Dr. Dan Kalish visits us again to discuss the landmark study he just published in collaboration with the Mayo Clinic. This study is a huge step in validating functional medicine. We discuss how patients were treated and the results they achieved. We also discuss our differing philosophies on adrenal testing.
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Episode Intro….. 0:42
Kalish Method Functional Medicine Study Intro….. 1:07
Study Setup….. 2:05
Statistically and Clinically Significant Outcomes….. 5:05
Further Insights of the Study….. 18:06
Differing Opinions—Adrenals….. 26:05
Last Thoughts on the Functional Medicine Study….. 30:29
Vegetarian or Vegan Diets….. 33:14
Dan’s Most Fun but Least Healthy Thing….. 44:20
- Evaluation of a functional medicine approach to treating fatigue, stress, and digestive issues in women
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Dr. Michael Ruscio: Hey, folks. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. And I am here with my good friend Dr. Dan Kalish, who is a repeat guest on the show. And he has recently published a fantastic study that I am looking forward to jumping into some of the details on. So, Dan, thanks for coming back on the show.
Dr. Dan Kalish: Appreciate it, as always. Thank you.
DrMR: So you’ve been a busy bee. You’ve recently published a study in collaboration with the Mayo Clinic.
Kalish Method Functional Medicine Study Intro
DrMR: Tell us a little bit about this, because I think this is the first study published with functional medicine on the title maybe. So this is exciting.
DrDK: Yeah, it is exciting. About six, seven years ago, a group of practitioners from the Mayo Clinic took my functional medicine training program. And they sat through the whole class and really enjoyed it. And we looked for a way that we could collaborate and work together. And they, being the Mayo Clinic is obviously do a research study since that’s what they do the best.
And so we set out on this project to get the funding and eventually conduct this six-month pilot study on using the Kalish method, but looking at it from a very analytical standpoint which is, as you know, quite different than what we do in our clinics when we’re checking in with people and saying, “Hey, feel any better this week or not?”
DrDK: This is more of a—I was nervous about it—how well this is going to go. Is this all going to stand up to scrutiny or not? And it turned out that things went really well.
DrMR: So tell us a little bit more about, I guess, the study set-up. People—and I guess just really briefly—you probably have one of the most popular—I’d say maybe one of the top three in terms of popularity and influence—functional medicine training courses. And you have a method, kind of your clinical model that you codified into an approach that you now teach as the Kalish method.
And that’s what you used here, which essentially entails some—and please elaborate on this—but some dietary and lifestyle changes, some vitamin therapy, adrenal support, and some GI testing and some GI treatment. But can you tell us a little bit more about the study set-up.
DrDK: Yeah, absolutely. So my model—as you know, the overall field of functional medicine is quite diverse and complex. And so what I’ve done with the Kalish method is to very much bring things down to their most simplest elements and to have this be a wonderful place for us to start with patients. Not necessarily going to cover everything for everybody by any means.
But it’s a great starting point. And so we look at lifestyle changes. And in this study we talked about gluten-free diets, no gluten, no dairy, no sugar, no alcohol—all the basic things that we do with food with a focus on blood sugar control.
And then we did HPA axis testing for the adrenals using salivary adrenal hormone assays. And basic GI testing, looking for GI pathogens. So we did all the labs at the beginning and end of the six months. And then the lifestyle component, we obviously tried to continue out throughout the whole six months. No one could do it perfectly. I think the holidays were in the middle of all this.
But we did, as much as we could, keep people on a gluten-and-dairy-free diet with really low amounts of sugar and good blood sugar control. So those are the basic premises—and—oh, here’s an important part too. We started off with women in the study. It was all women ages 30 to 55 who were in a high-stress position either through work or through family or through both.
DrMR: Gotcha. And it was 21 women?
DrDK: Yeah, we started out with 25. And by the end of the study, we got down to 21 who completed everything. It was pretty rigorous. They had a lot of assignments they had to do to stick with the whole thing.
DrMR: Sure. Sure. Yeah, and you always—I’m learning you have to kind of shoot high with your number because you’re always going to have some people drop out. And so, yeah, 21 was still enough to—when the data was analyzed—show some significant impacts.
And so there was a significant improvement in a number of things—total mood disturbances, fatigue and stress, significant improvement in vitality scores. And it appeared that the cortisol rhythm seemed to have fewer deviations from kind of the mean. These are things I just picked out from reading the paper.
Statistically and Clinically Significant Outcomes
DrMR: But do you want to expand upon some of the things that I guess were statistically significant and then also maybe things that you noticed were maybe more clinically significant?
DrDK: Yeah, this is the interesting thing. Those two didn’t overlap as much as one would think. In other words, we lost a lot of the clinical picture in all the statistical analysis. But the numbers showed less pain, more energy. People felt better in general, mood, etc.
And I think the most impressive thing to me about—I was actually shocked by this. Having done this for so many years, I had no idea this would happen. But out of all the initial series of tests, we found a total of 19 digestive tract infections. Some people had more than one. Some people didn’t have any.
On the retesting of those initial infections six months later, 18 out of the 19, or 93% of them, were cleared. Now, it got confusing with the analysis part because some people had more than one infection. Some people had new infections that showed up on the second test. So it was a little murky.
But the actual results were 18 out of 19 initial infections were cleared. And you really could see that in how people responded. And that’s kind of like my clinical side just wanting to make sure people are feeling, they’re doing better, that their symptoms are starting to improve.
The other thing I think that was really interesting was that we had to figure out a way to analyze these tests. And obviously, as you know, if someone has super high cortisol on a lab value and it drops down, that’s a positive. If someone has really low cortisol and it comes up, that’s a positive, as well.
So we did this sort of interesting little statistical analysis where we looked at the mean and how far the deviations from the mean were. And did they come closer to where the ideal numbers were? So that took a couple months of extra work for all the statisticians to figure that part out. But now we have it as a method that we can use for further research, which is really great.
DrMR: Yeah, I think that makes a lot of sense for cortisol because you’re not looking for a unidirectional change necessarily. I think we’re certainly going to see a lot more people with low cortisol than we are with high cortisol. But there will be some high cortisol. Let’s say the entire rhythm looks low. There may be some points that the cortisol is too high. And so it’s not just about moving the cortisol in one direction. It’s more corrective. And that’s why I like how much the change approximated the mean rather than deviated from the mean. I think that was a pretty sharp insight from someone. I’m sure someone kind of was looking at that and trying to figure out how to sort all that out though.
DrDK: Exactly. It was a statistician who happened to have a background in that exact subject area. What are the odds on that?
DrDK: We happened to get him assigned. Yeah, so that was a beautiful thing. And then the other part of it that was interesting to me was, I guess, a couple things. One is the power of the group because for the nutritional coaching, we split them up into groups of five. And just what a difference it makes when you have other people that you’re going through the process with! They start to support each other. They asked each other for each other’s phone numbers and email and contact information. And so they, in their little groups, really became a support network for each other, which is wonderful.
The other thing that really surprised me too is that there was sort of a lot of anger and resentment in general from at least half the women that women’s issues like this—stress, fatigue, digestive problems—aren’t taken very seriously in conventional medicine. And so there was also sort of an agenda for them to help other women and to show that, hey, this stuff can work. And so I think that led to a lot of compliance in terms of sticking with the diet because, as you know, it’s hard to get people to stay alcohol-, sugar-, and gluten-free for six months. But we had a pretty high level of compliance in that, I think, because they felt like they were on a mission to a certain extent to make a difference.
DrDK: And more so than just them feeling better, they felt like there was sort of a community aspect to what they were doing as well which I thought was—it kind of caught me by surprise, because when we’re in our solo practices usually our individual patients don’t communicate a lot with each other for obvious reasons. And they certainly don’t usually kind of bond together into groups.
DrMR: You make a great point. It’s something that I have thought on. And every once in a while, it kind of pops back into the forefront of my mind which is, how could I build more community into my practice because—just knowing how important community and how deficient I think we are in community?
We’ve come so far from kind of living in a tribe where we always have had people around and we’re just saturated in community to living much more isolation-type lifestyles. And I definitely think that that is a major deficiency that we all face. And it’s great that the study participants were able to kind of form that community aspect because I think that’s really underappreciated in healing and very much so needed.
DrDK: Yeah, and it’s not hard for us to structure our practices like this because the reason we did this was just because we couldn’t—didn’t have the logistics of doing 25 different weekly consults on nutrition was just overwhelming. And so we put them together in groups.
But it has this unintended consequence of really strengthening the compliance levels. And I think it’s something we could do in our practices as well if we have Wednesdays at 6:00 is your nutrition meeting. And you have more than one person show up. And you do some of your coaching more in a group context.
DrMR: Yeah, I think that’s a terrific idea.
DrMR: Definitely. There’s something you said a second ago I wanted to get some clarification on, because when I looked at the results, it looked like there were about 15 infections. There was one parasite, nine H. pylori, two yeast, two fungi. But what I found interesting—H. pylori was awesome. Went from nine H. pylori to one. And then went from—fungus—three to one. The yeast went from two to five. But it seemed like there was a lot with H. pylori that was shown positive. And then yeast seemed to be kind of a wash.
But tell me a little bit more about what you’re seeing. And I have some thoughts on this definitely. But looking at those numbers from the study, seems a little bit dissonant with what you were showing or you were seeing clinically 19 to one. So what are your thoughts on that?
DrDK: Yeah, so part of the confusing issue is—well, this goes way back to something I learned 25 years ago, which was just a theory. And honestly, I never really believed it until I was in practice for 10 or 12 years, which is this idea of crypt hyperplasia, meaning that when someone has a damaged gut lining—and I guess we call it leaky gut right now—when the damaged gut lining, of course the villi and micro villi are destroyed.
So the topographical features of the gut that stick up are damaged. But also the crypts that are normal structures in the gut lining that are little divots or dimples downward in the gut lining get deeper and deeper. And so one of the things Dr. Timmons taught me 25 years ago is that crypt hyperplasia means that as the gut lining is more and more damaged, not only are the micro villi damaged, but the crypts get deeper.
And you can have infections that are buried in these crypts. We might, in modern terms, use different—we have different words for this now than the way I learned it. A lot of people talk about this in different terms now. But the idea being that there may be this micro film or bio film or something like that that’s blocking the access to these deeper-seated infections.
But anyway, the naturopaths from generations ago noticed that if they did testing on people and follow-up testing on people even as they were improving across all measures—hormones getting better, digestive function getting better, food allergies being reduced—they would see other infections pop up further into the process.
And we saw that on a fair number of these patients where you noticed it with the yeast markers. But there were several parasites that also showed up on the six-month test that didn’t show up on the initial screening. And I think this is where kind of the stats maybe come into conflict a little bit with the clinical evaluation, because if you’re seeing a patient that’s consistently improving on all the GI measures and the hormones are getting healthier and healthier as well but you see a new infection pop up, it could either be that they were exposed during the time between the tests, or it could be that there’s old and chronic infection—this whole idea of crypt hyperplasia—starting to come out to the surface.
And I’m beginning to believe in that idea more and more because that was pretty consistently what we saw. The people with new infections on their retesting didn’t have new symptoms that would correlate with that even remotely.
DrMR: Yeah, and I’m assuming most of them—just looking at the overall data trend from your study—most of these people at the follow-up testing were symptomatically quite a bit improved compared to the baseline testing.
DrDK: Yeah. So the idea maybe—and I don’t know if this is true or not—but the idea is that these old, chronic infections that are deep-seated are coming flushed out to the surface as a person gets healthier, maybe a little bit like we think about heavy metals too. As a person gets healthier, they’re able to bind up and pull out metals that are deep in storage.
DrMR: Sure, and I think there is definitely some plausibility to that. I have a slightly different theory that I think brings us back to the same clinical action. But maybe a different attempted explanation for it. What I have been noticing over the past well over a year now, probably closer to two years, we’ve been running typically two stool tests in tandem along with a SIBO breath test.
And what I notice is that SIBO and dysbiosis, meaning there’s not an overt infection but there is stuff that is normally there that’s just out of balance, that seems to be way more common than overt infections.
So I think treating the gut with, of course, a healthy diet and then if there is minimal responsiveness considering some antimicrobials as you did in the study with these patients—I think that’s still a very sound clinical decision to make. I just think it’s—at least from what I’m seeing, it’s less about there being a true “parasite” but more, “Hey, here is stuff that a normal resident in the gut. But there’s too much here. Or there’s too little there. Or there’s too much overall.” And it’s just an issue of fixing the dysbiosis. That’s the one thing.
The other is—and even to criticize what I just said, the validity of, for example, breath testing for SIBO, has been questioned. And we actually just recorded a podcast not too long ago looking at how lactulose may really overestimate SIBO in the SIBO breath testing.
But it doesn’t change the fact that people still seem to respond very well symptomatically to either antibiotics or herbal antimicrobials to kind of give the microbiota a little nudge and help it come back to balance after the nudge.
So I guess what I’m driving at is sometimes our clinical interventions may be ahead of what we can use lab work to justify, which is why I think it’s important that we never think solely based upon labs, and we’re thinking in kind of the broader clinical context. Maybe the labs haven’t changed tremendously, but if we’re getting a nice symptomatic and clinical improvement, then it’s something that we should be happy about.
So those are a few things that kind of jogged through my head as we’re having this conversation.
DrDK: That makes a lot of sense. I think a lot of this stuff I learned 25 years ago was rational explanations by really smart doctors who were trying to explain what they were experiencing in their practices.
DrDK: But they didn’t necessarily have any science to go on because there wasn’t any science on the subjects that they’re looking at. And so I think as we kind of progress more and more—and I see this—I go to a lot of conferences every year. I’ll sit in the audience at one of these IFM meetings.
And I’m like, “Oh, yeah! That’s right. That’s right! That amazing. New research, new this, new that.” And then when I go home on the plane a few days later, I’m like, “Wait a minute. That’s all the same stuff I learned 25 years ago. But now we’re seeing why.” Now we can validate all this information at a much higher level, which is really—it’s exciting. It’s good.
DrMR: It is. And I think this is—what we need to continue to do is publish science in the natural and functional medicine field to help do two things. One, to help get this type of care broader acceptance but also, and maybe equally as importantly, to find out where our treatments are not very efficient so we can stop doing those and focus more on the ones that are efficient.
Further Insights of the Study
DrMR: So, Dan, what else did you learn in going through this study? Were there any other aha’s or things that…? Because now you have a team of people working to kind of analyze the results, and you’re tracking people more closely. Were there any kind of other insights that you gained through going through this process?
DrDK: Yeah, this is really interesting. The four women that dropped out or got excluded, it was all for technical reasons. It wasn’t that they weren’t doing well. One of them had this medical problem. It’s various things that happened.
So what we ended up including in this study—and this doesn’t usually happen I don’t think in a regular practice—were people that were not doing that well. There were a few people in the study who symptomatically and in terms of the labs really didn’t improve that much and I think maybe even one that got worse. And in a normal practice, those people probably wouldn’t be coming back in every month for six months.
DrDK: They certainly wouldn’t spend all this money on supplements. But they were. And so for me, I was worried about this honestly because, “Okay, wait a minute. I’ve got all these labs back. It’s the retesting.” I’m like, “Whoa. These ones are either not better or worse—” more infections, more GI problems, not improving on their cortisol levels, etc.
And so then I’m thinking, “Well, let’s actually maybe inject a little science in here and look at what was going on with these people.” And it turns out that there were reasons why this happened to each one of them. It wasn’t that the protocols weren’t working very well. It’s that stuff was happening. And one of the women that did poorly ended up going through a divorce during the study.
DrDK: And she’d been in a marriage for 20, 25 years. All of a sudden, they’re getting divorced right in the middle of this. It was a six-month study. It was a pretty long period of time. And so clearly the emotional impact of her life being shattered in that way was a big deal.
Another one that comes to mind was a woman maybe in her late 40s. Her father was hospitalized. Her grandfather was hospitalized—both with life-threatening conditions. And she was the only caregiver for each of these people. And they were at different hospitals. Can you imagine?
DrDK: She’s driving every day to see Dad, see Grandfather, talking to the doctors, assessments about medical care. And she has, of course, a full-time job and, I think, 11-year-old twins that she’s trying to take care of. So these medical issues came up during this study.
And it was really interesting to talk to these women. Again, they’re probably patients that you might not have seen in a regular practice. But they both stayed with it, I think, for a couple of reasons. I think at least they weren’t getting worse.
And maybe there is some sort of sense—and you never know this if you were making these things up in our heads as practitioners. But maybe it’s a fear-based thing. I don’t know. But what would have happened if we weren’t doing any sort of supplementation for the stress response or for gut function? Who knows?
DrDK: But anyway, it was maybe just sort of a confidence builder for each of them that they knew that they were doing something to take care of themselves even though they were in this emotional disarray.
And I think what every clinician knows is that the vast majority of time, 99% of the time, when people are going through divorce, when people have two family members in the hospital, we let go of every self-care thing that we ever thought of. The diet falls apart. Exercise falls apart. Sleep falls apart.
And so even if it was the lifestyle interventions that helped these women get through, and even though their labs didn’t get better, at least they had a sense that they were doing something positive amidst all the turmoil in their lives. And I think that’s really different because usually we see people get sick during these kinds of stressful periods when we let go of all the usual self-care that we do.
DrMR: Yeah. No, you make fantastic points. And it reminds me of something that I probably bring up every few episodes, but I think it’s just really worth reiterating all these times, which is the importance of, just as you said, emotions and stress on one’s ability to recover. And the type of patient that I picture in my head is the one who has become obsessed with their healthcare. And I don’t know if I just end up seeing a lot of these people or not.
But to me, it’s the ultimate travesty that when someone is so fixated and obsessed with their diet and all these other hypotheses they have about their health in their head, when they’re getting so wrapped up into that that they’re creating emotional stress, that is actually thwarting them from being able to heal. What’s that old saying? “Don’t make yourself miserable in attempts to be happy”? Don’t make yourself sick in attempts to be healthy.
And I really think it’s important for all of us as practitioners to realize how important what we say is to our patients, how important the way we frame things is to our patients, and how important what it is we say, do, write, or record and put out on the internet is, because if we’re not careful to be prudent and cautious in what we say, people will feed on that.
And there are a lot of patients that come in that are scared to death of things that are really not that big of a deal. But they’ve sunk into some black hole on the internet. And they’ve just been filled with fear.
And just like you were saying again, this is a different type of fear or stress than the lady who was going through the divorce. But I think, nonetheless, if it’s an appreciable amount of stress, then that can really thwart people from healing.
So sorry to maybe be a broken record with that to the audience. But I just always am so remorseful, because it’s at least one time a week I have to spend probably half of a consult with a patient talking them out of thinking that they’re super sick or they have irreparable problem because of stuff they’ve read on the internet or heard elsewhere. So I don’t know, Dan. Do you see that same type of thing yourself?
DrDK: Yeah, it definitely didn’t used to be a problem pre-internet.
DrDK: People more—but I’d say maybe it’s the same problem. If I want to think in a big picture kind of way that the big problem is that people don’t feel good. And they’re not sure why. And the not-knowing-why part is just as bad as not feeling good.
I know it is because I know that once we identify in patients why they’re not feeling good, that relieves half their symptoms right there. We don’t even sometimes get to doing any treatments. Just them knowing, “Oh, I’m sick because I have Giardia, because my thyroid is out of balance, and I have this HPA axis dysfunction.”
And they see the labs. They realize it’s real. It’s not something that they’re making up. And just that understanding that there is an identifiable reason why they’re not feeling well seems to help as much as any supplement possibly could.
So I think people are searching on the internet for these understandings because there is this sort of primary mystery. And then they are trying to put it together in a way that makes sense. And I’m really against people doing that because it’s too complicated. And there’s too much conflicting information on the internet anyway to actually—
DrMR: Right. Exactly.
DrDK: Figure this out. And the analogy I always use for patients is if you ever see one of these old movies where there was a criminal. And he or she did something really bad. And then they decide to represent themselves in court. They say, “No, I don’t want the public defender. I’m going to do my own law, present my own case.” And you’re always thinking, “Well, that’s really dumb. There’s no way you’re going to figure out everything that a lawyer needs to know, just you specifically.”
So I think when we try to be our own doctor, it’s the same thing. There’s a reason why they’re experts. I don’t even design my own health programs. The last thing I would do would be to analyze my own self. It’s like the more you know, the more dangerous you are in terms of self-prescribing things.
DrMR: Well said. All right.
DrMR: So there’s another topic I’d like to get your take on. And maybe to give a little bit of background, when I was a student, I learned from a number of different people. And they always didn’t agree on a certain issue. But that was actually—for me, it seemed like there were two types of students along with me.
There were students that could go to three different seminars or read the books of three different experts and hear conflicting things and find a way to reconcile those differences because they actually had to think. So that was one type. And another type just couldn’t handle that and just chose one leader to follow and kind of went into more like the lemming camp. So I think it’s good if people have differences of opinion.
I think you and I, Dan, have a slightly different way that we approach adrenals. I’ve stopped testing the adrenals, probably now about two years ago. And I more so just treat based upon symptoms because I was just seeing the same type of adrenal presentation match with the same type of lab.
And then the treatment always was pretty much the same. And the better people got, the less they needed. And we gradually kind of weaned them off. And so to me in my mind, it just seemed like the testing didn’t steer the treatment enough to justify the $150, the $175 done two or three times.
And it seems to be working well for me. But I know that there are probably a number of people listening who have heard our differing opinions on that. And they’d love to hear how we could maybe reconcile some of those or just offer people who are confused some ideas, tips, or what-have-you. So what are your thoughts on any of that?
DrDK: Well, it’s interesting. I think a couple things. I think that sometimes—well, it depends on the person. Sometimes, the power of the test—just to convey a message—
DrMR: Agreed. Yep.
DrDK: Is really the main point of doing the test versus anything that would lead you to do a different clinical treatment option. The other thing is that—and this is pretty recent. I’ve started to do these Dutch tests now for the hormone evaluations. And we’re getting so much more data. It has sort of eliminated the justifiable complaint you had about all these stage 3’s looks the same with low cortisol and all that.
DrDK: Because now, we can see these subtle variations within that. But I definitely know what you mean. When you order a lab and you get 500 in a row and they all look exactly the same, you kind of get a general sense of knowing what to do.
The other thing I found to be really problematic is retesting with the salivary tests. There are so many different things that can go into that equation. Like we were saying, this whole statistical team took months to figure out how to even make sense of all this.
So I think that’s another problem—the value of it as a test compared to the emotional impact it’s going to have on the patient. And what are you going to do in terms of reevaluating and having some kind of a benchmark to be sure the person is getting better.
I’m kind of drifting now more myself into the Dutch tests and using a lot of organic acids testing as well, as a way to follow up and make sure that stress markers are looking better, inflammatory markers are looking better. And granted, it’s not a direct measurement of cortisol. But you still see all the impacts of cortisol on the organic acids. And of course, the Dutch testing, you get this more sort of nuanced view of it all, as well.
DrMR: Agreed. I agree with a lot of those points. And I’m heading in a similar direction where what I have been doing is more so just trying to focus on factors that cause stress—dietary stressors, lifestyle stressors, and for me, of course, being so focused on the gut, problems in the gut.
And you were actually the first person who, I think, taught me the immense connection of the gut to the adrenals. And so I’ve been focusing more so on all the stuff that causes adrenal malfunction and really been trying to focus there so that we can just remove whatever obstacles there are to healing and then allow the healing to occur going forward. So it sounds like we’re kind of moving in similar directions.
DrDK: Mmm hmm.
Last Thoughts on the Functional Medicine Study
DrMR: So we had also talked about—well, I guess—I’m sorry. Before we shift gears out of anything related to the study, there was another topic that I thought people would enjoy hearing us talk about. But before we transition to that, anything else regarding the study or stuff that you learned that you want to mention?
DrDK: Yeah, I’d say one of the most important—well, one of the main reasons why I see practitioners not pushing forward with functional medicine is because they’re just not totally convinced that it’s going to work. And I know I felt like this for many years. I was a little nervous ordering that stool test. Is it really worth the $300 or $400?
And I think one of the things that this study helped me understand is that at ten times the price, any functional medicine lab assessment you do that’s good quality test is well worth it. And I really want to—it sort of just gave me a renewed sense of confidence in how effective what we’re doing is.
And it removed any kind of shred of doubt that I ever had about whether it’s worth doing these tests because when you’re sitting in your regular practice and you’re ordering labs, how carefully are you really tracking people? How much could you really say, “Well, my last 25 patients got this much better.”
You just don’t know. Most people couldn’t probably even find their last 25 patients. Probably half of them aren’t even in their practice anymore. And so that ability to follow these people and to be, in a sense, trapped with these people for the whole time and there was no out really increased my confidence and belief in the work.
DrMR: Yeah, I think that’s awesome. And it’s exactly what we’re trying to do in the clinic now. We have gotten every day—I shouldn’t say every day—but every couple months, we’re just continually refining how we’re tracking our patients because I’m planning on doing a lot of retrospective chart reviews and publishing that data to help exactly with what you were just mentioning, Dan, which is the, “Is this really worth it? Is it really going to help people? I’m not really sure. Is there some solid science to validate that?”
And the study you just published was a massive, probably the biggest peer reviewed, medical step we’ve taken in that direction. And I’m hoping to contribute to that same body of knowledge with a lot of what we’re doing just by being really rigorous with our tracking so that we can then analyze the data, publish it, and help give practitioners who are searching for some confidence and something to stand on the data for that.
So I totally agree. And hopefully after practitioners read this study, they’ll have a little bit more confidence in what they’re doing.
DrDK: Absolutely. Thanks.
Vegetarian or Vegan Diets
DrMR: So to transition, we were talking about the propendency many of us have in this space to go toward a very meat-centric diet, a Paleo-type diet. It doesn’t necessarily mean if you’re on a Paleo diet it has to have a lot of meat and a lot of protein.
But there definitely tends to be that thread, I think, that’s still there. And we were talking about if or when we think a vegetarian or a more plant-based diet or a lower-protein diet kind of works. So do you have anything you want to kind of lead in on that topic with?
DrDK: Yeah, because I think in functional medicine, we’re all biased by the kinds of patients that we get. And you know and I know for sure a lot of people that we get in our practice cannot tolerate grains. Even if you throw away the gluten-containing grains, they still can’t even handle grains.
And they may not be able to handle beans. They may not be able to eat half the vegetables that are out there. So we often see as part of this sort of chronic illness syndrome a really strong reaction to a lot of different commonly eaten foods. And as a result of that, I think there’s been this emphasis for decades now on higher animal fat, higher animal protein diets.
And I think that we all—everybody I’ve ever seen do any diet ever has the same problem. I think it’s just human nature. We all kind of overemphasize what’s the good part of the diet in our minds and then deemphasize all the other parts.
So if it’s a gluten-free diet, everyone will be strictly gluten-free. But that doesn’t eliminate gluten-free cookies and cakes. You know what I mean? Be all kind of—our minds sort of drift to ways that we can sneak around. With the Paleo diet, I think there’s been this huge overemphasis on consuming a lot of meat.
DrDK: And because meat in that diet plan is positive, there’s this overemphasis and this overconsumption of meat. If we had a potato chip diet—which is going to be my next book, I think—people would just overeat potato chips. You know what I mean?
It doesn’t matter that it’s meat, rice, macrobiotic, whatever. And because there are so many chronically ill people that react poorly to grains, I think we’ve all been forced in functional medicine to use a lot of meat-based and high-animal-fat diets to help people heal. But one of the things I’m seeing in my practice now or noticing more just because I’m older and been doing this a longer time is there’s a certain percentage of patients that absolutely fail on that kind of a diet. And they actually get quite a bit sicker. And my usual assumption is, “Oh, well, let’s figure out some better digestive enzymes you could take so you could eat the meat or whatever it is.”
And what I’m kind of opening up to now is more how I thought in my 20s—30+ years ago—where I was what we would call a vegan these days, I guess. I did a whole foods, plant-based diet for a long time. It’s actually how I felt the absolute best in my whole life. I was 18 years old. I was living in Japan. I was living in a Zen monastery in the mountains of Japan. And all we had to eat was rice and vegetables that we grew. It wasn’t like there was some political choice or health choice. We just didn’t have access to meat or fish because we didn’t grow meat or fish.
So we were just eating what we grew. And absolutely I felt the best in my entire life during those years when I was doing that kind of a diet. I guess we would call that macrobiotic here in the States. But to them, it was just Japanese peasant diet basically. And we had occasional fish and meat if we could get our hands on it, but it was pretty rare.
And now, I’m coming full circle back to that for myself in terms of how I’m eating and then just seeing how many of my patients do well on what we would call a whole foods, plant-based diet. And been researching that and starting to understand maybe there are a lot of gray areas.
We could have a book, 50 Shades of Paleo or something like that because there are the people who do really well on a plant-based, whole foods diet. And that’s indisputable. There are people that would get really sick if they ate beans and grains. And some people can eat broccoli; some people can’t. But I think what I’m seeing now in my “shades of gray” phase is that we really want to look for the subtleties and see who does well on what diet.
And so this is a great story because this just happened to me today. I had a patient. And he did this on his own. As you know, we learn most of what we learn from our patients, not from the books.
DrDK: And not from all the seminars. You learn this from human beings. So this guy, just on his own, decided to order an organic acids profile, which I test everybody for. And then he decided to stop doing his vegan diet that he’d been doing for awhile, on which he feels the best by the way.
He doesn’t do well with meat or dairy. He ate—this is hilarious. He ate a piece of cheesecake, a bowl of milk with cereal, and a piece of pizza and some meat every day for two weeks. He did all this on his own without me knowing. And then he redid his organic acids profile.
And he just saw the results today. And you can see on there his inflammatory brain markers that were fine on the first test skyrocketed after he broke the diet and started to eat the meat and dairy. You can see his B vitamins just tanked. His mitochondria got damaged. It was just like a nutritional bloodbath for this guy.
And he was kind of proving what he already knew. Maybe he wanted to prove it to me—I don’t know—prove it to himself. I’m not sure what his psychological angle on it was. But I was like, “Okay. This is very clear.” Kevin is not his real name. But, “This is very clear, Kevin. You’re going to do the best on a whole foods, plant-based diet.”
And I don’t say that to everybody. But we got the proof right here in how you’re feeling and in the fact that you created this nutritional havoc in the matter of a couple weeks that I couldn’t even believe that that was possible to do. It reminded me of—I don’t know if you ever saw the movie Super Size Me. Did you ever see that one?
DrDK: And you remember two or three weeks into his eating McDonald’s every day, and his conventional medical doctor is looking at his blood work and saying, “I can’t believe this. You have advanced liver disease. I can’t believe it.” And his mom is calling and is like, “You’ve got to stop the diet. You’re going to die.” No one can believe the amount of damage that this guy can cause in two or three weeks. It’s the same to me but from a functional medicine perspective. I was like, “No way.” I didn’t even know you could change organic acids results in that short a period of time.
But it turns out, you can inflame your brain, destroy your B vitamins, and destroy your mitochondria in just a couple weeks of the wrong diet. And the problem is that diet could be really healthy for someone else. And that’s the conundrum. That’s the problem, that we just don’t know. And how are we going to figure out what’s the best diet for everybody? That’s really the puzzle.
DrMR: I would have loved to have seen if he had made that meat and dairy diet a little bit healthier because he had what? A piece of cheesecake every day, was it?
DrDK: Yeah! [Laughs] This was his plan. I love this guy. Piece of cheesecake every day, pizza for lunch every day. He had a bowl of cereal with milk. And he said, “I threw in diet soda just to top it off.”
DrDK: So, yeah, it wasn’t like he just went from super healthy plant based to super healthy Paleo. He took a dive down this pro-inflammatory, dairy pathway. And I guess the fun thing to do would be probably to try it with dairy only and then with meat only and see which was the worst.
DrMR: Or even if he did dairy and meat but maybe had a Paleo-type diet where he could maybe have organic, raw cheddar cheese. And that could be his dairy. And then maybe steak as the meat. But it definitely shows you how an unhealthy diet can cause such sharp changes.
And it reminds me of what Christopher Gardner has said many times, which is when we move away from a diet that has processed food kind of like the standard American diet that would include things like cheesecake or pizza or whatever else and we go to any type of healthy diet whether it’s Atkins, Paleo, Ornish, Pritikin, vegetarian, or omnivorous, we see a heck of a lot of healthy improvement. And he says, I believe, it’s about 80% of the healthy improvements that we see are just from shifting away from unhealthy foods—
DrMR: To one of these healthy diet plans. And he says it’s comical that we obsess over maybe that 20%. To that endpoint, I’ve certainly noticed myself—and we did a podcast about this a little while ago—that lately, I’m doing better on a lower-insoluble-fiber diet.
And maybe it’s because I was drinking too much caffeine for awhile, under too much stress. And my gut got a little bit inflamed. And it couldn’t handle the higher insoluble fiber like vegetable fibers. But I ended up—for the past several week, my breakfast has been a healthy oatmeal bar and an apple.
And if you had asked 25-year-old me, I would have said, “You’re nuts. It’s too much carbohydrate. You’re going to gain body fat. You’re going to have a blood sugar up and down.” And I can tell you body fat hasn’t changed, maybe even gone down a little bit. And energy is great. So I’ve really had a shift from a lower-carb, high-in-insoluble-fiber diet now to a higher-carb and lower-in-insoluble-fiber diet.
And I see that, as you said also, Dan, reflected in a lot of my patients. Some people do better on an Atkins-type diet. Other people just do not do well there at all. And other people actually feel better when they add some grains back into their diet. And so I think it’s just important that we always remain open minded because we never want to pigeonhole somebody into the diet that we think is the best, especially if it clearly doesn’t work for them.
DrDK: Yeah, and the thing—the funny part of this is—and this is just human nature—that every doctor—it’s the Ornish diet. It’s the Pritikin diet. They’re eating that way themselves.
DrDK: And so it’s like—because for me personally, I think I actually do better on the whole foods, plant-based diet. And all those years of bacon and burgers are kind of behind me now. But that doesn’t mean that everyone needs to eat that way or should eat that way.
DrDK: So I think it’s that ability to kind of see beyond ourselves and realize that there’s a context in this and that you have to take into account the other person and how healthy that person is, how able they are to digest these different kinds of foods.
DrDK: I would have said the same thing too 10 years ago. Well, let’s see—boy, I’m getting old—15 years ago. Okay, 15 years ago. If I had tried to eat the way I’m eating today 15 years ago, I’m pretty sure I would have just ended up at three o’clock in the afternoon just on the floor with exhaustion because my blood sugar was so messed up back then.
But that was because of the emotional stress and running a practice and all these other things. So the more stressed out we are, the harder it is for us to even understand what a healthy diet is.
DrMR: Yeah, totally, totally agree. And things in your life, like you’re saying, factors in your life can change. And that may change the type of diet that you do best on. Absolutely.
Dan’s Most Fun but Least Healthy Thing
DrMR: So Dan, I often ask this question. And quite simply put, it’s to help people realize that we as doctors, researchers, healthcare providers, whatever, have a fun side, have an unhealthy side sometimes. So what might have been one of the maybe less healthy but more fun things that you’ve done lately?
DrDK: Well, I bought a 1971 Alfa Romeo convertible that—
DrDK: That doesn’t have—it’s like the seatbelts in it look like something that’s like a belt like you would use to hold your pants up. And it just hauls ass. It’s a fun little car. And there’s no roll bar. It’s like a suicide machine. It would be bad in an accident. But I’m telling you, it’s so fun to drive that thing that at the end of the day. When I just want a 30-minute cool off period, just hearing the car fire up, and I’m like, “Oh, this is going to be a good half hour.”
I think one thing I’ve learned from my meditation teacher—I also have a 1982 diesel Mercedes, which is like the most stable and beautifully built car ever made in the history of the whole world. I think it’s like the most durable engine ever produced by a human being.
But I think one of the things that I’m saying this for is because am I going to hop in the Mercedes and cruise? Am I going to jump in the Alfa and cruise? They’re not very expensive cars, either of them. They’re pretty inexpensive. But it’s that shift in energy that they create. Do I want to be driving this daisy, cruising along in this ancient Mercedes? Or do I want to zip along in the Alfa?
And I think that’s an important thing that we don’t do enough of—we don’t change our mental state. You could do it through a bike ride or a run or a yoga class too. It doesn’t have to be automobiles obviously. But something that we need to do on a regular basis that flips us out of our usual factory default settings that our mind tends to race to.
DrMR: Definitely. And I like that new car purchase. I definitely may have a little bit of a speed addiction myself. So I got a speeding ticket for skiing too fast in Tahoe last year. I didn’t know that you could get a speeding ticket for skiing too fast. I finished my run.
And the ski patrol man came up next to me. He goes, “Boy!” He goes, “You were really hauling there.” I didn’t know he was being sarcastic. But I was like, “Yeah. Thanks a lot. I appreciate that.” And then his face got really stern. He said, “Do it again, and you’re off the mountain.” And he handed me a ticket. He handed me a citation.
DrDK: That’s hilarious, isn’t it?
DrMR: Yeah, it really is. So one other thing I should maybe throw out there, Dan. Dr. Jolene Brighton and I are trying to set up a dinner because we’re all in the same area. And I think the last time all three of us had dinner—I think it was for my birthday actually.
DrDK: It was, yeah.
DrMR: Yeah. So we’re trying to set up another dinner and love to have you out. And I just want to give a plug for my favorite restaurant in Walnut Creek, totally unsolicited, but I love this place. If anyone is in the area of Walnut Creek, Vic Stewart’s is a steak house with fantastic food that’s built into the old Walnut Creek train station.
DrMR: And part of the restaurant, they refurbished an old train from the 50s or 60s. And you can actually reserve a private train car and have dinner in the train car. And you feel like you just walked into the 50s and 60s. It’s awesome!
DrDK: Oh, that’s great. I haven’t heard of that place. I’ll have to check it out.
DrMR: Yeah, I’ll shoot you an email after.
DrMR: But I just wanted to throw that out there on the recording because I love that place and I want to give them a shout out. So anyway, Dan, thanks so much for sharing everything. Thank you so much for publishing an awesome study, definitely a landmark study for functional medicine. And I’m sure we’ll have you back on at some point in the future.
DrDK: Appreciate it much. Thank you.
DrMR: Absolutely, Dan. Take care, buddy.
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