Today I speak with my good friend Chris Kresser. We discuss his new book, Unconventional Medicine, which lays out a plan to reinvent healthcare and thus allow us to solve our healthcare crisis. This was a great discussion and I am sure you will enjoy it!
Dr. R’s Fast Facts
About the book Unconventional Medicine
- Chronic disease is the biggest health challenge we face
- 7 of 10 deaths are caused by chronic disease
- Almost 30% of kids have a chronic disease, up from 13% in 1994
- 1 in 2 Americans has a chronic disease
- We spend 3.2 trillion dollars a year on healthcare with not much to show for it
- If spending continues on a global level, we’ll reach 50 trillion in expenditures by the yr. 2030
- If U.S. expenditures continue at their current pace, the country is in danger of bankruptcy by 2035
Three Fundamental Issues
1. Our modern diet and lifestyle are completely out of alignment with what our genes and biology are hard-wired for.
- Traditional societies that maintain their way of life pre and postmodern contact do not acquire modern chronic diseases because of their diet and lifestyle.
- Tsimane – hunter-gatherer group in Bolivia
- Prevalence of heart disease is 80% lower than in the US
- Completely clean arteries
- 80 yr. old is estimated to have the cardiovascular health of a 50 yr. old in the US
- They eat fish, wild plants, and vegetables
- They do not eat any processed or refined foods
- Tsimane – hunter-gatherer group in Bolivia
- Top 6 foods in the American diet from recent research
- Grain-based desserts
- Sugar-sweetened beverages
- Chicken dishes (primarily nuggets)
- Take lifestyle cues from traditional societies like the Tsimane..
- Walk an average of 8 miles a day
- Do not sit for long periods
- Live in sync with natural light and dark
- Live in close-knit tribal and social groups
2. Our medical paradigm is not well suited to handle chronic disease.
- 1900 is when our medical paradigm evolved – treatments for acute issues like Typhoid, Tuberculosis, Pneumonia, Gallbladder, Appendix, and broken bones were pretty straightforward
- Our medical model became extremely effective at treating acute problems
- Our current medical model is not well set up for dealing with chronic diseases – they are complex, difficult to treat, expensive, and last for a long time.
3. Our model for delivering care doesn’t support the interventions that would have the biggest impact on preventing and reversing chronic disease.
- appointment time with a primary care provider is between 8-12 minutes
- time a patient gets to speak before the doctor interrupts is 12 seconds
- We need to spend more time investigating the root cause of disease
- Longer appointments are needed
- Patients need support to put diet and lifestyle changes into practice
- Nutritionists, Health Coaches, Trainers, etc.
- Our current healthcare system is expensive – it costs $14,000 a yr. to care for a patient with Type 2 diabetes
- We’re starting to see glimpses of broader insurance acceptance for functional medicine
- Functional medicine practitioners need to be practical and cost-effective in their testing and treatment
Collaboration between conventional doctors and allied healthcare providers for support
- A structure in which licensed clinicians are supported by nurse practitioners and/or physician assistants
- Often-times have better diet and lifestyle and behavior change training
- Tend to have more time to spend with a patient
- Can do initial consults and regular check-ins
- Additionally, health coaches and nutritionists can work intensely with patients on diet and lifestyle change
- Can use techniques like motivational interviewing
- Can use principles of behavior change like shrinking the change (small steps to bigger change)
- This model is the only way we will be able to reverse the chronic disease epidemic
- 40% of adult Americans are obese
- 2/3 of adults are overweight
- 100 million people with diabetes or pre-diabetes
Moving into action – the book was written for 3 different audiences
- Practitioners in conventional medicine who have come to realize the current system isn’t working
- Practitioners outside of traditional medicine like functional medicine, naturopaths, chiropractors, nutritionists, etc. who want a more systematic approach
- Health activists, citizens who are passionate and want to help spread the message
The book will point to an online assessment to find out more about who you are and what you’re looking for in terms of how to support this movement.
Unconventional Medicine is available on Amazon, Audio, and Kindle
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- Get my free gut health eBook.
- Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.
About the book Unconventional Medicine … 00:01:30
Main contributing factors … 00:05:30
About the Tsimane, an indigenous population in the Bolivian Amazon … 00:09:00
Top 6 American foods … 00:10:15
Lifestyle changes … 00:12:15
Current medical paradigm … 00:15:20
Our model for delivering care doesn’t work for chronic disease … 00:18:45
(click gray Topics bar above to expand and see full outline/time stamp)
Health care costs … 00:23:00
What’s the solution? … 00:31:15
Recent statistics … 00:39:00
How do we move into action? … 00:43:07
Episode Wrap-up … 00:44:38
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Unconventional Medicine – Reinventing Healthcare with Chris Kresser
Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I am here with my good friend, Chris Kresser, and we’re talking about his new book, which I’m curious to pick his brain on. It’s entitled Unconventional Medicine, which I thought was a pretty cool title.
Chris, every time we’re at a conference together, we always grab food and chat. I’m thinking, It’d be great if we had a microphone here, because I feel like people would really benefit from some of these conversations. So I guess today’s our chance to nerd out.
Chris Kresser: That’s right.
DrMR: And hopefully, do it in the context of your book. But welcome back to the show.
CK: Thanks, Mike. I always enjoy hanging out with you and being on your show.
DrMR: Thank you. Same here. So you just wrote this book. I’m holding an advance copy in my hand. It’s not out just yet. Well, I guess by the time this recording goes out, it will be out. It’s going on November…?
CK: November 7th.
DrMR: November 7th. Okay.
CK: The 7th. Yeah. And depending on when this comes out, there’s also pre-order with some pre-order bonuses too. We can talk about that later.
About the book Unconventional Medicine
DrMR: Sweet. So it’s entitled Unconventional Medicine, which I thought was a clever kind of title, a little play on words there. But tell us a little bit about the book.
CK: We are dying from chronic disease. That’s basically as simply as I can put it. Seven of 10 deaths are now caused by chronic disease. And one in two Americans has a chronic disease, with one in four having multiple chronic diseases. And it’s not just adults that are affected now. Almost 30% of kids have a chronic disease which is up from just 13% in 1994. So, profound change in just the last 25 years alone.
The upshot of this is we all know someone with chronic disease. And chances are, half the people listening to this show have one themselves. So we tend to think of chronic disease as normal because they’re so common, but there’s a really big difference between what’s common and what’s normal.
And in this book, I argue that chronic disease, rather than acute problems, is by far the biggest health challenge that we face in that the consequences are really profound, not just for individuals who suffer from chronic disease which sucks. Anyone who knows, who has a chronic disease, medical expenses are the number one cause of individual bankruptcy, exceeding credit card debt and mortgage delinquency by a long shot.
It also affects healthcare practitioners. Something like 70% of doctors have thought of quitting medicine. They feel like medicine is not heading in the right direction. They’re not helping their patients in the way that they want to. They feel frustrated and dissatisfied. And they’re really as much victims of our conventional sick-care system as the patients are.
But it has societal effects too. We spend 3.2 trillion dollars a year on healthcare, and we don’t have very much to show for it. We’re ranked last of 11 measures of safety and performance among industrialized countries. The latest statistics I’ve seen suggest that if spending continues on a global level at its current pace, we’ll reach 50 trillion in expenditures by the year 2030. And that’s just an inconceivable number. But to put it in perspective, it’s equal to the GDP of the six largest countries in the world.
So this is a huge, huge problem. We’ve been talking about it a little bit with the healthcare debate: Obamacare versus Trumpcare and all of that. But I don’t think we really fully realize how much this could destroy our quality of life and threaten the health of future generations and even the very existence of our government and our society. Because it’s predicted if healthcare expenditures continue to rise at their current pace, the US will be bankrupt by the year 2035.
This is a big problem across the board. I wrote the book to raise awareness about that. But more than that, to propose a solution.
DrMR: Let’s talk about the solution, because I’m assuming the solution’s going to answer the next question I was going to ask, which was what do you see being the main contributing factors? So I guess we’ll just jump into how to solve the problem.
CK: Yeah, we can cover that because it will lead us into the solution. There are some more well-known problems with the healthcare system. And this includes things like misaligned incentives. Doctors are typically not compensated based on results. They’re compensated on the number of procedures run and number of patients seen.
In the US, we rely on insurance to pay for care, but the goals of insurance companies are not aligned with patient needs or even with doctors’ needs. We have the influence of Big Pharma. We’ve got bias in medical research. We’ve got broken payment models.
Main contributing factor
So these are all very real problems, and I don’t mean to diminish them. But I would actually argue that there are three much more fundamental issues. And number one is that our modern diet and lifestyle are completely out of alignment with what our genes and our biology are hardwired for, and that’s the primary driver of chronic disease.
Number two is that our medical paradigm is not well suited to tackle chronic disease. And we could talk about each of these a little more. And number three is that our model for delivering care doesn’t support the interventions that would have the biggest impact on preventing and reversing chronic disease.
DrMR: So let’s start off with a diet one because I’m sure—and this is one that’s very controversial. I’m curious to get your thoughts on a couple of things. And I’m sure many people are asking themselves as they listen to this, which is… Ok, so we’ve talked on the show many a time how really any diet that shifts or any diet that’s not the standard American diet, any diet that focuses on whole, fresh, unprocessed foods tends to shift you in a favorable direction. And we can get more nuance into paleo versus Mediterranean versus vegetarian.
But all those diets that cut out processed foods and focus on whole, fresh foods tend to shift us in the right direction. So are you taking this to the dietary and lifestyle solution? And I guess this would more so be a dietary question technically. But are you advocating we have to go all the way to paleo? And I know you’re not a super orthodox paleo guy. But outline that a little more, because I’m sure people are kind of wondering where you draw that line.
CK: I think the easiest way to think about it is looking at traditional societies’ cultures that have maintained their diet and lifestyle that they follow pre-modern contact. Or even after modern contact, they’ve still maintained their traditional ways. And we look at those cultures, we see that they don’t acquire modern chronic disease at anywhere near the rate that we do, and sometimes not at all.
So that tells us pretty conclusively that genes are not alone in driving the modern chronic disease epidemic, because we share the same genes as many of these contemporary hunter-gatherer populations. There might be some variation, but not enough to explain the difference in rates of chronic disease. This has become more and more clear lately. There have been some pretty high-profile studies.
There’s the Tsimané, which is a group in Bolivia. It’s a hunter-gatherer, subsistence farming population that has really maintained their traditional diet and lifestyle. Researchers have gone down there several times in the past few years to study them, and they’ve found that their prevalence of heart disease is 80% lower than that in the US. And nine of 10 Tsimané have completely clean arteries and no evidence of heart disease.
The common argument, like, oh, hunter-gatherers don’t get heart disease because they don’t live long enough to acquire it is false, because in this study population the adults range from ages 40-94. And the average 80-year-old Tsimané was estimated to have the cardiovascular health of the average 50-year-old in the US. So it completely blows that argument out of the water.
About the Tsimane, an indigenous population in the Bolivian Amazon
And what were these people eating? They were eating meat and fish, wild fruits and vegetables, some starchy plants, and also some other starches, including corn and rice. So not a classic paleo-type of diet. But what they weren’t eating was any processed and refined food. No flour, no sugar, no sugar-sweetened beverages, no cakes, crackers, cookies, juice boxes, cheese doodles, Super Big Gulps, candy bars, etc., which, now, if you look at the top six foods in the American diet, they’re grain-based desserts, bread, sugar-sweetened beverages, pizza, chicken dishes (primarily fried chicken nuggets), and alcohol. Those are literally the top six foods in the American diet in terms of calories consumed.
So I agree with you 100%. It’s not about paleo per se, but it’s about returning to a template of foods that are more consistent with our genes and our biology. What we know 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, which that kind of adaptation takes thousands, if not hundreds of thousands, of years, that’s when you get a mismatch. And that mismatch is the primary driver of disease.
Top 6 American foods
DrMR: Yep. Totally agreed, and I think it’s just nice to hear other people reinforcing what we’ve talked about on the podcast and what I think the science suggests, which is there’s no magical diet. But there’s a few general principles that you have to strive for. And if you do that, you can really see a lot of benefit. And I just echo that for the people who are beating themselves up because they’re trying to follow X diet to an absolute T, and they make their life difficult or they argue with people about what the best diet is.
DrMR: What about lifestyle? There’s another big area. And I think many people in the paleo community understand sleep, Circadian rhythm, walking. But are there any other points regarding lifestyle that you think are noteworthy to mention?
CK: Yeah, I would just point out—I know you agree with this—that if we look at the Tsimané, it’s not just their diet that was different. They were walking an average of 17,000 steps a day, which is eight miles. They’re not sitting for long periods. They are living in sync with the natural rhythm of light and dark. They live in close-knit tribal and social groups, so they have a lot of social connection and contact. They have plenty of time for leisure and play. Like many hunter-gatherer societies, they work four or five hours a day and their work is social and involves other people and is actually skilled and physically active.
So these things get varying levels of attention in the health world. In the ancestral community at large, I think there’s a lot of discussion about them, which is great. You and I as functional medicine practitioners both know that people can tend to get overly focused on diet at the expense of some of these other factors, which may actually be more important for them.
DrMR: Absolutely. It’s one thing I think we’ve talked about on the podcast before, which is sometimes what you have to do for a patient is really do less, not give them any more dietary recommendations, not give them any more tests or treatments. And sometimes the only thing I recommend for someone to do is to take two or three days a week off from any type of health research and invest that time with either friends, family, or into a hobby and to wean back all of your supplements to three items.
And sometimes a recommendation like that will yield a 40-50% change in like three weeks. It’s really amazing.
CK: People often ask me what health podcasts and stuff I listen to and blogs that I read. And they’re often surprised when I say none.
DrMR: Yeah, same thing here.
CK: I listen to podcasts, but they’re not health podcasts. I do an enormous amount of research in the world of health, of course. But I tend to read the primary studies. And there are a select few number of blogs that I follow that are primarily blogs from researchers, because I want to go straight to the source.
DrMR: Same here.
CK: I listen to Hardcore History and Radio-Lab sometimes and programs like that that are not related to health for some of the same reasons you just mentioned. There’s more to life than diet and even health. Or what I would say is there’s more to health than just food and the mechanics of it. There’s other things that are equally important to consider.
DrMR: Exactly. Now what about the medical paradigm? Of course, there’s a lot that one could say here, but are there a few that you think are most noteworthy?
CK: Yeah, I think the most important thing to consider—and when I explain this to people, they say, “Oh, yeah. That makes a lot of sense,” but often have thought about it from this perspective before. So I think it’s useful.
Back in 1900, which is really when our medical paradigm evolved in its current form, the top three causes of death were typhoid, tuberculosis, and pneumonia. So these were all acute infectious diseases. And then, the other main reasons that people would see a doctor at that point were also for acute problems. So they might have a gallbladder attack or appendicitis or maybe they have a broken bone.
And treatment for those issues was relatively straightforward. They would set the bone in a cast or they would take out the gallbladder or take out the appendix. Then later, once antibiotics were invited, they would prescribe an antibiotic for the infection. So it was just one doctor, one problem, one treatment, end of story. Patient wasn’t always cured and, in fact, didn’t even survive always in the early days. But it was straightforward.
And our medical model evolved in that context and actually became extremely effective at dealing with acute problems like infection and trauma and emergencies. Still today, it’s extremely effective on that end of the spectrum. If I get hit by a bus, I want to be taken to the hospital. I don’t want to go to an acupuncturist or even to a functional medicine doctor. Not right away, I want to do that after, but not right away.
Current medical paradigm
But today, if you fast forward to today, I mentioned at the beginning of this show, seven of the top 10 causes of death are chronic diseases. The average patient now has at least one chronic disease, if not multiple chronic diseases. And unlike acute problems, chronic diseases are complex. They’re difficult to manage. They’re expensive to treat and they often last a lifetime. So they don’t lend themselves well to that one doctor, one problem, one treatment model.
The average chronic disease patient requires multiple doctors, and, in fact, in our system they typically see a different doctor for every different part of the body. And they require multiple treatments, and those treatments will often last for a lifetime.
So it’s a fundamentally different landscape I would say, and the model, it’s like we had this model that was for one landscape. And now, we have a totally different landscape, and we’re trying to use that same model. And it’s just like fitting a square peg in a round hole: it doesn’t work.
DrMR: Hey, guys. I just wanted to take a quick moment to thank the sponsors that helped make this podcast possible. Equip Foods and Perfect Keto are two companies that are owned and operated by Dr. Anthony Gustin, who was on the podcast before. And he discussed the great lengths he had to go through to ensure that his product line was clean and devoid of fillers, sweeteners, and especially excipients. And he has a line of protein powders, pre-workout powders, carb powders, medium-chain triglyceride powders, exogenous ketones, and a lot of cool products.
And the thing that really struck me about his line, I noticed that with protein powders, I can do one serving a day, but if I have two servings too close to one another, I oftentimes get bloated. His line was actually the one line I have not noticed that with. And I’ve used a number of different lines. So, I do think there definitely something to what he has discussed, which is the lengths he has gone to make sure his line is clean.
When you mentioned the three points, you mentioned diet, lifestyle, the medical paradigm and the care model. Is there anything different about the care model than the paradigm that you want to speak to?
CK: Yeah. So let’s say that we accept the first two points that there’s a mismatch between our diet and lifestyle, what’s natural for humans and what we’re living. If you accept that Twinkies and Cheese Doodles and Big Gulps are not foods that we should be living on and we shouldn’t be sitting in a chair for eight hours a day and inside and not exposed to sunlight and looking at our iPad at two in the morning in bed, if you accept that, and then if you accept, “Yeah, now that you put it that way, Chris, our medical model doesn’t really seem like it is optimal for chronic disease. It’s really better for acute disease.”
Our model for delivering care doesn’t work for chronic disease
Then the next question is, does the way that we deliver care support the diet and lifestyle change and interventions that would be better for chronic disease? And my answer to that is no way, because if you look at the conventional healthcare system, the average appointment time with a primary care provider is somewhere between eight and 12 minutes, according to recent research. The average amount of time that a patient gets to speak before they’re interrupted by the doctor is guess what? Do you have any guesses?
DrMR: I’m guessing less than two minutes.
CK: 12 seconds.
DrMR: Wow. Geez.
CK: 12 seconds. So I should be pretty clear that if the main things that we need to do are bring our diet and lifestyle back into closer alignment with what our bodies are hardwired for, and then we need to spend more time investigating the root cause of disease rather than just suppressing symptoms with drugs. Can that actually be done in a 10-minute appointment when the patient has multiple chronic diseases, is taking multiple medications, and then shows up with a new problem?
CK: I think the answer is clear. Absolutely not. There’s no way that that method or framework for delivery in care is going to be effective. We need longer appointments with patients. We need a bigger support team, allied providers like nurse practitioners and physician assistants and health coaches and nutritionists that can provide patients with the support that they’re going to need in order to make these meaningful and lasting changes.
You and I both know, Mike, information is not enough. We have really motivated patients, but the average patient, if you just say, “Hey, look. You need to change your diet. You need to sleep more. You need to exercise. You need to sit less. Good luck.” What’s going to happen with that?
DrMR: Not a whole lot.
CK: Absolutely nothing in most cases. Yeah. Which is 8% of people follow through with their New Year’s resolutions. And it’s not because people are weak or lazy; it’s because people actually don’t know how to change. Were you taught how to change behavior in school?
CK: I wasn’t taught at any level of school, including my medical training, anything about behavior change and anything about supporting patients in making behavior change. So it’s not because people are lazy or they don’t want to do it or they’re just self-sabotaging. It’s that they really, honestly do not know how to make behavior changes.
Often when we do that, we’re working against some biologically hard-wired programming that’s hard to overcome. People really need support in order to put this stuff into practice, and they’re not going to get it through the conventional healthcare system as it exists today.
DrMR: And unfortunately, one thing that can compound that is just the American lifestyle of lots of work, of a shrinking family, so you have less familial support. That certainly gives us even more to work against, but I do think you’re dead-on where the conventional medical doctor, they need more support.
Sometimes patients come in and they’re frustrated. And they go, “I’m never going to my medical doctor again.” And I tell them that’s not really the best way to look at this. We want them to do what they do and do it well: screening for colorectal cancer, screening for thyroid cancer, fixing the broken bone.
But you can’t expect them to do everything. You can’t go to your accountant and expect him to also fix your car. People have certain things that they can do, so let’s let them do that. But let’s bring other players onto your healthcare team to fill in these other gaps. And I think this is bringing us to the solution. But this is where I think functional medicine and allied healthcare professionals really have a huge opportunity really to step up.
Health care costs
Just as a quick aside. This is one of the reasons I’m so passionate about helping functional medicine not to be excessive, overzealous, and super expensive, because if we do that, I think we’re going to ruin that chance to step up and really help people. If we can try to make things as practical and as cost-effective as we can, I think we can have some pretty lofty impacts on this problem.
CK: I totally agree with that. That’s a really insightful comment. I hope I haven’t come across as suggesting that we don’t need conventional medicine.
DrMR: Oh, no. I’m not pointing that at you at all.
CK: Yeah, we need specialists and experts to do all the things that you mentioned. Oncologists who know how to remove cancerous tumors and diagnose and screen for cancer. Gastroenterologists who can do colonoscopies and endoscopies.
The goal I’m pointing to is to have a wide range of practitioners who are all working within their scope of practice to provide the highest possible level of care to the patient. And this is attainable. There’s often like a “Oh, how are we going to pay for that? It’s so expensive.”
Look, our current healthcare system is expensive. Patients just don’t see those expenses sometimes because they’re heavily subsidized. So take type 2 diabetes as an example. Most statistics suggest that it costs about $14,000 a year to care for the average patient with type 2 diabetes. And now, the age of diagnosis is getting younger and younger every year, with now even kids being diagnosed with type 2 diabetes.
CK: Yeah, so sad. And then on the other end of the spectrum, we have these heroic technologies that enable people to survive for much longer, even if they have a disease like that. So the effect that that’s having on the healthcare system is—you imagine someone who is diagnosed with type 2 diabetes at age 40, but then they live to age 85. Well, that’s going to cost the healthcare system $630,000 at a minimum. That’s presuming they don’t develop other diseases, which need to be cared-for, which they almost certainly will. Because we know that that happens.
But that’s well over half a million dollars just for the lifetime of that one single patient with that one single disease. I think we can all agree that that’s an unsustainable expense. And people say functional medicine and the approach that we’re talking about now is expensive, and it’s true. We have to deal with out-of-pocket costs that are very high for patients. And we absolutely have to deal with that.
But if we step back and just consider the pure cost without thinking about who’s paying for them, functional medicine is orders of magnitude cheaper.
DrMR: Absolutely. Yeah.
CK: You and I both know that we could take someone with pre-diabetes, and if they follow the advice we give them, I know that I can reverse that nine times out of 10, if not more. It’s purely a diet and lifestyle-driven disease.
Let’s say you give me a $10,000 check, and I can hire a health coach. I can do some functional medicine lab testing. We can give $5000 to the patient to buy groceries for a year or whatever. We won’t use that $10,000.
DrMR: Come in under budget.
CK: We’ll have money back. We will prevent type 2 diabetes from ever happening in that patient. And we’ll save $620,000 to the healthcare system over a lifetime. And that doesn’t include any indirect costs that if the patient has type 2 diabetes, they’re probably eventually going to have to stop working. There’s going to be lost productivity, lost savings, depression, a whole bunch of other stuff that comes with this. And then, the intangibles like not being able to play with their grandkids because they have severe neuropathy or they’re incapacitated.
It just goes on and on and on. And I think we have to look at it that way because that’s looking at the real cost and not just who’s paying for what.
DrMR: Absolutely. The old saying that “an ounce of prevention is worth a pound of cure” probably applies to the equivalent in terms of a monetary savings.
CK: Or in this case, an ounce is equal to about 500 pounds, if you actually extrapolate the math.
DrMR: Right. Exactly. I think we’re definitely on the same page with neither one of us are anti-medicine and we’re trying to make this as practical as we can. One other thing just shot into my head, and I know this is kind of a reiteration of what I was just saying before, but it also ties into a point that you made, which is one of the things that I think is starting to shift and will continue to shift is a broader acceptance of insurance for what we do.
Again, coming back to my earlier point, and I hate to keep beating this dead horse, but I just have heard so many horror stories that it’s just something that I’m so keen on making sure to make a point at the end of most podcasts, which is if we start having the ability to order more labs through insurance and providers start abusing that, saying, “Oh, well, let me order everything I’ve been academically curious about,” and you’re not tempered in your approach, that’s going to be potentially a way to lose the ability to have enhanced insurance coverage if we abuse that.
So just be careful. Just because you have the ability to bill through insurance—and this, of course, is not pointed at you, Chris. This is just a general remark to the field—don’t look at that as, “Ok, now I can just go nuts and order everything that I want.” Because eventually, that will come back to bite us.
CK: Yeah, well, this is where I think the collaborative practice model that I talk about in the book can be so powerful and cost-effective. Imagine a scenario where the patient comes to the office. And rather than seeing the doctor right away, they start working with the health coach and the nutritionist. And they systematically address the diet and physical activity and sleep and stress management and all of these diet and lifestyle and behavior factors for six months.
DrMR: Way less lab testing will be needed.
CK: Yeah. They don’t even see the doctor until six months after that.
CK: And maybe they never see the doctor. Maybe those six months of working with the health coach and the nutritionist are all that patient needs to resolve their issues. And they continue working with those people for as long as they need to and then they’re on their way. They actually graduate and go back to living their life.
Or, maybe in some situations, after six months of that kind of work, there are a few issues that are left to resolve. But there are only two instead of 24 that there were before. So then, the practitioner can be much more judicious and focused in the testing, because they’re not trying to fix every problem with functional medicine. They’re actually relying on the diet and lifestyle and other factors to do the work that they should do.
So I agree with you, and I think that’s where we can use other practitioners to maximize their focus and scope of practice to not just support us as practitioners and patients, but to make it more cost-effective.
Dr. Ruscio’s Resources
DrMR: Hey, everyone, in case you’re someone who is in need of help or would like to learn more, I just wanted to take a moment to let you know what resources are available. For those who would like to become a patient, you can find all that information at drruscio.com/gethelp.
For those who are looking for more of a self-help approach and/or to learn more about the gut and the microbiota, you can request to be notified when my print book becomes available at drruscio.com/gutbook. You can also get a copy of my free 25-page gut health eBook there.
And finally, if you’re a healthcare practitioner looking to learn more about my functional medicine approach, you can visit drruscio.com/review. All of these pages are at the drruscio.com URL, which is D-R-R-U-S-C-I-O dot com, then slash either ‘gethelp,’ ‘gutbook,’ or ‘review.’ Okay, back to the show.
It’s a beautiful concept, in my opinion, because instead of a gastroenterologist scoffing at the nutritional advice someone got from a nutritionist saying, “Oh, there’s no dietary things that can help IBS,” which, of course, is absolutely insane…
What’s the solution?
DrMR: That a doctor would ever even say that, looking at what’s been published. But now, people are saying, “Ok, let’s start off with having you go to the nutritionist, which will be less money on the healthcare system, prevent you from maybe needing all this stuff to rule out more pathological-based causes of your IBS.” It’s really better for everyone involved. So that’s a better proposition. Let’s outline that a little bit more, because that’s the solution that you’re talking about. So let’s pick into that.
CK: Yeah, as a side note to what you just said, you’ve probably heard of this, but the autoimmune protocol for many years was just purely anecdotal. It was based on the experience of clinicians and patients, but a gastroenterologist at Scripps, one of her patients came to her and had basically reversed her Crohn’s disease using AIP.
And unlike many doctors who, as you said, just scoff at that and don’t display any curiosity at all, which I’ve never been able to understand. If somebody comes to me and says, “I cured my disease with a diet,” I’m all over that. I’m like, “What did you do?”
But anyways, this doctor, to his or her credit, said, “Wow. I want to learn all about that.” And not only that, ended up designing a trial and getting it funded somehow, which is amazing, given that most research is funded by pharmaceutical companies to explore drugs. And then found that the treatment was as effective as steroids and even biologic drugs with obviously no side effects other than the patient feeling better.
So this is changing, and I’m glad to see that kind of research. But the collaborative practice model in the book that I talk about is really just what we’ve been hinting at all along. It’s a structure in which the licensed clinicians are supported by a wide range of allied providers, including other licensed practitioners like nurse practitioners and physician assistants who have almost the same scope of practice as a medical doctor or an osteopathic physician and even in the case of nurse practitioners can operate autonomously in some states.
Or physician assistants who work under the supervision of a doctor, they can do a lot of the same things that doctors can do but they also tend to have more time to spend with the patient. They often are better trained at how to relate with and engage with the patient. They might, in some cases, have more diet and lifestyle and behavior change training. And they can offer another level of care for patients.
We use them in our practice. Our nurse practitioner does the initial consult with patients and does two-week check-ins where, in between appointments, patients will just briefly check in with her to see how things are going and make sure that they’re staying on track with their protocol.
And then, we have other allied providers like health coaches and nutritionists that can work very intensively with patients on diet, lifestyle, and behavior change. And the advantage to this is that most doctors have very little training in diet. They might have taken one nutrition class in medical school many years back. And that curriculum is often outdated, based on information that’s several decades-old.
Because of the short appointment times, they don’t really have time to work with patients in that way. And then, they have no training often in behavior change and things like positive psychology or motivational interviewing or coaching to strengths. And health coaches, presuming they’ve been adequately trained, have education in all of those areas. And that can make all the difference in the world.
If you think of like a hypothetical patient who is diagnosed with pre-diabetes and the doctor says, “Hey, you’re going to progress to full-fledged type 2 diabetes in five years”—that’s the average—“And when that happens, it’s going to be a lot harder to reverse. So you need to get on a healthy diet, you need to exercise, you need to do all these things.”
And the patient leaves that appointment feeling scared and probably overwhelmed and then maybe a few days or weeks pass and they kind of just revert to their habitual ways of eating and living. And they find it really difficult to get started. They know they should, but knowing is not enough to change behavior. And there are lots of studies that support the fact that knowledge is rarely enough to change behavior.
A health coach, what they would do they might use a technique called motivational interviewing, which helps patients to connect their deeper goals and values with the changes that are being made. So in this case, it may be that the patient really loves her grandkids and wants to be around for the grandkids as they get older and wants to be able to play with them and be active.
The motivational interviewing can help the patient to tie that desire with the diet and lifestyle changes. And positive psychology helps coaches to identify the patient’s strengths and to use those strengths in the service of change rather than just trying to fix what’s broken.
And so, there are lots of tools and then principles of behavior change. So the coach might be aware of this principle called “shrinking the change,” where instead of asking the patient to meditate for 45 minutes a day, just starting out, they start with two minutes a day. And they start with an app like Headspace to make it easier. And they know from the research that that’s going to be much more successful as an intervention than going whole-hog all at once.
This is where a health coach can be a really powerful advocate for a patient and also a powerful support person for a doctor or a licensed clinician. And I just think that that collaborative kind of model where you have all these people working together to provide this high level of care for patients is the only way that we’re going to be able to reverse the chronic disease epidemic.
DrMR: I agree with you. A lot of great points. One thing that just shoots into my head is sometimes in arguing on the internet between different camps, the vegetarians are telling the paleo people that the reason why we’re all sick is because of the amount of meat that we eat. And then, the paleo people are telling the vegetarians it’s because we’re eating too much carbs.
I think you’re really going a level way deeper than this, which is the fundamental model for which we’re delivering and how we’re delivering healthcare and trying to help people could really use some updating, because it’ll get more people the support and the resources that they need.
And I would be inclined to believe, and this is based upon what the literature shows, that if people had the right support, follow-through, and tools, and they could execute a diet and lifestyle plan, irrespective of the diet, if they could execute any plan, then that would give far better results, of course, than not executing any of those plans. And that’s really what you’re speaking to with your solution here, right?
CK: Exactly. I think you’ve made a great point, saying that we tend to get lost in the minutiae, especially when we’re talking about society-wide. The truth is, Mike, you and I inhabit a kind of small niche in the overall healthcare world. Our patients are not the typical patients, I think. At least mine aren’t. I shouldn’t speak for you.
If we think of the problems that the average American is facing, it’s obesity now 40%. I don’t know if you saw the recent CDC statistics. Now, 40% of American adults are obese and two-thirds are overweight. We have 100 million people with diabetes or pre-diabetes.
In these cases, we don’t need to get too advanced and tricky. We need to focus on the basics, which I know you’re such an advocate of. But even to do that, we need way more support…
DrMR: Yeah, exactly.
CK: Layered into the system that’s currently being offered. And I would say that’s even true within functional medicine. Just speaking personally, it’s only been in the last couple of years that we really expanded to include a nurse practitioner and physician assistant and health coaches and nutritionists. If I have one regret, it’s that I didn’t recognize this earlier, because I think there are a lot of patients that we weren’t able to help that we could’ve helped if we’d had this in place.
I don’t know about you, but this just wasn’t emphasized in my practice management class in school. I’ve had to learn, trial by fire, so to speak. I have a lot of super, highly-motivated patients who are able to just take the information that I give them and translate it into action. And I think I got kind of complacent or spoiled by that. And over time, as my practice grew and expanded, we started to get a lot more patients who, understandably, just felt overwhelmed by it all and needed more support.
Even in the functional medicine world, I think we need to pay more attention to this, because this episodic model of care where the patient just sees the doctor once every six months is often not enough for someone who’s dealing with multiple chronic illnesses.
DrMR: I completely agree. It’s something that I saw my practice going in the very direction that I think anyone’s would naturally go to where you start accruing a patient base of highly-motivated patients. Very easy to work with. Just like you said, they’re motivated; they’re very compliant. They don’t need a ton of support because they already know a lot about the basics.
But as I saw that starting to happen, I took a step back and said to myself, I really want to reach the people that haven’t tried paleo and a low FODMAP diet and a probiotic and an enzyme and intermittent fasting. And I want to reach the regular Joe, because there’s such an opportunity to really have a big impact there.
As I started speaking more about the kind of cost-effective functional medicine model, we started seeing more of kind of your average Joe, non-health-enthusiast patients coming in. And that’s really where I’ve started to see, as we’ve been shifting in that direction, more of a need for support.
And it’s definitely something that I’ve had kind of in the back of my mind as soon as things settle down with the book launch, which right now is just keeping me—I feel like it’s raising a small child at this point. [Laughs]
As soon as that’s done, one of the things to have on my radar screen is pretty much exactly what you said—which doesn’t surprise me, because I feel like we’re on the same page with a lot of these things—which is getting a support staff for the people that just aren’t super motivated. They’ll do it, but they don’t want to try to go and decode how to translate their day-to-day lifestyle to be compliant with a low FODMAP diet. They need some help with that. So, yeah, I think that’s well said.
How do we move into action?
So how do we transition into enacting this? And I’m sure your book lays this out, but how do we kind of pull this all together and move this into action?
CK: Yeah, of course, it depends on who we’re talking about. I actually wrote the book for three different audiences. One would be practitioners in the conventional medical world who have come to realize that it’s not working. It’s not working for patients, it’s not working for them, and it’s not working to reverse chronic disease. So that’s one group.
The second group is people like you and me, Mike, people who are outside of the conventional system practitioners: acupuncturists, chiropractors, naturopathic physicians, health coaches, nutritionists, people who are already working in some way with these concepts but who want a more systematic approach and a more robust framework, provide a higher level of support and care for their patients.
And then the third audience is what I call citizen scientists or health activists. These are the people who read our blogs and listen to our podcasts, who are really passionate about all this stuff. They’re not necessarily a practitioner or planning to become a practitioner, but they believe in this. And they want to help spread the message and do what they can and play a role.
We actually anticipated your question, people finishing the book and saying, “This is great. How can I get involved?” In the book, one of the last chapters, we created an assessment that people can take. So it’s actually online. The url is in the book. They go online and take this assessment that kind of asks them questions about who they are and where they are in their career and what they’re looking for, and then we make recommendations based on that. Because, clearly, someone who’s just a consumer who is passionate about this is going to have a different path than a conventional medicine doctor who wants to take the next step.
DrMR: Sure. You’ve thought of everything, I guess.
CK: Well, I don’t know about that. You know how it goes with the book. Once it’s out there, you’re like, “Oh, wait! There’s that and that.”
CK: But that’s just the nature of books, isn’t it?
Episode Wrap Up
DrMR: It is. Cool. I think that pretty much takes us through everything. Is there anything else that you wanted to mention? And also, please remind people, again, of the name of the book and where they can grab a copy and where they can also connect with you.
CK: No, I think that’s it. I always enjoy our conversations. The book is Unconventional Medicine. Depending on when this is out, you can either go and preorder the book at UnconventionalMedicineBook.com. And we have some pretty cool bonuses for preorder. Anyone who preorders the paperback will get the Unconventional Medicine audiobook version, so if you like to listen to audiobooks, that’s great.
There’s something else we anticipated, which is that a lot of people are passionate about this stuff and they want to talk about it, but they often encounter resistance when they do. So we created what we’re calling the “Power Pack,” which is statistics, facts, research, and persuasive comebacks and arguments for—respectful, evidence-based arguments that support the approach that we talk about in the book and the need for change.
So you can get that if you preorder, and then the book is available on November 7th on Amazon in paperback, Kindle, and audiobook formats.
DrMR: Awesome. Well, Chris, thank you again for taking the time, my friend. And keep plugging away. You’re doing some really great stuff.
CK: Thanks, Mike. I appreciate it.
What do you think? I would like to hear your thoughts or experience with this.
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