way, at least in my clinical visits, to go through all those genetics in that visit. So what I want is a company that's kind of fine tuning and highlighting the keys, and then giving me something really clear to give the patient. Because what happens when I give them a 100 page report, they want to go through every page. And I don't have time to do that. Absolutely, yeah, I want to ask you, Doc, because I know a lot of doctors that go from conventional care to DPC often bring in genetic testing as opposed to functional medicine as like their way of differentiating themselves and saying, hey, we do personalize medicine. Look, we've got these tests, but then have no idea what it means or no way of interpreting it. And it's actually not that useful to the patient or the doctor because it ends up sucking up a lot of time. Have you mentioned in that direction or do you think, as doctors transition, are there more high leverage, high value things that doctors can do to deliver personalized medicine but without having to go through all of that? Yeah, I mean, I started this journey a long time ago back in the pathway genomics days and they were trying to pioneer liquid biopsies and all sorts of things, probably 10 years ago. And Intellect's DNA probably is my fear, that's who I used to sequence my entire exome. And I found the same thing that Jill described, which is the report is so thick and burdensome to really sort through. So the thing that I recommend for most of my patients are the really, really actionable genetic information gathering systems like color genomics that actually looks at the particular genetic variants that are directly correlated with a significant increase risk of different cancers. Is that reasonable in primary care or in like what you're doing? Like, is that a reasonable use of time, have you found? That particular one? Well, just what you're talking about right now. Yes, absolutely. I mean, it's very fast, it's very cost effective. You know, to do your whole genome with Intellects, I mean, it's not cheap. Color genomics looks at the 35 major cancer genes and it's 249 bucks. So that's a test that we recommend for many, many people. And then, you know, for people that have various mood disorders, difficult to treat psychiatric conditions, I think the pharmacogenomics testing is also very useful, very affordable, very easy to sort through. But doing an entire metabolism, I mean, the problem too is all of the GWAS studies are so difficult to interpret, the genome-wide association studies to see which of these genotypes actually directly correlates to the phenotype. But I would look at pharmacogenomics and the oncogenomics as two that are super appropriate for primary care. Awesome. All right, we've got time for one more question. I'm gonna put Dr. Christopher Mote here on the spot for that question. One, because he's one of my favorite doctors, Cornerstone Health Community Centennial Colorado. Also, he is hiring. So if you're a doctor and you're gonna come and work for Dr. Mote, so that's the cost of admission you have to ask an awesome question. So I'm really grateful that you're here, because when we opened our clinic five years ago, we looked at the DPC model. What I saw people who are really skilled at functional medicine doing it at the deepest level 20 years ago, Jill, nobody better than you, they got in the weeds so deep and I thought, okay, then I had to go back to school as a chiropractor to become a medical physician. And I said, how do you blend that? I got in it to change the system. So I decided to stay in the system. But when I listened to you talk about it, there's a lot of primary care that can be delivered and the administrative cost taken out of it. So, but when I wanted to put the functional medicine, the deeper functional medicine, you can't do that for a cup of coffee a day. And so now you're causing me to think, maybe there's a way that we could be blending the DPC, but still have a plan on the side for functional medicine, do you do that? Do you offer people a separate track within your office to do concentrated functional medicine perhaps? Yeah, I think it's a great question. Chris hinted at it. So I'll answer it like this. I was sitting recently with a patient of mine and after two minutes of speaking to him, I said, here's what's gonna happen. I'm gonna call the CAF lab and you're gonna have a stent in the next 60 minutes. And that's literally exactly what happened in a 90% blockage in one of his main coronary arteries. I wasn't gonna put that stent in for him, right? And so similarly to our network of specialists that we trust, a number of my patients, we've referred to Dr. Carnahan, for instance, and Nature Med Clinic, which does a lot of advanced care for people who are suffering from Lyme and mold and other disorders. So we've developed a network of people who we've identified as particularly superb at treating various specialized disorders. So will I take on a severe, patient with severe chronic Lyme, mold, and all of the other co-infections independently? No. But those people need to have someone, I believe, to soundboard who could at least understand what's going on on a global level and still do their pap smear and still repair their laceration on their hand when they cut themselves and still do the colon cancer screening for them and to sort of put it all in a framework and a container of health that I think the primary care physician or the primary care provider community is best suited to handle. That's a great answer. And the community that you would trust, the only way to scale for practitioners to learn that is to be in community and meet other practitioners. And that's what we've heard from practitioners all across the country that have been in these communities is that that's the best way to find. Jill, one last word here and we'll... Yeah, I was gonna say this works so well because I literally on my website, you must have a primary care doctor to see me. So I don't do primary care. It's exactly what you said. Like we are such a complimentary piece of the puzzle because I need people like you to do the pap smear and do, because I don't have time for that. I wanna dive deep and do that, but I think it works so wonderfully. And so I think you're right, Chris. I think it's hard to do both because I don't do the primary care. All right, everyone, I'm proud of us. You know, the last time we did this, we went two hours too long and we didn't do the food before so everyone was having like hypoglycemia in their seats. Everyone ate at a time. Yeah, we did it. We stayed within time. Thanks everyone for watching. Can you put the slides back up? I just wanna give a final shout out here before we, for what's coming up. So the December Functional Forum, first Monday in December, we have it's all on the gut immune interface. And I just wanna share one quote from that which should intrigue all of you. It's from Dr. Tom Williams. And he said, the innate immune system is more adaptive than the adaptive immune system. So definitely tune in next month for his thoughts on that. January 2022. So for those of you who follow the Functional Forum closely, you know that this year was, last year was the year of resilience. This year has been the year of the reinvention of medicine. And next year, the theme is growth. So that's gonna be clinical growth, practical growth, personal growth, community growth. It's time to grow this movement and really grow to fill the capacity of what we need to do. Here's the map that I showed earlier with Glyver State. You know, here's the map that Dr. Tusek shared of the Direct Primary Care Clinics. This is the map of the practitioner communities. It's time to scale all of these. Thank you so much for tuning in and we'll see you next time. Thank you.