Podcast - Robb Wolf – Heart disease, gut health, medical politics and more - Dr. Michael Ruscio, BCDNM, DC

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Podcast – Robb Wolf – Heart disease, gut health, medical politics and more

The one and only Robb Wolf stops by to talk with Dr. Ruscio. Robb shares valuable information about work he is pioneering at Specialty Health in the areas of cardiac and metabolic health. Dr. Ruscio and Robb also discuss politics and medicine and ways we can improve the state of our current medical system. And of course there is some discussion of the gut and some great banter!

podcast-artwork new

Specialty Health overview…1:43
Gut, inflammation and cardiac health…..5:55
HPA axis, HPT axis and cardiac health…..8:30
Over-testing in functional medicine…..13:56
Strategies to overcome the effects of sleep deficiency…..16:03
Increased lipoproteins after positive diet and lifestyle changes…..20:50
Centralized medicine and the politics of healthcare…..29:16
Food reward and obesity…..40:51

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Robb Wolf – Heart disease, gut health, medical politics and more

Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine. To make sure you’re up today on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor.

Now, let’s head to the show!

Robb Wolf: Hello, folks. This is Robb Wolf, and this is not Paleo Solution podcast. This is actually Dr. Ruscio Radio. How’s everybody doing?

Dr. Michael Ruscio: Hey, Robb. Good to have you on board. We have one, one-and-a-half listeners, so we’re trying to catch your show. But, slow and steady, and hopefully we’ll get there.


RW: You know, going past six listeners really doesn’t do anything for anyone. So, keep the expectations low.

DR: That is my holy grail of the six (listeners) – it’s on my vision board at home. (laughter) Why I asked you to come on is I know you’re doing a lot of work in the cardiovascular arena. And I thought you could kind of give people an update on what you’re doing and what you’re finding. I know you’re getting pretty jiggy with it. Practical but pretty in depth, so why don’t you just jump in and share with us what, you know, what kind of essays you’re running, what kinds of tests you’re finding to be really helpful, some treatment that you’re doing. Any stuff like that?

RW: Sure, sure. And I’ll give folks just a quick 30,000-foot view of what that whole story is. When I moved to Reno three years ago, I was contacted by these folks at a clinic called Specialty Health and this guy Dr. Jim Greenwald, who goes by ‘Greenie’. (He) told me, “Hey, we really like what you’re doing, come down to the clinic, check out what we have going on.” And, what I rolled into was, kind of, an integrated medical clinic that was just midway through running a two-year pilot study, where they found police and firefighters with the local Reno Fire, Reno PD scene. They found some folks that were at high risk for Type 2 diabetes and cardiovascular disease. (They) put these folks on a paleo diet, tried to modify their sleep, started working with them on exercise. And, based off their changes in cardiometabolic risk parameters, it’s estimated that we save the city of Reno about $22 million. And at a really conservative 33-to-1 return-on-investment. I think the ROI is actually better than that, but this is the stuff that we absolutely know for sure, and can hang our hats on.

DR: Which is amazing, by the way.

RW: It is amazing, but you know when you look at…so, Dr. Ruscio and I, right before we rolled were actually just lamenting about podcasting; when our podcasting rigs end up failing, and our computers and everything. But, you know,  the phone that we have in our hand today will probably be twice-as-fast and half-as-expensive in a year or two from what it is now. And not everything follows this thing called a Moore’s Law trajectory, where it tends to get better and cheaper over time. But, most things that have some market forces applied to them, and this opportunity for innovation, tends to follow this course. But you know, medicine is this weird thing where most of medicine tends to get more expensive -clearly some some progress is made, but you could make an argument that things should be getting better and cheaper over the course of time instead of, you know, maybe not so much better and definitely much more expensive.

DR: Right.

RW: And not in this, kind of, you know, everything-is-free kind of way. But more, you know, if you go buy an appliance or something, these things tend to improve with time, and get cheaper. And, you know, all that we did was take this, kind of, ancestral health model, this evolutionary medicine model, and apply it specifically to, kind of, insulin resistance and cardiovascular risk issue. And when I first came on the scene, the folks at Specially Health were very heavy into their primary intervention being just a low-carb diet, like very Gary Taubes-esque. I think that Gary has done tons of fantastic work for bringing information to light around all this work. There’s so much more to the story – clearly when we start looking at this from, kind of, a functional medicine standpoint. I would say one of the greatest influences that I’ve had since being involved with this program, and I’m kind of a functional medicine hack. Like, I know enough to sound like I know what I’m doing, but I really don’t compare to you or Chris Kresser, or a lot of other people in the scene. But, we sat down and started looking at a lot of cases where people had elevated LDL particle count. They were, maybe, being recommended for a statin. And what’s interesting is, even in our clinic, most people were placed on a statin – if they go on Crestor, they may get like 30-35-40 milligrams of Crestor. We’ve been putting people on 5 milligrams of Crestor, and it’s usually something that we do for a short period of time, try to knock those lipoprotein numbers down, and then titrate the folks off, and go from there. But it’s still in the back of my head; I’m kind of feeling like were treating symptoms, like we’re not really treating the underlying issue. And a couple of things that I’ve, kind of, brought to the forefront there – which, folks that followed you, this is going to be old hat for them – addressing small intestinal bacterial overgrowth. Trying to figure out if folks have some sort of intestinal permeability, food sensitivity, or something that’s causing some low-grade inflammation that’s gut-driven, that is then driving up these LDL particles – specifically LDL particles. Folks forget, oftentimes, the lipoprotein play a really important part in the innate immune response, and it helps to clear polysaccharide out of circulation. And lipopolysaccharide is one of these interesting identification molecules that is found on various bacteria. And, when it makes its way into our system, it’s very pro-inflammatory; it leads into blood sugar dysregulation, nonalcoholic fatty liver disease  – somebody that’s experiencing acute sepsis, basically acute bacterial exposure, a very large amount. The condition that they experience in septic shock is really almost indistinguishable from very poorly controlled Type 2 diabetes. Their blood glucose levels are high, gluconeogenesis in the liver is very high, circulating lipids are elevated, inflammatory markers, all the interleukinare are quite elevated. That happens in an acute state, but what folks kind of forget is that, if we have low-grade inflammation, particularly if it gut-derived, because the ubiquity of things like E. coli in the gut. We get this kind of low-grade exposure to lipopolysaccharide, which needs to be detoxified, needs be removed from the system. And the way the body potentially copes with that is by up-regulating the production of our lipoproteins. This is one of those things that if somebody presents with elevated lipoproteins, in my opinion, even though it’s standard of care – and this is something for our docs in the clinical, we kind of have to do in a cover-your-ass kind of fashion is recommend something like a statin, or at least recommendation put the recommendation out there. But, I’m still left wondering if we’re not treating symptoms and allowing the underlying cause to perpetuate forward. And so, we’ve really gotten a lot better at screening for small intestinal bacterial overgrowth doing some of the Genova screening. And also, even before doing that, just basically trying to get people to modify their food. Can we just modify food and get some changes with that? And then the other thing that we’ve really been looking at is the interplay between cortisol status, like running an ASI (Adrenal Stress Index) test, and look if we’ve got any type of like a flip circadian rhythm, elevated cortisol in the PM, which might be antagonizing thyroid production. If we if we see some like elevated reverse T3, if we see elevated TSH or maybe some impaired thyroid uptake, then we maybe look at running both an adrenal recovery program protocol and/or potentially getting this person on some naturethroid or some armor or something to just address that issue and try to rebuild the person. And again, eventually titrate them off and see if we can we can get them to a more-normalized spot. But we’ve had just a lot of people that would have otherwise probably ended up on a statin. But we modified their gut flora and/or we modified what was going on with their adreno; you know, the HPTA (hypothalamus pituitary adrena) axis. And by addressing these more fundamental issues, their lipoproteins would go…their LDLP to go from, say, 2,600 down to, like, 800 over the course of six months.

DR: Boy, there are so many directions I want to go with what you just said. Maybe the first, most interesting point to jump in on would be the gut’s role in all this. And, you know, to throw out a little bit of my own thought process when looking at this human body: Where to start, what’s the most important? I hadn’t followed the cardiovascular literature very closely until about four years ago. And I’ve actually got to a point where I just really decided that the gut was an area I wanted to put the majority of my attention into, because I…No one can know everything about everything, right? It’s one thing I think for someone to research and write about a litany of different topics. But, I think to really become a skilled clinician, you can’t be specializing in gut thyroid, female hormones, cardiovascular, neurological – that’s just too much stuff to process, right? I think you have to – I shouldn’t say you have to, but you can really gain a lot of experience and knowledge if you pick a couple conditions that you are most passionate about and (that) you think are most important. And than you see hundreds of hundred of hundreds of patients with conditions in that same niche. And, over time, you really gain a lot of experience through applying the research or a knowledge base. And so, that’s kind of a fork in the road that I came to regarding cardiovascular health. And I’ve kind of let go following that very intently, and I’ve really, really gotten super deep into the gut. Where that comes back to the dialogue is, oftentimes patients will come in and they will be concerned about high cholesterol levels. They will say, “What can we do to start addressing the high cholesterol levels. And, one of the initial narratives I have to go through is, ‘Well, let’s see if there’s anything awry in the gut, because the gut can directly affect your levels of cholesterol,  in the numerous fractions of cholesterol, as you alluded to. And, as has been published recently, treating SIBO can help to rectify those imbalances. Not only that, but something like SIBO can also cause problems with thyroid. In fact, in my newsletter I think three weeks ago, I sat down with a gal who, after treating SIBO and a fungal overgrowth, we had a send her back to her prescribing physician to have the dose of thyroid hormone cut in half because her body got so much more efficient in utilizing thyroid hormone. So, certainly these gut-based problems can cause problems with thyroid, which can circle back to the cholesterol piece. And, also as you mentioned, the gut is pivotal in affecting the immune system. I think a lot of cardiovascular health definitely has a strong immune/autoimmune component to it. And so, by addressing the gut we can sure have a whole heck of a lot of impact in…pretty routinely we see cardiovascular – at least see at the initial screening that we do at the clinic – we see the cardiovascular panel normalize, or at least greatly improve after treating conditions that we find in the gut. So, I love that you’re making that part of your initial kind of investigation and treatment program, because I think that’s just vitally, vitally important. And something else you said that I really resonate with is how medical treatment doesn’t seem to be getting more efficient with time. That’s something…

RW: It’s appalling. It is really appalling.

DR: Right, right. And there’s maybe a whole political thing we could circle back to later if we want to get that that dirty, but, you know, that’s something I’m pretty passionate about with the functional medicine model. I sometimes see the functional medicine model following the same sort of trajectory, which is the clinician that does the most testing, is the quote unquote “smartest,” or quote unquote “best.” And something that I’ve really come to learn, especially over the past year or so, as the clinical rhythm has really been getting smooth, I’ve been seeing that there’s a lot of test you don’t have to run to get a patient well. I think it’s important that we approach clinical medicine from that perspective of, ‘OK, sure, there is a new markers – it’s an interesting piece of physiology, it may have some interesting corollaries. But, after we’ve run this marker on numerous patients, does that seem to really make a difference on the way we are going to treat the patient? Or, is it just a fancy bell and whistle? And, I think that the truly astute clinician is going to be constantly trying to weed down the amount of stuff they have to do in practice to only the vital few, rather than getting really caught up in the trivial many – but the trivial many can be very appealing, especially if you’re a sick person looking for answers. Sometimes you think the more, you know, robust the labs are, the higher the likelihood the clinicians going to be able to find the problem. But, I really don’t think that’s always the case. I really like the old adage that He is the best can do the most with the least. And, that’s definitely something I’ve seen reflected in practice. So, love everything that you’re saying there so far. So how about are there any interesting patterns that you’re seeing in applying this, in terms of things that seem to stand out as being really important? You kind of eluded to some of that with what you currently just said. Any really interesting patterns that you’re seeing or foundational pieces that are more important than others, maybe?

RW: Oh man. Well, you know because we are working with the first responder scene, the sleep disturbance that is probably, I want to say it’s potentially the primary driver of most of the issues that were seeing.

DR: Hummm.

RW: I think that if you have a poor diet, but the person sleeps really well, and their stress level is reasonably low, maybe that person is going to develop problems, but it’s going to be maybe 20 or 30 years later than what they actually do develop early significant problems. When we take these police military firefighters and sleep deprived them on a regular schedule, their vitamin D levels were low. You were just on my show – after you and I did the show, and we were talking about 25 versus 125 vitamin D, threw them some papers. I’m like, “Hey, we need to start looking at this if we have folks that their vitamin D levels aren’t responding well.” But, you know, that aside, low vitamin D altered circadian rhythm. This night shift worker individual is pretty uniformly insulin resistant, very inflamed, usually whether male or female we see, pregnenolone steal effect occurring, where their elevated cortisol levels are antagonizing their testosterone levels. That is something that we see just again and again and again. That gets a little difficult to figure out how to deal with those folks. Like, what we’ve been playing with is pretty low-carb on the days or particularly the first meal or two after the individuals coming off of a night shift protocol – some of these firefighters are on for 48 hours straight. They will run upwards of 30-to-35 calls in a 48 hour period. So, these guys and gals are just going the whole time. Like, they’re really not sleeping, you know? So, then they get done, they want to eat some food, that want to clearly go to bed. We know pretty clearly that when folks have been sleep deprived, they are transiently as insulin resistant as a Type 2 diabetic. If we really want to do damage to that person when they get off shift, going and doing a huge refined carbohydrate bolus is going to be a disaster for this person, you know? But, because of the demands of their training, because they do need to do physical training to be in shape to do their work in. And, you know, the nature of their work often times is physically demanding – they also can’t necessarily just be the ketogenic kid all the time. So we’ve had to do a lot of fiddling with targeting when they are low-carb, when they consumer their cabs – typically the carbs go post workout. I’m really a fan of Crossfit, up to a point. But, we find a lot of these folks that’s kind of their main strength and conditioning protocol, and unless you’re going to really good gym, they are taking a situation where they are already just burned out due to the stress of their job, the nature of their sleep deprivation. And then they go in and do a workout that is just to step down from like a fatal event.

DR: Right.

RW: So, we’ve been modifying their training to be more low-level cardio, just lifting some weights, doing a lot of mobility work, and really trying to be smart about when they do that really hard glycolytically demanding Crossfit-type stuff. And, that’s a tough, though, because it is very time-efficient, very popular within the first responder scene. But, you know, I guess that’s a major pattern that we see pop-up. And, you know, here’s an interesting aside: A pulled up a paper couple days ago; lipoprotein count alters cholesterol levels alter with just one night of short sleep. Like, immediately the lipoprotein count starts going up. Typically, I am pretty sure that’s in response to the lack of the normal immune response, which prunes back our gut flora while we are sleeping. Without that, the gut flora continues to kind overgrow, and then we get more lipopolysaccharides popping into circulation, and the inflammatory markers go up and everything. And then immediately we get upward bump in our lipoproteins. So, you can see that lipoprotein altar with just a single night of poor sleep, and when you look at some of these folks that have been dealing with years of altered sleep – like, it’s a really big challenge to figure out what to do with those folks. Another interesting pattern that is emerging is that you will have folks show up who are maybe not sleep deprived, they’ve been eating a pretty poor diet, they are insulin resistant, maybe carrying some extra weight. We get them on kind of a moderate glycemic load, paleo diet. Everything improves – they lose weight, their triglycerides improve, inflammatory markers improve, c-reactive protein improves, A1C improves, but their lipoprotein count goes up. This is something that we get every once in a while, and this is where we’re starting to really look even deeper at that potential gut pathology, potential thyroid issues. Because, this is not a lot of people, but it’s just interesting – and it’s, again, one of these things to make you question…forever mainstream medicine had really demonize cholesterol as being the causative factor in cardiovascular disease. And now the lipidologists have really changed, reframed the story to saying that it’s lipoprotein, which are the things that carry cholesterol around, those are the things that cause the problem. But, we have these folks that they’ve lost weight, their inflammatory markers have changed, their endocrine markers have improved dramatically, but their LDL particle count has gone up. One thing in all that has kind of gone in the wrong direction. And so, our lipidologiests really freak out over that. But we have no data to really hang our hat…the lipidologist would say that if that LDL particle count has gone up, then cardiovascular risk has increased. It doesn’t matter what else is going on. And I’m not sure I’m totally sold on that, but, at the same time, it’s not my life that were dealing with.

DR: (laughter)

RW: We have a shocking paucity of data on that. What we have been doing – so, maybe this will help a little bit for the clinicians that follow you, what we have been doing with those folks is what started doing a carotid intermediate thickness scans – we have just an amazing doctor who does. So, they are very consistent. And we get them on, like, a 6-to-8 week follow-up. So, we try to establish in these folks: Do they have any existent plaquing of the carotid arteries, so we have any occlusion going? So, you know, do we actually have disease process, and is that disease process staying the same, worsening, getting better? A good friend of mine, Rocky Patel, he’s an MD out in Arizona, he was eating kind of the standard high-carb, standard American diet, had very advanced coronary artery occlusion, when he had a scan done. (He) started doing a carbonite protocol, which is ketogenic throughout the week, and then one day a week you do a large carb meal. And, even though his…when he had atherosclerotic progression, his LDL particle count was on the low end – I think it was like 1,100 or something, but he was insulin resistant, and had these other factors going on. Now, he’s super insulin sensitive, all his inflammatory markers are really low, but his LDL particle count is sky high. But yet his carotid intimal medial thickness scan now is clean.

DR: Interesting.

RW: So, he’s reversed disease progression. But, does this happen with every person? Is he a genetic outlier? This is one of the things I think you and I were talking about the other day. Like, 10 years ago I felt like I understood this stuff way better.

DR: Right.

RW: Almost every day that goes by, you start seeing more nuance and, you know, a kind of outliers…you see this a little bit when new drugs are released on the market, and then three or four or five years, these things get pulled because the sample size that they had to run to try to establish if the drug was initially safe is maybe a couple hundred people. And then when you get a couple hundred thousand, maybe a couple million people using this drug, you get a bunch of epigenetic and genetic situations that maybe don’t lend itself well to the use of that particular pharmaceutical. And I think to some degree even on the nutritional side of the story, we see some of that. Because of the Internet, we can aggregate so much data and see so many N=1 experiments. You have somebody like Rocky, who, he appears to be on paper much worse off from a cardiovascular risk standpoint. But yet, one of the best tools we have to determine whether or not he actually has active cardiovascular disease progressing right now, seems to indicate that he has far less disease process occurring than what he had previously. But, as far as a tight, solid algorithm to follow, you know – if A then B, if B then C type-of-thing, that all gets kind of broken, and you’re really kind of floating out there without a super good answer to a lot of these stories with a few of these folks who go through the system.

DR: You know that I’m a big fan of trying to develop algorithms to try to be efficient and so as not to be wasteful. But, admittedly there’s often times where the algorithm gets you in the ballpark, and then the rest of the way you just have to look at all the information on the table and make the best decision based upon the individual that you are looking at. A certain patient comes to mind from a couple years ago: She had really bad candida and in the course of treating her…this is the one I think we spoke about on your show; this is the biofilm on that you said people lost their minds about, right? So, this was the first case that I had really strongly applied antibiofilm therapies and just seeing an incredible response. For people listening, a biofilm is just a protective coating that can form over fungi and bacteria, and this coating makes the pathogens, or the fungus, or the bacteria somewhat impenetrable to antibiotic or antimicrobial therapy. And, by administering an antibiofilm agent along with an antibiotic arinthum microbial, you helped increase the ability to clear the infection with a killing agent. She did really, really well. It took us awhile to get everything dialed in, but, at the end of everything, her sleep was much better, her gastrointestinal symptoms were much better, she had lost I think it was a little over 60 pounds over the course of six months. This is not someone who was obese; she was mildly overweight but certainly, it wasn’t like she had hundreds of pounds to lose. So 60 pounds was fairly…actually it was very significant. At the end of all that, she still had some signs of candida on her lab work. Now, for her that was actually a win. But, for someone else, that may be considered something that needs to be addressed. So, I guess the point I’m trying to make is: These lab markers aren’t always the end-all be-all, and you have to look at the entire context of the patient. So, a +1 on candida for this gal – she was on a level where everything was great, she was doing better, she was happy, she was thrilled with where she was. I was happy with where she was, and just left it at that and just monitored her periodically. For other people, they may come in and a +1 candida may be…

RW: Debilitating…

DR: what’s causing significant problems, exactly. So, while I love lab testing, and I rely on it heavily, you can’t blindly follow lab testing; you really have to compare and contrast that with the patient, their presentation, and their history. That’s kind of what this cardiovascular case you were just describing kind of alludes to that same sort of thing: It is not all about the lab values. It’s about looking at the whole person.

RW: Yeah, and you know, you threw out the politics things, so I’ll jump on that thing in ruin your listenership immediately. You know, lots of folks are very excited about this kind of centralized planning of the medical system. And one of the things of has occurred over the course of time is, as insurance companies have gained greater control over the way that the doctor and the patient interact, the doctor has had much fewer options in what they do. Dr. Ruscio mentioned that you try to create algorithms for creating, you know, efficient ways of dealing with folks, but you get to about an 80-percent spot and then you have to get out the weeds and really figure some stuff out. What algorithmic medicine that has grown out of both litigation and out of the encroachment of the centralized planning into medicine, what it does is it forces a diagnosis. You must have a diagnosis or you do not get reimbursement for this, you know, for the practitioner. And so, if you have somebody who is low-level immune activity, both in an innate immune cells and in some adaptive immune cells, they’re not really autoimmune, but they sure kind of look autoimmune, but it doesn’t quite meet this threshold criteria. And so, what this centralization of medicine does is it really creates dumb medicine. You as the practitioner are not able to build that, kind of, gestalt-y gut level understanding of what’s going on. You know, clearly we start with these big picture things: Sleep, food, exercise, movement, microbiota and whatnot, and that generally can get us quite a ways down the road. But, at some point, often times you’re left with an intuitive leap about where you go. And, the way that medicine is being steered, particularly as it becomes more and more centralized, the ability for a doctor to do those types of things, to do the type of medicine that I think most people want that doctor to do becomes unavailable. It becomes, you know, you can have vanilla, chocolate, or strawberry, and that’s it. I that that’s something that is really important for people to to keep in mind when we are pushing for, kind of, centralized planning in medicine. If you get that result, medicine is going to be very, very different than what I think most people want practiced day-to-day.

DR: I would agree, and I would also chime in that one of the things that I’ve always noticed is that competition helps to make things better, and things more efficient. And I think that’s one of the problems with things becoming highly centralized is that you crush any competition. Competition, to some extent, can drive people to become more efficient.

RW: Right.

DR: If there are two hospitals practicing in completely different fashions, and you’re trying to pick which hospital do I go to. Well, it might be the one that is able to do the same stuff at a better cost, because maybe they’ve pioneered a more-efficient system. And, of course, eventually that’s going to take business away from the other hospital, and, eventually, the other hospital is going to update so that they can compete, and you have this back-and-forth. That competition really drives prices down, dress quality up. That’s one of the things I like about the free marketplace. Of course, there’s constraints I think need to be put in place to keep things from getting out of hand and regulations. But I think having some of that in the system really helps. What’s your thought on that, Robb?

RW: Singapore healthcare model is a really interesting example of the government mandating healthcare for everyone, but everybody has a health savings account. And so, even the very poor folks who end up receiving government disbursements for healthcare – this goes into an interest-bearing account that they can use anywhere that they want for the medical care they receive. And whether you go to a primary care physician, a hospital, what have you, all the prices are listed up front – like, it’s literally like an order-before-you-eat type of menu. And then people can price compare, can shop around, they do some group health options where, you know, you may have eight people in a clinic room and the doctors, like, motivating from person-to-person-to-person. And it’s very much less expensive then, you know, seeing an individual practitioner. But they spend a fraction of the money that we do on healthcare and arguably they get much better outcomes. It’s very competition-driven, there are safety nets for the poor, there is regulation to make sure that, you know, unsavory chicanery does not occur.

DR: Right.

RW: But, there is a very potent market drive with that. One of the things it’s occurring in the United States – and, again, I’ll shut up about this after this, you know, so that people don’t completely check out. But, there is a movement towards these things called ACOs, accountable care organizations. This is basically like a large hospital system buying up all the doctors in an area. Then, everybody works for that accountable care organization, but for that doctor to get paid, they get paid a flat salary, and they have to meet a certain number of patient visits per day, they can’t over-prescribe this, they can’t under-prescribe that, there are all these parameters that the person must meet or they don’t get paid the full amount that they are supposed to get paid. And, if you think that that’s a high quality of healthcare, you’re you know maybe you have already been in Colorado and partaking of the newly legalized marijuana or something. It’s kind of a disaster, and I definitely – I’m pretty libertarian leaning, but I do get that a lot of people feel strongly about a social contract that we provide a safety net for people. And so, I think the really good middle ground would be something that’s like a mandatory health savings account where folks put pretax dollars into an account that can be spent on whatever type of medical issues you have. You have a high-deductible, catastrophic plan in case you get hit by a bus or something. And I think that’s a very cost-effective, very market-savvy way of addressing all the stuff. And, I really wish that when we had done our big healthcare overhaul in the United States, that this had been kicked back to each individual state, and those states had been asked, ‘Hey, you guys work on an internal system and let’s see what works. And a number of states been working on a HSA-driven program like this, and it’s reminiscent of the welfare reform that happened under the Clinton Administration. Instead of the welfare reform being mandated from a federal level, it was kicked back to the states. You had, basically, 50 different reaction vessels, a couple states had disastrous outcomes, a few states had really good outcomes, and they did some welfare reform that was pretty solid. Since then, it’s gotten kind of broken, and the good things that came out of it have kind of gone away. But, I think that’s, again…you know, it’s better to have more people competing, and experimenting, and tinkering, than fewer people in, kind of, centralization of that stuff. But, I will shut up about that before we really are down to one listener.

DR: Sure, sure. And I think to take us from one-to-zero here, I’ll just five my final chime in on this. I have a friend here in the area where I practice whom is a GP. And, he’s been seeing the changing tide of small private practices getting bought up or just getting absorbed into larger hospital systems where they’re, kind of like you said, forced to practice a certain way and have a certain salary. And, it’s really kind of akin to what we see in business, right? Where big chains come in and they wipe out all of the mom-and-pop shops. And then you’re only left with a Walmart or what have you. And all of the mom-and-pop stores are, kind of, wiped out. I think that really poses a challenge because this doctor now is going to go into antiaging medicine, because he said I don’t want continue on this path that were going down; I want to have some kind of autonomy, but how can I make a living in a cash-based practice as a GP? So, he’s going to go into more antiaging medicine. I think that’s one of the real challenges that clinicians face when they leave the insurance-based system, is you really have to have a business model and be somewhat entrepreneurial in order to survive. It’s not easy, and I think the thing that really sucks about that whole scenario is you may have some really good clinicians who either get forced out of medicine or forced into practicing medicine that they don’t want, or forced into practicing in a system that they don’t want because they have…if they don’t, they won’t be able to live financially. And, I think definitely it is a big challenge that’s facing us in the coming years.

RW: We definitely have a lot of job security in trying to figure that out, that’s for sure.

DR: What I will say, I think that’s what’s great about some of these – I’m not sure how to term them – but people in the internet community that have a lot of exposure, that out together documentaries or educational summits, or what have you, who find good practitioners and then do are a really good job of just bringing that information to the masses. That kind of is a marketing avenue for the practitioners that’s not a top-down, Kaiser commercial on television, or billboard for the large hospital conglomerate. It’s more of a grassroots form of marketing for just your average practitioners. So, I’m hopeful that may provide a solution to, you know, part of the economic or financial driver or this whole thing.

RW: Absolutely, yeah.

DR: Cool, cool. That has been, to me anyways, a great discussion. Hopefully…

RW: (laughter)

DR: …people listening still have a pulse.

RW: There’s a few people who need am AED right now. It’s like, ‘They’ve flatlined! Crash car!’

DR: One person asked a question I thought was worth asking, which is: If Robb Wolf goes back into the Paleolithic, does Robb Wolf enter the Paleolithic, or does the Paleolithic enter Robb Wolf?

RW: (laughter) Oh man. I don’t know; we’ll just have to hope for our supped up Delorean that can go back-and-forth in time, and then we will figure that one out .

DR: It’s to be determined, folks. We will keep you posted if we get the time-travel piece sorted out. Well, cool. This has been a great conversation. Thanks so much, Robb, for coming on. Anything you want to make people aware of? Any up-coming stuff you have going on?

RW: No, we are just motoring with this City Zero program. I will be at PaleoFX talking about kind of novelty and food reward and those sorts of things from kind of an evolutionary biology standpoint, and, hopefully, that’s well received. I think if people can wrap their head around this idea that we really are kind of wired up to eat anything that’s not nailed down, and the fact that any of us navigator our current environment and we’re not diabetic or overweight is really kind of miraculous. When you look at the environment in which our genes were forged, we really should all be overweight and diabetic and having problems. And, I think if people can wrap your head around the idea that the reason why it’s hard to pass up the Krispy Kremes and the Pringles and everything, is that there is some engineering that goes into our circuitry for that stuff, you can kind of…it’s not a moral thing then. It’s just like, ‘Hey, this is the way I’m engineered, but I’ve got to…even though that’s the way I’m engineered, I’ve got to make some choices that don’t negatively play into that engineering. And I think that could, hopefully, be very, very liberating for folks, if they are willing to marinate in that idea and take that on.

DR: Robb, thanks so much for coming on. It’s been a pleasure, and, hopefully, we’ll have you back on sometime in the near future.

RW: Oh, doc, huge honor. I always really appreciate you coming on my show, so it’s a huge honor to come on here and bring down property values.

DR: Likewise, we help bring each other down, right?

RW: Exactly. (laughter)

DR: That’s what friends are for. (laughter)

RW: Awesome, doc. Take care.

DR: Ok, take care my friend.

RW: OK. Bye-bye.

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