April 26, 2018
[01:06] Blue Apron/PuraTHRIVE
[04:47] About Chris Kresser
[06:16] How Chris Got Parasite and Amoeba Infections in His Mid Twenties
[14:06] Chris’ Experience with Fecal Transplantation and Pig Whipworm Therapy
[21:34] The Importance of UVA, UVB, Infrared and Visible Radiation for Prevention of Chronic Disease
[24:38] Whether Human Beings May Eventually Evolve to Deal with Things like Metals, Toxins and Wi-fi Signals
[28:36] Thrive Market/Kion Coffee
[33:06] How to Emulate the Lifestyle of the Tsimané Tribe while in our Post-Industrial Era Working Indoors
[36:09] Chris’ 2,000-Mile Walking Technique while Writing His First Book
[43:37] A Comparison and Contrast Between Functional Medicine and Traditional Allopathic Medicine
[46:52] How Can This Type of Health Care Be Affordable?
[50:41] What Kind of Health Insurance Chris Thinks America Should Have
[54:37] Chris’ Take on Smartphone Apps that Use Artificial Intelligence
[57:07] The Best Way to Find a Trustworthy, Good Physician in Your Community
[1:00:01] End of Podcast
Ben: Hey, what’s up? It’s Ben Greenfield. I’ve got my friend Chris Kresser on the show today. Chris is just pissed at Western medicine. Just absolutely pissed at Western medicine. No, I’m just kidding, he’s a good guy. He wrote a book though about what’s broken in Western medicine and how to fix it and it’s called “Unconventional Medicine”. I was able to harness him for this podcast. I don’t know why I just made him sound like a horse or something else one would harness. He’s not a barnyard animal he’s actually a pretty smart dude. I need to quit digging myself into a hole now and tell you a couple of things.
First of all, if the idea of a tasty little menu makes you salivate then keep listening, keep listening because I want to fill you in on orange beef with bok choy and scallion rice, baked Harissa chicken with farro and vegetable salad. You like how my voice is getting sexier and sexier as I say this? Or I’ll keep going. How about this? Baked pepper and potato hash with eggs and cheddar cheese in a world. I’m talking about Blue Apron. Blue Apron is the number one fresh-ingredient and recipe delivery service in the country in America. And Blue Apron for six weeks from April 16th to May 21st they’re teaming with Airbnb to bringing you the best home cooking from around the world. So what they do is each week their menu features a recipe development collaboration with an Airbnb experiences host like Chichi, a chef from Shanghai who makes incredible Kungpao Chicken. A sticky saucy mix of crispy browned chicken and vegetables and you can get recipes like that delivered straight to your home. All the ingredients are there. All the recipe cards. Everything you need to actually make these recipes yourself and better yet you can check out this week’s menu and get your first three meals free at blueapron.com/ben that’s blueapron.com/ben. Blue Apron a better way to cook.
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In this episode of the Ben Greenfield Fitness Show:
“If you understand the basic concept of evolutionary biology is that all organisms are adapted to survive and thrive in a particular environment. And then if you change that environment faster than the organism can adapt there’s going to be a problem.” “Functional medicine is the new model that is specifically designed to prevent and reverse chronic disease and it does that by addressing the root cause of these diseases instead of just suppressing symptoms so to use an example…”
Ben: Hey folks, it’s Ben Greenfield and I have on the call today the author of a relatively new book and it’s called “Unconventional Medicine”. “Unconventional Medicine” join the revolution to reinvent health care, reverse chronic disease and create a practice that you love. His name and you may have heard of him before because he kind of gets around in the functional medicine circles. His name is Chris Kresser and he was actually named one of the 100 Most Influential People in Health & Fitness. His blog is amazing. He has a podcast as well. He puts out some of what I consider to be the best most informed information especially when it comes to functional medicine and this particular book, he’s done a really good job wrapping all that information up into almost like this [0:05:37.5] ______ how you can combine functional medicine and an ancestral diet and lifestyle and what he calls a collaborative practice model to create this system for patients and for practitioners and to break all the crap that’s wrong in modern medicine. So Chris, welcome to the show, man.
Chris: Ben, it’s a pleasure to here with you.
Ben: Yeah, and I was actually thinking about you the other day. I found like some kind of nasty, looks like a ringworm, maybe athletes foot on the bottom of my foot so I’ve been smearing oil of oregano on it but I knew you have kind of like this history with parasites or some kind of like a worm infection that got you started with all these in the first place. Is that true?
Chris: Oh, yeah, I spent some time in my mid-twenties, I spent about a year travelling around the world and I was in Indonesia surfing which was the main purpose of that travel and I got what I later learned much, much later learned was three two parasite infections; one amoeba and two parasites and all at once. So… [laughs]
Ben: Was that just from the water?
Chris: So there was this in a tiny little village on the island of Sumbawa and you know, locals there didn’t have a lot of understanding about sanitation and there is a pool of stagnant water where cows were kind of milling around and defecating right near the river mouth that went out to where the surf spot was and unbeknownst to a few of us that were staying there in the village and surfing, and the locals had dug a trench that drained that stagnant water into the river mouth and then they carried it out into the river and…
Ben: Yeah, you were surfing in a giant cow toilet.
Chris: Yeah, pretty much. [laughs]
Chris: So you know, I had been pretty careful not to drink or eat anything that I shouldn’t while I was there but even despite that caution I couldn’t escape it.
Ben: Wow. So this sounds very similar to what I experienced when I used to do this race over in Thailand called the Laguna Phuket Triathlon. It was this amazing race like decades of history and all these famous triathletes would come race it but the swim after swimming in the beautiful [0:08:04.8] ______ sea you cross the sand and then you jump into a lagoon and you swim across this lagoon and I would always get sick a few days after the race and once I came back with all these crazy critters in my gut similar to what happened to you and I found out after about five years that the lagoon that we swim across, 500 meter swim across the lagoon is kind of the main lagoon that all of the resorts dump their sewage into.
Ben: So we were just basically swimming through tourist sewage. Same thing.
Chris: Yeah. Pretty much.
Ben: Yeah. So that’s what got you into functional medicine, was it cow poop?
Chris: Yeah, I mean at that time I was not considering a career in medicine and even for a few years after that I still wasn’t, I was just concerned with getting my health back but it turned out that conventional medicine was not very helpful in that process when I came back…
Ben: What did you try conventionally when you say it wasn’t effective?
Chris: Well, the first thing I did I came back and I saw a doctor. Actually, I continued travelling for six more months after that and because initially when I was there I took some antibiotics that a friend there had in his medical kit and I got better from the acute phase but then as I travelled for the next six months I just started to get worse and worse. So I came back home a little early, earlier that I had planned and then I went to a few doctors and they said, “Oh, you probably had a parasite.” Nobody did any testing. They just said, “Oh, you probably had a parasite, take these antibiotics.” I took the antibiotics, got a little bit better while I was on them but shortly after I stopped I got worse.
One very, very long story later I had seen probably 20 different doctors, by then I had lots of testing which initially was all negative but later revealed the parasites and then eventually did get rid of the parasites but the treatment is one of those cases where the treatment can be worse that the disease, so what I had to do to get rid of the parasites wrecked my gut and which then led to other symptoms and problems that it took me probably almost a decade to fully recover from. And all the doctors I saw were genuine, they wanted to help me but they just didn’t really have the tools to deal with the complex chronic and somewhat mysterious onus. They had been trained to use drugs to deal with mostly acute problems or to suppress symptoms from chronic problems not to really get to the root cause of what was causing my issue and do that kind of investigation that’s necessary to figure that out and of course that’s what functional medicine is really about.
Ben: What did you eventually do to wipe out the parasite. What did you say a parasite, an amoeba and there’s some…
Chris: Two parasites and an amoeba. I mean amoeba is a parasite too, but slightly different. So it’s giardia and blastocystis hominis and then E Histolytica Entamoeba histolytica which is the amoeba. So I took a ton of antibiotics and anti-parasitic drugs then I also took a lot of herbs. You know, sometimes with organisms like that herbs will be enough on their own and sometimes you need antibiotics as well, and so I had to take several courses and like I said that just really torpedoed my gut health. You know, way back at this time we do not know as much as we do now about the importance of the beneficial gut bacteria so I was much more cavalier. And I wasn’t a health professional at that point either so I was more cavalier than I would be now certainly about taking that stuff but that now led to pretty much a decimation of my gut flora which as we know now affects virtually every system of the body and so I developed a lot of other symptoms like fatigue and muscle pain and joint pain and you know, pretty severe insomnia, inability to get a restorative sleep and it just kind of wreaked havoc on me but there’s an opportunity in every challenge, right?
So as I became more and more interested in recovering and taking my health into my own hands and realized that I was going to have to do that if I wanted to get well because no one was coming to save me, [laughs] and that conventional medical establishment was just again not set-up for this kind of problem. It’s fantastic if you break your leg or need your gallbladder removed or something like that but it’s not really set-up for this kind of issue and so…
Chris: So that’s what led me down the path that I took.
Ben: Interesting. There was actually a documentary I was watching this morning, I doubt you went this far. I don’t know if you saw this it’s called, A Grueling and Grotesque Biohacking Experiment with this guy Josiah Zayner. I’ve to put a link in the show notes. By the way, if you guys are listening in show notes are going to be at bengreenfieldfitness.com/kresser today. That’s juts Chris’ last name K-R-E-S-S-E-R bengreenfieldfitness.com/kresser. Anyways, this synthetic biology research scientist at NASA and this documentary just came out, he did his own recolonization of his body with this ecosystem of microorganisms to fix this lifetime of gastrointestinal problems he’d been having. And it was apparently successful but it’s actually a very interesting documentary. It’s basically like a self-imposed poop transplant more or less.
Chris: [Laughs] Yeah.
Ben: But it sounds like you didn’t quite go that route but you…
Chris: Well, I actually did have a fecal transplant…
Ben: You did?
Chris: Several. Yeah. So I tried some pretty wacky stuff I mean, I maybe not quite the biohacker that you are, Ben, [laughs] but by necessity I have tried some stuff like way before it was like I think I did my first fecal transplant at least it could have been probably 15 years ago…
Ben: Oh, wow. You’re like one of OG’s of poop transplant…
Chris: One of the OGs. It was not a thing at all. I actually flew to Australia to Sydney to the Center for Digestive Disease there which is where Tom Borody who was on the Nobel Prize winning team that discovered that h-pylori bacterium was the cause of ulcers and he was also the person who pioneered the modern version of fecal transplants. The Chinese have been doing them in ancient Chinese medicine they were done but he pioneered the modern version. So I did that. I also. I think…
Ben: Poop transplants were done in ancient Chinese medicine?
Chris: They were. Yup.
Chris: Yeah, they’re discussed in ancient Chinese medical test. They were a lot lower tech at that point [laughs]….
Ben: [Laughs] I would imagine.
Chris: Yeah, but this treatment has been around for a long time. I also was probably one of the first people that did pig whipworm therapy which is where you swallow trichuris suis which is a nematode that’s aimed at restoring normal immune function. So this is based on the hygiene hypothesis…
Ben: What do you mean you swallow it? It’s like in a capsule or is this like a…
Chris: It’s in a vial.
Ben: Oh, wow.
Chris: So worm therapy is based on the hygiene hypothesis or the old friend’s hypothesis which recognizes it for the vast majority of human history we co-evolve with nematodes like whipworm or hookworm and these have a tuning and modulatory effect on our immune systems and modern sanitation which has led to some spectacular benefits, you know, dramatic reduction in acute infectious disease being the main one has had some downsides and that it’s lessened our exposure to these organisms that we’ve harbored for most of our evolutionary history and a lot of scientists and researchers think that it’s at least partly to blame for the dramatic increase in auto-immune disease and other conditions.
And so there are actually lots of pre-reviewed published studies that have investigated. Well, what if we reinoculated ourselves with these organisms? You know, whipworm and hookworm and others and they’ve looked at it for MS and inflammatory bowel disease and a number of other auto-immune conditions and at one point I thought that I had developed inflammatory bowel disease as a result of these parasite infections and so I swallowed some pig whipworms and I even went down to Mexico and inoculated myself with Necator Americanus, which is a human hookworm. So I’ve been around the block. I’ve done [laughs] a few things that are outside the box.
Ben: Do you think that in terms of this inoculation or in terms of kind of restoring some of these old friends to our gut that we need to go to those type of extremes like pig whipworms and fecal transplants or do we just need to get out more? And this is relevant to me ‘cause I was telling you before we started recording I just did an obstacle course race yesterday where like I was covered in dirt and mud and left tracks all through the airport as I was walking through the Sacramento airport you know, just leaving mud behind me. I was kind of guilty that I just destroyed their floor with dirt. But I was reading in Outside Magazine about Amelia Boone who’s one of my friends and also an obstacle course racer and they tested her gut. And when you look at her gut even compared to a lot of these other athletes who might be like a snowboarder or a basketball player. Somebody who’s not out in the dirt quite as much she had an extremely high level of this soil-based microorganisms kind of rolling around in her gut.
Ben: I’m curious for people who think that unconventional medicine is all pig whipworms and fecal transplants if there’s other methods that you’ve found to restore these old friends?
Chris: Yeah, functional medicine is absolutely not those methods that I just mentioned. Those are sort of the last resort. Functional medicine and really even stepping back before you even get to functional medicine I would say, just implementing an ancestral diet and lifestyle is the first step when you have any kind of chronic health problem and that means bringing our diet behavior and lifestyle back in alignment with what our teens and our biology are hardwired and adapted for over thousands of generations of human evolution. And I know you talk a lot about this diet and we’re talking about real whole nutrient-dense foods rather than processed and refined foods that make up most calories that Americans eat today. But it’s not just diet it’s also sleep. You know, sleeping in a cold dark room and making sure we’re getting enough of it. It’s physical activity and making sure we’re moving and not just getting enough exercise but we’re not sitting for too long and we’re getting…
Ben: A hundred and eighty minutes I think, is now kind of the approximate recommendation if you’ll get a lot of these comparisons to thrive. Like around 180 minutes which is a chunk-of-time to be active during the day.
Chris: Absolutely. And then what you’re saying too. Like spending time outdoors. We evolve in an outdoor environment. Believe it or not we did not evolve in houses and offices and cars that we lived outside, slept outside and we’re in close contact as a result with soil and soil-based bacteria. We consume milligram quantities of soil-based bacteria in the form of dirt that was still on the food that we ate and also dirt in water that we drank. Soil and water that we drank. So that doesn’t mean that just going on eating dirt is necessary to the solution here or that you have to spend time in the dirt but the idea is that we want to bring our lifestyle back into more alignment with what it is typically then because if you understand the basic concept of evolutionary biology is that all organisms are adapted to survive and thrive in a particular environment and if you change that environment faster than the organism can adapt there’s going to be a problem. You know, there are certain types of bacteria that can survive without exposure to light very deep in hydrothermal vents in the ocean and if you took one of those bacterium and you dropped it into a shallow tide pool it would die immediately because it wouldn’t have a chance to adapt to those new conditions.
The shift that happen for us wasn’t immediate it happened over several generations but on a relative time scale it’s not nearly enough for us to adapt to this new modern environment that were living in so yeah, I think getting outside, spending more time outside, being more physically active, eating more nutrient-dense food, those are all the starting places and it’s only in extreme cases like mine, where you even need to consider those kinds interventions. They’re not, I’d say less than 0.1%. Even of my patients who are pretty complex need to go down that road.
Ben: Yeah, one that I’d also throw in there would be like hefty doses of natural electromagnetic radiation, I mean that’s another big based on exposure.
Chris: Yup, huge.
Ben: Yeah, infrared, visible light, UV radiation. A lot of that stuff that people just don’t get. You cannot replace that with a Vitamin D capsule…
Ben: You know, people talk a lot about, you mentioned sleep and circadian rhythm in the microbiome and getting exposed to proper amounts of germ and physical activity but I don’t know why people still seem to shun the sun even when I go to these like ancestral medicine conferences or health events people sit inside so much.
Chris: Yeah, I know. It’s crazy. I think that a part of it is that for so many years we were taught that any exposure to sunlight was harmful, right? And so you get the situation where even when people do go outside they’re wearing like a huge straw hat and sunglasses and they’re slathered in sunscreen even if they’re going to step out of the door for one minute, but not just from an evolutionary perspective but actual modern research has shown that that’s really problematic. That we do need some exposure to sunlight to optimize our health and it’s a Goldilocks thing we don’t want too much so much that we can increase risk of skin cancer but we want enough. And it’s not just about vitamin D as you pointed out and it’s sun exposure increases the production of nitric oxide which is an important base of dilators so it would reduce the risk of high blood pressure which is the number one contributor to heart disease which is still the number one cause of death. It has powerful effects on the immune system and it also of course, has powerful effects on mood. So many reasons that sun exposure is important.
Ben: Yeah, including opioids. You could even argue that part of the opioid epidemic could be blamed partially on lack of sunlight because you get a huge beta-Endorphine release once you get out in the sunshine. So yeah, people don’t put enough emphasis on it in my opinion. But I want to back-pedal what you were talking about when it comes to genes and how our genetic code is hardwired for this specific environment and you say that our environment kind of changed pretty dramatically over the past several thousand years faster than our genes can evolve. Do you think we could make an argument that at some point the human genetic code will evolve to deal with let’s say, WiFi, heavy metals, toxins et cetera? When it comes to the human body is it smart enough to be able to evolve to keep up with some of these things that you say are causing chronic disease?
Chris: That’s a really great question and the truthful answer is we don’t know. But I’m skeptical for example, that our genes could change such that we can somehow extract the nutrients that we require from like big gulps and chicken nuggets and pizza…
Chris: And I’m also skeptical that we can figure out a way to transform the toxins that we’d be exposed to through things like mercury and cadmium and arsenic and thalium which is the most toxic heavy metal that we know of, and somehow learn to deal with that in such a way that we’re not impacted by it at all. Possibly over a very long period of time but my concern is will we have that opportunity? Will we get there without some really harmful effects?
It is true that over the last 10,000 years about 10% of our genome has shown evidence of recent selection and there have been some changes in some populations and people for example, have made them more able to process the starches and grains and legumes. We know studies of Japanese people who live on islands who have evolved genetic and epigenetic changes that allow them to process the certain fibers that are in seaweed. They’re indigestible for most other people but that they are able to digest and that just involve changes not only in their genes and epigenome but in their microbial epigenome. Then it gets passed on to future generations, so there are certainly some changes that have occurred over the past 10,000 years but 90% of our genes are still the same as they were when we were hunter-gatherers 30,000 years ago. So that just gives you some idea of the time frame we’re talking about.
Ben: Yeah. And I guess the other thing is you know, a lot of times it seems like these chronic diseases seem to spark even though they’re occurring earlier, a lot of times they strike people later in life when the impetus for genetic adaptations kind of goes down a little bit…
Ben: As your fertility decreases so it’s far less likely that really enable that the time that a chronic disease from a lot of these modern assailants would strike to be able to produce genetic adaptation just because the body doesn’t change its genes as much as you age.
Chris: No. Now that is very true. Some people might point out that in the future and there’s debate about how soon or far away this is. Evolution will not be driven by natural selection anymore. It will be driven by human choice via things like CRISPR/Cas9 Gene editing. [laughs] But that’s a whole another conversation. There’s a whole another set of risks that comes with that, with humans being in control of our own evolution. And I have some real concerns with that as well, but we certainly live in interesting times, let’s put it that way.
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Ben: There’s another tribe that you talk about. I don’t know how you pronounce this the Tsimane’?
Chris: Tsimane’, that’s right.
Ben: Tsimane’, your pronounciation sounds far more French than mine. The Tsimane’ tribe.
Chris: [Laughs] Tsimane’ there’s an accent on the E and it took me awhile to figure that one out.
Ben: Yeah, and you talk about how they have this lifestyle that’s very ancestral you know, sun exposure and dirt exposure and physical activity all day long and one of the issues of course when it comes to prevention of chronic disease is that’s all good and well for them but we’re inside. Well, like I’m inside talking to you right now on my computer…
Ben: And yesterday was great. I was on the sunshine and I was rolling through the mud and I was lifting heavy stuff and I was walking back and forth through the grass and the mud and the parking lot to this race I was at, but now today I’ll be spending probably eight hours inside. So what type of things you do with your patients to get them to hack their environment to be able to emulate a little bit more of this hunter-gatherer-gardener-esque existence like the Tsimane’ tribe has?
Chris: Yeah, it’s a great question. So of course, it depends on people’s circumstances you know, someone who works inside of an office building and doesn’t have a lot of control over their schedules is going to have fewer options than someone who works from home, for example and has complete control over their time. But let’s start with the person who works in an office and has little control over their schedule. Even there there are things that can be done especially when you add them all up, they can make a significant impact. One would be to either walk or ride bike to work if that’s possible because that gets you some outdoor exposure right there and it gets you some physical activity. You can take walking meetings and suggest that your colleague you go outside and walk around and talk instead of sitting in a conference room. You could go outside and eat your lunch on a park bench instead of eating it at your desk inside of your office. If you can’t walk or ride your bike to work you could still if you take your car or public transport you could park two miles away from work or a mile away from work and then walk a mile there and walk a mile back…
Ben: I haven’t thought of that one before.
Chris: It’s really helpful or you can take public transport and get off two stops away or one stop away and get some physical activity that way. So even within those limited circumstances there’s still quite a few things you can do during the work day. I for example, I have a combination where I have an office where I see patients. I have a home office and I also have an office at Wework which is kind of a shared communal office space. At my home office I have a treadmill desk where I can walk on the treadmill while I’m typing and working and I can stand and I can sit…
Ben: I’d like to back it up just a second, I don’t want to derail you. Do you find yourself able to successfully type when you’re walking?
Chris: I can. Actually, I learned to do that when I wrote my first book and I tracked and figured out that I walked about 2,000 miles in the course of writing my book.
Ben: Holy cow! Were your arms so not to go too deep into specifics…
Chris: Yeah, fine.
Ben: Were your arms like kind of extended and resting on a standing desk or how did you manage that?
Chris: So it requires a keyboard tray that’s very important and it has a to be zero tilt so my keyboard tray is not completely flat the back of it tilts down. And that creates a natural angle between my upper and lower arms and my hands so that my arms can hang loosely from my shoulders just as they would if I was standing and I can rest my wrist on a keyboard rest on the keyboard tray.
Chris: So it definitely requires focus in terms of how to set it up ergonomically to make it comfortable. But then at my Wework office I couldn’t do that because the treadmill is loud and it can bother other people so I found an under desk elliptical machine. So it’s a little mini elliptical thing and you put it on the floor under your desk so I can pedal the elliptical while I’m in a seated position working. So I’m still able to get some activity…
Ben: Yeah, I like it…
Chris: While I’m sitting at the desk…
Ben: You can just grab those on Amazon, right?
Chris: Yeah, they’re on Amazon and [0:37:54.3] ______ told me that according to what he’s seen in the research that the elliptical is even better for cognitive function than walking on the treadmill and I had found that yeah, I haven’t seen as big of a difference between myself but I think they’re both great. So there are a lot of little things that you can do even if you are working inside to get more time outside to be more physically active and anyone of those changes on their own might not be that big of a deal but when you put them all together it makes a really, really big impact.
Ben: Interesting. A lot of these things people just don’t think about because they hear that they need to hang the pull-up bar in the door of their office or put the kettlebell next to their cubicle and to some people who are just getting started with management of chronic disease through adaptation to a more ancestral lifestyle that seems exhausting or intimidating or even embarrassing to be swinging a kettlebell…
Ben: When you’re at your office but you can I mean, getting off at the bus stop that’s one bus stop away from your office or parking a mile away or walking that makes sense and it also kind of forces you into this corner where you finish work and you just have to freaking walk to your car [laughs] or…
Ben: Or stick out your thumb.
Chris: No getting an Uber for one block or you know, four blocks to your car without cheating but you know, like the underdesk elliptical is great too because you can be pedaling that thing and nobody would really even know…
Chris: I mean, your lower body’s…
Ben: Except for the mild BO you might have at lunch…
Chris: [Laughs] Right.
Ben: From the sweat. So I want to dive into a few more practical things when it comes to changing the face of health care. I know your time is limited today so I want to be sure that we get a chance to tackle some of these stuff. So first of all, something fascinating I noted was I saw you mention at the Cleveland Clinic opened this center for functional medicine to use some of the techniques that you talk about in the book and they already have a six-month waitlist. In your opinion, why is that? What is it that they’re doing that would make that approach so popular?
Chris: Yeah, well chronic disease is now the biggest health challenge we face by far. Seven of ten deaths are due to chronic disease. One in two Americans has one. On in four has more than one and this is the problem of our age you know, that wasn’t the case a hundred years ago. A hundred years ago the biggest problem was acute infectious disease. People were still dying of typhoid, tuberculosis, pneumonia. They were dying of appendicitis and other acute challenges but today we’re in a really different place and the problem is that our medical model evolved during that time when acute challenges were the biggest issue and it was set-up to deal with those acute problems but it was not set-up to deal with the chronic challenges that we’re facing you know, that most people are struggling with. Things like Type 2 diabetes and obesity and irritable bowel syndrome and auto-immune disease. These are the problems of today but our medical models are still built to address the problems of yesterday or rather of the last century.
So functional medicine is the new model that is specifically designed to prevent and reverse chronic disease and it does that by addressing the root cause of these diseases instead of just suppressing symptoms. So to use an example, irritable bowel syndrome is now the second leading cause of people missing work. It’s really epidemic behind the common cold and yet the treatments in conventional medicine are all based on suppressing symptoms so if the patient has diarrhea they’ll get Imodium or something like that to stop the diarrhea. They might get an analgesic for the pain or an anti-spasmodic for the gas or the bloating. None of these treatments although they can help relieve the symptoms which is welcome neither of them actually do anything to address the cause of the problems and so these patients end up having to take these drugs for the rest of their lives and these drugs often have side effects that then require other drugs and so on and so forth…
Ben: Yeah, that’s crazy. I didn’t know that irritable bowel syndrome was such a huge reason that people stay home from work.
Ben: That’s interesting also because when I worked as a personal trainer and I was drinking five ABB body building protein shakes per day and a couple of protein bars and had these I mean, anybody who is an exerciser knows protein farts and also knows that your irritable bowel syndrome you get from a typical “healthy gym diet.” I would have to literally schedule in my personal training sessions to be 15-minute long personal training sessions to give me 10-minute long breaks to go and use the restroom in between clients and just like get rid of all the bloating and the gas and literally just go to in the bathroom and fart because of my diet [laughs] and it wasn’t until I fixed my diet and I personally adapted kind of a Weston A. Price -ish approach and it fixed almost all of that but it comes full circle to what you’re outlining is that rather than me getting on some type of a drug or a pharmaceutical to control that, what I did was I changed my diet and it fixed everything. And that’s a very simple functional approach but I think a lot of people don’t really understand yet what it looks like when you work with the functional medicine practitioner like let’s say somebody wanted to come and see you, like let’s say I had irritable bowel syndrome like that and I were to come and see you. How does it work? How is it different if we were to compare and contrast it to what would happen if I were to go on and see my local MD?
Chris: Well, so I was just describing mostly what it would look like if you went to see your MD you’d get those various medications to address various symptoms but there would be no investigation into why your bowel is irritable in the first place and because there’s no investigation into why there can be no addressing the real causes. And it’s not like we don’t know what those causes can be if you look at the scientific literature there are thousands of studies exploring the connection between a disrupted gut microbiome and IBS or small intestinal bacterial overgrowth or SIBO and IBS or parasite infections and IBS or changes to the gut brain access HPA access like high cortisol or low cortisol or alternating cortisol, you know, inappropriate cortisol rhythm during the day and IBS so there’s many, many known causes of IBS that we can test for and then treat if they’re present and that’s what we exactly what we do in functional medicine so the patient would come to me and we would do stool testing and breath testing for things like SIBO and disrupted gut microbiome and parasites. We would test their HPA access, look at their cortisol production.
We would look for nutrient deficiencies, we would test for food intolerances. We would assess their diet of course, and then with all that information we will create a customized plan for them that would probably include a particular dietary approach. It would include some anti-microbials if they had SIBO or any kind of gut infection like h-pylori and include some behavior and lifestyle changes to address their HPA access or so called adrenal fatigue, I’m using [0:46:01.1] ______ quote. And then maybe some supplements to do that as well. And so then the patient actually has the chance to fully recover from this problem like much in the way that you change your diet and were able to address these symptoms. You know, a patient can change their diet, they get rid of their SIBO. They smooth out their cortisol production and guess what they don’t have IBS anymore. Instead of taking a handful of medications for the next 30 or 40 years they literally don’t have this condition anymore. So that’s the promise of functional medicine.
Ben: Now isn’t this expensive as hell though? I mean, I totally play devil’s advocate like I’ve heard people you know, even just to like see you have to pay a lot of money compared to going to see like an allopathic physician or getting things covered by insurance, I mean, how is it scalable financially to take that approach that would allow you to spend an hour rather than 10 minutes with a patient or to do all these tests or to dig as deeply as you need to dig for this type of approach to work?
Chris: Yeah, there are lots of ways to answer that question. First of all, let me just acknowledge that it is too expensive right now if the patient is paying out of pocket. It’s going to be severely limited in terms of who can access it. So there’s no question about that. However, we have to remember that our current medical model is heavily subsidized so it’s a question of what we would like to subsidize. So imagine the situation where you go to the doctor and you get your blood sugar tested and it’s a little bit high. Right now, what would typically happen is I’ll say, they might not even say anything that’s often the case. But if they do say anything at all might be like, “Ah, your blood sugar’s a little high. Make sure to eat better and exercise more. Okay. Next.” You know, because that’s literally all there’s time for in a 10-minute appointment and they don’t have any medications that they give when blood sugar’s just high normal. They wait until you have diabetes to prescribe these medications.
So then that patient will go back maybe five years later and they will have diabetes. They will get the medication prescribed and their insurance will cover that. And we know that that patient cost about $14,000 a year to treat to the health care system. Not to the individual patient but to the health care system to treat that patient with Type 2 diabetes. And that patient could go on let’s say their diagnosed at the age 40 and they die when they’re 80. That’s a cost of over half a million dollars to the health care system to treat that single patient for Type 2 diabetes. So these costs are enormous. They’re just not seen by the patient. That patients paying a $30 co-pay for that patient’s whole life.
But imagine a different scenario where that patient goes in when they’re 35 and they have the high normal blood sugar but instead of doing nothing the doctor says, “Hey well, we know that this will progress in five years to Type 2 diabetes. That’s what the statistics show us but we’re not going to let that happen. So we’re going to set you up with a health coach who is going to get you on a good nutrient-dense anti-inflammatory diet because we know that just telling you to eat better is not going to work. Information is not enough so we need to actually support you on this chain, so we’re going to set you up with this health coach. We’re also going to set you up with a personal trainer at a gym that we have a partnership with ‘cause we know that increasing your physical activity is going to help you keep the weight off as you lose it with the diet and it’s going to also reduce inflammation and make you healthier all the way around.” And good news is your insurance company in their infinite wisdom they know that it could cost some half a million dollars to treat you if they let this progress so they’re going to spend just a couple thousand dollars upfront on this health coach and personal trainer and they know they’re going to save half a million dollars [laughs] over your lifetime if they prevent this disease from happening.
So there’s absolutely nothing, there’s no financial or logistical reason that that could not happen. We couldn’t have a functional medicine diet lifestyle behavior change-based medical model other than the political will to make that change and of course to deeply vested financial interests of the pharmaceutical companies that do not want that to happen.
Ben: Yeah, that’s a big one. It’s one of those deals where you have to get the insurance companies on board isn’t it?
Chris: Yeah. And that’s actually starting to happen. It’s a little slower out here on the West Coast where we have more choices but my own podcast in the next couple of weeks I’m actually sitting down with a CEO of a hospital in Connecticut and also someone who’s a manager of one of the insurance companies in that state and they are going to talk about how they’re essentially moving more toward a functional medicine- based model and for this exact reason they recognize that our current system is not sustainable. Not only for patients but also for providers and insurance companies. They see the writing on the wall. The cost of chronic disease is going to bankrupt them. And so they’re shifting the burden and the responsibility of care to the provider, meaning the provider is going to have to be accountable for the results they get or don’t get.
Chris: And as that shift happens. Providers are going to start looking for more effective models of care and that’s really what’s already happening there. So yes. We’re not there yet. We’ve got a long ways to go and it’s going to be patchy and not happen at the same pace in every place but I think we’re going to get there one way or the other. Either the hard way where the model that we have now collapses and has to be replaced which I hope does not happen or we’re going to get there the easier way which will be that we take more progressive proactive steps like this group in Connecticut is doing.
Ben: Yeah, one of the things I’ve been looking into recently has been this concept of sharing medical bills. I was looking at a company called MediShare for example which shares medical cost between members. That’s a religious one where members are…
Ben: It’s church-based. They’re praying for each other and they’re also sharing medical cost. Do you think models like that are scalable?
Chris: I think we’re going to see a lot of different efforts to approach and that the solution is not going to come from one place. I don’t think it’s going to be only bottom-up although I think bottom-up efforts, grass roots efforts for change are going to be very effective and necessary. I don’t think it’s going to be only top down, coming from a mandate from the federal government or a change that is initiated and then trickled down from the top. I think it’s going to come from the public sector, the private sector, from public-private partnerships, from new models of insurance, from new models of health care where health coaches play a much bigger role because we recognize that diet, lifestyle and behavior change is the most important step we can take to prevent and reverse disease.
Again, like I was saying imagine if you go to your doctor but you end up actually doing most of the work with the health coach or a physician assistant or a nurse practitioner before you even see the doctor because what’s the point if we know what the most effective interventions are and doctors isn’t necessarily the best person to work with on those things. You can have many health coaches for every one doctor and we could get a lot further in most cases of these chronic conditions.
Ben: Interesting. I know you take a deeper dive into this in the book and again for those of you listening everything Chris and I talked about I’ll put at bengreenfieldfitness.com/kresser but I just wanted to throw a couple of rapid fire questions your way as we get close to the end here Chris. One is smartphone Apps ways we can interact with physicians using websites or Apps or technology or even artificial intelligence. Have you looked into that at all or are there any particular resources or Apps that you use or endorse?
Chris: There are a number of efforts that nothing that’s really impressed me enough to recommend. I am a believer in using technology to augment the kinds of in person and video interactions that I still believe are necessary and studies show are necessary to support behavior change. So for example, there’s a lot of enthusiasm about behavior change Apps initially. What they found was that if you use the App on it’s own without any interaction with another human being it’s not very effective but if you use the App in conjunction with interaction with the human being it is effective. So I think we need to kind of go back to the drawing board and redesign some of those Apps with that in mind.
Ben: Yeah, one that I was looking was this Human Diagnosis Project that uses AI. Scientific American did a big study or a big article on it last year.
Ben: Haven’t exported that much but it looks super interesting to be able to crowd-source/use AI to help to diagnose or treat a patient prior to them actually needing to go see a physician.
Chris: Absolutely, I think AI is going to play a huge role in that regard and more specific example would be understanding things like the microbiome and the genome and the epigenome like those are so vastly complex that I actually don’t think that human intelligence is going to be able to make sense of it. I think we’re going to need artificial intelligence to identify meaningful patterns and then help us to come up with ways of intervening based on those patterns. And that’s not very far away. There are already some start-ups that are based on that like Viome with the microbiome. Again, I think we’re not quite there yet but certainly in the next five to ten years we’re going to be seeing big changes in that area.
Ben: Last question, if people wanted to work with somebody like you but aren’t able to get to Berkeley to work with you, is there a particular medical practitioner directory that you like?
Chris: Yeah, there are two. So I train practitioners in my approach in the adapt framework. So at kresserinstitute.com there is a directory of practitioners that I’ve trained and have gone through the steps that are required to be listed there…
Ben: Meaning those people actually know how to give pig whipworm and fecal transplants effectively [laughs]…
Chris: [Laughs] No. The basics. The basics.
Chris: And we just started in 2016 so we’re relatively new but we’ve trained about 400 practitioners around the world and then there’s the Institute for Functional Medicine or IFM it’s functional medicine training equipped that’s been around for about 25 years and they have a directory at ifm.org. So those are two places you can find someone.
Ben: But Kresser Institute is yours?
Ben: Smart, man. You’re cloning yourself. I like it. [laughs]
Ben: I need to do something like that. But the Greenfield Institute doesn’t sound quite as good…
Chris: Greenfield Institute here it comes…
Ben: Yeah. It’d be how to lift a kettlebell with a training mask on while standing on a vibration platform. Alright…
Chris: Caked in mud.
Ben: Exactly. Caked in mud. Well, Chris thanks so much for coming on the show and sharing this stuff with us. This book is good and I don’t think that it’s just for doctors. I think it’s a great handbook for patients, too. I loved it and I’m obviously, not a doctor so I would highly recommend if you have any interest in medicine, chronic disease and changing the face of health care that you grab this one. It’s called the “Unconventional Medicine”. I’ll put a link to it along with everything else that Chris and I talked about. I’ll throw a few goodies in like that article in Outside about Amelia Boone and that gut biohacker documentary I talked about. Plenty more along with the Kresser Institute over at bengreenfieldfitness.com/kresser.
Chris, thanks for coming on the show today, man.
Chris: Thank you, Ben. I really appreciate it. Take care.
Ben: Alright, you too. Alright folks, I’m Ben Greenfield along with Chris Kresser signing our from bengreenfieldfitness.com. Have an amazing week.
Chris Kresser M.S., L.Ac., is the CEO of Kresser Institute and the co-director of the California Center for Functional Medicine. He’s also the creator of ChrisKresser.com and is the New York Times best-selling author of The Paleo Cure and Unconventional Medicine. Chris was named one of the 100 most influential people in health and fitness by Greatist.com, and his blog is one of the top-ranked natural health websites in the world.
And most notably, he's just released a book: Unconventional Medicine.
In the book, Chris presents a plan to reverse the dangerous trend of burned-out physicians, a sick population, and a broken healthcare system.. He shows how the combination of functional medicine, an ancestral diet and lifestyle, and a collaborative practice model can create a system that better serves the needs of both patients and practitioners.
During our discussion, you'll discover:
-How Chris got a host of amoeba and parasite infections all at once… 6:16
-Chris's fascinating history with fecal transplantation and pig whipworm therapy… 8:37
-The importance of UVA, UVB, infrared and visible radiation when it comes to prevention of chronic disease… 22:40
-Whether human beings may eventually evolve to deal with things like metals, toxins and wi-fi signals… 24:46
-How can we emulate the lifestyle of people like the Tsimané tribe while still living in our post-industrial era working indoors… 33:06
-Chris's technique for walking 2000 miles while he worked on his book… 36:09
-A comparison and contrast between functional medicine and traditional allopathic medicine… 39:54
-How we can make this type of health care affordable… 46:52
-What kind of health insurance Chris thinks America should have, and how we could get it paid for… 50:41
-Chris's take on smartphone apps that use artificial intelligence… 54:31
-The best way to find a trustworthy, good physician in your community… 57:05
-And much more!
Resources from this episode:
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Do you have questions, thoughts or feedback for Chris or me? Leave your comments below and one of us will reply!